Predictors of Retirement Voluntariness Using Canadian Longitudinal Study on Aging Data.

Objectives: Involuntary exit from the labor force can lead to poor health and well-being outcomes. Therefore, the purpose of this research is to better understand the factors that contribute to perceived retirement voluntariness. Methods: We conducted descriptive and multivariable logistic regression analyses using a sample of recent retirees (n = 2080) from the Canadian Longitudinal Study on Aging (CLSA). Results: More than one-quarter (28%) of older workers perceived their retirement to be involuntary. Among 37 possible predictors, 14 directly predicted retirement voluntariness and many more indirectly predicted retirement voluntariness. Only four direct predictors were common to both women and men, retiring because of organizational restructuring/job elimination; disability, health, or stress; financial possibility; and having wanted to stop working. Discussion: Findings suggest the need for employment support, health promotion, work disability prevention, financial education, and support that is sensitive to the differences between women and men to prevent involuntary retirement.

Cluster analysis of Canadian Armed Forces veterans living with chronic pain: Life After Service Studies 2016.

Objective: This study explored the heterogeneity of Canadian Armed Forces veterans living with chronic pain to inform service needs planning and research using cluster analysis. Design: We used a national cross-sectional Statistics Canada population survey. Participants: Participants included 2754 Canadian Armed Forces (CAF) Regular Force veterans released from service between 1998 and 2015 and surveyed in 2016. Methods: We used cluster analysis of veterans with chronic pain based on pain severity, mental health, and activity limitation characteristics. We compared clusters for sociodemographic, health, and service utilization characteristics. Results: Of 2754 veterans, 1126 (41%) reported chronic pain. Veterans in cluster I (47%) rarely had severe pain (2%) or severe mental health problems (8%), and none had severe activity limitations. Veterans in cluster II (26%) more often than veterans in cluster I but less often than veterans in cluster III endorsed severe pain (27%) and severe mental health problems (22%) and were most likely to report severe activity limitation (91%). Veterans in cluster III (27%) were most likely to report severe pain (36%) and severe mental health problems (96%), and a majority reported severe activity limitations (72%). There was evidence of considerable heterogeneity among individuals in terms of socioeconomic characteristics, pain characteristics, mental and physical health status, activity limitations, social integration, and service utilization indicators. Conclusions: About half of Canadian veterans living with chronic pain infrequently endorse severe pain or serious mental health issues without severe activity limitations. The other half had more complex characteristics. The heterogeneity of CAF veterans with chronic pain emphasizes the need for support systems that can address variability of needs.

Objectif: Cette étude portait sur l'hétérogénéité des anciens combattants des Forces armées canadiennes vivant avec la douleur chronique pour éclairer la planification et la recherche en matière de besoins de services à l'aide de l'analyse par groupes.Devis: Nous avons utilisé une enquête nationale transversale sur la population de Statistique Canada.Participants: Les participants comprenaient 2 754 anciens combattants de la Force régulière des Forces armées canadiennes (FAC) libéré du service entre 1998 et 2015 et enquêtés en 2016.Méthodes: Nous avons utilisé une analyse par groupes d'anciens combattants souffrant de douleur chronique fondée sur l'intensité de la douleur, la santé mentale et les caractéristiques en matière de limitation d'activité. Nous avons comparé les caractéristiques sociodémographiques, de santé et d'utilisation des services des groupes.Résultats: Sur 2 754 anciens combattants, 1 126 (41 %) ont fait état d'une douleur chronique. Les anciens combattants du groupe I (47 %) avaient rarement une douleur intense (2 %) ou de graves problèmes de santé mentale (8 %), et aucun d'entre eux n'avait de limitation d'activité sévère. Les anciens combattants du groupe II (26%) souffraient de douleur intense (27 %) et de problèmes de santé mentale graves (22 %) plus souvent que les anciens combattants du groupe I mais moins souvent que les anciens combattants du groupe III et étaient plus susceptibles de déclarer une limitation d'activité sévère (91 %). Les anciens combattants du groupe III (27 %) étaient les plus susceptibles de déclarer une douleur intense (36 %) et des problèmes de santé mentale graves (96 %), et la majorité d'entre eux a signalé une limitation d'activité grave (72%). Les données probantes ont révélé une hétérogénéité considérable parmi les individus en ce qui concerne les indicateurs relatifs aux caractéristiques socioéconomiques, aux caractéristiques de la douleur, à l'état de santé mentale et physique, à la limitation d'activité, à l'intégration sociale et à l'utilisation des services.Conclusions: Environ la moitié des anciens combattants canadiens vivant avec une douleur chronique souffrent rarement de douleur intense ou de problèmes de santé mentale graves sans avoir de limitations d'activité graves. L'autre moitié avait des caractéristiques plus complexes. L'hétérogénéité des vétérans des FAC souffrant de douleur chronique souligne l'importance que des systèmes de soutien capables de répondre à la diversité des besoins soient disponibles.

