Health-related quality of life of Canadian forces veterans after transition to civilian life.
Thompson, Jim ; Hopman, Wilma ; Sweet, Jill 等
Military personnel transitioning from military service to civilian
life undergo a complex, multifaceted process with variable
institutional, health, psychological, work, family, and community
dimensions. (1-4) For most, transition is relatively smooth; for some,
transition is characterized by decreased wellbeing, including
compromised physical and mental health, social problems, role
disability, disadvantages in determinants of health and decreased
quality of life. (5) While there is no clear consensus on how to define
successful transition, optimum self-perceived wellbeing is an important
public policy objective. (6-8) The terms "wellbeing" and
"quality of life" are often used interchangeably, and there is
little consensus on definitions. (9)
The well-being of serving and former Canadian Forces (CF) personnel
is of interest to Veterans Affairs Canada (VAC), the Department of
National Defence (DND), the CF, and to Veterans administrations
internationally. (10-12) There are no publications quantitatively
describing the well-being of Canadian Veterans after transition to
civilian life. More is known about Veterans participating in VAC
programs, but in 2010 only 10% of the 590,000 living Veterans with
service in other than the Second World War and the Korean War were VAC
clients. (3,13)
The 2010 Survey on Transition to Civilian Life (STCL) provided an
opportunity to study health-related quality of life (HRQoL) in former CF
Regular Force personnel who released from service during 1998-2007. (5)
They enrolled during the 1960s to 2000s and had varied experience in
training (19% released as recruits or cadets), domestic disaster
response, international peacekeeping and the recent increased
operational tempo experienced by the CF since the first Persian Gulf War
in 1990-91.5 The survey was conducted before Canada's Afghanistan
combat role ceased in 2011, and at a time when CF, DND and VAC were
introducing major initiatives to improve disease prevention, health
promotion, health care, and disability management for serving and
released personnel. (14,15)
The objectives of this study were to describe the HRQoL of recently
released CF personnel (Veterans) in relation to socio-demographics,
health, disability and determinants of health, to identify possible
protective and risk factors for HRQoL, and to compare HRQoL to Canadian
normative data. This will provide evidence to support agencies assisting
CF personnel with transition to civilian life, and identify factors that
might predict Veterans' well-being and quality of life as a basis
for further studies.
METHODS
This was a descriptive analysis of data from a national
cross-sectional computer-assisted telephone interview survey and data
linkage study of former CF Regular Force personnel conducted by
Statistics Canada. (5,16) The survey sampled 4,721 of 32,015 former CF
Regular Force personnel who: released from service during January 1998
to December 2007; were not living in institutions, the northern
Territories or outside Canada owing to small numbers and difficulties
contacting Veterans in those locations; and had not re-enrolled in the
CF. The sample was derived by Statistics Canada in November 2009 using
DND's human resources database. Contact information was obtained by
Statistics Canada through linkage with the T1 Family Tax File and VAC,
DND and Public Works and Government Services Canada administrative data.
A stratified design was used to oversample VAC clients. Statistics
Canada's Policy Committee provided approval for the study.
Statistics Canada interviewers experienced with population health
surveys administered the computerized questionnaires by telephone. (17)
They asked respondents for permission to share their responses and
linked administrative data with VAC and DND, and Statistics Canada
released anonymized data based on recorded consents.
The 30-35 minute questionnaire included self-reported indicators
based on a conceptual framework considering health, disability and
determinants of health, using questions largely consistent with national
Canadian population health surveys. (16) Military characteristics, VAC
client status, sex and age were obtained by linkage to DND and VAC
administrative databases. Deployment 30 days or longer outside
Canada--including combat, peace-keeping, humanitarian aid, or
non-routine deployments to sea, but excluding training --was
self-reported owing to administrative database limitations.
HRQoL was measured using Version 1.0 of QualityMetric's SF-12
Health Survey. This instrument family has been widely used to assess
self-perceived HRQoL and relationships between HRQoL outcomes, health
and determinants of health in civilian and Veteran populations.
