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Saturday 8 February 2020

2020-The War within a Military Veteran








THE WAR WITHIN A MILITARY VETERAN - A QUESTIONNAIRE BASED STUDY ON INDIAN VETERANS


Dr.V.S.Srikanth, Dr.Shruthi Rajkumar 1,Dr.(Col)Vishal Marwaha 1, Dr.M.Gopalakrishna Pillai 1, Dr.ValsrajMenon1,  Anuja Anil 1, Anupama Kurup 1, Anuja Jayan 1, Aparna Chandrababu 1, Anna Mariyam1, , Arfaz Nazer1, Andrea Susan 1, Maj.Priyank Yadav 2, Col.Shri Kumar 3  

1)Amrita institute of Medical science and research Centre, Affiliated to Amrita Vishwa Vidyapeetham, Kochi, 2) Indian Army, Hisar  3)Indian Army,  Anandhapur 





Published at the International Review of the Armed Forces Medical Services ,December 2019-Vol 92/4

Abstract

Veteran is the title earned by those citizens who have scarified their youth and life for their motherland serving in the Armed Forces, in this study we have focused on the life of veterans post retirement assessing their physical and mental wellbeing.

Methods

This pan Indian study was conducted on 220 veterans attending ECHS clinics in Kerala, Andhra Pradesh, and Haryana. SF 36 questionnaire applied to survey the health status & asses the wellbeing score, where the results are reliable and correlates with the outcome. The scores for different categories under SF 36 were calculated and the data tallied in Excel sheet.

Results

Overall health status score of our study population is positioned as ranging from Moderate Health Status to Progressing towards Good Health. High Quality of Life with individual parameters scoring minimum of 54 points .Comorbid conditions included COPD, CLD, SHTN, CAD, DM, Cancer, and Osteo Arthritis.  Younger age habituation to alcohol and smoking Parameters like physical health, emotional problems, energy failure, emotional wellbeing, pain scare, general health have a score of > 63, which indicated that the veterans were towards good health.

Conclusion

 Our study indicates the overall well-being & health status of our veterans is quite positive & Good SF-36 score. The scores can further increased with life style and family support.

INTRODUCTION

Veteran is the title earned by those citizens who have scarified their youth and life for their motherlandand stood against all odds to see their flag fluttering high. They have faced the scroatching heat of the desert, freezing colds of the glaciers for protecting their country. They are the ones who stood guarding even the tallest mountains and deepest of the oceans of a nation bearing all odds. As a whole, transitioning out of the military can be a very difficult experience, contrary to the common illusion of “everything being gravy in the civilian world.” The reality is that the civilian world abides by many standards that are seemingly opposite of those of the military (1)
Once retired, most of them find it difficult to reunite with the civil world, as the functioning is not as orderly as in the defense forces. Prime part of lifetime spent away from the family and the familiesalso get adjusted to such a life style without their presence in person, many of them find it difficult to re-establish the family bond immediately after retirement.
Being in combat and separated from your family can be stressful. The stress can put service members and veterans at risk for mental health problems. These include anxiety, post-traumatic stress disorder, depression and substance abuse. Suicide can also be a concern (2).To face the obstacles of post retirement reality alcohol and smoking become crutch to cope with, while readjusting to the civil life.
In a study done by Linda et al, showed Comprehensive literature review found limited knowledge about how to integrate veterans into a new workplace (3).   This is one of the few studies, which deals with the quality of life, post retirement from defense forces. In this study, we looked into psychological and common morbid condition, which the veterans develop, so that it can be tackled at the root level.

OBJECTIVE
To understand the quality of life post retirement in Indian veterans by assessing the physical social and mental wellbeing and to develop preventive strategies if there is any problems faces by the veterans.
METHODS
This Pan Indian study was conducted on 220 veterans attending ECHS clinics in Kerala, Andhra Pradesh, and Haryana. Informed consent was obtained, following which demographic details, history, comorbidities and questions to assess the general well-being
SF 36 questionnaire applied to survey the health status & asses the wellbeing score, where the results are reliable and correlates with the outcome (4,5). The scores for different categories under SF 36 were calculated and the data tallied in Excel sheet.
Quality of Life and Wellbeing scores were assed as per SF-36 questionnaire with maximum score of 100 indicating high quality of life and good health and Low score (< 40) indicating poor health status .Data analysis done using IBM - SPSS statistical tool

Inclusion criteria
Veterans attending ECHS clinics in Kerala, Andhra Pradesh, and Haryana where the study conducted. All age groups irrespective of their service period
Exclusion criteria
Terminally ill patients who could not participate in direct information collection and patients receiving psychological and psychiatric treatment.


RESULTS


Data collected using SF 36 questionnaire recorded and analyzed using SPSS tool. The results observed are presented here in the graphs in Fig1 to Fig 6 under various categories.


















