September 2023Regular Article: Potentially Psychologically Traumatic Event Exposure

Potentially Psychologically Traumatic Event Exposure Histories of new Royal Canadian Mounted Police CadetsAntécédents d’exposition à des événements potentiellement psychologiquement traumatiques des nouveaux cadets de la Gendarmerie royale du CanadaKatie L. Andrews, PhD¹

, Laleh Jamshidi, PhD¹, Jolan Nisbet, PhD¹

, Alain Brunet, PhD², Tracie O. Afifi, PhD³

, Gordon J.G. Asmundson, PhD⁴, Amber J. Fletcher, PhD⁵, Kirby Q. Maguire, BA¹, Taylor A. Teckchandani, MSc⁶, Lisa Lix, PhD³, Shannon Sauer-Zavala, PhD⁷, Jitender Sareen, MD⁸, Terence M. Keane, PhD⁹

, J. Patrick Neary, PhD⁶, and R. Nicholas Carleton, PhD⁴img1

The Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatrie
2023, Vol. 68(9) 663‐681
© The Author(s) 2023img4

Article reuse guidelines:
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DOI: 10.1177/07067437221149467
TheCJP.ca | LaRCP.caimg2
Abstract
Objective: Royal Canadian Mounted Police (RCMP) report extremely frequent and varied exposures to potentially psychologically traumatic events (PPTEs). While occupational exposures to PPTEs may be one explanation for the symptoms of mental disorders prevalent among serving RCMP, exposures occurring prior to service may also play a role. The objective of the current study was to provide estimates of lifetime PPTE exposures among RCMP cadets in training and assess for associations with mental disorders or sociodemographic variables.Methods: RCMP cadets (n = 772; 72.0% male) beginning the Cadet Training Program (CTP) completed a survey assessing self-reported PPTE exposures as measured by the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition-Extended. Binomial tests were conducted to compare the current results to previously collected data from the general population, a diverse sample of public safety personnel (PSP) and serving RCMP.Results: Cadets reported statistically significantly fewer PPTE exposures for all PPTE types than serving RCMP (all p’s< 0.001) and PSP (all p’s < 0.001) but more PPTE exposures for all PPTE types than the general population (all p’s < 0.001). Cadets also endorsed fewer PPTE types (6.00 ± 4.47) than serving RCMP (11.64 ± 3.40; p < 0.001) and other PSP (11.08 ± 3.23) but more types than the general population (2.31 ± 2.33; p < 0.001). Participants who reported being exposed to any PPTE type reported the exposures occurred 1–5 times (29.1% of participants), 6–10 times (18.3%) or 10 + times (43.1%) before starting the CTP. Several PPTE types were associated with positive screens for one or more mental disorders. There were associations between PPTE types and increased odds of screening positive for post-traumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD) and social anxiety disorder (SAD) (all p’s < 0.05). Serious transport accident (11.1%), physical assault (9.5%) and sudden accidental death (8.4%) were the PPTEs most identified as the worst event, and all were associated with positive screens for one or more mental disorders.Conclusion: The current results provide the first information describing PPTE histories of cadets, evidencing exposure frequencies and types much higher than the general population. PPTE exposures may have contributed to the cadet’s vocational choices. The current results support the growing evidence that PPTEs can be associated with diverse mental disorders; however, the results also suggest cadets may be uncommonly resilient, based on how few screened positive for mental disorders, despite reporting higher frequencies of PPTE exposures prior to CTP than the general population.Résumé
Exposition à des événements potentiellement psychologiquement traumatisants chez les nouveaux cadets de la Gendarmerie royale du CanadaObjectif: La recherche a indiqué que la Gendarmerie royale du Canada (GRC) déclare des expositions extrêmement fréquentes et variées à des événements potentiellement psychologiquement traumatiques (EPPT). Bien que les expositions professionnelles aux EPPT puissent être une explication des symptômes de troubles mentaux prévalents au sein des membres en service de la GRC, les expositions qui surviennent avant le service peuvent aussi jouer un rôle. L’objectif de la présente étude était de procurer des estimations de l’exposition aux EPPT de durée de vie chez les cadets de la GRC en formation et d’évaluer les associations avec des troubles mentaux possibles en formation ou des variables sociodémographiques.Méthodes: Les cadets de la GRC (n = 772; 72,0 % masculins) commençant le Programme de formation des cadets ont rempli un sondage évaluant les expositions aux EPPTauto-déclarées que mesure la Liste de contrôle des événements de la vie pour le DSM-5. Les tests binomiaux ont été menés pour comparer les résultats actuels à des données précédemment recueillies pour la population générale, un échantillon du personnel de la sécurité publique (PSP) et