Veteran social connectedness

The fieldwork for Wave 21 of the HILDA Survey was affected by various lockdowns and restrictions due to the COVID-19 pandemic. To maintain the safety of respondents and interviewers, most interviews were conducted via telephone during the lockdown periods, and self-administered forms were conducted online. Although the response rate for Wave 21 was slightly lower than previous years (94% compared with 95% in Wave 20, and 96% in Waves 18 and 19), detailed assessments by the Melbourne Institute determined that the quality of Wave 21 data are similar to previous waves despite the complexities of the fieldwork during the pandemic (Watson et al. 2022).

The initial HILDA sample developed in Wave 1 excluded people living in non-private dwellings, such as military and police installations. However, current serving ADF members are disproportionately more likely to live in non-private dwellings, with some living in barracks or other similar defence establishments as part of their military service. According to the 2021 Census, around 11% of current serving ADF members lived in non-private dwelling, compared with only 2.1% of ex-serving ADF members and 1.4% of people who had never served in the ADF (ABS 2022a). Most (97%) of the current service members living in non-private dwellings were engaged in the Regular service (ABS 2022a). 

Exploratory analysis of Wave 21 HILDA data indicated that only 7% of all veterans in the sample were currently serving in the regular service. This was somewhat lower than the rate observed in the 2021 Census, which found that around 10% of all veterans currently served in the regular service. These factors suggest that the findings in this report may not be representative of ADF members who were currently serving in the regular service and living in a non-private dwelling. As such, findings may be biased towards ex-serving ADF members and current serving members living in private dwellings.

No matter how good a questionnaire or interviewer is, errors can be introduced into a self-report survey either consciously or unconsciously by respondents through issues such as question misinterpretation, sensitivity, or respondent fatigue (ABS 2023a). These issues are known broadly as forms of respondent bias. All analysis in this report made use of self-report data from the HILDA survey, and so the findings may be subject to a degree of respondent bias.

The most noteworthy risk of respondent bias in this report is the potential for respondents to have different interpretations of what constitutes ADF service in the new survey questions added to Wave 21. Specifically, some respondents may consider ADF service limited to overseas deployments, leading to potential underreporting of veterans within the Wave 21 HILDA cohort. Service characteristics such as rank, length of service, the number, length, and frequency of operational deployments and income at time of separation were not captured in Wave 21 of HILDA, making it difficult to validate the scope of what respondents may consider “ADF service”. Exploratory analysis of the Wave 21 HILDA data has revealed that 3.7% of the sample reported that they had ever served in the ADF, which was a rate nearly one percentage point higher than observed in the 2021 Census (2.8%; ABS 2022a). This suggests that underreporting of veteran status is unlikely to be an issue in the Wave 21 HILDA data.

Some respondents may also respond inaccurately to survey questions they find embarrassing or do not want to continue answering or adjust their responses to appear more favourable to others. For example, loneliness is typically considered socially undesirable, with men often being less likely to report feeling lonely than women potentially due to stigma or social desirability bias (Lau and Gruen 1992, Lee et al. 2019, Manera et al. 2022). However, the longitudinal nature of the HILDA survey may also mean that compared to other surveys, respondents may be more likely to tell the truth to more sensitive survey questions such as those discussed in this report, irrespective of societal stigma or social desirability. The majority of respondents in this report would have been participating in the HILDA survey for a number of years by the time Wave 21 data were collected, and as such may have become more comfortable with, and less suspicious of, the survey and its administrators (Wooden 2009).