(12,18-26) The instrument is designed to be self-administered, but
telephone, computer-assisted and interviewer-administered methods are
also acceptable. (27) Comparisons of data collected using various
methods have demonstrated comparable results. (28-31) The differences
fall short of clinical relevance and these methods are generally
considered reasonably equivalent. (28,32)
Physical and Mental Component Summary scores (PCS, MCS) were
computed using QualityMetric's software to measure physical and
mental HRQoL. The software computes summary scores for individuals based
on normative data for the 1998 US non-institutionalized general
population. The PCS and MCS are transformed and standardized to a mean
of 50 and a standard deviation of 10, with scores above and below 50
indicating better or poorer than average HRQoL, respectively. Lower
SF-12 scores indicate lower HRQoL in a non-linear manner: 98% of the
reference population has better HRQoL than those with scores of 30 or
less, and 84% has better HRQoL than those with scores of 40 or less.
Respondent sampling weightings were incorporated in the calculation of
mean scores, population estimates and 95% confidence intervals (CI)
using Stata. Statistically significant differences in HRQoL between the
study population and Canadian norms were estimated by comparing
confidence intervals around the age- and sex-adjusted mean SF-36 scores.
Canadian norms for the SF-36 (50.5 for PCS and 51.7 for MCS) were
slightly higher than in the 1998 US general population. (25-27) Previous
work by Ware et al. demonstrated a high degree of correspondence between
scores obtained from the SF-36 and the SF-12. (27) Adjusting for age and
sex in the STCL population, the Canadian general population norm PCS was
51.9 and MCS was 52.0. CI were estimated to be 51.7-52.1 for PCS and
51.8-52.2 for MCS, using the CI distribution of the Canadian norms. (26)
RESULTS
Of the 4,721 former CF Regular Force personnel sampled, 3,355
responded (response rate 71%, 84% for VAC clients and 59% for
non-clients). Of these, 3,154 (94%) agreed to share their data with VAC
and DND. The SF-12 sample size was 3,151 owing to incomplete data for
three respondents. Mean age was 46 years (range 2067), 12% were women,
and one third were VAC clients. Compared to age- and sex-adjusted
Canadian general population norms (Table 1), they had below-average PCS
(47.3) and average MCS (52.0). Below-average PCS was more common (48.6%
of the study population) than below-average MCS (32.6%). PCS was below
Canadian norms for both men and women in the middle age groups and lower
than MCS in most age groups.
Determinants of health: Socio-demographic and military
characteristics
Compared to the study population means, PCS and/or MCS scores were
higher for youngest and oldest age groups, single/never married, the
employed and those satisfied with finances, higher education, strong
sense of community belonging, officers and privates, and release types
other than medical (possible protective factors). Mean PCS and MCS were
lower for female sex, middle age groups, relationship loss, low income,
unemployment, low social support, weak sense of community belonging and
low mastery, junior and senior non-commissioned rank, 10-19 years of
service, and administrative release for medical reasons (possible
protective factors) (Table 2). PCS was lower than average in those who
had deployed outside Canada for 30+ days and higher for those who had
not deployed, however on bivariate analysis, there were more officers
and younger individuals among the non-deployed which con tributed to the
relatively higher mean PCS of those who did not deploy.
[FIGURE 1 OMITTED]
Participation in VAC programs
Both VAC clients and non-clients had wide ranges of HRQoL (Figures
1 and 2). Compared to Canadian norms, non-clients had average PCS (52.0)
and slightly above-average MCS (53.9), whereas VAC clients had
significantly below-average PCS (38.2) and MCS (48.3). Of those with
below-average PCS, over half (57.3%) were participating in VAC programs,
as were half (50.3%) with below-normal MCS. Of those participating in
VAC programs, most (82.8%) had below-average PCS, and nearly half
(49.0%) had below-average MCS. Among those not participating in VAC
programs, nearly a third (31.3%) had below-average PCS and nearly a
quarter (24.3%) had below-average MCS.
Health and disability
PCS was generally lower than MCS for health and disability
indicators (Table 3). PCS was lowest for those with poor perceived
health and needing help with at least one task of independent daily
living. MCS was lowest for those with poor perceived mental health and
12-month suicidal ideation. Co-morbidity differed between those with
physical and mental health conditions. Few with physical health
conditions had mental health conditions (28%) while most of those with
mental health conditions had physical health conditions (95%).
