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U of Alberta scholar is first to embed with Canadian forces in Afghanistan

Research into soldiers’ resilience shows promise for early detection of mental distress.

By SUZANNE BOWNESS | FEB 12 2014
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Dr. Cernak, seen here in Afghanistan in October 2013, is researching the mental and physical effects of military service on soldiers. Photo by Frieda van Putten.

Ibolja Cernak has listened to soldiers describe the explosive blasts of combat for her work. And she has heard the blasts herself, by living in the environment where they’re a regular occurrence. As Canada’s first academic to embed with the Canadian Forces in Afghanistan, she is now researching the mental and physical effects of military service on soldiers, while also involving her military subjects as stakeholders in their own research.

Previously, researchers evaluated the effects of a military environment on the armed forces as a whole rather than individually, a practice that Dr. Cernak said can mask trends.  As holder of the Chair in Military and Veterans’ Clinical Rehabilitation at the University of Alberta, she is measuring the effects in individual soldiers over the course of their military careers. Dr. Cernak hopes this approach will help to make military rehabilitation more of a preventive intervention.

“Our idea was to measure individual resilience, both mental and physical, so perhaps we would able to jump in ahead of the fully developed problem and assist them to prevent development of that problem,” said Dr. Cernak, who has devoted more than 25 years to the welfare of soldiers. Before joining the faculty of rehabilitation medicine at U of A two years ago, Dr. Cernak worked in the applied physics laboratory of Johns Hopkins University. She holds a PhD in pathophysiology/neuroscience as well as a medical degree and master’s degrees in biomedical engineering and in Homeland Security in Public Health Preparedness.

In her current project, Dr. Cernak gauges soldiers’ changes in resilience during training, during military service, in the readjustment phase (the first three months after their return, often the most difficult), and then after six months, one year, three years and five years. She recruited 116 soldiers at pre-deployment and 30 more participants joined overseas. The experiment is open to newcomers at any point, and to everyone from active military personnel to reservists and veterans to civilians contracted by the armed forces. By using a broad group, Dr. Cernak plans to incorporate findings about experience level and position type in her research.

The tests are identical at each phase and address memory and emotional and physical health. Participants answer a series of questionnaires about their self-view, resilience, and social and emotional support networks. They complete computerized cognitive tests on things like impulse control, memory and multitasking. They provide saliva and urine so the researchers can measure bio-markers such as hormones. By balancing objective data from bio-markers with more subjective sources from self-reporting, the study aims to get a more complete picture.

Dr. Cernak said that even though she has analyzed only the pre-deployment and overseas phases so far, some revealing discoveries have started to surface. One of the most remarkable is that cognitive performance, such as memory, actually improved in the deployment environment compared with pre-deployment. This, said Dr. Cernak, shows that pre-deployment training was successful. She said the soldiers themselves even credit the strong organization of military leadership for making their sense of purpose clear.

Also important, the measurements are sensitive enough to flag participants who are becoming less resilient and more susceptible to mental problems. In some cases, signs emerge most strongly from the computerized cognitive tests, where soldiers are shown in quick succession photographs of a young man with different facial expressions, including happiness, sadness, anger, fear, surprise and disgust. People who are feeling depressed tend to lose their ability to see positive emotions, so over-identifying negative expressions can reveal subtle shifts in soldiers’ emotional profiles, she explained. These reactions are often confirmed by soldiers’ self-reporting in the questionnaires.

Since Dr. Cernak had spent time in wartime Kosovo in 1997 and 1998, her month-long stay at Camp Phoenix and other army bases in Afghanistan was not the shock it might have been for some. Being allowed to embed in a military force “is quite an honour, and very rewarding, but in some ways quite an obligation,” she said. The sense of responsibility derives from having to earn the soldiers’ trust; she tries to do this do by sharing the results of the research with them. “I make them participants, stakeholders, so they own it. It is their research.”

She offered each participant an hour-long, one-on-one meeting to go through their results in detail. For her, that meeting “was very rewarding, because I could see that after that one hour, they felt better,” she said. “They were full of energy and had completely different body language when they left.”

As for other scholars working in this field Dr. Cernak said she would “absolutely” recommend the embedding experience. “Lots of research money has been spent trying to identify how, when and why someone with PTSD [post-traumatic stress disorder] develops it, and still after 10 years we do not have better diagnostics,” she said. She suggested that personal experience is crucial to understanding the unique environment of deployment: “If I am doing military research, I need to go where military go.”

That’s not to say her research has no applications beyond the military; Dr. Cernak has started a pilot study of another high-stress group – first responders, including police, firefighters and emergency medical services personnel. She would like to study high-risk industries such as oil and mining and said that in the future this research could lead to early detection and prevention of stress factors: “Our dream is that as the numbers are getting higher and we have more participants, our database will gain the power of a predictive system.”

Meanwhile, her research on the military is showing potential for early detection of health problems. “I do believe that if we are able to pay attention to individual soldiers’ mental and physical health, and measure regularly how they are doing, we will and should be able to see declines in mental health resilience, and to intervene.”

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