Operation APOLLO 4 6 Month Followup Interview Preliminary Findings

1
Operation APOLLO4 - 6 Month Follow-up
InterviewPreliminary Findings

• Mark A. Zamorski, MD, MHSA
• Post-deployment Health Section
• Directorate of Medical PolicyCanadian Forces

2
Objectives

• Become familiar with the general content and
  process of the 4 to 6 month post-deployment
  follow-up interview process
• Understand the findings of the members
  evaluations of the process

3
Rationale

• Following deployment, Canadian Forces members
  experience
• Higher levels of stress (during and after
  deployment)
• Higher rates of diagnosable mental illness after
  deployment, particularly mood and anxiety
  disorders
• Higher rates of medically unexplained physical
  symptoms

4
Rationale for Screening

• For depression, screening is effective
• For MUPS, it may be effective
• Screening data has epidemiological value
• 4 6 month time interval chosen
• Reintegration is more or less complete
• Stress levels stable
• Little known about this time period

5
Process Overview
Member completes survey booklet (20)
Data entered into spreadsheet, generating report
(5)
Clinician reviews report (2)
Clinician interviews member (semi-structured) (30
45)
6
Process Overview
Clinician makes recommendations
Member completes evaluation form
Completes Disposition Form
6 8 weeks elapse
Clinician reviews Disposition Form and
follows-up as needed
7
Instruments Selected

• SF-36 health-related quality of life instrument
• Physical symptoms, mental health symptoms, and
  psychosocial concerns using the PRIME-MD PHQ-15
• Post-traumatic stress phenomenology using the CF
  Mississippi Short Form for Combat PTSD

8
Interview Progress to Date Roto 0
3,402 deployed
3,378 home ? 4 months
554 survey data available
1,363 evaluation forms
9
Sample Characteristics (N 3,402)

• 92.7 male
• Mean age 33 (SD 7)
• 10 Officer, 72 NCO
• 35 Land, 20 Air, 45 Sea
• 98 Regular Forces
• Mean deployment duration 154 days(SD 62)

10
Participant Satisfaction (N1,363)
The logistics (scheduling, waiting time, etc.)
of the screening process were satisfactory
overall.
11
Participant Satisfaction (N1,363)
My mental health was reviewedin appropriate
detail.
12
Participant Satisfaction (N1,363)
My physical health was reviewedin appropriate
detail.
13
Participant Satisfaction (N1,363)
I felt comfortable sharing personalinformation
with my interviewer.
14
Participant Satisfaction (N1,363)
15
Participant Satisfaction (N1,363)
By the end of the screening, my interviewer
understood my current social situation.
16
Participant Satisfaction (N1,363)
My interviewer provided meuseful guidance
and/or advice.
17
Participant Satisfaction (N1,363)
Overall, this post-deployment screeningprocess
was helpful to me.
18
Participant Satisfaction (N1,363)
I would have liked to see a medical doctor as
part of this post-deployment screening.
19
Participant Satisfaction (N1,363)
20
"Do you think that some sort of post-deployment
health screening should take place in addition to
the usual medical exam that occurs immediately
after deployment?
21
"Should the screening be mandatory or
optional?(for those who agreed or strongly
agreed)
22
"When should the screening take place?(of those
who agreed or strongly agreedthat one should
take place)
23
Exposure Concerns
I am concerned that medications, vaccinations,
chemicals, or toxins that I was exposed to in
preparation for or during my deployment may have
harmed my health.
24
Participants Exposure Concerns(N 106 who
identified any)

• Anti-malarials 61
• Mefloquine 45
• Unspec. drug 12
• Primaquine 4
• Vaccines 8
• Permethrin 11
• Other agents 23

• Environ. agents 39
• Asbestos 9
• Burning waste 8
• DU 6
• Unspec. agent 6
• Dust 4
• Russian equip. 4
• Noise 2

Totals add up to more than 106 because some
respondents identified more than one exposure.
25
Sample Comments(NOT Representative)

• Concerned because I don't know what I was really
  exposed to and what has been actually documented
• I can't say but there was probably something
  there that I'll pay for in 10-20 years

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Key Findings

• 4 6 month post-deployment follow-up interview
  process has been well-accepted by CF members
• Perceived as thorough
• Almost all satisfied without physician visit
• 18 had exposure concerns, largely surrounding
  anti-malarials

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Contact Information

• Mark A. Zamorski, MD, MHSA
• Email zamorski.ma_at_forces.gc.ca
• 1 [phone], ext. 3507
• 1 [phone] (mobile)