Australian Defence Force Members Research Articles

Enhancing occupational therapy service provision with military veterans through policy reform: Findings from a national survey.

Almost half a million Australians have served with the Australian Defence Force. Given the high prevalence of physical and mental health conditions and complexity of civilian life adjustment after military service, high-quality occupational therapy services are critical. However, there is limited description of occupational therapy service provision to individuals funded by the Australian Department of Veterans' Affairs to inform government policy. The aim of this study was to describe the practice of Australian occupational therapists working with former service members and identify opportunities to enhance practice and policy. A cross-sectional study using an online survey was conducted to collect information from occupational therapists providing services to Department of Veterans' Affairs clients. Frequency analyses were performed to describe quantitative data. Qualitative data were analysed using thematic analysis. No consumer or community involvement occurred. Participants included 123 Australian occupational therapists residing in metropolitan (47%), regional (28%) and rural/remote (23%) areas. Most occupational therapists (69%) had over 15 years of clinical experience and worked in private practice (87%). Common interventions included home modifications, equipment prescription and assistive technology (77%), goal-oriented rehabilitation (16%) and activities of daily living or function assessments and education (13%). Three themes describing practice issues were identified: (1) Service provision as rewarding yet underfunded, (2) Administrative complexity and lack of understanding of the occupational therapy role and (3) Need for specialist professional development opportunities. Australian occupational therapists are providing a range of services to Department of Veterans' Affairs clients although mostly relating to physical conditions. Occupational therapy practice with former Australian Defence Force members should be expanded to meet their diverse and complex needs. Further research and education are needed to support use of specialist knowledge and interventions. Advocacy by peak associations and policy reform are urgently required to ensure sustainable services, particularly in rural areas.

Employment outcomes among transitioned Australian Defence Force members: An exploration of sex differences

LAY SUMMARY Gaining employment is one of the many challenges Veterans face when transitioning out of the military. Females and males have different experiences while serving, as well as when transitioning to civilian life, that can affect employment after transition. This study explores the factors affecting employment for females and males, finding that some factors differ by sex. Children, housing, age, amount of time since transition, military service type, and education were all shown to affect employment differently for females and males. Similarities between females and males were found for factors such as mental health, trauma, reasons for leaving, and transitioning to the reserves. Results show that different factors affect employment for females and males. Further research is needed to develop more awareness of the female transition experience to ensure services support the unique needs of female Veterans.

Occupational identity and the military to civilian transition of former serving Australian Defence Force members

ABSTRACT Internationally, there is recognition that the transition from military service to civilian life is challenged by a military identity. The aim of this study was to present the impact of an occupational military identity on the transition to civilian life from the perspective of former serving Australian Defence Force members. A narrative inquiry methodology was employed to explore the transition experience of the participants who each shared the story of their transition, presenting a narrative for data analysis. This analysis utilised Braun and Clarke’s thematic analysis (2006, 2020), and the a priori theme of identity. The 12 participant narratives led to the presentation of four themes: 1) Transition and a military identity; 2) Military service and a military identity; 3) Military identity and separation type (voluntary and involuntary); and 4) Enabling transition and the military identity in civilian life. The participants’ narratives highlighted how their occupational participation in military training and culture shaped an identity to challenge transition. Yet, they also highlighted the positive influence of a military identity, offering insights into how best to enable the transition from military service to civilian life.

The “Transition” to Civilian Life From the Perspective of Former Serving Australian Defence Force Members

It is well recognised that the transition from the military to civilian life can create challenges. This study explores the multiple and dynamic experiences former serving Australian Defence Force members report in their transition to civilian life. A narrative inquiry methodology with two rounds of interviews was used to collect the data from 12 former serving Australian Defence Force members. Narrative thematic analysis was used to interpret the data. Our results indicate that transition for each participant is a unique experience that continues in the years following separation. For those who joined in early adulthood and served in high-tempo and/or combat roles, transitioning was complicated by military identity challenges. Their ongoing transition was related to the need to develop an individual civilian identity for civil society, challenged by the development of a collective identity as a member of the Australian Defence Force. We conclude that transition is the process of identifying as an individual following a collective identity, and for those still transitioning, was best supported by their military peers.