DISCUSSION
This is the first examination of HRQoL for a population of Canadian
military Veterans living in the general population within 12 years of
transition to civilian life. Many former CF Regular Force personnel who
released during 1998-2007 had PCS and MCS scores above the Canadian
norm. Mean PCS was below the Canadian norm while MCS was average. Above-
and below-average PCS and low MCS were found for indicators of health,
disability and determinants of health, suggesting possible protective
and risk factors among multiple biopsychosocial dimensions.
[FIGURE 2 OMITTED]
HRQoL and socio-demographic and military characteristics
SF-12 scores have been associated with various indicators of social
determinants of health by others. (24,33-36) In this study, HRQoL was
above the population average for youngest and oldest age groups,
single/never married, the employed and those satisfied with finances,
higher education, strong sense of community belonging, officers and
privates, and types of release from service other than for medical
reasons. HRQoL was below the study population average for women, being
widowed/separated/divorced, lower income, dissatisfaction with finances,
unemployment, low social support, weak sense of community belonging, low
mastery, junior and senior non-commissioned members, and those with
10-19 years of service. A large study of SF-36 findings for female
Veterans receiving US Veterans Affairs care found that while gender had
a clinically insignificant effect on HRQoL after adjusting for
socio-demographic variables, there were socio-demographic subgroups of
women who appeared to be vulnerable to low HRQoL. (35) VAC clients more
often had low HRQoL than non-clients, which is expected given that 98%
of VAC CF clients have entitlement for disability related to physical or
mental health conditions. Similar results are reported in studies of
Veterans receiving health care at US Veterans Health Administration
facilities, where SF-36 scores: were significantly lower than those of
the general US population and lower than those of civilians and other
Veterans; were correlated with socio-demographics and morbidities; and
varied regionally and between rural and urban communities.
(14,20,33,34,36-38)
Relative impact of physical and mental health on quality of life
Physical health appeared to have a greater overall impact than
mental health on HRQoL in CF Regular Force Veterans released in
1998-2007. PCS was considerably lower than MCS, and significantly lower
than the Canadian general population norm. In the Canadian general
population, PCS assessed by interview was lower than MCS but not to the
same degree. (25,26) The tendency for MCS scores obtained by telephone
interview to be slightly lower than by other methods, possibly owing to
interviewees' reluctance to report mental health issues by
telephone, (30,31) does not explain all the mean PCS-MCS differences in
this study. In the initial report from this survey, (5) it was found
that diagnosed physical health conditions were more than twice as
prevalent as mental health conditions; almost half of Veterans had a
musculoskeletal condition; and nearly two thirds had chronic pain or
discomfort. Arthritis, back problems and participation and activity
limitation were more prevalent than in the general Canadian population
after adjusting for age and sex. In this study, PCS was lower than MCS
for those with chronic physical health conditions, and MCS was near
average for Canadians. The much higher co-morbidity of physical
conditions in those with mental health conditions than the other way
around (14) could in part explain why both PCS and MCS were low (40.1
and 41.2, respectively) in those with mental health conditions whereas
MCS was generally much higher in those with physical health conditions.
These findings are comparable with other studies. In a recent health
survey of serving CF Regular Force personnel, 57% had a diagnosed
chronic physical health condition considerably more than the number with
possible depression (7%), possible PTSD (8%) or diagnosed anxiety
disorders (4% women, <2% men).39 Physical health conditions account
for the great majority of Canadian Veteran disability pensions and
awards (3) and play a role in decreased HRQoL in elderly Canadian
Veterans with PTSD. (18) In studies of US Veterans, chronic physical
conditions were more commonly associated with lower PCS and MCS, and as
in this study the effect on PCS was greater than on MCS. (22,40)
In this study, PCS declined with age, while MCS was below average
only for age 40-49 years. Unlike for mental health conditions, the
prevalence of physical health conditions increased with age. The finding
that MCS was similar and PCS was lower than Canadian norms is consistent
with previous research which demonstrated a remarkable stability of the
MCS even in the face of advanced age and significant co-morbidity.
