Health status

Data considerations

Data from the 2017–18 NHS presented in this chapter have been tested for significance at the 5% level using confidence intervals, and comprehensive tables are available in Health of veterans: supplementary data tables – Table S2 and S3. For more information on the methodology used, see Technical notes.

While comparisons can be inferred from the information provided here from the 2017–18 NHS, some differences between the populations are likely to be confounded by the older age structure of the population who have ever served in the ADF,  and comparisons should be used as a guide only. The results presented below have not been adjusted for age as the data could not meet requirements to do so, and readers should take this into consideration when interpreting the results presented.

Currently, women comprise around 14% of the population who have ever served in the ADF (based on self-reported data from the 2017–18 NHS). These relatively low numbers constrain reporting on the health of women who have served, therefore this section of the report presents data for men only.

Self-assessed health status

Self-assessed health status is a commonly used measure of overall health which reflects a person’s perception of his or her own health at a given time (ABS 2018). As a self-reported measure, it captures the combined effects of physical, social, emotional, and mental health and wellbeing.

Based on self-reported data from the 2017–18 NHS among males aged 18 years and over:

  • The majority of people who had served in the ADF rated their health as good or better (Figure 3). Over three quarters (78%) of people who had ever served in the ADF considered themselves to be in excellent, very good or good health, while 22% of people who ever served considered their health to be fair or poor.
  • However, the proportion of people who rated their health as excellent/very good was lower for those who had served in the ADF compared with those who had never served – 48% compared with 56%. 

Figure 3: Self-assessed health status by ADF service status, males aged 18 years and over, 2017–18

The bar chart shows that males who had served in the ADF were less likely to rate their health as excellent or very good than males who had never served

* A statistically significant difference between men who have served in the ADF and men who have not served in the ADF, calculated using the confidence interval of the difference between the two proportions.

Notes

1. Results have been randomly adjusted to avoid the release of confidential data.

2. Proportions have been calculated using weighted estimates.

3. The thin vertical lines superimposed over the top end of each bar are 95% confidence intervals.

Chart: AIHW.

Source: ABS (2018) Microdata: National Health Survey, 2017–18, ABS cat no. 4324.0.55. 001, findings based on TableBuilder analysis. Canberra: ABS. See Health of veterans: supplementary data tables – Table S2.

Of males aged 18 years and over who self-reported being a DVA client in the 2017–18 NHS:

  • #37%3 of males who had ever served in the ADF and were DVA clients considered their health as being excellent/very good, which is less than those who had ever served and were non-DVA clients (50%) (Figure 4).
  • Those who had ever served in the ADF and were DVA clients were more likely to consider their health as fair or poor than those who ever served and were non-DVA clients – 34% compared with 20%.

3 Proportions marked with a hash (#) have a high MoE and should be interpreted with caution. A high MoE is considered as greater than 10%.

Figure 4: Self-assessed health status by DVA client status, males aged 18 years and over, 2017–18

The bar chart shows that DVA clients were less likely to rate their health as excellent or very good than non-DVA clients.

* A statistically significant difference between men who have served in the ADF and were DVA clients, and men who have ever served in the ADF and were not DVA clients, calculated using the confidence interval of the difference between the two proportions.

# Proportion has a high margin of error and should be used with caution.

Notes

1. Results have been randomly adjusted to avoid the release of confidential data.

2. Proportions have been calculated using weighted estimates.

3. The thin vertical lines superimposed over the top end of each bar are 95% confidence intervals.

Chart: AIHW.

Source: ABS (2018) Microdata: National Health Survey, 2017–18, ABS cat no. 4324.0.55. 001, findings based on TableBuilder analysis. Canberra: ABS. See Health of veterans: supplementary data tables – Table S2.

Health conditions

Long-term health conditions, both physical and mental, have a significant impact on health. In particular, mental health conditions, including depression, post-traumatic stress disorder (PTSD) and alcohol dependence disorder, have been identified as an issue of concern for Australia’s veterans (DVA 2015). Those who have served in the ADF also experience these and other conditions to varying degrees.