Rural former service members participate in meaningful occupations to 'fill the void' after military service.

Over 50% of former service members report debilitating health conditions and difficulty adjusting to civilian life. Former service members living in rural areas are even more likely to experience poor health outcomes and have decreased access to specialist health-care services. Participation in meaningful occupations can support health and adjustment after military service. However, little is known about rural former service members' perspectives and experiences of participating in occupations after separating from military service. This study explored rural former service members' experiences of participating in occupations during their transition and their perceptions of how these experiences influenced their health and adjustment. Purposive sampling was used to recruit 10 rural former Australian Defence Force members discharged from service between 1 July 2013 and 1 July 2018. Former service members participated in a series of semi-structured interviews. Interpretative phenomenological analysis was used to determine themes for individual participants and then overarching themes that characterised the experiences of the group. A single overarching theme, 'It can't all be for nothing': Searching for ways to fill 'the void' through meaningful occupational participation, reflected rural former service members' experiences. The different ways that participants sought to fill 'the void' after military service were interpreted through two sub-themes: (1) 'You can't heal if you're still in a battlefield': Participating in occupations to re-establish safety and wellbeing, and (2) 'I was in a uniform and I could still do well': Participating in occupations to reconnect with self and continue the mission to serve. Rural former service members participated in various occupations to establish safety, wellbeing, and reconnection after transitioning from military service. The findings point to the need for further research to inform the development of consumer-led occupation-based interventions that are sensitive to individuals' service history, environmental context, and trauma recovery needs.

Epidemiology of cruciate ligament reconstruction in the Australian Defence Force and predictors of outcome

BackgroundThe ability to predict the risk of poor outcome following knee cruciate ligament reconstruction in the Australian Defence Force (ADF) population would help direct individual rehabilitation programmes and workforce planning....

Service and demographic factors, health, trauma exposure, and participation are associated with adjustment for former Australian Defense Force members

ABSTRACT Approximately 50% of transitioning service members report difficulty adjusting to civilian life. However, there is limited research exploring factors that influence adjustment for former Australian Defence Force (ADF) members. The aim of this study was to investigate the influence of demographic and service-related characteristics, trauma exposure, health, and participation in meaningful occupations on adjustment for former ADF members. One hundred and ninety-eight former ADF members completed a voluntary, online survey containing validated self-report measures for adjustment, health, and exposure to combat and military sexual trauma. Participation in meaningful occupations was assessed using open-ended questions and a rating scale for frequency of participation. A more difficult adjustment was reported by participants who had completed operational service, reported exposure to combat and/or military sexual trauma, had poor physical health and were discharged for medical reasons. Other characteristics associated with a difficult adjustment included emotional distress, involuntary discharge, age category 30–49 years, final rank of Senior Noncommissioned Officer/Warrant Officer or below, and discharge 6–8 years previously. Employment, voluntary work and care, and social and community interaction were associated with an easier adjustment. Screening tools that consider health, age, deployment type, final rank, type of discharge and exposure to combat or military sexual trauma may be helpful to identify and refer high risk individuals to employment, rehabilitation or transition support programs.

Next Generation Sequencing of Genotype Variants and Genetic Association between Heat Shock Proteins HSPA1B Single Nucleotide Polymorphism at the g.31829044 Locus and Heat Tolerance: A Pilot Quasi-Experimental Study.

Heat tolerance and exertional heat stroke (EHS) are rare health conditions that have been described and characterised but have never been genetically solved. Knowledge of the role of single nucleotide polymorphisms (SNPs) in heat shock proteins (HSPs) genes and their associations with heat tolerance and EHS is limited. This pilot study aimed to identify SNP in HSPA1B, HSP90AA2 and DNAJA1 genes and their associations with heat tolerance and EHS history in a quasi-experimental design. Participants comprised Australian Defence Force members (ADF) who had a history of EHS and the general population. Genomic DNA samples were extracted from the venous blood samples of 48 participants, sequenced and analysed for SNP. Forty-four per cent (44%) of the participants were heat intolerant, and 29% had a history of EHS. Among participants with a history of EHS, there was an association between heat tolerance and HSPA1B SNP at the g.31829044 locus. However, there were no associations between HSPA1B and HSP90AA2 SNP and heat tolerance. All participants had the same distribution for the DNAJA1 SNP. In conclusion, the findings indicate an association between the HSPA1B genetic variant at the g.31829044 locus and heat tolerance among ADF participants with a history of EHS. Further research with a larger number of military participants will shed more light on the associations between HSP genes and heat tolerance.

