LONG TERM RAMIFICATIONS OF MILITARY SERVICE ON VETERAN HEALTH
Dr Roma Patil, Intern, Bangalore Medical College and Research Institute
Being a part of the military forces of a country is a matter of pride for the individual, their family, and the nation as well. Choosing this field as a career option is often looked upon as a brave decision, due to high levels of morbidity associated with the job. Nevertheless, thousands of men and women join the military services every year, sacrificing their lives to instil a sense of security and peace in the nation.
Army men need to be in the pinnacle of their health and meet physical standards, to get into the services and more so to give their 100% on field. Military personnel are often fitter and healthier at the time of enlistment than the general population, leading to a phenomenon termed, ‘healthy warrior effect’. Optimal physical health is crucial to military readiness, resilience, and veteran well-being. But did you know that the service men too face physical, mental and social health problems? These are generally less talked about, either due to confidentiality of information and hence limited literature or lack of health seeking behaviour by veterans, due to stigmas and service-connected repercussions.
Military service members face different health issues than civilians. During their service, they are at risk for various injuries such as sharpnel and gunshot wounds, amputation of limbs, traumatic brain injury, hearing loss, sprains and strains. There may also be a risk of health problems from exposure to environmental hazards, such as contaminated water, chemicals, radiation, infections, animal bites, burn pits, heat and cold injury. Being in combat and remaining separated from their families, can be stressful. The stress can put service members and veterans at risk of mental health problems. These include anxiety, post-traumatic stress disorder(PTSD), depression and substance abuse. Suicide is also a concern.
Members in the Army, Navy and Marines have higher reported cases of PTSD and a lower health composite score as compared to their counterparts in the Air Force, who tend pay greater emphasis on their physical health due to stricter protocols for substance use and workouts, resulting in higher levels of positive affect (excited about life). But what are some of the long term implications of military service on the health of veterans? Lets have a look!
VETERANS AND PHYSICAL HEALTH:
Most veterans tend to think they are physically fit due to the military training exercises and sports. However, several veterans stated that, they developed chronic arthritis and other musculoskeletal health complaints in older age, which were thought to be due to physically demanding activities required in the armed forces(eg, parachuting, marching exercises, etc). On leaving the forces, a minority of veterans experienced difficulties in continuing with their workout regime, either due to the long working hours of their civilian job, being employed in a more sedentary civilian role, limited access to sports facilities or due to a military-related physical injury, which also added to their physical health dilemma.
Lack of protective gears such as ear defenders in loud engine rooms or shooting ranges, led to hearing problems among veterans later in life. Skin cancers due to lack of sun protection during training activities or deployment, were also reported.
Some deployed veterans have retained toxic embedded fragments in their bodies after blast injuries, which could contain depleted uranium. These are potentially harmful in two ways: chronic infection at the site of fragment and adverse effects on other parts of the body due to metal ions released from the fragment into the bloodstream.
COMBAT VETERANS:
Veterans who were posted for combat, experienced more adverse health effects such as, high levels of PTSD/anxiety, smoking addiction, difficulty in transitioning to civilian life, difficulties with spouse, proximity to death, war injuries and disability. Combat exposure has been associated with new-onset cardiac problems, new-onset pulmonary complaints, and a higher prevalence of somatic symptoms.
Airborne hazards encountered during deployments such as, open-air burn pits, dust storms, and high ambient levels of particulate matter, showed an increase in respiratory symptoms (e.g., shortness of breath). A study found that a greater number of life stressors and prior infectious gastroenteritis were associated with subsequent inflammatory bowel disease (e.g., Crohn’s disease and ulcerative colitis). Those who reported PTSD due to combat experience, were more likely to gain weight and become obese over time. These coupled with poor sleep led to development of newly reported hypertension, new onset coronary heart disease and Type 2 diabetes. Combat experience was also associated with elevated risk of sexual trauma(harassment/assault).
The process of reintegration into society can be challenging, more so for combat veterans, due to psychological and social issues. Combat experiences involving injuries or casualties to one’s comrades, may produce long-term guilt, second-guessing, and fatalism. In addition, they tend to be more aggressive and prone to risk-taking behaviour, characterised as a sense of invincibility.
Combat veterans having PTSD reported a higher rate of divorce. This correlation explains that a veteran who has been exposed to trauma may have troubles coping, which in turn may affect their ability to maintain a relationship. Lack of health seeking behaviour and usage of alcohol to cope with mental health issues only adds to it.
WOMEN VETERANS
Women in the military face unique reproductive health risks during and after completion of service, including infertility, increased risk of hysterectomy, and sexually transmitted illness(HSV-2 and genital warts). Limited access to bathrooms in deployed settings have been associated with poor vaginal hygiene, vaginitis, urinary retention and urinary tract infection. Overactive bladder affects 22% of women veterans, twice the rate in the general population, and may be related to these deployment challenges as well as to lifetime sexual trauma, PTSD, and depression. Among active duty women, the rate of unintended pregnancy is approximately 60% and is associated with low utilisation rates of long-acting reversible contraceptives, as the adverse effects limit their physical activity. Intimate partner violence and military sexual assault are important risk factors for developing post-traumatic stress disorder (PTSD). Women veterans are at higher risk of cardiovascular disease, obesity, gastrointestinal disorders, and chronic pain than their civilian counterparts.
REFERENCES:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661607/
https://medlineplus.gov/veteransandmilitaryhealth.html
https://journals.sagepub.com/doi/full/10.1177/2378023118813017
https://www.researchgate.net/publication/241730154_Long-Term_Implications_of_Military_Service_for_Later-Life_Health_and_Well-Being
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1547-0
https://doi.org/10.1016/j.annepidem.2021.12.002
https://pubmed.ncbi.nlm.nih.gov/31560263/#:~:text=Members%20in%20the%20Army%2C%20Navy,perception%20of%20their%20own%20health
https://doi.org/10.1016/j.pop.2018.07.006https://theprint.in/opinion/dont-tinker-with-indian-militarys-way-of-life-to-fix-your-out-of-control-fiscal-deficit/539018/
https://www.pexels.com/search/military/https://images.app.goo.gl/ERBVNGwRDYeSCC1F8