les membres de la GRC en service.Résultats: Les cadets ont déclaré statistiquement significativement moins d’expositions aux EPPT pour tous les types d’EPPT que les membres en service de la GRC (tous ps <.001) et le PSP (tous ps <,001) mais plus d’EPPT pour tous les types d’EPPT que la population générale (tous ps <,001). Les cadets ont aussi appuyé moins de types d’EPPT (6,00±4,47) que les membres en service de la GRC (11,64±3,40; p <, 001) et d’autre PSP (11,08±3,23) mais plus de types que la population générale (2,31 ±2,33; p < ,001). Les participants qui ont déclaré être exposés à tout type d’EPPT ont dit que les expositions survenaient 1-5 fois (29,1 % des participants), 6-10 fois (18,3 %), ou plus de 10+ fois (43,1 %) avant de commencer le PFC. Plusieurs types d’EPPT étaient associés avec des dépistages positifs d’un trouble mental ou plus. Il y avait des associations entre les types d’EPPT et les probabilités accrues de dépistages positifs de TSPT, TDM, TAG et TAS (tous ps<,05). Un accident de transport sérieux (11,1 %), une agression physique (9,5 %), et une mort subite accidentelle (8,4 %) étaient les EPPT les plus identifiés comme étant les pires, et tous étaient associés à des dépistages positifs d’un trouble mental ou plus.Conclusion: Les résultats actuels nous procurent la première information qui décrit les histoires des EPPT des cadets, et nous expose des fréquences et des types beaucoup plus élevés que dans la population générale. Les expositions aux EPPT ont peut-être contribué au choix de carrière des cadets. Les résultats actuels soutiennent les données probantes croissantes selon lesquelles les EPPT peuvent être associés à divers troubles mentaux; cependant, les résultats suggèrent aussi que les cadets peuvent être extraordinairement résilients, étant donné que peu d’entre eux ont eu de dépistage positif de troubles mentaux, même s’ils déclaraient des fréquences plus élevées d’expositions aux EPPT avant le Programme de formation des cadets que la population générale.Keywords
mental disorders, critical incident, post-traumatic stress injury (PTSI), police, public safety personnelPotentially psychologically traumatic events (PPTEs) include direct or indirect exposures to actual or threatened death, serious injury or sexual violence.¹ PPTEs can be causally related to symptoms of post-traumatic stress disorder (PTSD)² and other mental disorders,³ collectively referred to as post-traumatic stress injuries (PTSI).¹ PTSI is a term used as part of the associated Federal Framework on PTSD Recognition and Support by the Public Health Agency of Canada⁴ to broadly describe and destigmatize several mental disorder diagnoses (e.g., generalized anxiety disorder [GAD], major depressive disorder [MDD], social anxiety disorder [SAD] and panic disorder [PD]) that might follow exposure to one or more PPTEs. Approximately 30% of the global population report never having been exposed to a PPTE, 40% report being exposed to between one and four PPTEs and 30% report being exposed to four or more PPTEs.⁵ Among the exposed, most report being exposed to two different types of PPTEs⁶ and most do not develop a PTSI.⁷Public safety personnel (PSP; e.g., border services personnel, correctional workers, firefighters, paramedics, police, and public safety communicators)¹ are exposed to hundreds or thousands of diverse PPTEs as a function of their service,³ increasing their risk for developing a PTSI.^8,9 In Canada, Royal Canadian Mounted Police (RCMP) report high frequencies of exposures to diverse PPTEs.⁷ PPTE exposures can compromise the physical,^10,12 psychological,^13,16 and relational^17,19 health of police officers. Many RCMP report clinically significant symptoms of one or more PTSI (50.2%),^4,8,20,22 including PTSD (30.0%), MDD (31.7%), GAD (23.3%), SAD (18.7%) and PD (12.0%).³ PTSI symptoms in PSP and Canadian Armed Forces (CAF) samples have also been associated with personal stressors (e.g., adverse childhood experiences,²⁴ socioeconomic challenges²⁴ and occupational stressors⁹).Long-standing notions implicate mental disorders among serving CAF or PSP as resulting from pre-existing mental health injuries, with suggestions that service selection processes should pre-emptively exclude people with pre-existing mental health injuries.²³ The same notions appear to influence contemporary opinions on mental disorders, mental health training, service use intentions and stigma among police.^24,25 There is very limited research evidence regarding the life experiences and mental health of police recruits starting their careers. The limited research available suggests municipal police recruits and the general population in the United States have comparable mental health.^26,27 Recent research suggests cadets starting the RCMP Cadet Training Program (CTP) report having better mental health than the general population.