DISCUSSION
This is one of the few studies, which assessed both health and mental status of the veterans
The Age wise spread of our population had mean age of 59 year and Median age of 61 years with Min age being 36 &  Maximum age being 89 .Common Comorbid conditions faced by veterans of study included COPD,CLD,SHTN,CAD, DM , Cancer & Osteoarthritis of which the most common  were diabetes and systemic hypertension.
On evaluating the quality of heath with SF-36 scoring system which asses both physical and mental wellbeing wherephysical wellbeing is assessed based on the scores obtained from parameters of (Physical function, Role of limitation of physical health, Role limitation emotionalproblems, Fatigue) 
Mental Welling was assessed based on by (Emotional wellbeing, social functioning, Pain, General Health) .Where higher the score less is the disability. Where < 40 is poor functioning, 40-60 were moderate functioning and the above 60 score falls in the good range.
Parameters like physical health, emotional problems, energyfailure, emotionalwellbeing, painscare, general health have a score of > 63, which indicated that the veterans were towards good health. This can be correlated to Regular exercise, high pain tolerance, and strong mental makeup, which they develop during the service
Overall health status score of our study population is positioned as ranging from Moderate Health Status to Progressing towards Good Health & High Quality of Life with individual parameters scoring minimum of 54 points.
Due to younger age habituation to alcohol and smoking, veterans are more prone for development of co morbid conditions. This leads to decrease in physical function and energy levels at later years of life. The result of our study co related well with results of study done by Jenni et al where they found veterans demonstrate high rates of SUD in American Army (6, 7, 8 ).
In our assessment, we had found that the veterans had overall all mental well-being because of “Better health care schemes for veterans by the armed forces like Ex-servicemen Contributory Health Scheme (ECHS), played an important role delivering timely heath care services (9,10).
Veteran housing colonies help to live in a mutually supportive environment provided a platform for veteran’s emotional and psychological support by peers and community
Emotional wellbeing & Social functioning show more positive reflections in veterans of higher age group Strong mental makeup and development of self-sustainable skill and training their social functioning and emotional independence post retirement can be related to this fact.
CONCLUSSION

Our study indicates the OVEALL well-being & health status of our veterans is quite positive & Good SF-36 score, thanks to various measures provided to care for their healthy life.
In order to improve the scores further, we suggest few additional measures as follows
Periodic follow up ofthe physical and mental veterans every quarter for immediate couple of years post retirement in a medical facility .The score could be reassessed and necessary psychological and timely psychiatric guidance can be provided on need basis.
Provide sufficient counselling sessions prior to retirement for a seamless / stress free integration in to civilian society.Counselling Sessions for Rehabilitation: inorderto support for withdrawal of Alcohol andSmoking.
Assist them in finding opportunities to use their skills and find placements to absorb them in right positions and keep them engaged.
The study can be extended to cover wider band of veteran population across the age groups and demographics in order to understand the applicability of SF-36 scores and customise the measures. Providing quality life and Pride filled engagement of Veteransin their post service lifetime is one of means by which civilian society can pay as gratitude to their service.

An important message what we also wanted to convey from our study is that 


- Its responsibility of every citizen to value our veterans who stood awake in the frontiers guarding our borders so that they could sleep peacefully at home and support then with love , honour and pride  





CONFLICT OF INTEREST

There is no conflict of interest in this study 

REFERENCES

3)   Linda Van Til,  Deniz Fikretoglu et al, Work Reintegration for Veterans With Mental Disorders: A Systematic Literature Review to Inform Research. Physical Therapy, Volume 93, Issue 9, 1 September 2013, Pages 1163–1174,https://doi.org/10.2522/ptj.20120156
4)   Wilma M. Hopman et al., Canadian normative data for the SF- 36 health survey CMAJ. 2000 Aug 8; 163(3): 265–271. PMCID: PMC80287
5)    Ronan A. Lyonset al., Measuring health status with the SF-36: the need for regional norms. Journal of Public Health Medicine. Vol. 17, No. 1, pp. 46- 50
6)   Jenni B Teeters, et al, Substance use disorders in military veterans: prevalence and treatment challenges Subst Abuse Rehabil. 2017; 8: 69–77. Published online 2017 Aug 30. doi: 10.2147/SAR.S116720 ,PMCID: PMC55871
7)    Seal KH, Cohen G, Waldrop A, Cohen BE, Maguen S, Ren L. Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001–2010: implications for screening, diagnosis and treatment. Drug Alcohol Depend2011;116(1–3):93–101
8)   Hoggatt KJ, Lehavot K, Krenek M, Schweizer CA, Simpson T. Prevalence of substance misuse among US veterans in the general population. Am J Addict2017; 26(4):357–365.
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