(25,32,41,42) This has led some researchers to suggest that there may be
a process of adaptation to physical difficulties in advanced age or
disability, leaving mental health relatively high and stable even when
physical health is poor. (41)
The survey did not assess undiagnosed physical and mental health
symptom burden, however SF-12 scores assess HRQoL affected by both
diagnosed and undiagnosed states. The tendency to not seek help for
mental health symptoms or to delay seeking help was common prior to
recent initiatives by DND/CF (12,43) and was also likely to have
occurred in these Veterans since 35% did not seek help for 12-month
suicidal ideation, (44) possibly contributing to the differential in PCS
and MCS scores seen in this study.
Strengths
Veterans and their socio-demographic and military characteristics
were objectively identified using DND administrative data. The SF12
measures self-perceived HRQoL, an important public policy objective.
(6-8,27) The Short Form Health Survey has been widely used as a measure
of self-perceived HRQoL for several decades, and there are Canadian
norms. (25) The response rate was good and the sample was representative
of CF Regular Force personnel who released during 1998-2007 and were
living in the general Canadian population. The SF-12 remains one of the
most widely used measures of HRQoL in the world today. (27) The SF-12
does not measure disorder severity and measures HRQoL subjectively, and
so is best complemented with other measures to provide a complete
picture of well-being, health and disability, as was done in this study.
The lower response rate for non-clients was due largely to lack of
contact information, but sampling weights provided by Statistics Canada
accounted for age and sex differences between responders and
non-responders. Owing to the high consent-to-share rate (94%), small
differences that might exist between those who agreed to share and those
who did not were thought to be insignificant.
Limitations
Conclusions cannot be drawn from this cross-sectional study about
causal relationships between military service or government programs and
Veteran HRQoL. Descriptive analysis cannot account for confounding. The
findings do not reflect the impact of a wide variety of new initiatives
in health promotion, health care and the management of disability that
were put in place by the CF, DND and VAC after many of the study
population had served and released. (14,15) Indicators of health and
disability and many of the indicators of determinants of health were
determined by self-report. STCL was representative of Regular Force
Veterans who released during 1997-2008, but was not necessarily
representative of all Canadian Veterans. Subjective perception of HRQoL,
well-being and the severity of physical and mental health disorders are
not always correlated and HRQoL measures do not necessarily measure
qualities of well-being not directly related to health status. (8,9) The
SF-12 captures past-month HRQoL which does not correspond to the time
frames of many indicators.
Further research
These descriptive findings inform hypotheses for further
multivariate analysis underway to better understand relationships
between HRQoL and health conditions, disability and determinants of
health in Veterans. Unlike the case with this study, a national US
general population survey found little or no difference in self-reported
HRQoL between Veterans and non-Veterans after controlling for
demographic and lifestyle factors, (23) so a measure of HRQoL should be
considered in further studies. Further surveys of Canadian Veterans
should consider stratifying for women and should consider assessing
symptom burden as well as diagnosed conditions. Longitudinal surveys are
required to understand Veterans' well-being and functioning over
the life courses of individuals.
Utility of the findings in assisting veterans with transition to
civilian life
This study suggests that a wide variety of biopsychosocial factors
impact HRQoL and therefore well-being in Veterans, implying need for
collaboration and coordination among public and private sector agencies
that specialize in various determinants of health when Veterans require
assistance. The findings will be of interest to agencies that assist
transitioning CF personnel by suggesting both protective factors and
vulnerable subgroups of Veterans who may benefit from targeted
interventions. These findings have provided useful information to
support considerable ongoing investments by DND and CF over the past two
decades to significantly enhance health care, prevention and promotion
for serving personnel, (15) by VAC in developing new programs to assist
Veterans with service-related health conditions and disability over the
same period, (14) and efforts to coordinate services. The finding that
some Veterans who were not VAC clients had low HRQoL supports efforts to
ensure that programs reach eligible Veterans.
Received: May 26, 2012 Accepted: November 22, 2012
Funding: Government of Canada.
Conflict of Interest: None to declare.
