Health and Well-Being of Canadian Forces Veterans: Findings from the 2013 Life After Service Survey (July 2014) - Executive Summary

Citation: Thompson JM, Van Til L, Poirier A, Sweet J, McKinnon K, Sudom K, Dursun S, Pedlar D. Health and Well-Being of Canadian Armed Forces Veterans: Findings from the 2013 Life After Service Survey. Charlottetown PE: Research Directorate, Veterans Affairs Canada. Research Directorate Technical Report. 03 July 2014.

To obtain the complete report, please contact research-recherche@vac-acc.gc.ca

Introduction

The first comprehensive survey of the health and well-being of Canadian Armed Forces (CAF) VeteransFootnote 1 was the 2010 Survey on Transition to Civilian Life (STCL 2010). STCL 2010 was one of two studies that together comprised the 2010 Life After Service Studies (LASS) program of research, the other being the 2010 LASS Income Study. LASS 2010 studied the health and well-being of former Regular Force personnel who had released from service during 1998-2007. Reserve Force Veterans were not included in the 2010 studies owing to limitations in the data available at the time. The CAF has increasingly drawn on Primary Reserve Force personnel to supplement the Regular Force since the 1990-91 first Gulf War including the missions in Bosnia and Afghanistan, so it is important to also study their health and well-being.

The 2013 program extended the 2010 studies by including Primary Reserve Force Veterans for the first time, and by including Regular Force Veterans who had released in 1998-2012. Two studies were conducted, as in 2010: the 2013 income study and the Life After Service Survey (LASS 2013). This report gives findings from the survey.

Methods

LASS 2013 was a computer-assisted telephone interview survey conducted by Statistics Canada for Veterans Affairs Canada (VAC) and the Department of National Defence (DND) in February-March 2013. The survey sampled former Primary Reserve Force personnel with Class A/B and C serviceFootnote 2 who released from service 01 January 2003 to 31 August 2012 and Regular Force personnel who released 01 January 1998 to 31 August 2012:

  1. Reserve Force Class A/B. Veteran who was a Primary Reserve Force member with any Class B temporary full-time service in addition to Class A service, and no Regular Force service.
  2. Reserve Force Class C. Veteran who was a Primary Reserve Force member with Class C service, and also had Class A, and Class B service and no Regular Force service. Class C service is full-time service in support of deployed operations, domestically or internationally.
  3. Regular Force. Veteran who was a member of the Regular Force. Some in this category also had service in the Primary Reserve Force.

The sample consisted of Primary Reserve Force Class A/B (514 sampled, 60% response rate, 93% share rate) and Class C Veterans (1,013 sampled, 70% response rate, 91% agreed to share data with VAC and DND), and Regular Force Veterans (2,611 sampled, 72% response rate, 89% share rate). The samples are considered representative of CAF Primary Reserve Force Class A/B and Class C and Regular Force Veterans living in the general Canadian population who were released during those time periods.

Importance of Age and Gender

Reserve Class A/B Veterans who released in 2003-12 were younger (average age 31 years, range 18-67) than Reserve Class C Veterans who released in 2003-12 (40 years, range 20-67). They in turn were younger than Regular Force Veterans who released in 1998-2012 (44 years, range 18-78). There were also differences in the proportions of women: 19% for Reserve Class A/B, 23% for Reserve Class C and 13% for Regular Force Veterans. These differences in age and gender are important to consider when comparing prevalences across the three Veteran groups. For example, physical health conditions are more prevalent with age, and mental health conditions are more prevalent in adult middle years.

Well-Being of the Primary Reserve Force and Regular Force Veterans

The following table paints pictures of the health, disability, stress/satisfaction and determinants of health status of the three Veteran groups. Statistical analysis that accounts for confounding (differences in age, sex and other factors) is required to confirm differences and similarities, and to identify reasons for differences between the groups.