^28,29There is currently no published research regarding the relationship between PPTE exposures and mental disorders among newly recruited cadets prior to starting the CTP. Understanding the life experiences of new cadets may provide important insights that can inform recruitment and retention efforts, as well as training efforts to protect their mental health. There may be a relationship between PPTE exposures and a desire to help that influences career decisions towards helping vocations.^30,33 There is also evidence that PPTE exposures can be risk factors for future mental health challenges.^34,36 Previous research with serving RCMP has evidenced against a specific subset of PPTE as being consistently the “worst” and most likely to be associated with mental disorders³ however, no such assessments have been made regarding RCMP cadet experiences prior to the CTP and might help to identify putative risk factors.The RCMP Study³⁷ provides an opportunity to address several gaps regarding the frequency and diversity of PPTE exposures among a sample of cadets prior to starting the CTP. The current paper was designed to: (1) assess the history and prevalence of PPTE exposures among newly recruited cadets prior to starting the CTP; (2) clarify the PPTEs perceived by cadets as the worst event; (3) assess relationships between lifetime PPTE exposures and screening positive for diverse mental disorders; and (4) compare PPTE exposure experiences across demographic categories. PPTE exposures were expected to be associated with positive screens for mental disorders.MethodsProcedureFull details on the RCMP Study methods have been published in the RCMP Study protocol paper.³⁷ Data were collected, as part of the longitudinal RCMP study, using a web-based self-report survey available in English or French through Qualtrics. The RCMP Study was approved by the University of Regina Institutional Research Ethics Board (file No. 2019-055) and the RCMP Research Ethics Board (file No. SKM_C30818021312580). The study was also approved through a Privacy Impact Assessment as part of the overall approval NARMS 201611123286 and PSPC 201701491/M7594174191. The current paper focuses on cross-sectional data collected from the Full Assessment administered at the start of CTP between May 2019 and October 2021. Specifically, participants self-reported PPTE exposures and mental disorder symptoms.Data and SampleParticipants were RCMP cadets (n = 772) starting the CTP. To qualify for CTP, cadets must be Canadian citizens or permanent residents, 19 to 57 years old, who could fluently read, write and speak either English or French.³⁸ Cadets must also meet several recruiting requirements, including security clearances, medical examinations, a polygraph test and minimum physical standards. There were no conditions requiring exclusion of persons otherwise qualified for the CTP. A total of 1696 cadets were invited to participate in the RCMP Study as part of the standard training condition.³⁷ The final sample was a total of 772 cadets. Participants were mostly male (72.0%), 19–29 years old (59.8%), single (47.2%), from Western Canada (52.8%; i.e., British Columbia, Alberta, Saskatchewan, Manitoba), and completed post-secondary school education (43.4%).Self-Report Symptom MeasuresThe Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5)-Extended (LEC-5)³⁹ assessed participants’ lifetime exposure to 17 types of PPTEs. The LEC-5 does not include unexpected death of a loved one, which no longer meets the criteria for PTSD in the DSM-5.² Participants reported on the PPTE exposure modality (e.g., indirectly or directly) and all experiences were treated as exposures for the current paper: (a) it happened to them personally; (b) they witnessed it happen to someone else; (c) they learned about it happening to a close family member or close friend; and/or (d) they were exposed to it as part of their job. The total number of different PPTE exposure types was quantified by summing exposure frequencies across the 17 items. The LEC-5 Extended was modified to ask participants to report the number of exposures to each PPTE type they reported. If the participant reported exposure to more than one PPTE type they were asked to select the PPTE they considered the worst or to be currently causing them the most distress, as well as the number of exposures to that PPTE type, and the length of time since the first and most recent exposure.Mental disorder symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5)^40,41; the 9-item Patient Health Questionnaire (PHQ-9)⁴²; the Panic Disorder Symptoms Severity scale, Self-Report (PDSS-SR)⁴³; the 7-item Generalized Anxiety Disorder scale (GAD-7)⁴⁴; the Social Interaction Phobia Scale (SIPS)⁴⁵; and the Alcohol Use Disorders Identification Test (AUDIT).