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Jim Thompson, MD, CCFP(EM), fcfp, [1] Wilma Hopman, MA, [2,3] Jill
Sweet, MSc, [4] Linda VanTil, dvm, MSc, [5] Mary Beth MacLean, MA, [6]
Elizabeth VanDenKerkhof, DrPH, [3] Kerry Sudom, PhD, [7] Alain Poirier,
[8] David Pedlar, PhD [9]
Author Affiliations
[1.] Medical Advisor, Research Directorate, Veterans Affairs
Canada, Charlottetown, PE; Adjunct Associate Professor, Department of
Community Health and Epidemiology, Queen's University, Kingston, ON
[2.] Clinical Research Centre, Kingston General Hospital, Kingston,
ON
[3.] Department of Anesthesiology and Perioperative Medicine and
the School of Nursing, Queen's University, Kingston, ON
[4.] Statistician, Research Directorate, Veterans Affairs Canada,
Charlottetown, PE
[5.] Epidemiologist, Research Directorate, Veterans Affairs Canada,
Charlottetown, PE
[6.] Health Economist, Research Directorate, Veterans Affairs
Canada, Charlottetown, PE
[7.] Department of National Defence, Ottawa, ON
[8.] Statistics Officer, Research Directorate, Veterans Affairs
Canada, Charlottetown, PE
[9.] Director, Research Directorate, Veterans Affairs Canada,
Charlottetown, PE
Correspondence: Dr. Jim Thompson, Research Directorate, Veterans
Affairs Canada, P.O. Box 7700 DJM 406G, 161 Grafton Street,
Charlottetown, PE C1A 8M9, E-mail: research-recherche@vac-acc.gc.ca
Table 1. STCL SF-12 Scores and 95% Confidence Intervals
Compared to Canadian SF-36 Norms by Age and Sex
PCS
Sex and Age STCL SF-12 Canadian SF-36
Group (years)
Mean CI Mean CI
Men 20-29 54.3 (53.5-55.0) 53.7 (53.4-54.9)
30-39 50.3 * (49.4-51.1) 52.8 (51.8-53.7)
40-49 44.7 * (44.0-45.4) 53.4 (52.7-54.1)
50-59 44.9 * (44.1-45.7) 50.1 (49.3-50.8)
60-69 48.2 (47.0-49.3) 49.6 (48.5-49.7)
Women 20-29 51.8 (49.4-54.2) 53.0 (52.3-53.6)
30-39 49.5 (47.1-52.0) 52.3 (51.3-53.2)
40-49 42.4 * (40.2-44.5) 50.7 (50.0-51.4)
50-59 42.4 * (39.8-45.1) 49.3 (48.8-49.8)
60-69 48.9 (43.6-54.3) 47.6 (47.2-48.1)
MCS
Sex and Age STCL SF-12 Canadian SF-36
Group (years)
Mean CI Mean CI
Men 20-29 53.5 * (52.5-54.6) 49.3 (48.2-50.3)
30-39 51.3 (50.2-52.7) 52.8 (51.9-53.8)
40-49 50.3 (49.6-51.0) 51.4 (50.4-52.3)
50-59 53.0 (52.4-53.7) 53.3 (52.7-54.0)
60-69 56.5 * (55.7-57.3) 55.0 (54.5-55.5)
Women 20-29 52.2 * (49.1-55.3) 47.6 (46.5-48.7)
30-39 52.7 (50.5-54.8) 49.6 (48.5-50.7)
40-49 46.9 * (44.9-49.0) 50.4 (49.7-51.2)
50-59 52.4 (50.3-54.6) 52.1 (52.6-52.6)
60-69 54.0 (50.8-57.2) 52.9 (52.5-53.3)
* Significant difference between the study population and
Canadian means comparing 95% confidence intervals.
STCL=Survey on Transition to Civilian Life.
