Abstract
OBJECTIVES: Describe health-related quality of life (HRQoL) of former Canadian Forces (CF) men and women in uniform (Veterans) after transition to civilian life, and compare to age- and sex-adjusted Canadian norms.
METHODS: The 2010 Survey on Transition to Civilian Life was a national computer-assisted telephone survey of CF Regular Force personnel who released during 1998–2007. HRQoL was assessed using the SF-12 Physical (PCS) and Mental (MCS) Component Summary scores. Descriptive analysis of HRQoL was conducted for socio-demographic, health, disability and determinants of health characteristics.
RESULTS: Mean age was 46 years (range 20–67). Compared to age- and sex-adjusted Canadian averages, PCS (47.3) was low and MCS was similar (52.0). PCS and MCS were variably below average for middle age groups and lowest for non-commissioned ranks, widowed/divorced/separated, 10–19 years of service, physical and mental health conditions, disability, dissatisfaction with finances, seeking work/not working, low social support and difficulty adjusting to civilian life. Among Veterans Affairs Canada clients, 83% had below-average physical PCS, 49% had below-average MCS, and mean PCS (38.2) was significantly lower than mean MCS (48.3).
CONCLUSIONS: HRQoL varied across a range of biopsychosocial factors, suggesting possible protective factors and vulnerable subgroups that may benefit from targeted interventions. These findings will be of interest to agencies supporting Veterans in transition to civilian life and to researchers developing hypotheses to better understand well-being in Canadian Veterans.
Key words: Veterans, veterans health, SF-12, health-related quality of life, mental health, chronic disease
Résumé
OBJECTIFS: Décrire la qualité de vie liée à la santé (QVLS) des hommes et des femmes en uniforme ayant été membres des Forces canadiennes («anciens combattants ») après leur transition à la vie civile, et la comparer aux normes canadiennes ajustées selon l’âge et le sexe.
MÉTHODE: L’Enquête sur la transition à la vie civile de 2010 était une enquête téléphonique nationale assistée par ordinateur menée auprès du personnel de la force régulière des Forces canadiennes ayant été libéré entre 1998 et 2007. Nous avons évalué la QVLS à l’aide des cotes sommaires physiques (CSP) et mentales (CSM) du questionnaire SF-12. Nous avons procédé à l’analyse descriptive de la QVLS selon les caractéristiques sociodémographiques, de la santé, de l’invalidité et des déterminants de la santé.
RÉSULTATS: L’âge moyen des répondants était de 46 ans (20–67 ans). Comparativement aux moyennes canadiennes ajustées selon l’âge et le sexe, la CSP (47,3) était inférieure et la CSM était semblable (52,0). Les CSP et CSM étaient variablement inférieures à la moyenne dans les groupes d’âge moyen; elles étaient les plus faibles pour le grade des sous-officiers, les personnes veuves, divorcées ou séparées, les personnes ayant entre 10 et 19 ans d’ancienneté, les personnes ayant des troubles médicaux physiques et mentaux, les personnes handicapées, les personnes insatisfaites sur le plan financier, les personnes cherchant du travail ou sans travail, les personnes ayant peu de soutien social et celles ayant du mal à s’ajuster à la vie civile. Parmi la clientèle du ministère des Anciens Combattants du Canada, 83 % avaient une CSP inférieure à la moyenne, 49 % avaient une CSM inférieure à la moyenne, et la CSP moyenne (38,2) était significativement inférieure à la CSM moyenne (48,3).
CONCLUSION: La QVLS varie en fonction d’un éventail de facteurs biopsychosociaux, ce qui suggère l’existence de facteurs de protection et de sous-groupes vulnérables qui pourraient bénéficier d’interventions ciblées. Ces constatations intéresseront les organismes d’appui aux anciens combattants en transition vers la vie civile et les chercheurs qui élaborent des hypothèses pour mieux comprendre le bien-être des anciens combattants canadiens.
Mots clés: ancien combattant, santé anciens combattants, SF-12, qualité de vie liée à la santé, santé mentale, maladie chronique
Footnotes
Funding: Government of Canada.
Conflict of Interest: None to declare.