Health care access and use among male and female Canadian Armed Forces veterans.

BACKGROUND: Veterans are more likely than other Canadians to have chronic health conditions, making access to health care an important issue. However, little research has addressed health care access and use among veterans. This paper examines access and use among veterans compared with other Canadians. DATA AND METHODS: Health care access and use indicators were examined for Regular Force veterans using the 2016 Life After Service Survey. Information for male and female veterans was compared with information on the Canadian general population from the 2015 and 2016 Canadian Community Health Survey, using age-adjusted rates and 95% confidence intervals. RESULTS: More than 80% of male and female veterans reported having a regular medical doctor in the 12 months before the survey. The majority of veterans (71% of males and 81% of females) had consulted a family doctor, while a minority had been hospitalized (8% of males and females). These rates were similar to those in the Canadian general population. However, veteran consultation rates for mental health care and with audiologists, speech therapists or occupational therapists among both sexes were double to triple those of the Canadian general population. Among veterans, males reported lower rates of unmet needs compared with females. DISCUSSION: Veterans had similar rates of access to a regular medical doctor and higher rates of use compared with other Canadians. However, these may be comparatively low, given previous findings on higher rates of disability and some chronic conditions among veterans. Noted differences between males and females highlight the importance of research and services that account for sex and gender. The extent to which health care needs explain health care use and barriers to care requires further research.

Characterization of occupational, demographic and health determinants in Canadian reservists veterans and the relationship with poor self-rated health.

BACKGROUND: Self-rated health is an useful indicator of the general health in specific populations and used to propose interventions after service in the military context. However, there is scarce literature about self- rated health (SRH) in the Canadian Veterans of the Reserve Force and its relationship with demographic, health and occupational characteristics of this specific group. The aims of this research were to determine the SRH in Canadian Reserve Force Veterans and to explore the relationship between demographic, military service and health factors by reserve class. METHODS: Data from the individuals was collected from the Life After Service (LASS) 2013 survey, including Veterans with Reserve Class C (n = 922) and Class A/B (n = 476). Bivariate and multivariate analysis using logistic regression models, were used to assess the association between the demographic characteristics, physical health, mental health, and military service characteristics and the self-rate health by both reserve classes. RESULTS: The overall prevalence of poor SRH in Reserve Class C Veterans was 13.1% (CI:11.08-15.4) and for Reserve Class A/B was 6.9% (CI:5.0-9.1). Different degrees of associations were observed during the bivariate analysis and two different models were produced for each reserve class. Veterans of Reserve Class C showed that being single was (OR = 2.76, CI: 1.47-5.16), being 50-59 years old (OR = 4.6, CI: 1.28-17.11), reporting arthritis (OR = 2.49, CI: 1.33-4.67), back problems (OR = 3.02, CI:1.76-5.16), being obese (OR = 1.96, CI: 1.13-3.38), depression (OR = 2.34, CI: 1.28-4.20), anxiety (OR = 4.11, CI: 2.00-8.42), PTSD (OR = 2.1 CI: 0.98-4.47), PTSD (OR = 20.9, CI:0.98-4.47) and being medically released (OR = 4.48, CI: 2.43-8.24) were all associated with higher odds of poor SRH. The Reserve Class A/B model showed that completing high school (OR = 4.30, CI: 1.37-13.81), reporting arthritis (6.60, CI: 2.15-20.23), diabetes (OR = 11.19, CI: 2.72-46.0), being obese (OR = 3.37, CI: 1.37-8.27), daily smoking (OR = 2.98, CI: 1.05-8.38), having anxiety (OR = 9.8, CI: 3.70-25.75) were associated with higher odds of poor SRH. CONCLUSIONS: These results suggested that the relationship of poor SRH with demographic, health and military occupation domains varied depending on the class on the Reserve Force Service. Different strengths of association showed different risk compositions for both populations. This can be used to better understand the health and well-being of Veterans of the Reserve Force.

Understanding future needs of Canadian veterans.