Table 2. Mean SF-12 Scores for Socio-demographic and Military
Characteristics and Determinants of Health
Characteristic Weighted Population Estimate
Overall 100%
Client status
VAC clients 33.6%
Non-clients 66.4%
Sex
Men 88.2%
Women 11.8%
Age group in years
20-29 15.8%
30-39 18.4%
40-49 33.8%
50-59 24.1%
60-69 7.9%
Marital status
Married/common-law 75.5%
Widowed/divorced/separated 9.2%
Single/never married 15.3%
Education
Less than high school 6.8%
High school 40.6%
Post-secondary 52.6%
Household income below LIMX 5.4%
Satisfaction with finances
Satisfied/very satisfied 73.1%
with finances
Dissatisfied/very dissatisfied 15.2%
with finances
Main activity in the 12 months
before the survey
Working 75.4%
Attending school 3.7%
Seeking work/not working 19.4%
([section])
Adjustment to civilian life
Very/moderately easy 61.7%
Very/moderately difficult 25.3%
Low social support ([parallel]) 31.8%
Sense of community belonging
Very/somewhat strong 58.9%
Very/somewhat weak 40.6%
Mastery
High ([parallel]) 30.4%
Low ** 2.1%
Environment (Service Branch)
Air Force 48.8%
Army 31.0%
Navy 15.7%
Military rank
Senior Officer 8.0%
Junior Officer/Cadet 12.4%
Senior NCM ([dagger][dagger]) 28.2%
Junior NCM 30.1%
Private/Recruit 21.2%
Years of service
<10 34.1%
10-19 13.2%
[greater than or equal to]20 52.8%
30+ day deployments outside Canada
Yes 59.8%
No 40.2%
Release type
Involuntary 4.6%
Medical 24.4%
Voluntary 56.9%
Service complete/retirement 14.0%
Mean PCS
Characteristic (95% CI)
Overall 47.3 (47.0-47.6)
Client status
VAC clients 38.2 (37.6-38.8) *
Non-clients 52.0 (51.6-52.4) ([dagger])
Sex
Men 47.6 (47.2-47.9)
Women 45.3 (44.0-46.5) *
Age group in years
20-29 54.0 (53.3-54.7) ([dagger])
30-39 50.2 (49.4-51.0) ([dagger])
40-49 44.4 (43.7-45.0) *
50-59 44.7 (43.8-45.3) *
60-69 48.3 (47.1-49.3)
Marital status
Married/common-law 46.9 (46.5-47.3)
Widowed/divorced/separated 44.5 (43.1-45.8) *
Single/never married 51.1 (50.1-52.0) ([dagger])
Education
Less than high school 44.9 (43.4-46.4) *
High school 46.4 (45.8-47.0)
Post-secondary 48.3 (47.9-48.8) ([dagger])
Household income below LIMX 46.6 (44.7-48.5)
Satisfaction with finances
Satisfied/very satisfied 48.5 (48.1-48.9) ([dagger])
with finances
Dissatisfied/very dissatisfied 42.9 (41.7-44.1) *
with finances
Main activity in the 12 months
before the survey
Working 49.0 (48.6-49.3) ([dagger])
Attending school 50.6 (48.7-52.6) ([dagger])
Seeking work/not working 40.4 (39.4-41.5) *
([section])
Adjustment to civilian life
Very/moderately easy 50.0 (49.7-50.4) ([dagger])
Very/moderately difficult 41.4 (40.5-42.3) *
Low social support ([parallel]) 44.0 (43.2-44.7) *
Sense of community belonging
Very/somewhat strong 48.6 (48.2-49.1) ([dagger])
Very/somewhat weak 45.5 (44.8-46.1) *
Mastery
High ([parallel]) 50.6 (50.1-51.2) ([dagger])
Low ** 31.8 (29.3-34.3) *
Environment (Service Branch)
Air Force 47.2 (46.5-47.8)
Army 47.0 (46.5-47.6)
Navy 47.5 (46.5-48.4)
Military rank
Senior Officer 50.6 (49.6-51.6) ([dagger])
Junior Officer/Cadet 51.8 (50.9-52.8) ([dagger])
Senior NCM ([dagger][dagger]) 44.7 (44.0-45.4) *
Junior NCM 43.7 (42.9-44.4) *
Private/Recruit 52.2 (51.4-52.9) ([dagger])
