The East Timor Health Study (McGuire et al. 2009b), conducted as part of the Centre for Military and Veterans’ Health’s Deployment Health Surveillance Program, investigated the health of ADF veterans who deployed on Operations FABER, SPITFIRE, WARDEN, TANAGER, CITADEL and SPIRE. The design was retrospective and cross-sectional, and the study compared the health of those who deployed on the named operations with frequency-matched veterans who did not. Data were collected from self-report health and deployment questionnaires, ADF health records and psychological screening, and mortality and cancer registries. It is important to note that the Timor-Leste Family Study did not repeat the East Timor Health Study of veterans but focused instead on outcomes for families associated with the same deployments.
The East Timor Health Study found no statistically significant differences in psychological distress, physical symptoms, health behaviour, and mortality and cancer incidence between the East Timor and comparison groups. Deployed personnel did, however, report more symptoms. The majority of the veterans (64 per cent) were married, and approximately 60 per cent had children (with an average age of 12 years in 2009). These demographics helped the Timor-Leste Family Study team with developing content for the self-report questionnaire, in which questions about marital satisfaction and older children were included.The East Timor Health Study Project Completion Report is available on the Centre for Military and Veterans’ Health website (www.cmvh.org.au).
The first survey of Australian Defence Force families
The Defence Community Organisation conducted the first survey of ADF families in 2009. The sample included all partners of permanent ADF members, and the survey asked partners about deployment experiences, the reactions of children to parental absence, perceived support of families by Defence, the demands of service life, and their own employment experiences. The survey found a link between conditions of service (for example, relocations and long periods of absence) and work–family conflict.
The Timor-Leste Family Study team reviewed the content of the survey to isolate clear points of difference between the two studies. The Timor-Leste Family Study focuses on physical, mental and family health outcomes and uses scientifically validated measures (described in Chapter 3).
The First Survey of Australian Defence Force Families General Report is available on the Department of Defence website (www.defence.gov.au).
The development workshop
The Timor-Leste Family Study team held a development workshop with a variety of stakeholders and consultants in order to help refine the study design and content. Members of the DVA Family Study Program, the Department of Defence, and veteran and family support services, as well as academics, attended. The study team provided a background paper and a draft protocol for critical comment.
The workshop resulted in the refinement of the research aims and confirmation of the study sample, which consisted of ADF members who had deployed to Timor-Leste and their partners and ADF members who had not deployed to Timor-Leste and their partners. Those present agreed that the direct involvement of parents and children of ADF members in the study, while a worthy goal, would pose ethical difficulties and be beyond the reasonable scope of the first Australian study of this type.
Workshop participants also noted the unique opportunity the study presented for detecting risk and protective factors for families who had experienced deployment. Social support, coping and family functioning were identified as factors that should be examined. Participants particularly endorsed the inclusion of questions about the identification, use and effectiveness of support services.
Between May and August 2010 the study team conducted four focus groups and four individual telephone interviews with current partners (and one former partner) of serving and ex-serving ADF members. This resulted in personal accounts from partners of ADF members who had been on a deployment, assisted with the development of the self-report questionnaire, and publicised the study to military families.
Twenty-one females aged between 20 and 52 years (17 in the focus groups) voluntarily participated in the qualitative research and identified health impacts on their families resulting from their partner’s ADF deployment. For some of these families the impacts were short-lived; for those with impacts related to mental health the effects were enduring. The participants noted that social support was an important factor in reducing adverse health impacts arising from deployment.
The participants also explained that how long they had been with their ADF member partner at the time of a deployment and the presence, number and age of their children during a deployment greatly influenced how they experienced the separation. This insight resulted in inclusion in the questionnaire of questions about relationship length and whether a respondent was with their ADF member partner during a particular deployment. Additionally, the questionnaire asked about the number and age of children living in the household.
Appendix C presents a summary of the qualitative research report that was delivered to the Department of Veterans’ Affairs.
A pilot study testing all questionnaire administration and participant tracking processes was conducted between November 2010 and February 2011. One hundred ADF members and 70 partners were invited. Twenty volunteers contacted the study team after learning about the study via the study website or promotional material; these people were also included.
The pilot study found that ADF members completed their questionnaire at a higher rate than did their partners. A lower completion rate for both the partner and ADF member comparison groups had been expected. In all, though, the numbers were too small for tests of significance.
The pilot study confirmed that the procedure of telephoning individuals who had not responded to their invitation or reminder (referred to as ‘phone follow-up’) was essential for encouraging and facilitating participation. A number of participants, however, did not receive phone follow-up because of time constraints.
The study results led to refinement of the questionnaires—for example, changes to phrasing and re-ordering of question sets—and revised estimates of the number of staff and time required for phone follow-up. Appendix D presents a summary of the pilot study.