Based on self-reported data from the 2017–18 NHS of males aged 18 years and over:

  • Males who had ever served in the ADF had higher prevalence of long-term health conditions (such as arthritis, back problems and diabetes), to males who had never served.
  • Males who had ever served in the ADF were twice as likely to have diseases of the circulatory system (41%) than those who had never served (19%).

Of males aged 18 years and over who self-reported being a DVA client in the 2017–18 NHS:

  • 35% had arthritis, compared with 25% of non-DVA clients
  • 16% had diabetes, compared with 8.3% of non-DVA clients

Results for health conditions have been tested for statistical significance (see Technical notes). Detailed results for all self-reported long-term conditions by ADF service status and DVA client status can be found in Health of veterans: supplementary data tables – Table S3.

Mental and behavioural conditions

Addressing the development and management of mental disorders such as depression, PTSD, other anxiety disorders and alcohol dependence for the veteran community has been identified as a priority for the Australian Government (DVA 2015). International studies suggest an increased prevalence of dementia among veterans compared with the general population; veterans have an increased prevalence of risk factors for dementia: including traumatic brain injury sustained through active duty, PTSD, and major depressive disorder (Rafferty 2018; Singer 2015).

The disclosure of mental health conditions during service is often associated with stigma and fear of repercussions on career. Mental health stigma is also associated with barriers to seeking help following transition to civilian life. It may be the case that non-DVA clients (or veterans who chose not to engage with DVA) are more reluctant or less likely to disclose poor mental health rather than those who are DVA clients or who have sought support from DVA. This limitation may apply to the data presented in this report.

There are limited data available about the current prevalence of mental disorders among veterans and the Australian population more broadly. However, further information will be available from the first wave of the National Study of Mental Health and Wellbeing, with detailed information from this Study expected to be available in mid-2022.

Based on self-reported data from the 2017–18 NHS of males aged 18 years and over:

  • Similar proportions of males who had or had not served in the ADF had a mental or behavioural condition (22% compared with 18%).
  • 14% of males who ever served in the ADF and 11% who never served reported having had depression or feeling depressed (Figure 5).
  • 15% of males who had ever served in the ADF reported having anxiety related disorders, which is higher than those who had never served (11%).

Figure 5: Depression and anxiety-related conditions by ADF service status, males aged 18 years and over, 2017–18

The bar chart shows that males who had served in the ADF were more likely to have anxiety related disorders than males who had never served.

* A statistically significant difference between men who have served in the ADF and men who have not served in the ADF, calculated using the confidence interval of the difference between the two proportions.

Notes

1. Results have been randomly adjusted to avoid the release of confidential data.

2. Proportions have been calculated using weighted estimates.

3. The thin vertical lines superimposed over the top end of each bar are 95% confidence intervals.

Chart: AIHW.

Source: ABS (2018) Microdata: National Health Survey, 2017–18, ABS cat no. 4324.0.55. 001, findings based on TableBuilder analysis. Canberra: ABS. See Health of veterans: supplementary data tables – Table S3.

Of males aged 18 years and over who self-reported being a DVA client in the 2017–18 NHS:

  • 44% of DVA clients reported having mental and behavioural conditions, which is higher than those who had ever served but were non-DVA clients (17%).
  • More than one-quarter (26%) of DVA clients reported having had depression or feeling depressed, which is higher than the 11% of non-DVA clients who also reported having had depression or feelings depressed (Figure 6).
  • 37% of DVA clients reported having anxiety related disorders, which is higher than non-DVA clients (8.4%).

Figure 6: Depression and anxiety-related conditions by DVA client status, males aged 18 years and over, 2017–18

The bar chart shows that DVA clients were more likely to have depression/feel depressed, and have anxiety related disorders, than non-DVA clients.

* A statistically significant difference between men who have served in the ADF and were DVA clients, and men who have ever served in the ADF and were not DVA clients, calculated using the confidence interval of the difference between the two proportions.

Notes

1. Results have been randomly adjusted to avoid the release of confidential data.

2. Proportions have been calculated using weighted estimates.

3. The thin vertical lines superimposed over the top end of each bar are 95% confidence intervals.

Chart: AIHW.