References
- 1.Woods WS. Rehabilitation (A Combined Operation): Being a History of the Development and Carrying Out of a Plan for the Re-establishment of a Million Young Veterans of World War II. Ottawa, ON: Queen’s Printer; 1953. [Google Scholar]
- 2.Neary P. On to Civvy Street - Canada’s Rehabilitation Program for Veterans of the Second World War. Kingston, ON: McGill-Queen’s University Press; 2011. [Google Scholar]
- 3.Pedlar DJ, Thompson JM. Research in the life courses of Canadian military Veterans and their families. In: Aiken A, Bélanger SAH, editors. Shaping the Future, Military and Veteran Health Research. Kingston: Canadian Defence Academy Press; 2011. pp. 15–31. [Google Scholar]
- 4.Adler AB, Zamorski MA, Britt TW. The psychology of transition. In: Adler AB, Bliese PD, Castro CA, editors. Deployment Psychology: The Impact of Deployment on Mental Health. Washington, DC: American Psychological Association Press; 2010. [Google Scholar]
- 5.Thompson JM, MacLean MB, Van Til L, Sudom K, Sweet J, Poirier A, et al. (Veterans Affairs Canada, Research Directorate; Department of National Defence, Director General Military Personnel Research and Analysis). Survey on Transition to Civilian Life: Report on Regular Force Veterans. Charlotte-town, PE: Veterans Affairs Canada Research Directorate Technical Report; 2011. [Google Scholar]
- 6.Canadian Institute for Health InformationStatistics Canada. Health Indicators 2011. Ottawa: CIHI; 2011. [Google Scholar]
- 7.The Institute of Medicine US, Committee on Living Well with Chronic Disease. Living Well with Chronic Disease: Public Action to Reduce Disability and Improve Functioning and Quality of Life. Washington: The National Academies Press; 2012. [Google Scholar]
- 8.Stewart AL, Greenfield S, Hays RD, Wells K, Rogers WH, Berry SD, et al. Functional status and well-being of patients with chronic conditions. JAMA. 1989;262(7):907–13. doi: 10.1001/jama.1989.03430070055030. [DOI] [PubMed] [Google Scholar]
- 9.Galloway S. A literature review in well-being and quality of life: Measuring the benefits of culture and sport. Section 1 in Quality of Life and Well-being: Measuring the Benefits of Culture and Sport: Literature Review and Think-piece. Edinburgh, Scotland: Information and Analytical Services Division, Scottish Executive Social Research, Scottish Government; 2006. pp. 4–97. [Google Scholar]
- 10.Veterans Affairs Canada. Report on Plans and Priorities 2012–13. Ottawa: Veterans Affairs Canada; 2011. [Google Scholar]
- 11.Chief Review Services. Review of Quality of Life Project Management. Ottawa: Department of National Defence; 2004. [Google Scholar]
- 12.Kazis LE, Ren XS, Lee A, Skinner K, Rogers W, Clark J, et al. Health status in VA patients: Results from the Veterans Health Study. Am J Med Qual. 1999;14(1):28–38. doi: 10.1177/106286069901400105. [DOI] [PubMed] [Google Scholar]
- 13.Van Til L, MacLean MB, Thompson J, Pedlar D. Life after service studies: A program of population health research at Veterans Affairs Canada. In: Aiken AB, Bélanger SAH, editors. Shaping the Future, Military and Veteran Health Research. Kingston: Canadian Defence Academy Press; 2011. pp. 317–22. [Google Scholar]
- 14.Thompson JM, Sweet J, Poirier A, VanTil L. (Veterans Affairs Canada, Research Directorate). Mental Health Findings in the Survey on Transition to Civilian Life. Charlottetown: Veterans Affairs Canada Research Directorate Technical Report; 2012. [Google Scholar]
- 15.Zamorski M. Towards a broader conceptualization of need, stigma, and barriers to mental health care in military organizations: Recent research findings from the Canadian Forces. Bergen, Norway: HFM-205 Mental Health and Well-Being across the Military Spectrum, Human Factors and Medicine Symposium, NATO Research & Technology Organization; 2011. [Google Scholar]
- 16.MacLean MB, Van Til L, Thompson JM, Pedlar D, Poirier A, Adams J, et al. (Veterans Affairs Canada, Research Directorate; Department of National Defence, Director General Military Personnel Research and Analysis) Charlottetown: Veterans Affairs Canada Research Directorate Technical Report; 2010. [Google Scholar]
- 17.Statistics Canada. Survey on Transition to Civilian Life: Questionnaire and Reporting Guide, Description, Data Sources and Methodology and Data Accuracy. Available at: http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=get-Survey&SDDS=5172&lang=en&db=imdb&adm=8&dis=2 (Accessed October 25, 2012).
