The Physical and Mental Health of Australian Vietnam Veterans 3 Decades After the War and Its Relation to Military Service, Combat, and Post-Traumatic Stress Disorder

ANZAC Research Institute, Repatriation General Hospital Concord, New South Wales, Australia.
American journal of epidemiology (Impact Factor: 5.23). 07/2009; 170(3):318-30. DOI: 10.1093/aje/kwp146
Source: PubMed


The long-term health consequences of war service remain unclear, despite burgeoning scientific interest. A longitudinal cohort study of a random sample of Australian Vietnam veterans was designed to assess veterans' postwar physical and mental health 36 years after the war (2005-2006) and to examine its relation to Army service, combat, and post-traumatic stress disorder (PTSD) assessed 14 years previously (1990-1993). Prevalences in veterans (n = 450) were compared with those in the Australian general population. Veterans' Army service and data from the first assessments were evaluated using multivariate logistic regression prediction modeling. Veterans' general health and some health risk factors were poorer and medical consultation rates were higher than Australian population expectations. Of 67 long-term conditions, the prevalences of 47 were higher and the prevalences of 4 were lower when compared with population expectations. Half of all veterans took some form of medication for mental well-being. The prevalence of psychiatric diagnoses exceeded Australian population expectations. Military and war service characteristics and age were the most frequent predictors of physical health endpoints, while PTSD was most strongly associated with psychiatric diagnoses. Draftees had better physical health than regular enlistees but no better mental health. Army service and war-related PTSD are associated with risk of illness in later life among Australian Vietnam veterans.

