8.0 Summary of Findings
8.1 General Findings
8.2 Self Reported Medical History of the Veterans
8.3 Current Marital Status
8.4 Health of Partner(s)
8.5 Health of Children
8.6 ValidationIn considering the outcomes of the female Vietnam Veterans Morbidity Study it should be noted that only about half of the target group was located. There is also an apparent sample bias towards single rather than married/de facto female Vietnam veterans. Generally the results of this study should be considered to be suggestive rather than definitive, and should be interpreted with caution.
Developing a register of female Vietnam veterans would enable the profile for the cohort to be expanded and enhance any further study of this group. Additional research into the health of female Vietnam veterans may be considered once the results of research into the health of US female Vietnam veterans become available.
8.1 General Findings
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Recognising the sampling limitations outlined above, the conditions in the female study for which there is apparently statistical significant excess in comparison with the general community are:
- asthma
- breast cancer
- depression
- eczema and dermatitis
- gastric reflux
- haemorrhoids
- hearing and ear problems
- hepatitis (A and B)
- hydatidiform mole
- ischaemic heart disease
- live births with labour complications
- malaria
- overall total of cancers
- panic attacks
- self-assessed rating of fair or poor health
- stillbirths
An excess level is defined as statistically in excess of what may be expected in a community sample.
These conditions are presented in alphabetical order. Where appropriate, provisional judgements are made about the public health importance of the differences between the veteran and comparison populations in the commentary of Section 7.
It is a reasonable hypothesis that some aspect of the association between the veterans and their service in Vietnam may have contributed to these conditions. However, because of the small sample size and potential sample bias in the survey group, none of these conditions (with the probable exception of malaria) should be considered to have a properly established association with war service. It is also generally not possible to distinguish between factors that would have led women to be recruited for service, and environmental or other possible causes of disease that these women may have experienced while in, or since leaving, Vietnam.
Notwithstanding, the overall outcome lends some weight to the hypothesis that the general health of female Vietnam veterans is worse than that of other Australian women of comparable age. It should be noted that the degree of severity of this finding does not seem as marked as in male veterans.
8.2 Self Reported Medical History of the Veterans (Questionnaire Part A and Part E)
When asked to assess their health as excellent, very good, good, fair or poor (Question E1 of the survey) 12% of veterans who responded reported their health as excellent, 27% as very good, 37% as good, 19% as fair, and 5% as poor.
The majority of female veteran respondents thus reported that their health was good or very good. However, community comparison indicates that the female veterans were less likely than other Australian women of the same age to classify their overall health as excellent or very good and more likely to report their health as being good or fair. The female respondents and the community comparison group were equally likely to classify their health as poor (5% in both cases).
Although the female respondents' rating of their health falls below that of their community counterparts, their view of their health was more positive than that of male veterans. Female veterans were twice as likely as male veterans to report their health as excellent or very good, and three times less likely to report their health as poor.
The response to Question E1 reflects the excess levels of a number of specific conditions reported by female veterans in Part A of the questionnaire.
It is noted that the prevalence of Post Traumatic Stress Disorder (PTSD) does not appear to be excessive in female veterans, whereas other psychiatric conditions (panic attacks, depression) are conditions that are statistically significantly in excess. This result supports the recommendation flowing from the male survey results that there should be a broader diagnostic and treatment focus on mental health conditions in veterans, rather than mainly concentrating on PTSD.
In regard to the hypothesis that the prevalence of cancer is greater in Vietnam veterans than in other Australians of comparable age, the findings of this study appear consistent with the hypothesis for a cumulative total of all the cancers investigated.
It should be noted that developing a cumulative total of 'all cancers' is unreliable as it compounds reporting errors, issues of definition and categorisation of types of cancers and problems associated with establishing reliable community prevalence rates. However, it draws attention to the minor excesses reported for several specific cancers. The findings of the female study with respect to cancers are not as pronounced as those for the male study.
A particular hypothesis set out in this study is that the cumulative prevalence of hysterectomy amongst female veterans is greater than in a comparable age cohort within the general female population of Australia. The cumulative prevalence of hysterectomy in female Vietnam veterans appears to be comparable to that for Australian women in a similar age group.