Source: ABS (2018) Microdata: National Health Survey, 2017–18, ABS cat no. 4324.0.55. 001, findings based on TableBuilder analysis. Canberra: ABS. See Health of veterans: supplementary data tables – Table S3.

Deaths

In 2021, a study population of members who served in the ADF between 1985 and 2019 was created by using administration data from historical and current ADF personnel systems. Previous analysis on ADF members were restricted to members who served in the ADF from 2001 and were based on the current ADF personnel system.

The expansion of the ex-serving population has more than doubled from previous analysis. The larger study population enables more detailed analysis, providing greater insight into the risk and protective factors within the permanent, reserve, and ex-serving populations. A limitation is the study population does not include members who separated prior to 1 January 1985. For more information, see Serving and ex-serving Australian Defence Force members who have served since 1985: population characteristics 2019 and Serving and ex-serving Australian Defence Force members who have served since 1985: suicide monitoring 2001 to 2019.

Between 2001 and 2019, there were 12,060 registered deaths among members with ADF service since 1 January 1985. Of these, around 10,800 (89%) occurred among ex-serving ADF members, almost 600 (5.0%) among permanent ADF members and 680 (5.6%) among reserve ADF members (Table 3).

Table 3: Number of deaths by all causes, ADF members with at least 1 day of service since 1 January 1985 and Australian population, 2001–2019
  Males Females Persons
Permanent 550 47 597
Reserve 628 52 680
Ex-serving 10,017 766 10,783
Total in all ADF service groups(a) 11,195 865 12,060
Total deaths in Australian population(b) 1,419,131 1,339,953 2,759,084

(a) Consists of deaths by all causes for males and females aged 16 years and over for permanent, reserve, and ex-serving ADF members.

(b) Number of deaths by all causes for all ADF members are included in the Australian population deaths by all causes count.

Source: AIHW analysis of linked Defence Historical Personnel data–PMKeyS–NDI data 1985–2019, AIHW NMD 2002–2019.

The number of deaths by permanent, reserve, and ex-serving members with at least 1 day of service since 1 January 1985 by year is presented in Table 4. When interpreting Table 4, it is important to remember that the ex-serving population increases each year.

Table 4: Number of deaths by all causes, ADF members with at least 1 day of service since 1 January 1985, 2001–2019
Year Permanent Reserve Ex-serving Total in all ADF service groups(a)
2001 41 35 250 326
2002 42 40 252 334
2003 30 28 320 378
2004 24 33 336 393
2005 34 36 339 409
2006 29 35 369 433
2007 32 42 415 489
2008 29 30 424 483
2009 33 49 489 571
2010 42 37 502 581
2011 43 37 559 639
2012 29 38 610 677
2013 24 47 637 708
2014 26 44 723 793
2015 28 25 774 827
2016 27 37 823 887
2017 38 24 947 1,009
2018 23 32 975 1,030
2019 23 31 1,039 1,093
Total 597 680 10,783 12,060

(a) Consists of deaths by all causes for males and females aged 16 years and over for permanent, reserve, and ex-serving ADF members.

Source: AIHW analysis of linked Defence historical personnel data–PMKeyS–NDI data 1985–2019.

Figures 7 and 8 show age-specific all-cause mortality rates of males and females who served in the ADF since 1985 for the period 2002–2019. Data for 2001 are not included in the calculation of these rates, as data for the permanent and reserve populations were not available before 2002 due to a change in Defence personnel management systems at that time. Analysis of ex-serving personnel was restricted to data from 2002 onwards, in line with reporting for permanent and reserve ADF population groups.

Age-specific all-cause mortality rates for permanent, reserve, or ex-serving ADF males were lower than rates for Australian males, except for ex-serving ADF males aged 16–29 where the rate was higher than Australian males (Figure 7).

Figure 7: Age-specific rates of all-cause mortality (per 100,000 population per year), males in ADF service status group with at least 1 day of service since 1 January 1985 and Australian males, 2002–2019 

The bar chart shows that across all ages, male ex-serving ADF members had higher rates of all-cause mortality than permanent and reserve members.