- 18.Richardson D. Posttraumatic stress disorder and health-related quality of life in pension-seeking Canadian World War II and Korean War Veterans. J Clin Psychiatry. 2010;71(8):1099–101. doi: 10.4088/JCP.09l05920blu. [DOI] [PubMed] [Google Scholar]
- 19.Kazis LE, Miller DR, Skinner KM, Lee A, Ren XS, Clark JA, et al. Patient-reported measures of health: The Veterans Health Study. J Ambul Care Manage. 2004;27(1):70–83. doi: 10.1097/00004479-200401000-00012. [DOI] [PubMed] [Google Scholar]
- 20.Kazis LE, Miller DR, Skinner KM, Lee A, Ren XS, Clark JA, et al. Applications of methodologies of the Veterans Health Study in the VA healthcare system: Conclusions and summary. J Ambul Care Manage. 2006;29(2):182–88. doi: 10.1097/00004479-200604000-00011. [DOI] [PubMed] [Google Scholar]
- 21.LeardMann CA, Smith TC, Smith B, Wells TS, Ryan MAK. Baseline self reported functional health and vulnerability to post-traumatic stress disorder after combat deployment: Prospective US military cohort study. BMJ. 2009;338:b1273. doi: 10.1136/bmj.b1273. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Iqbal SU, Rogers W, Selim A, Qian S, Lee A, Ren XS, et al. (Center for Health Quality, Outcomes and Economic Research (CHQOER), and Section for Pharmaco-Outcomes and Epidemiology, Veterans Administration Medical Center. Boston, MA: CHQOER; 2006. [Google Scholar]
- 23.Barrett DH, Boehmer TK, Boothe VL, Flanders WD. Barrett DH. Health-related quality of life of U.S. military personnel: A population-based study. Mil Med. 2003;168(11):941–47. doi: 10.1093/milmed/168.11.941. [DOI] [PubMed] [Google Scholar]
- 24.Burdine JN, Felix MR, Abel AL, Wiltraut CJ, Musselman YJ. The SF-12 as a population health measure: An exploratory examination of potential for application. Health Serv Res. 2000;35(4):885–904. [PMC free article] [PubMed] [Google Scholar]
- 25.Hopman WM, Towheed T, Anastassiades T, Tenenhouse A, Poliquin S, Berger C, et al. Canadian normative data for the SF-36 health survey. Canadian Multicentre Osteoporosis Study Research Group. CMAJ. 2000;163(3):265–71. [PMC free article] [PubMed] [Google Scholar]
- 26.Hopman WM, Berger C, Joseph L, Towheed T, Prior JC, Anastassiades T, et al. Health-related quality of life in Canadian adolescents and young adults: Normative data using the SF-36. Can J Public Health. 2009;100(6):449–52. doi: 10.1007/BF03404342. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Ware JE, Kosinski M, Keller SD. SF-12: How to Score the SF-12 Physical and Mental Health Summary Scales. Boston: QualityMetric Inc.; 1995. [Google Scholar]
- 28.Rohlfs GM, Vila J, Sala J, Pena A. Masiá R, Marrugat J; REGICOR Investigators. Comparison between telephone and self-administration of Short Form Health Survey Questionnaire (SF-36) Gaceta Sanitaria. 2005;19(6):433–39. doi: 10.1016/S0213-9111(05)71393-5. [DOI] [PubMed] [Google Scholar]
- 29.Mingay DJ. Is telephone audio computer-assisted self-interviewing (T-ACASI) a method whose time has come? 2000. [Google Scholar]
- 30.McHorney CA, Kosinski M, Ware JE., Jr. Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: Results from a national survey. Med Care. 1994;32(6):551–67. doi: 10.1097/00005650-199406000-00002. [DOI] [PubMed] [Google Scholar]
- 31.Lungenhausen M, Lange S, Maier C, Schaub C. Trampisch HJ, Endres HG. Randomised controlled comparison of the Health Survey Short Form (SF-12) and the Graded Chronic Pain Scale (GCPS) in telephone interviews versus self-administered questionnaires. Are the results equivalent? BMC Med Res Methodol. 2007;7:50. doi: 10.1186/1471-2288-7-50. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Ware JE, Jr., Snows KK, Kosinski M, Gandek B. SF-36 Health Survey Manual and Interpretation Guide. Boston: The Health Institute, New England Medical Centre; 1993. [Google Scholar]
