Factors associated with self-reported health among New Zealand military Veterans: a cross-sectional study

Abstract

ABSTRACTObjectiveTo identify factors associated with better or poorer self-reported health status in New Zealand Military Veterans.DesignAn online cross-sectional survey.ParticipantsThe total number of eligible Veterans is unknown, but a total of 1,817 Veterans responded, including 1009 serving personnel providing a 26% response rate from that group.Study variablesHealth status was self-reported using the EQ-5D-5L, which asks about problems across five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), with five levels of severity (e.g. no, slight, moderate, severe or extreme problems). The EQ-5D-5L also contains a visual analogue scale (EQ-VAS), scaled from 0 (worst) to 100 (best) imagined health. Hypothetical relationships with better health were positive social support, sleep and psychological flexibility; with poorer health, exposure to psychological trauma, distress and hazardous drinking.ResultsThe proportion of Veterans reporting ‘any problems’ compared to ‘no problems’ with the five EQ-5D dimensions, was similar to those found in the general NZ population, although a higher proportion of Veterans reported problems with mobility, self-care, usual activities and pain/discomfort. Psychological flexibility and better sleep quality were associated with higher EQ-VAS scores; distress was associated with lower EQ-VAS scores.ConclusionIn this sample of New Zealand Veterans, psychological flexibility and good sleep are associated with better self-rated health, and distress and poor sleep with diminished health. These factors might be used as sentinel health indicators in assessing Veteran health status. As distress, psychological flexibility and sleep are closely related, cognitive behavioural therapy encompassing these domains may be useful in improving the health of New Zealand Veterans.Strengths and limitations of this studyMany studies of Veterans have focused on adverse outcomes, but we have been able to focus on a holistic measure of ‘health’.The study was sufficiently powered to detect important relationships indicating opportunities for intervention.The exact response rate is unknown, and possible bias may be a limitation.The cross-sectional design means that we cannot explore cause and effect relationships.