Prevalence of gambling problems, help-seeking, and relationships with trauma in veterans.

Background and aimsVeterans who have recently left the military (i.e., transitioned) may be vulnerable to the development of psychiatric disorders, but little is known about gambling problems in this population. This study investigated the prevalence and risk factors of gambling problems, help-seeking amongst veterans with gambling problems, and relationships with trauma and posttraumatic psychopathology.MethodsCross-sectional self-report survey data from 3,511 Australian Defence Force members who left the military within the past five years. Surveys included measures of gambling problems (PGSI); depressive symptoms (PHQ-9); posttraumatic stress disorder (PCL-5); help-seeking behaviours; military and non-military-related trauma.ResultsPrevalence rates for problem gambling (PGSI ≥ 5) were 4.6%, while an additional 8.8% were classified in terms of at-risk gambling (PGSI = 1–4). Time since leaving the military was not associated with gambling problems. Only 2.1% of veterans with problem gambling reported help-seeking for their gambling. While trauma exposure, depression, and Posttraumatic Stress Disorder (PTSD) were all related to gambling problems at the bivariate level, only arousal and dysphoric-related affect were uniquely associated with gambling problems when adjusting for covariates.DiscussionGambling problems may be under-recognised relative to other psychiatric issues. Posttraumatic mental health problems, rather than trauma exposure per se, may explain the relationship between trauma and gambling problems.ConclusionsSome veterans are in a period of vulnerability during transition out of military service, and harms associated with gambling problems may be exacerbated during this period.

Participation in occupations, health and adjustment during the transition from military service: A cross-sectional study

ABSTRACT Participation in meaningful occupations is central to health, well-being, and adjustment during the transition from military service. The aim of the present study was to identify what occupations transitioning Australian Defence Force members participate in for the purpose of improving their health and well-being. A secondary aim was to identify if participation in various occupations was associated with better self-reported health and/or adjustment outcomes. One hundred and ninety-eight former Australian Defence Force members discharged on or after January 1, 2004 responded to a cross-sectional survey measuring adjustment, physical and mental health, and participation in occupations. Occupations were coded using the Time Use Classification system developed by the Australian Bureau of Statistics. An easier adjustment was reported by former service members who participated in employment-related activities, domestic activities, voluntary work and care activities, and social and community interaction (MD = −0.63 to −0.45, d = .37 to .52). Participation in employment-related activities, social and community interaction, and sport and outdoor activity was associated with better physical health (MD = 3.20 to 3.73, d = .34 to .40). Participation in employment-related activities was also associated with better mental health (MD = −3.75, d = .54). This research indicates that participation in occupation is a factor that may be utilized with former service members to positively influence health and adjustment during military transitions. Given differences in participation and outcomes among different sub-groups, it is recommended that occupation-based programs be tailored to individual preferences and transition needs.

Massed versus standard prolonged exposure for posttraumatic stress disorder in Australian military and veteran populations (RESTORE trial): Study protocol for a non-inferiority randomized controlled trial

Posttraumatic stress disorder (PTSD) can be a severe problem, affecting veterans and military personnel at higher rates than the general community. First-line treatment for PTSD, prolonged exposure (PE), is typically delivered weekly for 10–12 weeks, however this duration can pose a barrier to accessing and completing the treatment, particularly for current serving military. This paper presents the RESTORE trial protocol, the first randomized controlled trial of massed PE therapy outside of the United States and by an independent research group. One hundred and thirty-five Australian Defence Force members and veterans (18–80 years) who meet criteria for PTSD related to a military trauma will be randomly allocated to one of two conditions: standard PE (SPE; 10 weekly 90-min sessions) or massed PE (MPE; 10 daily 90-min sessions). Across eight sites, patients will be assessed at pre-treatment, and at 4 weeks, 12 weeks, and 12 months post-treatment commencement. The primary outcome is clinician-measured and self-reported PTSD symptom severity at the 12 week assessment. We hypothesize that MPE will be as effective as SPE in reducing PTSD severity at 12 weeks post-treatment commencement. The adaptation and testing of evidence-based interventions is critical to reduce barriers to treatment uptake among veterans and military personnel. Outcomes of this study have the potential to result in international, cross-service uptake and delivery of this rapid treatment for veterans and military members, as well as civilians, thereby improving clinical outcomes for patients and their families.