Notes

1. The thin vertical lines superimposed over the top end of each bar are 95% confidence intervals.

2. Rate of all-cause mortality in the Australian population matched by sex and within the same age range.

Chart: AIHW.

Source: AIHW analysis of linked Defence historical personnel data–PMKeyS–NDI data 1985–2019; AIHW NMD 2002–2019. See Health of veterans: supplementary data tables – Table S4.

Due to the small number of deaths among females in permanent and reserve service, these service status groups have been aggregated.

Age-specific all-cause mortality rates for permanent and reserve ADF females were lower than rates for Australian females. For ex-serving ADF females compared with Australian females (Figure 8):

  • Ex-serving ADF females aged 16–29 had a higher rate
  • Ex-serving ADF females aged 30–49 had a similar rate
  • Ex-serving ADF females aged 50–70 had a lower rate.

Figure 8: Age-specific rates of all-cause mortality (per 100,000 population per year), ex-serving ADF females with at least 1 day of service since 1 January 1985 and Australian females, 2002–2019 

The bar chart shows that across all ages, female ex-serving ADF members had higher rates of all-cause mortality than permanent and reserve members.

Notes

1. The thin vertical lines superimposed over the top end of each bar are 95% confidence intervals.

2. Rate of all-cause mortality in the Australian population matched by sex and within the same age range.

Chart: AIHW.

Source: AIHW analysis of linked Defence historical personnel data–PMKeyS–NDI data 1985–2019; AIHW NMD 2002–2019. See Health of veterans: supplementary data tables – Table S5.

Leading causes of death

Tables 5 and 6 provide the top leading cause of death in permanent, reserve, and ex-serving ADF males and ex-serving females for 2002–2019 for age groups, with the Australian comparison.

For permanent, reserve, and ex-serving ADF males, and males in the Australian population aged 16–49, the leading cause of death was suicide, except for permanent males aged 16–29 where the leading cause was land transport accidents (Table 5). For those aged 50 years and over, the leading cause of death for all groups was Coronary Heart Disease.

Additional information on leading causes of death is available in Health of veterans: supplementary data tables – Tables S9 and S10.

Table 5: Leading cause of death among males(a) in ADF service status group and Australian males, by age, 2002–2019(b)
Age group (years) Permanent males Reserve males Ex-serving males Australian males
16–29 Land transport accidents (38.6%) Suicide (29.2%) Suicide (42.2%) Suicide (29.1%)
30-49 Suicide (20.8%) Suicide (22.4%) Suicide (25.3%) Suicide (17.4%)
50 years and over Coronary heart disease (12.3%) Coronary heart disease (11.6%) Coronary heart disease (14.1%) Coronary heart disease (16.5%)

(a) Excludes 174 male deaths that have no underlying cause recorded.

(b) Proportions are of all deaths with a recorded underlying cause of death within each age group.

Source: AIHW analysis of linked Defence historical personnel data–PMKeyS–NDI data 1985–2019, AIHW NMD 2002–2019.

The leading cause of death for ex-serving ADF females, and females in the Australian population was death by suicide for those aged 16–29 (Table 6). Whereas for those aged 30–49 and 50 years and over, the leading cause of death was different for ex-serving ADF females, and females in the Australian population.

Figures were too small to present leading causes of death by age group for permanent and reserve ADF females separately.

Table 6: Leading cause of death among ex-serving females(a) and Australian females, by age, 2002–2019
Age group (years) Ex-serving females Australian females
16–29 Death by suicide (41.4%) Death by suicide (22.0%)
30-49 Death by suicide (18.0%) Breast cancer (12.6%)
50 years and over Breast cancer (14.6%) Coronary heart disease (14.3%)

(a) Excludes one female death that has no underlying cause recorded.

(b) Proportions are of all deaths with a recorded underlying cause of death within each age group.

Source: AIHW analysis of linked Defence historical personnel data–PMKeyS–NDI data 1985–2019, AIHW NMD 2002–2019.

