Reports
- Health of veterans,, opens in a new tab Australian Institute of Health and Welfare (AIHW), (updated 31 October 2024). While good health is a requirement for joining the Australian Defence Force (ADF), the experience of military service means current and ex-serving ADF members may have different health challenges compared to other Australians. This is why monitoring of the health and wellbeing of the ADF veteran population is important. According to the 2021 Census of Population and Housing, more than half a million Australians (581,000) have ever served in the ADF, representing 2.8% of Australians aged 15 and over. Around 84,900 (15%) are currently serving ADF members (60,300 permanent and 24,600 reservists), and over 496,000 (85%) are ex-serving. Veterans are mostly male – 86% (497,000) compared to 48% of non-veterans aged 15 and over. Fourteen per cent (84,100) of veterans are female. Ex-serving veterans are an older population – 53% (263,000) are aged 65 years and over, compared with 20% of the non-veterans aged 15 and over.
- In 2020–21, male veterans were less likely to rate their health as excellent or very good than male non-veterans (45% compared with 57%, respectively), and reported a higher prevalence of several long-term health conditions than male non-veterans. This may be explained by the older age of Australia’s male veteran population.
- Data on mental health conditions are complicated due to methological differences between data sources. In 2020–21 NHS, male veterans were more likely to self-report a current and long-term mental or behavioural condition than male non-veterans (27% compared with 17%, respectively). In particular, they were nearly twice as likely (21%) to report having a long-term anxiety-related disorder compared with male non-veterans (11%).
- According to self-reported data from the 2020–21 NHS, almost 2 in 5 (37%) male veterans had a disability with a limitation or restriction, while 1 in 5 (20%) had a disability but with no limitation or restriction. These proportions were around twice as high as those of male non-veterans (17% and 12%, respectively).
- Between 1997 and 2022, males currently serving in the permanent or reserve forces were around half as likely to die by suicide as all Australian males. However, ex-serving males were 26% more likely to die by suicide than all Australian males. While the rate of suicide for ex-serving females was lower than that for ex-serving males, ex-serving females were more than twice as likely to die by suicide than all Australian females. The suicide rate for ex-serving males who separated involuntarily for medical reasons was around three times the rate of those who separate voluntarily (62.7 compared with 22.0 per 100,000 population per year). However, the suicide rate for ex-serving females was similar between those who separated involuntarily for medical reasons and those who separated voluntarily.
- Beyond The Finish Line: Research report,, opens in a new tab Celina H. Shirazipour, Emily Mayhew, Jessica Capaldi, et al., Invictus Games Foundation, Forces of Mind Trust, (May 2024). The current report provides, to our knowledge, the first international longitudinal investigation of the benefits of international adapted sport competition for Service Members and Veterans experiencing physical and/or psychological illnesses and injuries. Having examined approaches to military sport recovery programming across 23 countries, we also present the first global guide to evidence-based best practices for competitive military adapted sport, with 71 best practice strategies identified that can support quality participation and outcomes in military sport recovery programming.
- Competitors in the Invictus Games Sydney 2018 experienced greater positive impacts on their wellbeing compared to non-competitors.
- The research highlighted the importance of the “between Games” activities to maintain health and wellbeing levels and found that the strategies that provide the most benefit were centred more on mental fitness skills and resilience training than on sports development.
- The benefit to participating in the Invictus Games was clearest during training when individuals are coming together regularly with their community and taking on new challenges, or when participating in the Invictus Games. In the long-term post-Sydney, when non-competitors were included in the Invictus community and provided with access to Hague 2020 training opportunities, including sport camps, selection trials, and eSport programming, they began to demonstrate improvements in well-being, sometimes narrowing the gap with competitors.
- The strategies that promote optimal outcomes from sport recovery programming are less about sport development and more about focusing on mental fitness skills by integrating formal resilience training alongside sport, as well as reinforcing resilience training after competition.
- Programming and sport strategies are often siloed with a focus on either physical or psychological illnesses or injuries. However, the experience of illness and injury is multi-faceted. Individuals experiencing both physical and psychological illness and injury often demonstrated poorer health outcomes regardless of whether an individual was a competitor or a non-competitor.
- Veteran social connectedness,, opens in a new tab Australian Institute of Health and Welfare (AIHW), (updated 26 October 2023). Social connectedness plays a significant role in the health and wellbeing of veterans both during and after service. Strong social connectedness has been associated with an increase in social support networks and general happiness levels with reduced severity of Post Traumatic Stress Disorder (PTSD) symptoms and lower suicidality (Flack and Kite 2021). However, the risk and protective factors against poor social connectedness are not well researched in Australia’s veteran population. Analysis of Wave 21 HILDA data found that overall, Australia's veterans experienced similar or better social connectedness than the broader Australian population. However, analysis also revealed that some subgroups of veterans, such as those in poor general or mental health, were often at higher risk of issues with social connectedness than other veterans.