Walking Forwards with Moral Injury: Narratives from Ex-serving Australian Defence Force Members

Military personnel can be exposed to events such as killing or human suffering that can breach or violate their core moral frameworks. The breaching or violation of one’s core moral framework can create moral trauma—often termed “moral injury.” Moral injury has gained increased attention during the last decade due to its links to military suicide. The core characteristics of moral injury have not yet reached a universal consensus but can include deep feelings of shame, guilt, distrust, anger, and self-condemnation. Few studies have focused on moral injury in Australia. This paper is one of several published from a larger PhD study. The purpose of this paper is to understand participants’ experiences of moral injury. Analysis of the data revealed the overarching theme—walking forwards with moral injury—describing participants’ experiences of living with a moral injury and how they navigated and made meaning of their experience. From this overarching theme, three sub-themes emerged: (a) meaning-making and moral injury, (b) narratives of transformation, and (c) leading the charge. The study found that to continue “walking forwards” a transformation of identity was needed. The transformation happened when an understanding of the meaning underpinning identity occurred, and when validation and reconciliation of the experience were achieved. These findings enhance knowledge of the mechanisms needed to better support veterans living with moral injury in Australia. Outcomes from this work may assist clinicians or those working with military veterans in providing more appropriate care to those experiencing moral injury.

A Shield for the Tip of the Spear

The defence of superior orders is not new. However, within Australia, its statutory codification is lamentably underexplored. The 2018 Amendments to Part IIIAAA of the Defence Act 1903 (Cth) provides a neat catalyst to expand the defence and look at possible manners in which it can be constructed. Utilising a theoretical case study of Australian Defence Force members killing a possible terrorist, ‘this article addresses’ the key elements of the defence—what an order is, when can it be constructed as being manifestly unlawful and what does reasonable and necessary force mean for Australian Defence Force members.

Evaluation of mental health first aid training for family members of military veterans with a mental health condition

BackgroundA concerning proportion of former Australian Defence Force (ADF) members meet criteria for a mental health condition. Mental health difficulties not only affect the individual veteran. They have been found to negatively impact the mental health of family, with an increased likelihood for family members of veterans developing a mental health condition. The aim of this study was to evaluate whether participating in a Mental Health First Aid (MHFA) program improved family members of veterans mental health knowledge, reduced personal and perceived mental health stigma, reduced social distancing attitudes and increased confidence and willingness to engage in MHFA helping behaviours. Additionally, the study measured participant’s general mental health and levels of burnout.MethodThe study utilised an uncontrolled design with assessment at three time points (baseline, post-program and three-month follow-up). Participants (N = 57) were immediate and extended family members of former ADF members with a mental health condition, who took part in a two-day standard adult MHFA program. At each time point, participants completed self-report measures assessing mental health knowledge, personal and perceived mental health stigma, social distancing attitudes, confidence and willingness to engage in MHFA helping behaviours, general mental health and burnout. Cochranes Q and repeated measures ANOVA was computed to measure the impact of time on the outcome variables.ResultsResults indicated significant improvements in MHFA knowledge and confidence in providing MHFA assistance. Significant reductions in personal mental health stigma (i.e. an individual’s attitude towards mental health) for schizophrenia were observed and maintained at follow up. High levels of perceived mental health stigma (i.e. the belief an individual holds about others attitudes towards mental health) were reported with no significant changes observed following the MHFA program. Results did not indicate any significant benefit in improving general psychological distress or burnout at follow up. The participant sample had high levels of mental health difficulties with over half reporting a lifetime mental health diagnosis.ConclusionThe study is an important contribution to the international literature on MHFA. The provision of a MHFA program to family members of military veterans has not previously been evaluated. Implications of the findings are discussed with regards to future directions of MHFA research and implementing MHFA programs in this population.