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    • "Veterans are at higher risk of poor physical health[34] and mental health.[5] They also more frequently report health compromising behaviors such as smoking.[6] The long-term health outcomes among veterans, however, have been less frequently studied. "
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    ABSTRACT: Background: The aim of the current study was twofold: To investigate the effect of veteran status on risk of developing heart disease over a period of 20 years in the United States and to test if socio-economic characteristics, chronic conditions, health behaviors, body mass index (BMI) and depressive symptoms explain the association between veteran status and risk of heart disease. Methods: Data came from the Health and Retirement Study, a 20 year national cohort from 1992 to 2012. The study enrolled a representative sample of Americans over the age of 50. We included 8,375 individuals who were older than 50 years at entry, did not have heart disease at baseline and provided data on heart disease over the next 20 years. Veteran status was considered to be the independent variable. Self-reported data on physician diagnosis of heart disease, which was measured on a biannual basis, was the outcome. Baseline socio-economic data (i.e. age, gender, race, marital status and education), chronic conditions (diabetes and hypertension), health behaviors (i.e. drinking, smoking, and exercise), BMI and depressive symptoms (modified Center for Epidemiologic Studies Depression Scale) were entered into logistic regressions. Logistic regression was used for data analysis. Results: Veterans were at higher risk of having a new onset of heart disease (unadjusted relative risk [RR] = 1.996, 95% confidence interval [CI] =1.694-2.351), compared with non-veterans. Logistic regression confirmed the association between veteran status and heart disease (adjusted RR = 1.483, 95% CI = 1.176-1.871) after controlling for all covariates. Conclusions: Veterans may be at higher risk for heart disease over time and this link may be independent of baseline socio-economic characteristics, chronic medical conditions, health behaviors, BMI and depressive symptoms. Veterans may require more rigorous cardiovascular prevention programs.
    International journal of preventive medicine 06/2014; 5(6):703-9.
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    • "Previous reports have confirmed the validity of assessing the prevalence of self-reported chronic disease among middle-aged and senior recruits [14-17]. Likewise, Vietnam veteran research utilizes self-reported disease information [5,18-20]. However, compared with diagnoses by physicians, a number of limitations when using self-reported diseases require the reader's attention [21]. "
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    ABSTRACT: The aim of this study was to evaluate the association between Agent Orange exposure and self-reported diseases in Korean Vietnam veterans. A postal survey of 114 562 Vietnam veterans was conducted. The perceived exposure to Agent Orange was assessed by a 6-item questionnaire. Two proximity-based Agent Orange exposure indices were constructed using division/brigade-level and battalion/company-level unit information. Adjusted odds ratios (ORs) for age and other confounders were calculated using a logistic regression model. The prevalence of all self-reported diseases showed monotonically increasing trends as the levels of perceived self-reported exposure increased. The ORs for colon cancer (OR, 1.13), leukemia (OR, 1.56), hypertension (OR, 1.03), peripheral vasculopathy (OR, 1.07), enterocolitis (OR, 1.07), peripheral neuropathy (OR, 1.07), multiple nerve palsy (OR, 1.14), multiple sclerosis (OR, 1.24), skin diseases (OR, 1.05), psychotic diseases (OR, 1.07) and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the division/brigade-level proximity-based exposure analysis, compared to the low exposure group. The ORs for cerebral infarction (OR, 1.08), chronic bronchitis (OR, 1.05), multiple nerve palsy (OR, 1.07), multiple sclerosis (OR, 1.16), skin diseases (OR, 1.05), and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the battalion/company-level analysis. Korean Vietnam veterans with high exposure to Agent Orange experienced a higher prevalence of several self-reported chronic diseases compared to those with low exposure by proximity-based exposure assessment. The strong positive associations between perceived self-reported exposure and all self-reported diseases should be evaluated with discretion because the likelihood of reporting diseases was directly related to the perceived intensity of Agent Orange exposure.
    09/2013; 46(5):213-25. DOI:10.3961/jpmph.2013.46.5.213
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    • "Pre-trauma factors Younger age at trauma ϩ (Brewin et al., 2000; Nasky, Hines, & Simmer, 2009) Lower education ϩϩ (Brewin et al., 2000; Iversen et al., 2008; Schnurr et al., 2004; Zohar et al., 2009) Lower intelligence ϩϩ (Brewin et al., 2000; Gale et al., 2008; Zohar et al., 2009) Lower military rank ϩϩ (Iversen et al., 2008; Nasky et al., 2009; Zohar et al., 2009) Lower socioeconomic status ϩϩ (Brewin et al., 2000; Schnurr et al., 2004) Prior trauma ϩϩ (Brewin et al., 2000; Ozer et al., 2003) Prior psychiatric history/symptoms ϩϩ (Brewin et al., 2000; Rona et al., 2009) Family psychiatric history ϩϩ (Brewin et al., 2000; Ozer et al., 2003) Behavioral problems in childhood ϩϩ (Helzer, Robins, & McEvoy, 1987; King, King, Foy, & Gudanowski, 1996; Koenen et al., 2005) Childhood abuse or adversity ϩϩ (Brewin et al., 2000; Cabrera, Hoge, Bliese, Castro, & Messer, 2007; Gahm et al., 2007; Iversen et al., 2008) Trauma characteristics Trauma/combat exposure severity ϩϩϩ (Brewin et al., 2000; Cabrera et al., 2007; Gahm et al., 2007; Koenen et al., 2003; O'Toole et al., 1996; Rona et al., 2009; Schnurr et al., 2004) Perceived life threat ϩϩϩ (King et al., 1998; Schnurr et al., 2004) Combat-related injury ϩϩϩ (Koren, Norman, Cohen, Berman, & Klein, 2005; MacGregor et al., 2009) Exposure to death, killing, or abusive violence ϩϩ (Gahm et al., 2007; Iversen et al., 2008; Maguen et al., 2010; Marx et al., 2010; McCarroll, Ursano, Fullerton, Liu, & Lundy, 2001) Peritraumatic distress or dissociation ϩϩϩ (Ozer et al., 2003; Schnurr et al., 2004) Post-trauma factors Lack of social support ϩϩϩ (Brewin et al., 2000; Ozer et al., 2003) Negative homecoming experience ϩϩϩ (Johnson et al., 1997; Koenen et al., 2003) Exposure to additional life stressors ϩϩϩ (Brewin et al., 2000) 2000; King, King, Foy, Keane, & Fairbank, 1999; Ozer, Best, Lipsey, & Weiss, 2003; Wolfe et al., 1999) highlight the complexity of predicting who will and will not develop chronic PTSD. Risk and resilience factors, including the quality of the family environment during childhood, age at trauma exposure, history of prior adversity, severity of trauma exposure , breadth and strength of the social support network, exposure to additional life stressors, and individual-level characteristics such as hardiness and neurobiology have consistently been found to influence the development of PTSD (King et al., 1999; King, King, Fairbank, Keane, & Adams, 1998; Pietrzak et al., 2010; Pietrzak, Johnson, Goldstein, Malley, & Southwick, 2009). "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) is a psychiatric disorder that affects 7-8% of the general U.S. population at some point during their lifetime; however, the prevalence is much higher among certain subgroups, including active duty military personnel and veterans. In this article, we review the empirical literature on the epidemiology and screening of PTSD in military and veteran populations, including the availability of sensitive and reliable screening tools. Although estimates vary across studies, evidence suggests that the prevalence of PTSD in deployed U.S. military personnel may be as high as 14-16%. Prior studies have identified trauma characteristics and pre- and posttrauma factors that increase risk of PTSD among veterans and military personnel. This information may help to inform prevention and screening efforts, as screening programs could be targeted to high-risk populations. Large-scale screening efforts have recently been implemented by the U.S. Departments of Defense and Veterans Affairs. Given the prevalence and potential consequences of PTSD among veterans and active duty military personnel, development and continued evaluation of effective screening methods is an important public health need. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
    Psychological Services 11/2012; 9(4):361-382. DOI:10.1037/a0027649 · 1.08 Impact Factor
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