There are several characteristics explored within this report that are inherently more likely to occur in older Australians. With nearly half (49%) of all veterans in Wave 21 of the HILDA data aged 65 years and older compared with only 20% of people who had never served in the ADF, there is a chance that some differences observed between the two groups are better explained by the skewed age distribution of the veteran cohort. This most notably includes findings relating to veterans who are:

• Not in the labour force: Retirement is a common reason why a person may not be in the labour force, with over 3 in 4 (78%) Australians aged 65 years and older retired in the 2018-19 financial year (ABS 2020).
• In a couple with dependent children: Given only between 4.3% to 4.5% of women who gave birth in Australia each year between 2011 and 2021 were aged 40 years and older (AIHW 2023a), it would be uncommon for a person aged 65 years and older to live with dependent children as they are defined in this report.
• Volunteers: previous longitudinal analyses of the HILDA data have revealed that Australians aged 65 years and older have historically had both the highest rate of volunteering, and highest number of hours volunteered, of any age group (Gray et al. 2011; Zhu 2022).

Usually, age standardisation would be employed to correct for the effects of the different age distribution of veterans compared with people who had never served in the ADF. However, the variables analysed in this report did not meet the criteria for age standardisation due to the small size of the veteran cohort. Instead, age-specific rates have been provided where possible and relevant throughout this report.

For more information about the age-specific rates of different individual characteristics explored throughout this report, see A profile of veterans in Wave 21 of HILDA.

Veterans made up a small portion of the overall Wave 21 HILDA data. This has caused several results in the analysis for this report to have high relative standard errors (RSEs) and margins of error (MoEs), and so the reliability and validity of some findings may be limited. All efforts have been made to select only the highest quality findings for commentary on this report, however instances where proportions have high MoEs have been annotated with a hash (#) to clearly identify that results should be interpreted with caution. In this report, a high MoE is considered an MoE larger than 10%.

Irrespective of high RSEs or MoEs, the small size of the veterans’ sample in the HILDA data means that any differences observed between this group and people who had never served in the ADF in this report should be interpreted with caution and may be due to chance.

In this report, two variables have had values aggregated due to small cell counts in the underlying unweighted data. These are:

• Defence workforce type: Veterans who responded ‘Don’t know’ when asked whether they served in the regular or Reserve service were aggregated with veterans who responded that they served in both services.
• States and territories: Results for Tasmania, the Northern Territory, and the Australian Capital Territory have been aggregated together.

The scope of this report is limited to simple univariate analysis, and as such does not include multivariate modelling such as factorial ANOVAs or logistic regression. This means that the findings outlined throughout this report do not control for the potential covariance of interrelated risk and protective factors being measured. For example, limited exploratory testing of Wave 21 HILDA data has revealed potential positive correlations between general health status, mental health status, psychological distress status, and disability status. Potential positive correlations were also observed between unemployment and financial stress. This suggests that there may be interaction effects influencing key findings in this report that are not captured as part of the analysis. This potential for covariance between independent variables is an important limitation to consider, as the real-world relationships between these risk or protective factors and social connectedness are likely more complex than is presented throughout this report. Future work could be undertaken to explore multivariate statistical modelling techniques, however these are outside the scope of this report.

Defence workforce type refers to whether a veteran served in the regular service, Reserves, or both. It was selected for analysis to identify whether serving in the reserves helps or hinders social connectedness.

Reservists are ADF members who have held service categories 2 through 5 in the ADF Total Workforce System (Defence n.d.). Their roles and level of involvement with the ADF are broad, ranging from minimal participation and only eligibility for call out, to an enduring, regular part-time tenure with the ADF. The flexibility and part-time nature of working in the Reserves services enables members to work in employment outside of the ADF, with 65% employed full-time and 19% employed part-time in 2021 (ABS 2022a). Maintaining a connection to civilian life during service by means such as employment outside of the ADF may facilitate a more positive transition out of the military, and so Reservists may be better protected from issues with social connectedness due to the retained connection they have to the civilian world (Flack and Kite 2021).

However, Reservists may also experience their own unique struggles with social connectedness that could place them at increased risk. For example, international research suggests that deployed Reservists are at greater risk of psychiatric injury than those in the regular service, with PTSD and other mental health conditions in turn associated with increased risk of isolation and loneliness (Crompvoets 2013; Soloman et al. 2014). Some Reservists also struggle to integrate with their regular serving peers due to differences in training and experience, and hostility and stereotyping by permanent members, which may increase feelings of loneliness and isolation during deployment (Crompvoets 2013). Some Reservists can also feel poorly understood by their workplace and have their work contributions over or undervalued because of their service, creating difficulties reconnecting with colleagues following a period of military service (Lander et al.  2019). Overall, each of these factors may serve to increase reservist’s risks of isolation or loneliness on their return to civilian life.