  • Class A/B Primary Reserve Veterans were the youngest on average and in general had the best health and well-being. Very few were participating in VAC programs.
  • Class C Primary Reserve Veterans looked more similar to Regular Force Veterans than Class A/B Veterans. Most were doing well, but they were older on average than Class A/B Veterans and were experiencing problems more often.
  • Regular Force Veterans in LASS 2013 were very similar to the picture in STCL 2010: most Regular Force Veterans who released in 1998-2012 were doing well, but of the three groups they had the highest prevalences of health and well-being problems.
Well-Being of the Primary Reserve Force and Regular Force Veterans
Characteristic or IndicatorFootnote a Reserve Class A/B Released 2003-2012 Reserve Class C Released 2003-2012 Regular Force Released 1998-2012
Mean Age 31 years, Range 18-67 40 years, Range 20-67 44 years, Range 18-78
Women (CI) 19% (15-22%) 23% (21-26%) 13% (12-15%)
Marital status 56% married or commonlaw
39% single or never married
F* for widowed, separated or divorced
72% married or commonlaw
22% single or never married
6% widowed, separated or divorced
74% married or commonlaw
16% single or never married
10% widowed, separated or divorced
Educational attainment 25% high school
39% post-secondary other than university degree
35% university degree
26% high school
41% post-secondary other than university degree
30% university degree
43% high school
36% post-secondary other than university degree
17% university degree
Unemployment rate (CI) 6% (4-9%) 5% (4-7%) 7% (6-8%)
Labour force participation in 2013 84% employed
10% not in the workforce
80% employed
13% not in the workforce
71% employed
19% not in the workforce
4% unable to work
Main activity in the past year 77% working at a job or business
14% in school or training
77% working at a job or business
6% in school or training
5% disabled or on disability
6% retired
69% working at a job or business
5% in school or training
6% disabled or on disability
12% retired
Low income (CI) 12% (9-15%) 8% (6-10%) 8% (6-9%)
Length of service 21% <2 years
66% 2-9 years
10% 10-19 years
F* > 20 years
F* <2 years
41% 2-9 years
36% 10-19 years
22% > 20 years
21% <2 years
20% 2-9 years
12% 10-19 years
48% > 20 years
Release type (CI) 76% (72-80%) voluntary
16% (12-20%) involuntaryFootnote b
F* for other types, including medical release
65% (61-68%) voluntary
10% (8-12%) involuntary
13% (11-15%) medical release
8% (6-10%) service complete
5% (4-7%) retirement age
52% (50-55%) voluntary
7% (5-8%) involuntary
21% (19-23%) medical release
16% (14-17%) service complete
5% (4-5%) retirement age
Rank at release F* for senior officers and senior NCMs
7% junior officers
33% junior non-commissioned members (NCM)
14% privates
39% recruits
17% officers
20% senior NCMs
58% junior NCMs
F* for number of cadets, privates and recruits
15% officers
4% cadets
25% senior NCMs
30% junior NCMs
7% privates
18% recruits
Enrolment era 16% 1990s and 77% 2000s, suggesting a high turnover rate Peak in the 1990s but spread across all eras from the 1960s Broadly spread across all eras from the 1950s
Release year Little variation, ranged 6-12% in the release period (2003-2012) Slightly highest in 2011 (16%) Ranged 4-10% by year across the release period 1998-2012, peak in 2008
Service Environment 83% Army
13% Navy
F* for Air Force
80% Army
13% Navy
7% Air Force
54% Army
16% Navy
30% Air Force
Last military occupation 59% combat arms
15% administration, logistics or security
10% maritime
F* for the other 5 groups
44% combat arms
27% administration, logistics or security
11% communications
8% maritime
F* for the other 4 groups
26% combat arms
24% administration, logistics or security
8% communications
14% aviation
12% maritime
11% engineering/technical
5% medical
Adjustment to civilian life (CI) 74% (70-78%) easy
11% (8-14%) difficult
61% (58-64%) easy
24% (21-27%) difficult
56% (54-59%) easy
27% (25-29%) difficult
Self-rated health (CI) 69% (65-73%) very good/excellent
7% (5-10%) fair/poor
61% (58-64%) very good/excellent
13% (11-15%) fair/poor
53% (50-55%) very good/excellent
18% (16-20%) fair/poor
Self-rated mental health (CI) 74% (70-77%) very good/excellent
6% (5-9%) fair/poor
67% (64-70%) very good/excellent
11% (9-13%) fair/poor
62% (59-64%) very good/excellent
16% (14-18%) fair/poor
1+ chronic physical health conditionFootnote c (CI) 55% (50-60%) 68% (65-71%) 74% (72-76%)
Chronic physical health conditions (CI)