⁴⁶ Participants reported for the last year on the AUDIT, the past month for the PCL-5, the past 14 days for the PHQ-9 and GAD-7 and the past 7 days for the PDSS-SR. There is no specific time window used for SIPS. For the PCL-5, a positive screen required participants to report exposure to at least one LEC-5 item, meet minimum DSM-5² criteria for each PTSD symptom cluster subscale (e.g., intrusions, avoidance, negative alterations in cognitions and mood and alterations in arousal and reactivity), and exceed the clinical cut-off of >32.⁴¹ A positive screen required the PHQ-9 total score to be >9,⁷ the PDSS-SR total score to be >7,⁴³ the GAD total score to be >9,⁴⁶ the SIPS total score to be >20,⁴⁵ and the AUDIT total score to be >15.⁴⁷Statistical AnalysisParticipants were grouped into sociodemographic categories for comparison. Descriptive analyses provided frequencies and percentages of sociodemographic variables and PPTE exposures among participants for comparisons to serving PSP and RCMP,³ as well as the general population.^5,6 Binomial tests were performed to compare the significant differences between prevalence of PPTEs exposure among cadets and serving RCMP, PSP,³ and the general population.^5,6 The general population PPTE prevalence data⁵ was collected from World Mental Health Surveys conducted in 24 countries. The Canadian general population PPTE prevalence data was sampled proportionately from Canada’s ten provinces and three territories by a random digit dialing method, using ASDE software.⁶ RCMP and PSP PPTE prevalence data were collected using similar methods as the current study.³ Means and standard deviations for total number of different PPTE types and total number of exposures to each type were compared across demographic categories using one-way ANOVAs. All tests were two-sided and used an alpha of .05. Holm-Bonferroni adjustments were applied to alpha levels in post hoc analyses to control Type I errors in multiple comparisons.Multivariable logistic regression models were conducted to examine associations between each type of PPTE exposure with positive screenings of mental disorders. All regression models were adjusted for sociodemographic covariates (i.e., sex, age, marital status, ethnicity, province of residence and education). No participants screened positive for alcohol use disorder (AUD) using the AUDIT, so the measure was removed from subsequent analyses.ResultsMost participants (88.1%; n = 678) reported at least one PPTE exposure, averaging 5.81 ± 4.49 out of 17 PPTE types (Table 1). Participants from Western Canada (i.e., British Columbia, Alberta, Saskatchewan and Manitoba) reported exposure to statistically significantly (p < 0.01) more PPTE types than participants from Eastern (i.e., Ontario, Quebec) or Atlantic Canada (i.e., Newfoundland & Labrador, New Brunswick, Prince Edward Island and Nova Scotia). Participants with previous PSP or CAF experience (M = 7.28) reported more (p < 0.001) exposures to different PPTE types than participants without such experiences (M = 5.09). Table 2 presents PPTE exposure prevalence results for the current sample compared to a previously published sample of serving PSP and RCMP and the general population.The most frequently reported PPTE types were physical assault (58.2%); serious transportation accident (52.2%); serious accident at work, home or during recreational activity (45.2%); fire or explosion (43.9%); and sudden accidental death (41.6%). Participants also reported multiple exposures to different PPTEs. Participants who reported exposure to any PPTE type reported the exposures occurred 1–5 times (29.1% of participants), 6–10 times (18.3%) or 10 + times (43.1%). There was substantial variability with respect to exposure frequency to each PPTE type. The PPTE reported occurring most frequently by participants was physical assault, with 61.4% of those who reported exposure to physical assault reporting exposure 1–5 times and 13.6% reporting exposures 6–10 times.Participants reported statistically significantly fewer PPTE exposures for all PPTE types than PSP and serving RCMP (all ps < .001)³ and fewer types of PPTE exposures than PSP and serving RCMP (ps < .001). Participants reported more PPTE exposures for all PPTE types than the general population (all p’s < 0.001), except for “serious injury, harm or death you caused to someone else”, where the general population reported more exposures (p < 0.001).