I'd like to thank everyone here for inviting me to speak on this very important topic of mental health and suicide prevention in veterans. I'm not going to speak for a long time, because it might be more interesting to have a question and answer presentation.
I'll give some information about my own background. I'm a consultant psychiatrist working at the Parkwood operational stress injury clinic. My academic affiliation is associate professor at Western University and assistant professor at McMaster University. For the past 20 years most of my clinical and research interest has been in still-serving members of the Canadian Forces and veterans.
In our topic today, as you probably already have heard from many other witnesses, mental health conditions are common in a significant minority of veterans. One of my colleagues, Dr. Jim Thompson, has published on this. Almost 25% of veterans in the Canadian population have a mental health condition, the most common being depression, followed by post-traumatic stress disorder, and then anxiety disorders.
Psychiatric disorders in general rarely occur in isolation, what we would typically call comorbidity, which is if you have one condition, what's the likelihood you have something else. When we talk about PTSD especially, it rarely will occur as one single condition. The most common conditions that co-occur with it would be major depressive disorder, other anxiety disorders, and also a whole host of addiction disorders.
When we looked at our treatment-seeking population, those who sought treatment at the Parkwood OSI clinic, almost 80% of those who had PTSD also met the criteria for probable major depressive disorder and about 40% had alcohol use disorder.
Suicidal behaviour, suicidal thoughts and attempts often co-exist with mental health conditions, especially major depressive disorder. In the general population—this was also research done by my colleague, Dr. Jim Thompson—the past year's suicidal ideations—these are thoughts—was found to be approximately 6.6% in veterans, while for those veterans in the community who were clients of Veterans Affairs Canada, their past year suicidal ideation prevalence was much higher at 12%.
When we looked at our treatment-seeking population, we found that 17% had endorsed having thoughts of suicide more than half the days or greater in the past two weeks. When you're looking at a treatment-seeking population, it's much higher.
I also want to point out some of the new research that's showing the association between sleep disturbances and suicidal ideation. Emerging evidence shows that sleep disturbance is a significant predictor of having suicidal ideation even in those without mental health conditions. However, when we look at the area of comorbidity—and we've examined this in our treatment-seeking population—once you have other mental health conditions, especially depression and the predictor of having problem sleeping is no longer significant.
In general, on the topic of suicide prevention, as you can probably imagine—and you've heard from other people already—this issue is very complex and there's probably no simple solution. You've probably already heard of the need for more research and statistics not only on suicidal ideations and thoughts, but also on suicide attempts and suicide deaths that would probably help in program development and public health strategies.
We also know that treating mental health conditions, especially depression, is an effective suicide prevention strategy. Therefore, it's important to stress timely care for veterans as well as a public awareness campaign for veterans to be aware that treatments are available.
At Western we are in the process of establishing a zero suicide strategy, where the fundamental belief is that suicide deaths for individuals under care within health and behavioural health systems are preventable. Adapting this strategy was one of the recommendations that was made by the Veterans Affairs Canada mental health advisory group.
My final comment would be in terms of treatment outcomes. There is much research that has been published on treatment outcomes and it's important to distinguish PTSD in the civilian population and PTSD in the veteran population, what we call military-related PTSD. In general, military-related PTSD has demonstrated a poor response not only to the psychotherapy, which is the talking therapy, but also to medication therapy or pharmacotherapy.
In general, when we look at the treatment outcomes, if an individual will participate in evidence-based care, approximately 40% to 60% will recover. We have been able to demonstrate that within our own treatment outcome studies at our clinic. However, this still means that a significant proportion of individuals, despite attending evidence-based treatment, are still suffering with significant symptoms of PTSD and depression.
Thank you.