17% (14-21%) Back problems
6% (4-8%) Arthritis
7% (5-10%) Cardiovascular
7% (5-10%) Gastrointestinal
10% (7-13%) Migraine
18% (15-22%) Obesity
13% (10-16%) Chronic pain
F*  Others

32% (29-35%) Back problems
16% (14-19%) Arthritis
14% (12-17%) Cardiovascular
9% (7-11%) Gastrointestinal
7% (6-9%) Respiratory
11% (9-13%) Migraine
3% (2-4%) Traumatic brain injury (TBI) effects
5%  Diabetes
24% (21-26%) Obesity
28% (25-31%) Chronic pain
F*  Others

35% (32-37%) Back problems
22% (21-24%) Arthritis
19% (18-21%) Cardiovascular
9% (7-10%) Gastrointestinal
7% (6-9%) Respiratory
14% (13-16%) Migraine
3% (2-4%) Traumatic brain injury (TBI) effects
6%  Diabetes
26% (24-28%) Obesity
2% (1-2%) Cancer
3%  Urinary incontinence
34% (32-36%) Chronic pain

1+ chronic mental health conditionFootnote d (CI) 9% (7-12%) 17% (15-20%) 24% (22-26%)
Chronic mental health conditions F*

12% (10-14%) Mood disorder
8% (6-10%) Anxiety disorder
8% (6-9%) Posttraumatic stress disorder (PTSD)

17% (15-19%) Mood disorder
11% (10-13%) Anxiety disorder
13% (12-15%) Posttraumatic stress disorder (PTSD)

Likely mental disorders (K-10) (CI) 7% (5-9%) mild
F* moderate and severe
8% (6-10%) mild
F* moderate
6% (5-8%) severe
9% (7-10%) mild
5% (4-6%) moderate
8% (6-9%) severe
Both a physical and a mental health condition F* 16% (14-18%) 22% (20-24%)
Past-year suicidal ideation F* 5% (4-7%) 7% (6-8%)
SF-12 Health-related quality of life (CI) Physical 54.1 (53.5-54.8)
Mental 52.6 (51.8-53.3)
Physical 50.8 (50.1-51.4)
Mental 51.1 (50.4-51.8)
Physical 47.9 (47.4-48.5)
Mental 51.3 (50.8-51.8)
Reduction of activity in a major life domain (CI) 23% (19-27%) 40% (37-43%) 49% (47-52%)
Satisfied with life (CI) 94% (91-96%) 89% (87-91%) 86% (84-87%)
Stress on most days 33% not at all/not very
17% quite a bit/extremely
29% not at all/not very
26% quite a bit/extremely
36% not at all/not very
23% quite a bit/extremely
Work stress past year 29% not at all/not very
18% quite a bit/extremely
26% not at all/not very
28% quite a bit/extremely
33% not at all/not very
22% quite a bit/extremely
Satisfaction main activity past year 80% satisfied or very satisfied 75% satisfied or very satisfied 75% satisfied or very satisfied
Daily smoking 10% 13% 17%
Heavy drinking 32% 28% 25%
Health insurance 83% prescription drugs
75% dental insurance
68% eye glasses
88% prescription drugs
78% dental insurance
73% eye glasses
92% prescription drugs
87% dental insurance
84% eye glasses
Regular medical doctor (CI) 76% (71-79%) 78% (76-81%) 81% (79-83%)
Home care paid by government F* 4% (3-5%) 7% (6-9%)
Home care not paid by government F* 9% (7-11%) 8% (7-9%)
Unmet need for health care past year (CI) 12% (9-15%) 16% (14-18%) 16% (14-18%)

CI – 95% confidence interval.
F* - Sample size too small for reliable estimate.
Proportions and prevalences not adjusted for differences in age, sex and other factors.