Although there are acknowledged limitations associated with the reliability of self-reported surveys, it is not recommended that validation of the responses made by female veterans to Part A be undertaken. Treatment, compensation and counselling, if required, for the conditions surveyed are already available under the VEA to eligible veterans following diagnosis and acceptance of a claim.
The survey results can thus be accepted as indicative without the need for further investigation of these results. It is recommended that veterans who report suffering the conditions should be urged to seek acceptance of the condition for treatment and compensation purposes, if they have not already done so. It is also recommended that DVA uses the responses to Parts A and E as a guide in planning the coverage of treatment and counselling services, and of preventative programs for female Vietnam veterans.
The male study reports that the prevalences of multiple sclerosis and cancers are significantly higher than in a comparable community sample. These results are being validated.
In regards to the findings on multiple sclerosis and cancers in the female study, although not excessive, it is recommended that the cases reported in the female study be considered alongside the male validation study results.
For veterans entitled under the VEA, compensation is governed by Statements of Principles (SoPs) prepared for individual medical conditions by the RMA. It is recommended that the findings of the survey be referred to the RMA for their consideration.
It is further recommended that the outcomes of this survey be forwarded to the Australian Defence Force for use in refinement of preventative measures. Similarly, it is recommended that the findings are referred to Comcare for their consideration.
8.3 Current Marital Status (Questionnaire Part B)
Part B of the survey sought to ascertain the marital status of veterans. Responses to this part show that the numbers of married, separated, divorced and widowed female veterans are lower than would be expected in a similar group of Australian women, while the number of female veterans who never married greatly exceeds community expectations.
This finding could be the result of the inability to locate about half of the female Vietnam veterans, which appears to have resulted from problems in locating married female veterans and some of the official entertainers who were known by stage names during their time in Vietnam.
As it stands, the finding tends to support a hypothesis that the marital-status profile of female veterans is different to that of the general population. The primary difference lies in the number who never married.
Responses to the male survey showed no essential difference in the marital profile of male veterans and that of the community as a whole.
8.4 Health of Partner(s) (Questionnaire Part C)
Part C of the questionnaire sought to ascertain the effect of the health of veterans on the health of partners.
In this part, 13% of respondents reported that service in Vietnam, or health problems arising as a consequence of their service in Vietnam, have had a serious adverse effect on current or past partners. Fourteen per cent (14%) reported physical or psychological health problems in their partners that may be related to the veteran's Vietnam service. Stress (14%) anxiety (12%) and insomnia/sleep disturbance (9%) were the most commonly cited conditions. Thirteen per cent (13%) of respondents reporting these conditions indicated that treatment for their partner had been required.
Community comparisons are not available for these data. The responses themselves appear to support the hypothesis that the health status of the veteran has an effect on the health status of the immediate family, although to a lesser extent in the female survey than in the male Vietnam veterans survey. Again, these findings may have been affected by sample bias.
These findings support the recommendation made in the male veterans report that the level of resources available for counselling on mental health conditions experienced by veterans and their families be reviewed for adequacy.
8.5 Health of Children (Questionnaire Part D)
8.5.1 Fertility and Adverse Pregnancy Outcomes
This section sought responses in relation to fertility, stillbirth, miscarriage, termination, ectopic pregnancies and live births with labour complications.
Seventeen per cent (17%) of female veterans reported trying for more than twelve months without success to conceive a child. Twenty-six per cent (26%) reported a miscarriage, 9% a termination, 3% a child that was stillborn, 1% an ectopic pregnancy, and 41% a birth with labour complications.
Reliable estimates of infertility, miscarriage and stillbirth rates are difficult to obtain from community data. Notwithstanding, all conditions surveyed appeared to be within or under expected community rates with the potential exception of stillbirth.
In relation to the number of children, female veterans reported a total of 215 births since the first day of service in Vietnam. This is approximately half the number that might have been expected based on the Australian average. The result, and others concerning fertility and adverse pregnancy outcomes, may have been affected by the number reporting never having married.