- Social isolation among veterans (9.4%) was similar to people who had never served in the ADF (11%). However, some subgroups of veterans were at greater risk than others.
- Loneliness among veterans (18%) was similar to people who had never served in the ADF (19%). However, some subgroups of veterans were at greater risk than others.
- Nearly 1 in 5 (19%) veterans volunteered. This was higher than people who had never served in the ADF (14%). Some subgroups of veterans had particularly high rates of volunteering.
- Two in 5 (40%) veterans were active members of clubs or associations. This was higher than people who had never served in the ADF (29%). Some subgroups of veterans had particularly high rates of active club or association membership.
- Over a quarter (27%) of veterans did not feel part of their local community. This was similar to people who had never served in the ADF (26%). However, this pattern differed among subgroups of veterans.
- Just over 1 in 5 veterans (22%) had infrequent social contact with persons outside their household (that is, once every three months or less). This was similar to people who had never served in the ADF (20%). However, some subgroups of veterans were at greater risk of infrequent social contact than others.
- Adaptive sport programs for Australian Defence Force veterans,, opens in a new tab Senate Foreign Affairs, Defence and Trade References Committee, Parliament of Australia, (May 2023). The committee conducted an inquiry to examine the role of adaptive sport programs [and sport more broadly] for Australian Defence Force veterans in addressing issues identified by the ongoing Royal Commission into Defence and Veteran Suicide. The committee recognises the overwhelming evidence of the benefits that adaptive sports have provided and continue to provide to veterans and their families. The committee notes the range of activities that are now available across the sporting paradigm for veterans to participate in, and acknowledges the role that many organisations, sporting bodies, and codes have played to ensure these activities are available. That said, the benefits to veterans could be better realised through greater coordination and a stronger focus on the role of sport in supporting veteran wellbeing.
- Understanding the wellbeing characteristics of ex-serving ADF members,, opens in a new tab Australian Institute of Health and Welfare (AIHW), (1 September 2022). Findings from this report show that the majority of ex-serving ADF members were doing well in 2016. Many had attained higher education qualifications, were employed, earned higher incomes than the Australian population, owned their own homes (including those paying mortgages), and were socially connected by living in a family type household. It is important to note however this was not the case for everyone. Those who separated from the ADF involuntarily for medical reasons experienced wellbeing challenges such as higher unemployment rates, had lower levels of education qualifications, and were receiving lower incomes in 2016 than those who separated for any other reason. Those who served fewer years or who separated from the Navy experienced similar wellbeing challenges as mentioned above when compared to those who served longer or who served in the Army or Air Force.
- Rapid Evidence Assessment to identify strategies to support and sustain healthy behaviour as part of active ageing in Australian veterans: Summary Report,, opens in a new tab N Warren, B Barbosa Neves, K Hutton Burns, et al., Monash University, Australian Government, Department of Veterans’ Affairs, (February 2022). Findings suggest that successful and healthy ageing interventions should be informed by a set of core priorities, namely: 1) address social isolation and loneliness, 2) promote movement and physical exercise, 3) cognitive functioning, 4) quality of life and wellbeing, 5) consider veteran identity, and 6) reduce risk behaviours and mitigate risk factors. A military identity can contribute to a sense of connection among veterans. It can change over time and result in both positive and negative outcomes. Those who can combine a military and civilian/family social identity have more stable transitions and civilian re-integrations characterized by a heightened sense of belonging. Studies suggest that veterans may be more likely to take part in peer support programs run by veterans than in non-veteran programs.
- Exercise provides a wide range of physical, cognitive, mental, and other health benefits for midlife and older people. Many of the intervention articles contained in the REA supported maintaining physical movement as an important aspect of active ageing.
- Active Choices: A ‘stepped-down’ program to promote self-managed physical activity in DVA clients: Summary Report,, opens in a new tab Nicholas Gilson, University of Queensland, Australian Government, Department of Veterans' Affairs, (December 2021). Self-managing physical activity can be challenging and programs that help DVA clients to manage their own physical activity regimes are needed. This project developed and trialled a new physical activity support program for DVA clients called Active Choices. The Active Choices program is based on a strong theoretical framework and incorporates evidence based BCTs to support clients as they transition to self-managed PA. These BCTs include education, goal setting, goal review, self-monitoring, action planning and social support. 35 participants were recruited into the study. Participants were typically older male veterans (mean age = 61 years; 77% male), who lived with their partner, children, or both (68%); were retired (56%) and had acquired an educational qualification past high school (80%). The majority of the sample (94%) were non-smokers. Most (62%) met current nutrition guidelines for fruit consumption, but few (6%) met guidelines for vegetable consumption. The majority (68%) did not engage in hazardous drinking or only did so less than monthly. Most of the sample (68%) were overweight or obese (average BMI = 29 kg/m²).