^5,6 Participants also reported more types of PPTE exposures than the general population (p < 0.001).Tab1Table 1. Total Number of Different Types of Potentially Psychologically Traumatic Event Exposures Across RCMP Cadets at the Start of the CTP.PPTE exposures across different demographic categories are presented in Table 3. Males reported more exposures to fire or explosion (p < 0.05), but females reported more exposures to assault with a weapon (p < 0.05), sexual assault (p < 0.001), and other unwanted or uncomfortable sexual experience (p < 0.05). Cadets 50–59 years old reported more exposures to sexual assault than other age groups (p < 0.001). Separated or divorced participants reported more exposures to serious accident at work, home or during recreational activity, and sexual assault than cadets with other marital statuses (all p’s < 0.01). Participants with previous PSP or military experience reported more exposures to fire or explosion; serious transportation accident; serious accident at work, home or during recreational activity; physical assault; life-threatening illness or injury; severe human suffering; sudden violent death; and sudden accidental death (all p’s < 0.01).The prevalence of each PPTE type most frequently identified as the worst is provided in Table 4. The PPTE types most frequently identified as worst were serious transportation accident (11.1%), physical assault (9.5%) and sudden accidental death (8.4%).Associations between exposure to PPTE through any modality (i.e., happened to me, witnessed it and learned about it) and positive screens for mental disorders are provided in Table 5. All models were adjusted for sociodemographic variables (i.e., sex, age, province of residence and education). Exposure to some PPTE types wereassociated with increased odds of screening positive for PTSD, MDD, GAD and SAD (all p’s < 0.05), but the patterns of association differed across PPTE type and mental disorder. Further analyses were performed to examine associations between “non-exposure” to PPTEs (i.e., those respondents who reported never having been exposed to any PPTEs) and screening positive for mental disorders; no statistically significant associations were observed.Tab2Tab2aTab2bTab2cTab2dTab2eTable 2. Prevalence of Potentially Psychologically Traumatic Event Exposure Types at the Start of CTP.Tab3Tab3aTable 3. Categorical Participant Demographics and Mean Scores on Total Number of Exposures to Potentially Psychologically Traumatic Events When Starting the CTP.Tab4Table 4. Prevalence of Worst Potentially Psychologically Traumatic Event Exposure Types for Cadets and Previously Published PSP and RCMP.DiscussionThe current paper presents for the first time the PPTE exposure histories of RCMP cadets prior to starting the CTP. The current research provides novel results regarding PPTE exposures among cadets prior to service. The exposure histories of cadets can inform recruitment and retention by providing insight into life experiences that may have influenced their vocational choices, inform on mental health training and resources needed to protect their mental health throughout their careers, and identify risk factors for future mental health challenges.The current results provide the first information about exposure histories of cadets compared to the general population, serving RCMP and PSP. The results were consistent with expectations; specifically, prior to starting the CTP, cadets have experienced many more PPTEs than the general population,^5,6 but far fewer PPTEs than serving PSP or RCMP.³ The types of PPTEs reported by cadets (i.e., physical assault, serious transport accident, serious accident at home, work or during recreational activity) were different to the PPTEs most frequently reported in the general population (i.e., sudden accidental death, fire or explosion, life-threatening illness or injury)⁶ but similar to the PPTEs most frequently reported by serving RCMP. Nevertheless, the frequencies of exposures to each PPTE type were statistically significantly higher for serving RCMP,³ which is consistent with expectations given their vocational requirements. The differences in PPTE exposures between cadets, serving RCMP and other PSP further support the contention that serving RCMP, and PSP are exposed to a diverse range of PPTEs more frequently than the general population.^5,6Among cadets, differences in exposure frequencies were observed across sociodemographic categories including sex and previous PSP or military experience. Males reported more frequent exposures to fires or explosions, whereas females reported more frequent exposures to assault with a weapon, sexual assault and other unwanted or uncomfortable sexual experience. Most participants were male (70%), which suggest that the most frequent PPTE type across all cadets prior to the CTP might become sexual harassment and assault rather than fires or explosions as the relative proportion of female cadets increases. Further research is needed to understand how specific PPTEs exposures may differentially affect male and female cadets which can help to inform support strategies and policies that consider the PPTEs most likely to be experienced by female officers. As might be expected from previous research, participants with previous PSP³ or military experience⁴⁸ reported more frequent exposures to most PPTE types as a function of their previous vocational requirements.⁴Tab5Table 5. Relationship Between Potentially Psychologically Traumatic Event Exposures and Positive Screens for Mental Disorders at the Start of CTP.The exposure histories of cadets and a desire to help may have influenced career decisions towards helping vocations.