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
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