- The most successful recruitment strategy involved advertising the program directly to clients through DVA and ex-service organisation communication channels. 75% of expressions of interest and participant sign-ups came from these sources, highlighting this recruitment process as a preferred option for future work.
- Device-based measures indicated that only 16% of the sample were meeting the recommended guidelines for PA (i.e., 150 minutes/ week of moderate-intensity PA) at baseline. At the end of the program, this had increased to 42%.
- Self-accountability was a key mechanism underpinning this PA change. Participants frequently identified three BCTs within the program which they believed drove their motivation and accountability, and consequently, improved their PA levels: self-monitoring, action planning and goal setting.
- 46% of the sample reported at the end-program interview that their social connectivity had improved as a result of the program. This was achieved through attending the program’s meet-and-greets and engaging in group-based PA opportunities that were supported through Active Choices.
- At interview, 76% of participants reported benefits to psychological wellbeing. Process and interview data identified improvements in mood, and a sense of achievement that was experienced through selfmanagement of PA regimes. Survey scores on anxiety and depression were seen to reduce over time, with the proportion of participants reporting no issues increasing from 26% at baseline to 40% at follow-up.
- Participants incurred less costs for EP and physiotherapy services during the study ($60.51/week) than the ‘average’ DVA client who accessed these services in 2020 ($97.06/week), although caution should be used in assuming this was due to the intervention given the absence of a comparative group. At the follow-up interview, 36% of participants (n = 9) identified that they were seeing their EP or physiotherapist less frequently or not at all and had, through the support of the program, started selfmanaging their condition more regularly at home.
- The data provides evidence that Active Choices had a positive impact on those DVA clients who participated in the program. There was evidence of an increase in PA across the program and into follow-up, with participant feedback highlighting a move towards more self-managed PA. Improvements in social connectivity and support networks were observed, with this facilitated by Active Choices: A ‘stepped-down’ program to promote self-managed physical activity in DVA clients engagement with local PA communities. Aspects of psychological wellbeing, such as positive mood, were also seen to improve over the duration of the study.
- ‘Stepped-down’ Intervention Programs to Promote Self-managed Physical Activity in Service Veterans and their Dependants: Summary of the Rapid Evidence Assessment,, opens in a new tab Gilson ND, Papinczak ZE, Mielke GI, et al., University of Queensland, Australian Government, Department of Veterans' Affairs, (November 2019). The aim of this Rapid Evidence Assessment (REA) was to: 1) examine the scientific literature for evidence on the effectiveness of interventions to promote self-managed physical activity in service veterans and/or their dependants; 2) assess studies that compared the effectiveness of ‘stepped-down’ models of PA self-management to ‘usual care’ controls and; 3) identify key behaviour change techniques that have been used in these studies to successfully promote physical activity change.
- Overall, 64% (n=18) of studies (service veterans only) found positive intervention effects (physical activity, physical function/fitness, psychological health or social support).
- When considering only those selected studies that compared a ‘stepped-down’ intervention to a ‘usual care’ group (n=14), 79% of studies (n=11) observed a positive between-group intervention effect in the primary outcome of physical activity; the mean magnitude of change was 53 minutes/week of self-reported moderate intensity physical activity.
- All included studies were from the United States. The REA found no Australian based studies that met inclusion criteria, or positive intervention effects with dependants. The generalisability of findings to DVA clients was therefore rated as: Unknown – insufficient evidence of beneficial effect, and further research required.
- Adaptive Sports for Disabled Veterans,, opens in a new tab Nancy Greer, et al., prepared for Department of Veterans Affairs (USA), (February 2019). The purpose of this report is to systematically review the available evidence on the benefits and harms of adaptive sports participation and the barriers to and facilitators of participation. The report was intended to guide the VHA in developing, making available, and evaluating regional and national adaptive sports programs for Veterans that go beyond general recommendations to participate in sports.
- What are the physical and mental wellbeing benefits veterans achieve through participating in sporting activities? A Rapid Evidence Assessment: Summary Report,, opens in a new tab Milanese, S, Crocker, M, Ransom, M, et al., for the Australian Government Department of Veterans’ Affairs, (2018). The aim of this Rapid Evidence Assessment (REA) was to examine the evidence to investigate the physical and mental wellbeing benefits veterans achieve through participating in sporting activities and whether these benefits are linked to the type of sporting activity being undertaken. Reflecting the broad definition used in this review, the sporting activity interventions featured in this review fell into six categories: structured competitive sport; supervised aerobic exercise; supervised mind body exercise; supervised combined aerobic and anaerobic exercise; unmonitored unsupervised physical activity and structured recreational physical activity.