^30,33 Early research evidence suggests people choose policing as a career because of a desire to enforce laws and, in so doing, help others.³¹ Subsequent studies evidenced the primary reason for choosing a policing career appears to be helping others.^30,32,49 There is also evidence of a positive correlation between PPTE exposures and protracted increases in prosocial behaviours, including actively choosing to help others.^32,50,51 The current results indicate a similar relationship between PPTE exposures and subsequently choosing policing as a career may exist for cadets. The relatively frequent and diverse PPTE exposure histories of cadets starting the CTP suggest cadets may have been motivated by these experiences to select a career in policing.The current results also provide the first information about PPTEs identified as the worst or most distressing by cadets, which can help to identify putative risk factors and inform training to protect officers’mental health. Similar results were observed between cadets and serving RCMP regarding selection of the worst events. The PPTE most frequently selected as the worst by cadets were serious transport accident (11.1%), physical assault (9.5%) and sudden accidental death (8.4%). Serving RCMP also selected sudden accidental death and serious transportation accident along with sudden violent death.³ Physical assault was reported to occur most frequently by cadets, with 61.4% reporting exposures occurred 1–5 times. High frequencies of exposures were also reported for serious transport accident, with 72.5% of cadets reporting exposure 1–5 times and 62.1% reporting exposure to sudden accidental death 1–5 times. The relative frequency and variable severity of such types of PPTEs cadets experience prior to the CTP may increase the probability of selecting such PPTE types as the worst event if asked to select a single Criterion A event² and suggests psychoeducation or evidence-informed training during the CTP, such as the Emotional Resilience Skills Training (ERST) currently being evaluated by the RCMP Study,³⁷ may be beneficial for protecting their mental health.The current results further support associations between PPTE exposures and increased odds of screening positively for several different mental disorders. PPTE exposures were most commonly associated with screening positive for MDD or GAD, and only assault with a weapon was associated with screening positive for PTSD; however, the results should be interpreted cautiously because of how few cadets screened positive for any mental disorder despite the preponderance of PPTE exposures. In any case, the current results further support arguments that, instead of any specific subset of PPTE types, a wide variety of PPTE types may be associated with increased risk of developing a PTSI, including PTSD.³Considering the relatively frequent PPTE exposure histories and recent evidence that newly recruited cadets have mental health better than the general population^28,29 prior PPTE exposures do not seem to be implicated in the high prevalence of PTSI among serving RCMP and by extension serving PSP^4,8,20,22 and should not preclude eligibility for service selection. Mental health challenges among serving PSP populations increasingly appear resultant from service experiences⁸ rather than pre-existing mental health challenges and exposure histories. The current results also indicate that cadets may be uncommonly resilient given the juxtaposition of their PPTE exposure histories and their relatively good mental health when starting the CTP. However, individual difference variables regarding risk and resiliency were not assessed in the current study. Further research is needed to examine associations between resiliency, PPTE exposure histories and mental health of cadets starting the CTP.LimitationsThe current study has several limitations that can inform directions for future research. The voluntary nature of cadet participation in the RCMP Study creates an unknowable influence from self-selection biases of cadets who chose to participate in the RCMP Study. The current sample includes relatively larger proportions of cadets from Western and Eastern Canada, therefore the current sample may not be entirely representative of the entire RCMP cadet population. However, the survey sociodemographics indicate the sample was generally proportionally consistent with the age and sex of cadets. Participant responses were based on anonymous self-reporting to a web-based survey completed at the start of the CTP. The reliability and validity of web-based selfreported mental disorder symptom clusters remain ambiguous for the current population.⁵² Meta-analytic comparisons of self-report and interview assessments suggest against substantial differences.