Further support for the families of Australia’s war veterans requires a broad research strategy

Shortly before the 2004 federal election, the former Minister for Veterans’ Affairs announced a second health survey of the children of Vietnam veterans.1 The Minister acknowledged her department already funded counselling and other support for veterans’ dependents. However, it needed to know how children of Vietnam veterans could be further supported. The current Minister has made a commitment to honour that announcement.

A survey of children of Vietnam veterans and of a comparison group of non-deployed veterans has been proposed. Although the Australian Government has recently completed a health study of the dependents of Vietnam veterans,2 this relied on veterans’ reports about medical conditions affecting their partners and children, and lacked a control group. Nevertheless, more than 40 000 veterans responded. The results are summarised in Box 1. Reports of selected conditions were verified against documentation from doctors, national databases, or the children. A higher prevalence of accidental deaths and suicide among the children than the Australian norm was confirmed. Many problems were not verified, so we do need to collect reliable diagnostic information from the children themselves — and from veterans’ partners.

The proposed study has the support of veterans1 and affords the opportunity to follow the children, at least, through middle age. However, given that most of these children are now adults, the opportunity to find out how the findings in Box 1 came about and how they might have been avoided has been lost. Earlier studies of the children of Vietnam veterans in Australia have been small or lacked rigour (Box 1).

A high prevalence of problems among partners and children more than 30 years after the Vietnam War suggests that researchers need to take a life-course perspective on the health of veterans’ families. Such a perspective has illuminated the aetiology of children’s health problems in the general population and generated a theoretical basis for new interventions.7 Box 2 covers conflicts after World War II, in which only a minority of fathers participated and it is possible to compare their children with those of men not involved. The similarity of the findings from different conflicts means that we might glean an idea of how a veteran’s war service affects his or her children and partner at different stages in their lives if we studied the families of veterans from more recent conflicts, such as Iraq, East Timor and the Gulf War, in addition to Vietnam.

We also need to know how the health of veterans’ children and grandchildren relates to that of the veterans and their parents. Such trans-generational research in Australia has focused on congenital malformations and other reproductive problems and whether they could have been caused by exposure to chemicals (Box 1). However, research on the possibility of a veteran’s behaviour being transmitted to his or her children, and from children to grandchildren, through shared time in the early years of life has been neglected in Australia, despite the obvious possibilities for prevention.

Studies of children in the general population with similar problems to the children of war veterans have often included their siblings and parents. Such research has led to theoretical support for family-based interventions, many of proven effectiveness.7 However, none of the studies in Box 1 included veterans, partners and children. Such research should recognise the diversity of veterans’ families in composition, stage in life course and religion; look beyond separate households to a network of relatives; and recognise the unique features of military families.8 It should also look at veterans’ families over time. For example, a supportive partner may become less so as a veteran’s depression becomes chronic, with interpersonal, economic and social consequences.9

Research should also look at the relationship between a veteran’s family and the community. A positive partnership between families, their networks of relatives and friends, employers and health, welfare or religious organisations enhances family wellbeing.8 The converse is also true. For example, lack of community awareness about depression, unwillingness of other family and friends to help, adverse experiences with health care providers and the exclusion of family members from decision-making may impair a family’s ability to cope with a veteran suffering from depression.9 This sequel might be avoided by community education and provision of more family-inclusive services.

The term “resilience” denotes a combination of abilities and characteristics that allow individuals to bounce back, cope successfully and function above the norm in spite of significant stress or adversity.10 Epidemiological studies have demonstrated the importance of resilience for health, for example, of children.11 There has been no research in Australia into why some veterans’ families are more resilient than others and how this resilience might be enhanced. Programs focusing on resilience were well received by participants in the Vietnam Veterans’ Sons and Daughters Project.12 The project was part of the Australian Government’s response to a higher rate of suicide among sons and daughters of veterans than the Australian norm.2 It aimed to reduce suicide risk by increasing personal strengths, coping skills, resilience and access to care.

Although participants in the Sons and Daughters Project do benefit, only 2% of children use the service.12 That being so, research into why the children do not use services provided for them, and whether their needs are being met elsewhere, would seem worthwhile.

Involvement of spouses in a lifestyle management course for Australian war veterans improved the mental health of both.13 Given this, research is needed into whether the services available to veterans and their dependents involve other family members as often as they could. If service providers are shown not to have been trained to deliver family-inclusive programs, resources could be developed to assist them, as has recently been the case with drug and alcohol workers.