- Based on the findings of this REA, sporting activity was overall categorised as ‘promising’ as a means to benefit veteran mental wellbeing but received a ranking of ‘unknown’ for its effect on veteran physical wellbeing.
- The evidence base of this REA is at a relatively low level, due to a reliance on cohort studies and the small number of higher level of evidence studies (2 SRs, 2 RCTs). Therefore, the findings of this REA need to be interpreted in this context and future, more rigorous studies are required to investigate the relationship between sporting activity and veteran mental and physical wellbeing.
- Based on the evidence contained in this REA, and the small number of reported adverse events, any form of sporting activity could be considered as a supplement to any veteran, mental wellbeing program.
- Mental Health Prevalence, Mental Health and Wellbeing Transition Study,, opens in a new tab Van Hooff M, Lawrence-Wood E, Hodson S, et al., Department of Defence and the Department of Veterans’ Affairs, (2018). This report investigates the prevalence of 12-month and lifetime mental disorders, trauma exposure, suicidal ideation and self-reported mental health symptoms among Transitioned ADF members. Comparisons are also made between the self-reported mental health symptoms in Transitioned ADF with 2015 Regular ADF members and where possible, with the Australian Community.
- Approximately, 84% of the Transitioned ADF were either working or engaged in some purposeful activity with 62.8% being employed. Just over 5.5% of the Transitioned ADF had retired.
- Just over one-fifth of the Transitioned ADF were estimated to have been medically discharged.
- Almost three in four Transitioned ADF members are estimated to have met criteria for a mental disorder at some stage in their lifetime that is either, prior to, during or after their military career.
- Anxiety and (46.1%) Alcohol disorders (47.5%) were the most common classes of lifetime disorder.
- One quarter of Transitioned ADF members were estimated to have met criteria for posttraumatic stress disorder (PTSD) in their lifetime (24.9%).
- Just over half of the Transitioned ADF had not experienced a mental disorder in the previous 12 months. 46.4% of Transitioned ADF members are estimated to have experienced a mental disorder in the previous 12 months.
- Anxiety disorders were the most common type of 12-month mental disorder among the Transitioned ADF with over one in three (37.0%) experiencing an anxiety disorder in the last 12 months. PTSD (17.7%), panic attacks (17.0%), agoraphobia (11.9%) and social phobia (11.0%) were the most common types of anxiety disorders in the Transitioned ADF.
- One in five (23.1%) Transitioned ADF are estimated to have experienced an affective disorder in the last 12 months. The most common affective disorder type in Transitioned ADF was depressive episodes (11.2%).
- 12.9% of the Transitioned ADF met criteria for an alcohol disorder in the last 12 months.
- Just over 20 per cent of Transitioned ADF experienced suicidal ideation, plans or attempts in the last 12 months, with 2.0% of Transitioned ADF reported having attempted suicide.
- Transitioned ADF who had been medically discharged had significantly higher rates of affective, anxiety and alcohol disorders and suicidality than those who discharged for other reasons.
- Compared to 2015 Regular ADF, nearly twice as many Transitioned ADF had high to very high psychological distress (33.1% vs 18.7%).
- Levels of psychological distress in the Transitioned ADF were significantly higher than the Australian Community, with almost three times more Transitioned ADF reporting high to very high psychological distress (33.1%) compared to the Australian Community (12.8%). Patterns of psychological distress were similar in the Australian community and the Transitioned ADF for males and females and consistent across all age bands.
- Frequency of alcohol consumption in the last 12 months was similar for the Transitioned ADF compared to the Australian Community, but results varied by age and sex. A significantly higher proportion of Transitioned ADF females reported drinking daily, weekly and monthly compared to Australian Community females.
- Physical Health Status Summary Report, Mental Health and Wellbeing Study,, opens in a new tab Kelsall, H., Sim, M., Van Hooff, M., et al., Australian Government, Department of Defence and the Department of Veterans’ Affairs, (2018). This Physical Health Status Study compared the self-reported physical health of Transitioned ADF members who had transitioned out of full-time regular service in the five years between January 2010 and December 2014 with that of Regular ADF members in 2015, using general health indicators as well as indicators relevant to several body systems. Overall, Transitioned ADF members were more likely to report poorer physical health, to have increased lifestyle risk factors, and to report poorer self-perceived health, satisfaction and quality of life than 2015 Regular ADF. Among the Transitioned ADF, poorer physical health outcomes overall were reported for DVA clients compared with those who were not DVA clients, for Ex-Serving members compared with Active Reservists or Inactive Reservists, and for those who had been medically discharged compared with those who had been discharged for other reasons.
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