Individual Anthropometric, Aerobic Capacity and Demographic Characteristics as Predictors of Heat Intolerance in Military Populations

Background and objectives: The Australian Defence Force (ADF) engages in combat-related activities in hot climatic conditions, which exposes ADF members to the threat of exertional heat illness (EHI). After an episode of EHI, the heat tolerance test (HTT) is conducted to determine heat tolerance. Heat intolerance is the inability to maintain thermal balance while exercising in a hot environment. This study investigated the predictive roles of individual characteristics (age, gender, aerobic capacity (VO2max) and body composition) on physiological responses to the HTT in a group comprising ADF personnel and civilian volunteers. Materials and Methods: A quasi-experimental design was used and 52 (38 males and 14 females) participants were recruited from the ADF and the general population for the HTT. Heat intolerance was defined following the standard criteria for the HTT (temperature and heart rate). Data were analysed using inferential statistics. Results: The mean age of the participants was 31.1 ± 11.6 years, and 44% (23 people: 19 males and 4 females) of the participants were heat intolerant. Independent samples T-test showed that body mass index (p = 0.011) and body fat% (p = 0.034) of heat-intolerant participants were significantly higher than their heat-tolerant counterparts. Body surface area to mass ratio (p = 0.005) and aerobic capacity (p = 0.001) were significantly lower in heat-intolerant participants. Regression analyses showed that age, gender, aerobic capacity and body fat% were significant (p < 0.001) predictors of heat tolerance outcomes, with R2 values ranging from 0.505 to 0.636. Conclusions: This study showed that aerobic capacity, body fat%, age and gender are predictors of heat intolerance among military and non-military populations. However, there may be a need for future studies to consider identifying other indicators such as clinical biomarkers of heat intolerance, which could be used to develop a more reliable HTT protocol.

Psychosocial factors associated with psychological distress and functional difficulties in recently transitioned and current serving regular Australian Defence Force members

The transition period from military-to-civilian life can be one of the most significant and stressful periods in the military life cycle. We explore the psychosocial factors associated with psychological distress and functional impairment among those who recently transitioned from the Australian Defence Force (ADF) and those currently serving in 2015. Using data from the Transition and Wellbeing Research Programme, multinomial logistic regression models were used to analyze the associations between a combined measure of psychological distress and functional impairment (K10/SDS) with various psychosocial, lifestyle, and physical health factors. There were 10,210 in the final analytic cohort (Transitioned=3,254; Regular 2015 ADF=6,956). Overall, the odds of belonging to the highly distressed/impaired group were greatest among those with insomnia (Odds Ratio 18.53), low resilience (OR 7.67), physical health symptoms (OR 7.16), and alcohol risk (OR 4.67). Other factors included pain (OR 3.36), financial issues (OR 2.38), and social strain (OR 1.98). The associations with insomnia and physical health symptoms were stronger among the Transitioned compared to the Regular 2015 ADF. Results of this research highlights the importance of taking a multi-dimensional perspective of symptoms in military populations, particularly in those recently transitioned from permanent service, as predictors of future risk of disorder.

Military Loyalty as a Moral Emotion

Loyalty between soldiers is idealized as an emotion that promotes cohesion and combat effectiveness. However, little empirical work has examined how military personnel understand, feel, and enact loyalty. We use a symbolic interactionalist informed frame to explore the lived experience of 24 retired Australian Defence Force members via in-depth semi-structured interviews. Our analysis revealed three core themes: (1) Loyalty as reciprocity, where there was an expectation that loyalty would be returned no matter what. (2) The importance of emotional connection for cohesion. (3) Loyalty as a prioritizing process, where a soldier’s loyalties gave them a way of choosing between competing demands. Loyalty is a moral emotion that enabled sensemaking. Close interpersonal loyalties tended to trump wider/diffused loyalties. Respondents understood their loyalties to fellow soldiers within wider social constructs of mateship and professionalism. The findings show the risks that come from a reliance on loyalty for combat cohesion.