Years of service
<10 52.0 (51.5-52.5) ([dagger])
10-19 42.6 (41.4-43.8) *
[greater than or equal to]20 45.5 (45.0-46.0) *
30+ day deployments outside Canada
Yes 45.3 (44.8-45.7) *
No 50.5 (49.9-51.0) ([dagger])
Release type
Involuntary 51.4 (49.9-53.0) ([dagger])
Medical 37.1 (36.3-37.9) *
Voluntary 51.1 (50.7-51.5) ([dagger])
Service complete/retirement 48.5 (47.6-49.3)
Mean MCS
Characteristic (95% CI)
Overall 52.0 (51.6-52.3)
Client status
VAC clients 48.3 (47.7-48.9) *
Non-clients 53.9 (53.4-54.3) ([dagger])
Sex
Men 52.2 (51.8-52.6)
Women 50.4 (49.2-51.5) *
Age group in years
20-29 53.4 (52.4-54.4) ([dagger])
30-39 51.4 (50.4-52.4)
40-49 49.8 (49.2-50.5) *
50-59 52.9 (52.3-53.6)
60-69 56.3 (55.6-57.1) ([dagger])
Marital status
Married/common-law 52.6 (52.2-53.0)
Widowed/divorced/separated 46.5 (44.8-48.2) *
Single/never married 52.1 (51.1-53.1)
Education
Less than high school 50.9 (49.4-52.3)
High school 52.1 (51.5-52.7)
Post-secondary 52.0 (51.5-52.5)
Household income below LIMX 48.7 (46.8-50.7) *
Satisfaction with finances
Satisfied/very satisfied 54.2 (53.9-54.6) ([dagger])
with finances
Dissatisfied/very dissatisfied 43.2 (41.9-44.4) *
with finances
Main activity in the 12 months
before the survey
Working 53.0 (52.6-53.4) ([dagger])
Attending school 51.7 (49.3-54.1)
Seeking work/not working 48.0 (47.1-49.0) *
([section])
Adjustment to civilian life
Very/moderately easy 55.4 (55.1-55.8) ([dagger])
Very/moderately difficult 43.7 (42.8-44.6) *
Low social support ([parallel]) 46.1 (45.3-46.9) *
Sense of community belonging
Very/somewhat strong 54.3 (53.9-54.7) ([dagger])
Very/somewhat weak 48.5 (47.9-49.2) *
Mastery
High ([parallel]) 56.5 (56.1-56.9) ([dagger])
Low ** 30.7 (28.6-32.7) *
Environment (Service Branch)
Air Force 52.4 (51.8-53.1)
Army 51.3 (50.7-51.8)
Navy 52.7 (51.8-53.6)
Military rank
Senior Officer 55.4 (54.6-56.2) ([dagger])
Junior Officer/Cadet 53.0 (52.0-54.1)
Senior NCM ([dagger][dagger]) 52.7 (52.1-53.3)
Junior NCM 49.1 (48.3-49.8) *
Private/Recruit 53.1 (52.3-53.9)
Years of service
<10 52.5 (51.8-53.2)
10-19 47.4 (46.2-48.6) *
[greater than or equal to]20 52.8 (52.3-53.2)
30+ day deployments outside Canada
Yes 51.2 (50.7-51.6)
No 53.2 (51.6-53.8)
Release type
Involuntary 50.9 (48.8-53.1)
Medical 45.9 (45.1-46.8) *
Voluntary 53.9 (53.5-54.4) ([dagger])
Service complete/retirement 54.8 (54.0-55.5) ([dagger])
* Possible risk factor: less than overall STCL mean and 95%
confidence intervals do not overlap.
([dagger]) Possible protective factor: greater than overall STCL
mean and 95% confidence intervals do not overlap.
([double dagger]) LIM=Low Income Measure, used by Statistics Canada
to describe low household income.
([section]) Not working included: retired and not looking for work,
looked for work, cared or nurtured a family member, or was disabled
or on disability.
([parallel]) Sum of 19 five-point social support variables [less
than or equal to] 74.
([paragraph]) Sum of 7 five-point mastery indicators [greater than
or equal to] 23.
** Sum of 7 five-point mastery indicators [less than or equal to]
7.
([dagger][dagger]) NCM=Non-commissioned member.