- 33.Selim AJ, Berlowitz DR, Fincke G, Cong Z, Rogers W, Haffer SC, et al. The health status of elderly veteran enrollees in the Veterans Health Administration. J Am Geriatr Soc. 2004;52(8):1271–76. doi: 10.1111/j.1532-5415.2004.52355.x. [DOI] [PubMed] [Google Scholar]
- 34.Weeks WB, Wallace AE, Wang S, Lee A, Kazis LE. Rural-urban disparities in health-related quality of life within disease categories of Veterans. J Rural Health. 2006;22(3):204–11. doi: 10.1111/j.1748-0361.2006.00033.x. [DOI] [PubMed] [Google Scholar]
- 35.Frayne SM, Parker VA, Christiansen CL, Loveland S, Seaver MR, Kazis LE, et al. Health status among 28,000 women veterans. The VA Women’s Health Program Evaluation Project. J Gen Intern Med. 2006;21(Suppl3):S40–S46. doi: 10.1111/j.1525-1497.2006.00373.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Kazis LE, Miller DR, Skinner KM, Lee A, Ren XS, Clark JA, et al. Applications of methodologies of the Veterans Health Study in the VA healthcare system: Conclusions and summary. J Ambul Care Manage. 2006;29(2):182–88. doi: 10.1097/00004479-200604000-00011. [DOI] [PubMed] [Google Scholar]
- 37.Singh JA, Borowsky SJ, Nugent S, Murdoch M, Zhao Y, Nelson DB, et al. Health-related quality of life, functional impairment, and healthcare utilization by veterans: Veterans’ quality of life study. J Am Geriatr Soc. 2005;53(1):108–13. doi: 10.1111/j.1532-5415.2005.53020.x. [DOI] [PubMed] [Google Scholar]
- 38.Payne SM, Lee A, Clark JA, Rogers WH, Miller DR, Skinner KM, et al. Utilization of medical services by Veterans Health Study (VHS) respondents. J Ambul Care Manage. 2005;28(2):125–40. doi: 10.1097/00004479-200504000-00004. [DOI] [PubMed] [Google Scholar]
- 39.Canadian Forces Health Services GroupMilitary Personnel Operational ResearchAnalysis. Results from Health and Lifestyle Information Survey of Canadian Forces Personnel 2008/09 - Regular Force version. Ottawa: Canadian Forces; 2012. [Google Scholar]
- 40.Dominick KL, Golightly YM, Jackson GL. Arthritis prevalence and symptoms among US non-veterans, veterans, and veterans receiving Department of Veterans Affairs Healthcare. J Rheumatol. 2006;33(2):348–54. [PubMed] [Google Scholar]
- 41.Singer MA, Hopman WM, MacKenzie TA. Physical functioning and mental health in patients with chronic medical conditions. Qual Life Res. 1999;8(8):687–91. doi: 10.1023/A:1008917016998. [DOI] [PubMed] [Google Scholar]
- 42.Hopman WM, Harrison MB, Coo H, Friedberg E, Buchanan M, VanDenKerkhof EG. Associations between chronic disease, age and physical and mental health status. Chronic Dis Can. 2009;29(2):108–16. [PubMed] [Google Scholar]
- 43.Fikretoglu D, Brunet A, Guay S, Pedlar D. Mental health treatment seeking by military members with posttraumatic stress disorder: Findings on rates, characteristics, and predictors from a nationally representative Canadian military sample. Can J Psychiatry. 2007;52(2):103–10. doi: 10.1177/070674370705200208. [DOI] [PubMed] [Google Scholar]
- 44.Thompson JM, Sweet J, Poirier A, VanTil L. (Veterans Affairs Canada, Research Directorate). Suicide ideation and attempt findings in the Survey on Transition to Civilian Life: Descriptive Analysis. Charlottetown: Veterans Affairs Canada Research Directorate Technical Report; 2011. [Google Scholar]