BACKGROUND: Planning for the future needs of Canadian veterans requires comprehensive and detailed data on the size of the Canadian veteran population and their health. This article describes current veteran population estimates and examines the health of two eras of veterans compared with the health of Canadians in general. DATA AND METHODS: This study describes the size and age structure of the Canadian veteran population forecasted by Veterans Affairs Canada (VAC). Veteran health was examined for two eras of Regular Force veterans. The health of earlier-era veterans (released between 1954 and 2003) was examined using the 2003 Canadian Community Health Survey. The health of recent-era veterans (released between 1998 and 2012) was examined using the 2013 Life After Service Survey. Health indicators for veterans were compared with the Canadian general population using age- and sex-adjusted rates and confidence intervals. RESULTS: The VAC forecast points to a stable population of about 600,000 veterans for the next decade, but a growing proportion will be older than 70 years old. Regular Force veterans of both eras had a higher prevalence than the Canadian general population of activity limitations and back problems, a lower prevalence of low income, and a similar prevalence of life stress and heavy drinking. Recent-era veterans had a higher prevalence than the Canadian general population of many more indicators-in particular, arthritis, self-rated mental health, depression and anxiety. DISCUSSION: Veterans differed from the Canadian general population in many areas of well-being, and recent-era veterans differed in more areas than earlier-era veterans. These results highlight the need for forecasting and planning, and for policy that is sensitive to these differences and incorporates health status changes as veterans age. Multiple data sources will be required to describe the future health needs of the entire Canadian veteran population.

Pain in Canadian Veterans: analysis of data from the Survey on Transition to Civilian Life.

BACKGROUND: Little is known about the prevalence of chronic pain among Veterans outside the United States. OBJECTIVE: To describe the prevalence of chronic pain and associated sociodemographic, health behaviour, employment/income, disability, and physical and mental health factors in Canadian Veterans. METHODS: The 2010 Survey on Transition to Civilian Life included a nationally representative sample of 3154 Canadian Armed Forces Regular Force Veterans released from service between 1998 and 2007. Data from a telephone survey of Veterans were linked with Department of National Defence and Veterans Affairs Canada administrative databases. Pain was defined as constant/reoccurring pain (chronic pain) and as moderate/severe pain interference with activities. RESULTS: Forty-one percent of the population experienced constant chronic pain and 23% experienced intermittent chronic pain. Twenty-five percent reported pain interference. Needing help with tasks of daily living, back problems, arthritis, gastrointestinal conditions and age ≥ 30 years were independently associated with chronic pain. Needing help with tasks of daily living, back problems, arthritis, mental health conditions, age ≥ 30 years, gastrointestinal conditions, low social support and noncommissioned member rank were associated with pain interference. CONCLUSIONS: These findings provide evidence for agencies and those supporting the well-being of Veterans, and inform longitudinal studies to better understand the determinants and life course effects of chronic pain in military Veterans.

Disability correlates in Canadian Armed Forces Regular Force Veterans.

PURPOSE: This study was undertaken to inform disability mitigation for military veterans by identifying personal, environmental, and health factors associated with activity limitations. METHOD: A sample of 3154 Canadian Armed Forces Regular Force Veterans who were released during 1998-2007 participated in the 2010 Survey on Transition to Civilian Life. Associations between personal and environmental factors, health conditions and activity limitations were explored using ordinal logistic regression. RESULTS: The prevalence of activity reduction in life domains was higher than the Canadian general population (49% versus 21%), as was needing assistance with at least one activity of daily living (17% versus 5%). Prior to adjusting for health conditions, disability odds were elevated for increased age, females, non-degree post-secondary graduation, low income, junior non-commissioned members, deployment, low social support, low mastery, high life stress, and weak sense of community belonging. Reduced odds were found for private/recruit ranks. Disability odds were highest for chronic pain (10.9), any mental health condition (2.7), and musculoskeletal conditions (2.6), and there was a synergistic additive effect of physical and mental health co-occurrence. CONCLUSIONS: Disability, measured as activity limitation, was associated with a range of personal and environmental factors and health conditions, indicating multifactorial and multidisciplinary approaches to disability mitigation.

Roles of physical and mental health in suicidal ideation in Canadian Armed Forces Regular Force veterans.