The risk and protective factors for social connectedness that a veteran is exposed to can differ substantially based on whether they are currently serving in the ADF or have transitioned to civilian life.

For example, veterans may often be well-protected from social isolation and loneliness while serving due to the strong sense of camaraderie, trust and mateship during deployment (Reijen and Duel, 2019). Although some ex-serving veterans retain this protection through other means such as financial stability or staying connected with their peers, others may experience unemployment, financial stress, disability and mental health conditions following separation, potentially placing them at greater risk of issues with social connectedness (Kuwert et al. 2013; Na et al. 2022; Reijen and Duel 2019). Given the established link between isolation and loneliness with poor mental health outcomes and suicidality among veterans (McGuire et al. 2023; Teo et al. 2018), it is vital to understand how social connectedness differs between current and ex-serving ADF members.

Unfortunately, current serving ADF members form a small portion (11%) of the total sample of veterans in Wave 21 of the HILDA survey, significantly reducing the quality of any findings related to this cohort. As such, commentary comparing social connectedness between current and ex-serving members has not been provided in this report. 

Given the importance of this data, results have been retained in the Supplementary tables accompanying this report. However, any findings relating to current serving members should be interpreted with caution, and in some measures of social connectedness, may be too unreliable for general use.

The relationship between a person’s sex and their social connectedness is complex, with findings mixed in the broader literature. Previous analysis of HILDA data has found that men are typically more likely to report feeling lonely than women (AIHW 2021; Flood 2005; Relationships Australia 2018). In contrast however, literature using other data sources have reported higher rates of loneliness in women, while others again have found that levels of loneliness are similar between men and women across the lifespan (Lee et al. 2019; Maes et al. 2019).

These inconsistencies may reflect the degree to which different genders are willing to admit to feeling lonely across these studies. It is well-established that men in western countries face greater social stigma around feelings of isolation and loneliness than women due to societal expectations and masculine stereotypes of stoicism and self-reliance, in turn making men more reluctant to outwardly admit to, or seek help for, loneliness (Barreto et al. 2021; Willis and Vickery 2022). These inconsistent findings may also reflect different study methodologies, or that men and women may define loneliness in different ways (Lee et al. 2019). 

In the 2021 Census, 87% of ex-serving ADF members were male, compared with around 49% of the overall Australian population (ABS 2022a; ABS 2022d). Given that previous HILDA studies have found that men are more likely to be lonely than women, this strong male skew in the veteran population is likely to influence the findings for isolation and loneliness throughout this report. Findings for veterans throughout this report should be considered in the context of the differing experiences of loneliness between men and women in Australia.

Studies investigating the relationship between age and loneliness often have contradictory findings, likely related to differences in study methods and sample variations. Some studies find higher levels of loneliness among older people while others find lower levels in these age groups (Relationships Australia 2011; Relationships Australia 2018). The relationship between age and loneliness may also vary according to relationship status, with another study finding that Australians aged over 65 who are married experience the lowest levels of loneliness (Australian Psychological Society 2018). Previous research using the HILDA survey has found that among men, loneliness increased towards middle age before decreasing again after retirement age (Baker, 2012).

In 2020–21, 47% of males who served in the ADF were 65 years and older, compared with only 18% of males who had never served in the ADF (AIHW 2023b). This strong skew of older adults in the veteran population may influence Wave 21 HILDA findings discussed in this report.

In this report, a DVA client is defined as a person who has been issued a White, Gold or Orange card by the Department of Veterans’ Affairs. Many Australians with one of these DVA cards are veterans, however some spouses or dependants of veterans are also eligible to receive Gold Cards. 