Table 3. Mean SF-12 Scores for Indicators of Health and Disability
Indicator Percent of Mean PCS
Population (95% CI)
Overall 100% 47.3 (47.0-47.6)
Health, General
Perceived health
Very good/excellent 55.8% 53.2 (52.9-53.5)
([dagger])
Fair/poor 17.5% 32.9 (32.0-33.8) *
Perceived mental health
Very good/excellent 66.5% 50.2 (49.8-50.6)
([dagger])
Fair/poor 14.2% 37.9 (36.7-39.0) *
Life stress most days
Not at all/very much 36.8% 49.9 (49.4-50.4)
([dagger])
Extreme/quite a bit 21.2% 43.3 (42.4-44.3) *
Satisfaction with life
in general
Satisfied/very satisfied 84.9% 48.9 (48.6-49.2)
([dagger])
Dissatisfied/very 7.0% 36.0 (34.0-37.9) *
dissatisfied
Health, Chronic Conditions
Hearing problem 27.8% 42.1 (41.4-40.9) *
Musculoskeletal condition 48.7% 41.4 (40.9-42.0) *
([double dagger])
Obesity 28.3% 44.6 (43.8-45.3) *
Other chronic physical health 31.0% 41.1 (40.3-42.0) *
condition ([section])
Chronic pain/discomfort 64.3% 42.9 (42.4-43.4) *
([parallel])
Mental health conditional 23.6% 40.1 (39.9-41.0) *
12-month suicidal ideation 5.8% 40.2 (38.1-42.2) *
Co-morbid PHC and MHC ** 19.8% 38.0 (37.2-38.8) *
Co-morbid MSCtt, pain/ 15.8% 35.8 (35.0-36.7) *
discomfort ,and MHC
Disability
Participation and activity 56.1% 41.1 (40.6-41.6) *
limitation ([double dagger]
[double dagger])
Needs help with at least 1 17.1% 32.2 (31.4-33.1) *
task ([section][section])
Indicator Mean MCS
(95% CI)
Overall 52.0 (51.6-52.3)
Health, General
Perceived health
Very good/excellent 55.1 (54.8-55.5) ([dagger])
Fair/poor 42.1 (41.1-43.1) *
Perceived mental health
Very good/excellent 56.1 (55.8-56.4) ([dagger])
Fair/poor 35.5 (34.4,36.5) *
Life stress most days
Not at all/very much 56.6 (56.2-56.9) ([dagger])
Extreme/quite a bit 42.9 (41.9-43.9) *
Satisfaction with life
in general
Satisfied/very satisfied 54.2 (53.9-54.5) ([dagger])
Dissatisfied/very 34.6 (33.0-36.2 *
dissatisfied
Health, Chronic Conditions
Hearing problem 49.6 (48.9-50.3) *
Musculoskeletal condition 50.1 (49.6-50.7) *
([double dagger])
Obesity 50.6 (49.9-51.4) *
Other chronic physical health 49.0 (48.2-49.8) *
condition ([section])
Chronic pain/discomfort 50.4 (49.9-50.9) *
([parallel])
Mental health conditional 41.2 (40.3-42.1) *
12-month suicidal ideation 33.5 (31.9-35.2) *
Co-morbid PHC and MHC ** 40.7 (39.8-41.6) *
Co-morbid MSCtt, pain/ 40.2 (39.2-41.3) *
discomfort ,and MHC
Disability
Participation and activity 49.6 (49.0-50.1) *
limitation ([double dagger]
[double dagger])
Needs help with at least 1 42.6 (41.6-43.7) *
task ([section][section])
* Possible risk factor: less than overall STCL mean and 95%
confidence intervals do not overlap.
([dagger]) Possible protective factor: greater than overall STCL
mean and 95% confidence intervals do not overlap.
([double dagger]) Arthritis or back problems excluding
fibromyalgia.
([section]) Asthma, chronic obstructive pulmonary disease,
diabetes, heart disease, stroke effects, bowel disorder, intestinal
or stomach ulcers, cancer.
([parallel]) Always and recurrent.
([paragraph]) Anxiety disorders, mood disorders, anxiety or
depression, post-traumatic stress disorder.
** PHC = physical health condition (hearing problem, arthritis,
back problem, diabetes, cancer, bowel disorder, asthma, COPD,
intestinal or stomach ulcers, obesity, heart disease, effects of
stroke; MHC = mental health condition (anxiety disorders, mood
disorders, anxiety or depression, post-traumatic stress disorder).
([dagger][dagger]) MSC = musculoskeletal condition (back problem or
arthritis).
([double dagger][double dagger]) Sometimes/often has difficulty
hearing, seeing, communicating, walking, climbing stairs, bending,
learning or doing similar activities; or felt that a long-term (>6
months) physical or mental condition reduced their activities at
home, school, work, transportation or leisure.
([section][section]) Because of any physical condition or mental
condition or health problem, needs the help of another person with
preparing meals, getting to appointments and running errands,
everyday housework, personal care, mobility inside the house, or
looking after personal finances.