Comparison to the General Canadian Population

Each of the groups were compared to the Canadian general population by adjusting the prevalences for the general population to fit each of the age-gender structures of the Veteran groups and using 95% confidence interval comparisons to assess statistical significance.

All three Veteran groups had similar rates of unemployment and lower rates of low income compared to the Canadian general population.

Class A/B Reserve Force Veterans were similar to Canadians with the same age-gender structure in the general population. They had higher prevalences than the general population for being married or common law and having high school and post-secondary education, and lower prevalences of having quite a bit/extreme life stress and daily smoking. They had similar prevalences to the general population for most health and well-being indicators, but had slightly higher prevalences of back problems and gastrointestinal conditions.

Class C Reserve Force Veterans were more like Regular Force Veterans than Canadians in the general population. They had lower prevalences of excellent/very good self-rated mental health and higher prevalences of arthritis, back problems, gastrointestinal problems, obesity, hearing problems, pain or discomfort, mood disorders, anxiety disorders, and activity limitations (both types). They were less often satisfied with life than Canadians in the general population.

Regular Force Veterans were least like the general Canadian population after adjusting the general population prevalences to match the age-gender structure of the Regular Force Veterans. They had lower prevalences of excellent/very good self-rated health and self-rated mental health and higher prevalences of arthritis, back problems, gastrointestinal problems, cardiovascular disorders, migraine, obesity, hearing problems, pain or discomfort, mood disorders, anxiety disorders, and activity limitations. They less often had a strong sense of community belonging and were less often satisfied with life than Canadians in the general population, but less often had quite a bit or extreme life stress.

Regular Force Veterans Released in 1998-2007: 2010 and 2013 Surveys

Both LASS surveys in 2013 and 2010 gave similar health and well-being pictures for Regular Force Veterans who released in 1998-2007. The mean age was 44 in 2010 and 47 in 2013, consistent with the 3-year span between surveys. The proportions of women (12%) and VAC clients (34%) were the same in both studies. Prevalences were not significantly different for most chronic health conditions (prevalences within 1-2% between the two surveys), anxiety disorders (10% in 2013 vs. 11% in 2010), PTSD (11% vs. 13%) and past-year suicidal ideation (6% in both). Prevalences of most other health and well-being indicators appeared to be approximately similar. In both studies, age and sex-adjusted statistical comparisons to the Canadian general population showed that Regular Force Veterans had poorer well-being in several areas.

Regular Force Veterans Released in 2008-2012 versus 1998-2007

Regular Force Veterans who released in 2008-2012 had similar notable prevalences of health conditions and disability compared to Regular Force Veterans who released in 1998-2007. The mean age of those released in 2008-12 was 39 years, younger than those who released in 1998-2007 (47 LASS 2013). They had similar proportions of women (13% in LASS 2013). They were slightly more often single/never married (27% vs. 10%) in keeping with their younger age. They had a similar prevalence of difficult adjustment to civilian life (29% vs. 26%). Fewer had musculoskeletal conditions (39% vs. 46%), attributable in part to their younger average age. Considering their younger average age they had notable prevalences of poor self-rated health, poor self-rated mental health, physical and mental health conditions and disability assessed as both reduction of activities in major life domains and as basic and instrumental activities of daily living.