To help alleviate issues with social isolation and loneliness during and after their transition to civilian life, DVA offers services such as Coordinated Veterans’ Care (CVC) Social Assistance (as part of the CVC Program) which provides eligible and at-risk clients with chronic health condition/s or DVA-accepted mental health condition/s limited short-term assistance with community and social connections (DVA 2020). DVA’s rehabilitation program also assist eligible veterans to make social and community connections and engage in activities in their local community (DVA 2022). 

Given the above, DVA client status has been included as a variable of interest in this report as it provides an opportunity to identify potential areas of success or development in this domain of social connection-based service delivery.

Labour force status is one indicator of the socio-economic status of an individual. It is influenced by their choices and life circumstances, as well as by broader conditions of the labour market. 

The benefits of social connectedness to a person’s health and wellbeing are well-established in the workplace context. Employment provides a place for socialisation, and having friends at work can make a person’s job more enjoyable, provide them with social support, and improve their job satisfaction and performance (Brown and Leite 2022). Conversely, long-term unemployment may increase broader social isolation from friends and family among men in particular, potentially due to associated feelings of inferiority or shame, and more limited financial resources (Eckhard 2022).

ADF service provides secure and stable employment, and after separating from the ADF, many ex-serving ADF members aim to transition into the civilian workforce (Van Hoof et al. 2018). In 2016, over three quarters of ex-serving ADF males and females (78% and 76%, respectively) were employed, compared with 67% of Australian males and 57% of Australian females (AIHW 2022d). For some ex-serving ADF members however, securing and maintaining employment may be challenging due to issues such as poor physical or mental health. As such, labour force status is important to explore in the context of its effects on social connectedness among the Australian veteran community.

Financial stress is defined as having difficulty meeting basic financial commitments due to a shortage of money or debt; it can have severe short- and long-term consequences for individuals, and negatively impact an individual’s health and psychological wellbeing (Department of Education n.d.). 

The link between financial stress, social isolation, loneliness and poor mental health outcomes is well established in the literature. Withdrawal from community and social interactions is common during times of financial hardship, due to being unable to afford to participate as well as associated feelings of shame or guilt as a result (AIHW 2021; Gladstone et al. 2021; Tough et al. 2021; Tough et al. 2022). Inversely, the existence and quality of close interpersonal relationships, social support and community connection may also help to protect against adverse health and wellbeing outcomes during times of financial hardship (Singh et al. 2021).

Recent Australian findings from the Transition and Wellbeing Research Programme (TWRP) Family Wellbeing Study revealed that nearly 1 in 4 (24%) ex-serving ADF member families had experienced two or more financial hardship indicators. Specifically, ex-serving ADF members were more likely to report being unable to pay the mortgage or rent on time (8.8%); needing to pawn or sell something (13%); asking for financial help from friends or family (21%); and seeking help from community organisations (8.0%) (compared with 4.8%, 8.0%, 13% and 4.7% among current-serving ADF members, respectively) (Daraganova et al., Smart and Romaniuk 2018). Because of the large cohort of ex-serving ADF members captured within Wave 21 of HILDA, financial stress was assessed as an important variable to explore in the context of social connectedness as part of the analysis of this report.

Remoteness area is a geographical classification determined according to population and distance to services. Around 7 million people – or 28% of the Australian population – live in rural and remote areas, which encompass many diverse locations and communities (ABS 2023b). These Australians face unique challenges due to their geographic location and often have poorer health outcomes than people living in metropolitan areas. Recent Australian research has revealed that people living in rural and remote areas have higher rates of hospitalisations, deaths and injury, and also have poorer access to, and use of, primary health care services, when compared with people living in Major cities (AIHW 2022b).