The impact of potentially traumatic events on the mental health of males who have served in the military: Findings from the Australian National Survey of Mental Health and Wellbeing.

The study investigated the impact of potentially traumatic events on mental health outcomes among males who had ever served in the Australian Defence Force. Data from a nationally representative household survey of Australian residents, the 2007 National Survey of Mental Health and Wellbeing, were used for this study. Compared with community members, Australian Defence Force males were significantly more likely to have experienced not only deployment and other war-like events but also accidents or other unexpected events, and trauma to someone close. For non-deployed males, Australian Defence Force members were at increased risk of accidents or other unexpected events compared to community members. After controlling for the effect of potentially traumatic events that were more prevalent among all Australian Defence Force members, the increased risk of mental disorders among Australian Defence Force members was no longer evident. For non-deployed males, Australian Defence Force and community members were at comparable risk of poor mental health outcomes. A significant minority of Australian Defence Force members had onset of a mental disorder prior to their first deployment. Deployment and other potentially traumatic events among Australian Defence Force members can help to explain their increased vulnerability to mental disorders compared with community members. Providers should routinely enquire about a range of potentially traumatic events among serving and ex-serving military personnel.

Effect of Uniform Design on the Speed of Combat Tourniquet Application: A Simulation Study.

Tourniquets are issued to deployed members of both the United States (U.S. military and the Australian Defence Force (ADF). The ease of removing the tourniquet from the pocket of the combat uniform may influence its time to application. The ADF uniform uses buttons to secure the pocket, whereas the U.S. uniform uses a hook and loop fastener system. National differences in training may influence the time to and effectiveness of tourniquet application. To compare the time taken to retrieve and apply a tourniquet from the pocket of the Australian and the U.S. combat uniform and compare the effectiveness of tourniquet application. Twenty participants from both nations were randomly selected. Participants were timed on their ability to remove a tourniquet from their pockets and then apply it effectively. The U.S. personnel removed their tourniquets in shorter time (median 2.5 seconds) than Australians (median 5.72 seconds, p < 0.0001). ADF members (mean 41.36 seconds vs. 58.87 seconds, p < 0.037) applied the tourniquet more rapidly once removed from the pocket and trended to apply it more effectively (p = 0.1). The closure system of pockets on the combat uniform might influence the time taken to apply a tourniquet. Regular training might also reduce the time taken to apply a tourniquet effectively.

Factors associated with low unit cohesion in Australian Defence Force members who deployed to the Middle East (2001-2009).

IntroductionUnit cohesion has been shown to bolster the mental health of military personnel; hence, it is important to identify the characteristics that are associated with low unit cohesion, so that interventions to improve unit cohesion can be targeted and implemented. Little is known about the factors associated with low unit cohesion. This research aims to identify demographic, military service and deployment factors associated with low unit cohesion.MethodsData from a self-reported cross-sectional study of 11 411 current or ex-serving Australian military personnel deployed to Iraq or Afghanistan between 2001 and 2009 were used. Multivariable logistic regression was used to investigate the research aims.ResultsBeing female (adjusted OR (aOR) (95% CI) 1.35 (1.21 to 1.51)), non-commissioned officer (aOR (95% CI) 1.50 (1.39 to 1.62)), lower ranked (aOR (95% CI) 1.74 (1.51 to 2.01)) or having left military service (aOR (95% CI) 1.71 (1.46 to 2.02)) was associated with reporting low unit cohesion. Potentially modifiable factors such as performing logistic roles on deployment (aOR (95% CI) 1.13 (1.01 to 1.27)), dissatisfaction with work experience on deployment such as working with colleagues who did not do what was expected of them (aOR (95% CI) 4.09 (3.61 to 4.64)), and major problems at home while deployed (aOR (95% CI) 1.50 (1.38 to 1.63)) were also associated with reporting low unit cohesion.ConclusionsThis is the first study to identify demographic, military service and deployment factors associated with low unit cohesion. The modifiable nature of unit cohesion means that military leaders could use this information to identify subgroups for targeted resilience interventions that may reduce vulnerabilities to mental health problems and improve the job satisfaction, preparedness and deployment experiences of serving members.