Veterans Receiving Services from VAC (VAC Clients)

Just over a third of Regular Force Veterans were receiving services from VAC (35%) while a smaller proportion of Reserve Class C Veterans were VAC clients (17%). Very few Reserve Class A/B Veterans were VAC clients (3%)Footnote 3, consistent with their younger average age and lower prevalence rates of chronic health conditions. Of Class C and Regular Force Veterans, almost all who were VAC clients had one or more chronic physical health condition (95% and 92%) and half had a mental health condition (50% and 47%) almost always complicated by a comorbid chronic physical condition (49% and 44% had co-occurring mental and physical health conditions). Both Regular Force and Reserve Class C Veterans who were VAC clients had high prevalences of chronic health conditions, as described below. Less than 10% of non-clients had comorbidity of physical and mental health conditions, demonstrating that while Veterans with more complex health conditions are largely reached by VAC programs, some are not.

In general, Reserve Class C and Regular Force VAC clients were similar. Compared to non-clients, VAC clients:

Were older on average:
48 vs. 39 years for Reserve Class C and 48 vs. 41 years for Regular Force Veterans.
More often had difficult adjustment to civilian life:
56% vs. 18% for Reserve Class C and 47% vs. 17% for Regular Force.
More often were unemployed:
15% vs. 6% for Reserve Class C and 11% vs. 7% for Regular Force Veterans.
Were not more likely to have low income:
5% vs. 9% for Regular Force Veterans.
Were more likely to have 20 or more years of service:
39% vs. 18% for Reserve Class C and 64% vs. 39% for Regular Force Veterans.
Much more often had service career-limiting employment limitations (medical release):
52% vs. 4% Reserve Class C and 49% vs 5% Regular Force.
Much more often had chronic physical health conditions:
95% vs. 63% Reserve Class C and 92% vs 63% Regular Force
Much more often had mental health conditions:
50% vs. 10% Reserve Class C and 47% vs 11% Regular Force
Much more often had co-occurring (comorbid) physical and mental health conditions:
49% vs. 9% for Reserve Class C and 44% vs. 9% for Regular Force.
Were experiencing lower physical and mental health-related quality of life using the SF-12 Short Form Health Survey:
Physical component score 39 vs. 53 for Reserve Class C and 39 vs. 53 for Regular Force Veterans.
Mental component score 45 vs. 52 for Reserve Class C and 47 vs. 54 for Regular Force Veterans.
Much more often had disability measured as activity limitations:
Reduction in activity in a major life domain: 93% vs. 29% for Reserve Class C and 88% vs. 28% for Regular Force Veterans.
Needing assistance with at least one basic or instrumental activity of daily living: 47% vs. 6% for Reserve Class C and 46% vs. 6% for Regular Force Veterans.
More often had markers of stress, difficulty coping and satisfaction with life:
Most days extremely/quite a bit stressful: 42% vs. 23% for Reserve Class C and 30% vs. 19% for Regular Force Veterans.
Work stress past year quite a bit/extreme: 39% vs. 27% for Reserve Class C and 28% vs. 20% for Regular Force Veterans.
More often had a regular medical doctor:
90% vs. 76% for Reserve Class C and 87% vs. 77% for Regular Force Veterans.

Interpretation Guidance

  • Use caution comparing the Veteran groups. Statistical analysis that accounts for confounding (differences in factors such as age, sex etc.) is required to confirm differences and similarities, and to identify reasons for differences.
  • LASS 2013 was a point-in-time, cross-sectional survey, therefore causal conclusions cannot be drawn from this study alone, including effects of military service or DND/CAF/VAC programs.
  • Be cautious about drawing conclusions about the presence of "risk" and "protective" factors. Inferential statistical methodology is required to control for the joint effects of characteristics and indicators on each other (confounding), and because the survey was cross-sectional then conclusions cannot be made about causal relationships.
  • Findings cannot be generalized to all Veterans because the survey included only those who released in 1998-2012 (Regular Force) and 2003-2012 (Reserve Force).

Next Steps

These descriptive findings provide valuable insights into the socioeconomics, military characteristics, health, disability and well-being of CAF Primary Reserve and Regular Force Veterans. Further analyses are being planned that will deepen understanding of the health and well-being of these Veterans to inform policies, programs and services supporting CAF personnel in transition to civilian life.

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