⁵³ The current results assessed frequencies of exposure to diverse PPTE types using retrospective recall and an artificially plateaued exposure frequency of 11 + times. Future research should consider using multimodal tools for assessing exposure history (e.g., diarizing) and frequency reporting with no artificial ceiling. The comparisons of PPTE exposures between current participants and previously published results from serving PSP and RCMP were based on the same data collection method; however, comparisons with previously published results from the general population should be interpreted with caution because of the different measurement methods. The prevalence and impact of other stressors (e.g., operational, organizational and familial) and individual difference variables regarding risk and resiliency were not assessed and may have substantially interacted with PPTE exposures to influence mental health.⁸ The longitudinal design of the RCMP study³⁷ will allow for the assessment of risk factors that can be targeted and best practices identified for administering additional resources or interventions, but the current analyses focused on pre-training data.ConclusionThe current results offer the first known empirical evidence of PPTE exposure histories of RCMP cadets prior to the CTP. The results indicate that, prior to starting the CTP, cadets are exposed to diverse PPTEs more frequently than the general public. There may be a relationship between PPTE exposures and a desire to help that influences career decisions towards helping vocations such as serving as an RCMP officer. The results also indicate associations between PPTEs and mental disorders; nevertheless, cadets may be more resilient than the general public since very few cadets screened positive for mental disorders^28,29 despite reporting higher prevalence of exposures to PPTEs compared to the general population. Such speculation requires further research examining the resiliency of cadets, PPTE exposures and mental disorders. The highlighted differences between cadets starting the CTP and serving RCMP members suggest a need for ongoing mental health support to mitigate the substantial impact of service and PPTE exposures on mental health.AcknowledgementsThe RCMP Study is made possible by a large and diverse team with detailed acknowledgements available online (www.rcmpstudy.ca) and in the study protocol paper.Author’s NoteCorrespondence regarding the described study should be addressed to rcmpstudy@uregina.ca. Additional information is available in English and French are available at www.rcmpstudy.ca. The RCMP Study hypotheses were pre-registered. Hypotheses specific to individual difference variables are provided in supplemental tables (see http://hdl.handle.net/10294/14680), i.e., “Posttraumatic Stress Injury Symptom Measures”; “Primary Differences Associated with Posttraumatic Stress Injuries”; and “Secondary Individual Differences Associated with Posttraumatic Stress Injuries”).Data AvailabilityData access will not be provided due to the sensitive nature of the content.Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.FundingThe author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The RCMP Study is supported by the RCMP, the Government of Canada, and the Ministry of Public Safety and Emergency Preparedness. L. M. Lix is supported by a Tier I Canada Research Chair in Methods for Electronic Health Data Quality. T. O. Afifi is supported by a Tier I Canada Research Chair in Childhood Adversity and Resilience. Asmundson is supported by a University of Regina President’s Research Chair. The development, analyses, and distribution of the current article was supported by a generous grant from the Medavie Foundation.ORCID iDsKatie L. Andrews

https://orcid.org/0000-0002-0376-5290Jolan Nisbet

https://orcid.org/0000-0002-7348-2800Tracie O. Afifi

https://orcid.org/0000-0002-3745-9785Terence M. Keane

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¹Canadian Institute of Public Safety Research and Treatment (CIPSRT), University of Regina, Regina, SK, Canada²McGill’s Psychiatry Department, Douglas Institute Research Center, Montreal, QC, Canada³Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada⁴ Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK, Canada⁵ Department of Sociology and Social Studies, University of Regina, Regina, SK, Canada⁶ Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada⁷ Treatment Innovation for Psychological Services Research Program, Department of Psychology, University of Kentucky, Lexington, Kentucky, USA⁸ Department of Psychiatry, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada⁹ National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System & Boston University School of Medicine, Boston, Massachusetts, USACorresponding author:
Katie L. Andrews, PhD, Canadian Institute of Public Safety Research and Treatment (CIPSRT), University of Regina, Regina, SK, Canada S4S 0A2.
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