Experiences of social isolation and loneliness can also differ depending on how remote a person lives within Australia. For example, people living in rural areas can experience higher levels of community connectedness, participation, and social cohesion than those in urban areas. Compared to people living in metropolitan areas however, rural communities often also experience decreasing populations, loss of health and social support services and limited public transport. The dispersion of families, geographic isolation, and less cohesive communities may all increase the risks of social isolation and loneliness among rural residents (Tittman et al. 2016; Williams et al. 2022).

According to the 2021 Census, 45% of ex-serving ADF members lived in a regional area (ABS 2022a). As such, remoteness area is an important factor to consider when examining social connectedness amongst veterans.

The state or territory of Australia that a HILDA respondent lives in is an important variable for consideration in this report for several reasons. Most notably, data collection for Wave 21 of HILDA was conducted between July 2021 and March 2022, which was at the height of the third wave of the COVID-19 pandemic in Australia. By the time data collection for this wave had ended, there had been over 6 million cases and over 7,000 COVID-related deaths, as well as several border closures and stay-at-home orders (herein referred to as “lockdowns”) implemented by Government to prevent the spread of the disease (AIHW 2022c). However, the effects of COVID over this period varied widely between Australian states and territories, with people living in Victoria – particularly metropolitan Melbourne – disproportionately affected over 2021. 

Recent research has revealed that rates of loneliness, isolation and psychological distress were significantly higher amongst Victorians in prolonged lockdown compared with other Australians (Griffiths et al. 2022). Given that only 19% of ex-serving ADF members lived in Victoria compared with 26% of Australians who had never served in the ADF during 2021 (ABS 2022a;ABS 2022b), it was considered important to include state and territory-specific analysis in this report to account for the above influence of COVID-19 on the health and wellbeing of Australians over the data collection period.

The HILDA survey measures general health using the Short Form (36) Health Survey (SF-36). The SF-36 is a questionnaire that measures a variety of health-related quality of life domains and is widely regarded as one of the most valid instruments of its type (Wilkins et al. 2022). In this report, the SF-36 scale for general health has been used to identify veterans who may be in poor overall health, which is formed using self-reported responses to questions about a person’s perceived health status (Ware et al. 1993).

The relationship between social connectedness and health is complex and can often be bi-directional in nature. For example, social isolation and loneliness can be significant risk factors for health conditions such as dementia, cardiovascular disease, stroke, and chronic conditions including high cholesterol and diabetes. Conversely, many of these health conditions can also create issues with social isolation and loneliness by limiting a person’s ability to maintain regular and meaningful relationships with others due to issues with accessibility or stigma (National Academies of Sciences, Engineering, and Medicine 2020). The scope of this report is limited to exploring social connectedness in line with the latter, with general health being assessed as a risk factor for isolation and loneliness rather than as an outcome.

Based on self-reported data from the 2020–21 National Health Survey (NHS), male veterans had higher rates of several chronic health conditions, including arthritis, back problems, heart, stroke and vascular disease, diabetes, cancer, and chronic obstructive pulmonary disease, compared with males who had never served in the ADF (AIHW 2023b). As such, general health status was selected as a key risk factor for analysis in this report given the well-established link between poor health, social isolation and loneliness outlined above.

The HILDA survey measures mental health using the SF-36. This is a 36-item questionnaire that measures a variety of health-related quality of life domains, and is widely regarded as one of the most valid instruments of its type (Wilkins et al. 2022). In this report, the SF-36 scale for mental health has been used to identify veterans who may be in poor mental health, which is formed using self-reported responses to questions about the degree to which a person feels nervous, calm or happy (Ware et al. 1993).

The relationship between social connectedness and mental health is complex, and similarly to general health, is often bi-directional in nature. For instance, mental health issues may lead to greater feelings of loneliness due to poor social functioning, low mood or energy, fatigue, or finding socialising in public spaces too overwhelming. Conversely, loneliness and social isolation can also lead to a decline in mental health, as individuals may have more time to ruminate on negative thoughts, and in the absence of other people to confide in, may become even more overwhelmed, isolated, and withdrawn (DCMS 2022). The scope of this report is limited to exploring social connectedness in line with the latter, with mental health being assessed as a risk factor for isolation and loneliness rather than as an outcome.