OBJECTIVES: Suicide in recent veterans is an international concern. An association between mental disorders and suicide has been established, but less information is available about an association between physical health problems and suicide among veterans. This study extends this area of inquiry by examining the relationship of both physical and mental health problems with suicidal ideation in a representative national sample of Canadian veterans. METHODS: Subjects were a stratified random sample of 2,658 veterans who had been released from the Canadian Armed Forces Regular Force during 1998-2007 and had participated in the 2010 Survey on Transition to Civilian Life. Associations between physical and mental health and past-year suicidal ideation were explored in multivariable regression models using three measures of physical and mental health. RESULTS: The prevalence of suicidal ideation was 5.8% (95% confidence interval [CI]: 5.0%-6.8%). After adjustment for covariates, ideation was associated with gastrointestinal disorders (adjusted odds ratio [AOR] 1.66, CI: 1.03-2.65), depression or anxiety (AOR 5.06, CI: 2.97-8.62) and mood disorders (AOR 2.91, CI: 1.67-5.07); number of physical (AOR 1.22, CI: 1.05-1.42) and mental conditions (AOR 2.32, CI: 2.01-2.68); and SF-12 Health Survey physical health (AOR 0.98, CI: 0.96-0.99 for each 1 point increase) and mental health (AOR 0.88, CI: 0.87-0.89). CONCLUSIONS: Physical health was independently associated with suicidal ideation after adjustment for mental health status and socio-demographic characteristics. The findings underscore the importance of considering physical health in population-based suicide prevention efforts and in mitigating suicide risk in individual veterans.

Postmilitary adjustment to civilian life: potential risks and protective factors.

BACKGROUND: Adjustment to civilian life in Canadian veterans after release from military service has not been well studied. OBJECTIVES: The objectives of this study were: (1) to explore dimensions of postmilitary adjustment to civilian life and (2) to identify demographic and military service characteristics associated with difficult adjustment. DESIGN: Data were analyzed from a national sample of 3,154 veterans released from the regular Canadian Forces during 1998 to 2007 in a cross-sectional survey conducted in 2010 called the Survey on Transition to Civilian Life. METHODS: The prevalence of difficult adjustment to civilian life for selected characteristics was analyzed descriptively, and confidence intervals were calculated at the 95% level. Multivariable logistic regression analysis was used to identify characteristics available at the time of release that were associated with difficult adjustment. RESULTS: The prevalence of difficult adjustment to civilian life was 25%. Statistically significant differences were found across indicators of health, disability, and determinants of health. In multivariable regression, lower rank and medical, involuntary, mid-career, and Army release were associated with difficult adjustment, whereas sex, marital status, and number of deployments were not. LIMITATIONS: Findings cannot be generalized to all veterans because many characteristics were self-reported, important characteristics may have been omitted, and causality and association among health, disability, and determinants of health characteristics could not be determined. CONCLUSIONS: Postmilitary adjustment to civilian life appears to be multidimensional, suggesting the need for multidisciplinary collaboration between physical therapists and other service providers to mitigate difficult transition. Potential risk and protective factors were identified that can inform interventions, outreach strategies, and screening activities, as well as further research.

Health-related quality of life of Canadian Forces veterans after transition to civilian life.

OBJECTIVES: Describe health-related quality of life (HRQoL) of former Canadian Forces (CF) men and women in uniform (Veterans) after transition to civilian life, and compare to age- and sex-adjusted Canadian norms. METHODS: The 2010 Survey on Transition to Civilian Life was a national computer-assisted telephone survey of CF Regular Force personnel who released during 1998-2007. HRQoL was assessed using the SF-12 Physical (PCS) and Mental (MCS) Component Summary scores. Descriptive analysis of HRQoL was conducted for socio-demographic, health, disability and determinants of health characteristics. RESULTS: Mean age was 46 years (range 20-67). Compared to age- and sex-adjusted Canadian averages, PCS (47.3) was low and MCS was similar (52.0). PCS and MCS were variably below average for middle age groups and lowest for non-commissioned ranks, widowed/divorced/separated, 10-19 years of service, physical and mental health conditions, disability, dissatisfaction with finances, seeking work/not working, low social support and difficulty adjusting to civilian life. Among Veterans Affairs Canada clients, 83% had below-average physical PCS, 49% had below-average MCS, and mean PCS (38.2) was significantly lower than mean MCS (48.3). CONCLUSIONS: HRQoL varied across a range of biopsychosocial factors, suggesting possible protective factors and vulnerable subgroups that may benefit from targeted interventions. These findings will be of interest to agencies supporting Veterans in transition to civilian life and to researchers developing hypotheses to better understand well-being in Canadian Veterans.