8.5.2 Sight and Hearing Conditions, Psychiatric Conditions and Major Illnesses
One per cent (1%) of veterans reported that at least one of their children had suffered an eye condition not correctable by spectacles and 6% reported children with long-term hearing or ear problems. Twenty-eight per cent (28%) indicated that a child had suffered a major illness. In regard to mental health issues, 7% of veterans reported that they had one or more children diagnosed with a psychiatric problem and 23% reported having one or more children with an anxiety disorder.
Definitional problems precluded precise comparison with community data for these conditions, but it was concluded that it was unlikely that any of these conditions were occurring excessively in the children of female Vietnam veterans.
8.5.3 Congenital Abnormalities
Responses were sought from veterans in relation to diagnoses of spina bifida, anencephaly, Down's syndrome, tracheo-oesophageal fistula, cleft lip or palate, absent or extra body parts, and other abnormalities in their children.
Responses indicated one instance each of Down's syndrome, tracheo-oesophageal fistula and absent body parts; and two instances of extra body parts. Fifteen instances of other abnormalities were reported.
These responses neither confirm nor refute an increased level of genetic abnormality in the children of Vietnam veterans. The sample size of the survey was too small to give the statistical power needed to enable valid comparison of the rates of these relatively rare conditions.
Responses to the male survey indicate an increased incidence of such defects and the male report recommended the reported rates be validated as a matter of urgency. The validation results will be contained in Volume III of the Vietnam Veterans Morbidity Study. It is recommended that the findings of the female veterans study are considered in conjunction with the Volume III results when developing potential policy action.
8.5.4 Prevalence of Cancer in Female Veterans' Children
Responses were sought to the incidence of three specific forms of cancer in female veterans' children (leukaemia, Wilms' tumour and cancer of the nervous system). An opportunity was also provided to report any other forms of cancer the children had.
Two cancers were reported: one case of Wilms' tumour, and one of melanoma.
The statistical power of the survey was insufficient to either confirm or refute the hypothesis of an increased prevalence of cancer in the children of female Vietnam veterans.
Responses to the male survey indicate an increased incidence of cancers in children and the male report recommended that reported rates be validated as a matter of urgency. The validation results will be contained in Volume III of the Vietnam Veterans Morbidity Study. It is recommended that the findings of the female veterans study are considered in conjunction with the Volume III results when developing potential policy action.
8.5.5 Death
Veterans were asked whether any of their children had died from illness, suicide, accident or any other reason. Four deaths from illness, and one from accident/other reason were reported. No deaths from suicide were reported.
Community comparison of these responses is not possible. The exact number of children and their age distribution for the purposes of making a comparison is unknown. The reason is that the question sought responses in relation to all of the veterans' children, but the survey only requested that veterans enumerate the number of children born after service in Vietnam. The total number of children born to the veterans, and the number born prior to Vietnam service, is unknown. The survey also did not seek the age of the children. However, at face value, reported instances of deaths do not seem excessive.
Responses to the male survey indicate an increased incidence of suicide and accidental death in children. The male report recommended that the reported rates be validated as a matter of urgency. The validation results will be contained in Volume III of the Vietnam Veterans Morbidity Study. It is recommended that the findings of the female veterans study be considered in conjunction with the Volume III results when developing potential policy action.
8.6 Validation
Consideration was given as to whether validation should occur as a result of the female veterans survey. On balance, a decision was made that validation would not be recommended.
The decision was taken in the light of the following points:
- The findings of the female study are suggestive rather than definitive because of the small size of the female Vietnam veteran sample who could be found for the study. Validation would not improve the status of the findings as the female veteran cohort is much smaller than the male cohort.
- There were too few respondents in the female veterans survey to enable meaningful community comparisons of relatively rare conditions and cancers.
- For Part A of the female study, claims for conditions which were identified as being statistically significantly worse amongst the female veterans than in the community can already be submitted under the VEA. As a consequence, validation of results found in the study would not result in greater access to treatment or compensation for female Vietnam veterans.
- None of the conditions reported in the children of female Vietnam veterans was found to be statistically significant.
- There was concern highlighted by the DVA Ethics Committee that validation would be imposed on the female veteran population for no real purpose.
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