Australian Vietnam Veterans Health Study
Group Leader: Dr Brian O’Toole
Email: Brian O'Toole
Collaborators and Staff: S Catts (Univ of Qld), Jill Cockburn (Univ of Newcastle), Kate Pierse
The Australian Vietnam Veterans Health Study is an epidemiological cohort study of a random sample of 1,000 Australian Army Vietnam veterans, examining the long term health effects of war zone exposures and experiences in combat veterans. Based at Westmead and Concord Hospitals, the study began in the late 1980s and the first wave collected data from veterans from 1991-1993. This current wave interviewed veterans during 2005-06 right across Australia, with fieldwork completed in November 2006. The study is concerned with all aspects of health, and is using assessment instruments that are standardized and that have national norms to allow comparison of veterans with the background male population.
The Australian Institute of Heath and Welfare searched the National Death Index on behalf of the study to determine mortality in the cohort. Of the original 1000, 8 had died in Vietnam, and a further 117 have been found to have died since their return. This gives a post-war mortality rate of 11.9%. Risk factors for mortality so far emerging from analysis indicate that the deceased are more likely to have been Regular soldiers rather than National Servicemen, to have enlisted in earlier years, to have been older in Vietnam, to have served longer in the Army before Vietnam and overall, and to have had higher ranks and been older at discharge. Analysis of causes of death and the search for risk factors for mortality is continuing.
Because the random sample of veterans resides right across Australia, interviews were conducted in veterans’ homes or worksites. Interview teams located in WA, SA, Victoria, NSW and Qld were supported by Clinical Investigators travelling to rural localities to conduct assessments. The assessments took an average of four hours and consisted of modular interviews: the study was licensed to use the Australian Bureau of Statistics (ABS) software for computer-administered health interviews to assess physical and mental health. The study developed software to administer a clinical assessment schedule for post traumatic stress disorder (PTSD). Psychiatric health was assessed using the Composite International Diagnostic Interview, for which there are Australian population data to compare. Interviews were conducted by CI-A and by part-time counsellors (psychologists or social workers) associated with the Vietnam Veterans Counselling Service and with the National Centre for Veteran and Military Health.
Follow-up of the cohort in Wave 2 was about as expected: of the living members of the cohort, 308 could not be found and a further 99 refused to participate; a number agreed but could not be interviewed for logistical reasons (resident overseas, on extended ‘grey nomad caravan tour’, away on business). Assessments have been conducted with 455 veterans, representing a 53% response rate of living veterans or 80% of locatable veterans.
The first wave revealed a large untreated population of men with PTSD for whom the lifetime prevalence was 20.1% and the current (1-month) prevalence was 10.5%. In a preliminary analysis of the second wave, the prevalence rates were more than doubled - approximately 42% and 32%. For some men, after the war, those who ‘just got on with it’, positions of responsibility combined with workplace stresses caused spectacular breakdowns in later life; other veterans remain undamaged and in healthy mid-life. Still others, who carry most the serious wounds, are reaping the consequences of an angry life of alcohol and penury and passing this down to their children. In this study, we will examine more closely the time-course of the symptoms of PTSD in an attempt to identify factors that may ameliorate the symptoms, or factors that may trigger the symptoms in later life: for about 25% of the men with PTSD, the full syndrome took many years to emerge and in some cases was preceded by a major life change, such as Army discharge, retirement or retrenchment, business problems, or family events such as children’s illness or death. There is evidence from the study that PTSD has an influence on physical health, with PTSD more likely to be associated with conditions for which an underlying inflammatory mechanism is responsible, such as asthma and arthritis.
The study investigators had received funding in 2006 and again in 2007 from the Australian Rotary Health Research Foundation to include veterans’ wives in the study, using exactly the same data collection procedures as used for the men, but with interviews conducted by telephone. This component of the study will assess the effects of veterans’ problems on their wives and partners. In particular, the team has developed an assessment instrument that measures the amount of stress experienced by each woman and relates this to each of her partners’ symptoms of PTSD (if any). This, for example, will give a different view of the effects of recurrent and distressing nightmares on veterans’ wives and partners. This study will also examine the women’s reproductive history and major illnesses and survival of their children.