Death by suicide among ADF members

There is continuing concern within the ADF and the wider Australian community about deaths by suicide in permanent, reserve, and ex-serving ADF members. In particular, the ex-serving members may face increased risk of death by suicide (AIHW 2021). See Serving and ex-serving Australian Defence Force members who have served since 1985: suicide monitoring 2001 to 2019 for more information.

Death by suicides by age and service status group

Between 2001 and 2019 there were 1,273 certified deaths by suicide among members with ADF service since 1 January 1985 (AIHW 2021).

For those with service since 1985, the rate of death by suicide was highest for ex-serving males. Rates of death by suicide between 2002 and 2019 by service status and sex were as follows:

  • 11.3 per 100,000 population per year for permanent males
  • 12.5 per 100,000 population per year for reserve males
  • 29.8 per 100,000 population per year for ex-serving males
  • 14.9 per 100,000 population per year for ex-serving females.

Due to the small number of deaths by suicide among females in permanent and reserve service, rates of deaths by suicide are not reported for these subgroups.

Compared with the Australian population and after adjusting for age, rates of deaths by suicide between 2002 and 2019 were:

  • 51% lower for permanent males
  • 48% lower for reserve males
  • 24% higher for ex-serving males
  • 102% (or 2.02 times) higher for ex-serving females (AIHW 2021).

Younger age groups are at greater risk of suicide

The rates of death by suicide for both ex-serving males and females between 2002 and 2019 varied by age at time of death by suicide. Between 2002 and 2019, the rate of death by suicide for ex-serving males aged 50 years and over was lower than ex-serving males under 50 years of age (18.9 and 35.2 per 100,000 population per year). However, ex-serving females’ rates of death by suicide were similar regardless of age at death by suicide (AIHW 2021).

Those with a longer length of service have lower rates of death by suicide

Rates of death by suicide between 2002 and 2019 for ex-serving males decreased as length of service increased. The rate of death by suicide was lowest for ex-serving males who served more than 20 years (15.4 per 100,000 population per year) and highest for those who had served less than one year (46.4 per 100,000 population per year) (AIHW 2021).

Those who separate as commissioned officers have lower rates of death by suicide

Between 2002 and 2019, the rates of death by suicide for ex-serving males who were commissioned officers at the time of separation was half that of those who were all other ranks (15.1 compared with 31.8 per 100,000 population per year). For ex-serving females, rates of death by suicide were similar for both commissioned officers and all other ranks (AIHW 2021).

Members who separate voluntarily have lower rates of death by suicide

Due to a change in the way the reason for separating from the ADF was recorded in 2002, analysis is presently only reported for ADF members who separated from 1 January 2003 onwards. Between 2003 and 2019, the rate of death by suicide for ex-serving males by reason for separation was lowest for those who separated voluntarily (22.2 per 100,000 population per year) and highest for those whose reason for separation was involuntary medical (73.1 per 100,000 population per year). In addition, ex-serving males who separated voluntarily from the ADF have a similar rate of death by suicide as the Australian males (22.4 compared with 22.2 per 100,000 population per year) (AIHW 2021).

Disability

A disability or restrictive long-term health condition exists if a limitation, restriction, impairment, disease, or disorder has lasted, or is expected to last, for 6 months or more, and restricts everyday activities (ABS 2019a).

According to the 2017–18 NHS, a disability or restrictive long-term condition is classified by whether or not a person has a specific limitation or restriction. There are 5 levels of activity limitation in the 2017–18 NHS: profound, severe, moderate, mild, school/employment restriction. These are based on whether a person needs help, has difficulty, or uses aids or equipment with any core activities (mobility, self-care, and communication).

According to self-reported estimates from the 2017–18 NHS, almost 2 in 5 (37%) males who had served in the ADF had a disability. After taking age into consideration between the two groups, males who had served in the ADF were more likely to have a disability (28%) than males who had never served (20%) (ABS 2019b).

Further information will be available from the Survey of Disability, Ageing and Carers (SDAC), with detailed information from this survey expected to be available from the ABS in late-2023.

The DVA supports many veterans who suffer from injuries or diseases caused or aggravated by ADF service. As at 30 June 2021, there were over 189,500 veterans with an accepted disability, equating to 72% of the DVA treatment population (DVA 2021).