Based on self-reported data from the 2020–21 NHS, veterans were around twice as likely to report having an anxiety-related disorder than people who had never served in the ADF (AIHW 2023b). As such, mental health status was selected as a key risk factor for analysis in this report given the well-established link between poor mental health, social isolation and loneliness outlined above.

Psychological distress can be described as unpleasant feelings or emotions that affect a person’s level of functioning and interfere with the activities of daily living. Psychological distress can result in having negative views of the environment, others and oneself, and manifest as symptoms of mental illness, including anxiety and depression (AIHW 2023c). Among other things, persons exposed to traumatic events may experience prolonged psychological distress if they are exposed to reminders of the trauma within their environment (Bryant 2019; Littleton et al. 2007; Norbury et al. 2022).

In the HILDA survey, psychological distress is measured using the Kessler Psychological Distress Scale (K10). This is a 10-item questionnaire about negative emotional states experienced in the past 30 days. In this report, high levels of psychological distress are indicated by a K10 score between 22 and 50.

Previous research suggests that the relationship between social connectedness and psychological distress is bi-directional in nature. Loneliness and social isolation can have a significant impact on levels of psychological distress, with recent research finding that loneliness significantly contributed to increased levels of psychological distress among Australians during the COVID-19 pandemic (Biddle et al. 2020; AIHW 2021). Conversely, high levels of psychological distress can negatively impact a person’s social functioning, potentially further perpetuating feelings of loneliness (Matud and Garcia 2019). The scope of this report is limited to assessing psychological distress as a risk factor for isolation and loneliness rather than as an outcome.

Service in the military can carry a higher risk of psychological distress above and beyond other occupations. In 2015, levels of high to very high psychological distress amongst ex-serving ADF members were almost three times higher than observed in the broader Australian community (33% compared with 13%) (Van Hooff Et al. 2018). As such, psychological distress was selected as a key risk factor for analysis in this report.

Disability is diverse, encompassing people with varying types and levels of impairment across all socioeconomic and demographic groups in Australia. Social connectedness enables the inclusion of people with disability to participate in many aspects of life. However, people with disability can also face various barriers to building strong social connections and participating in society, including those related to discrimination. This can lead to greater risk of isolation and loneliness than experienced by those without disability. In 2017, Australians with disability aged 15–64 were twice as likely (17%) to experience social isolation as those without disability (8.7%) (AIHW 2022a). 

Service in the military can carry inherent risks of injury during training and deployment above and beyond that of other occupations. In 2021, male veterans were around twice as likely to have disability with a limitation or restriction as males who had never served (37% compared with 17%, respectively) (AIHW 2023b). Veterans are also more likely to experience disabilities that may put them at a disadvantage in terms of social engagement, such as deafness or hearing disability and having activity limitations (Wells 2018). Because of this increased risk among veterans, disability status was selected as a key variable of interest for analysis in this report.

Disability severity refers to the amount of assistance or supervision a person needs with self-care, mobility, or communication (referred to as ‘core activities’) because of their disability. In this report, people who always or sometimes need help or supervision with at least one core activity because of their disability are referred to as people with ‘severe or profound disability’.

In 2017, people with severe or profound disability were less likely to be active members of a club or association, and less likely to be satisfied with their community, than people with other disability types and people without disability. People with severe or profound disability were also more likely to be isolated and lonely (AIHW 2022a).

Service in the military can carry inherent risks of severe injury during training and deployment, such as traumatic brain injuries, amputations and noise-induced hearing loss from blast events in conflicts (Bennett et al. 2015; Wallace 2012; Yankaskas 2013). 

Similarly, to the broader population, rates of social isolation and loneliness among veterans can differ depending on the disability severity, with previous research finding that loneliness increased among veterans who had a severe injury or disability such as an amputation (Asadollahi 2023). Because of the risks of serious injury associated with military service and its connection with isolation and loneliness in the broader literature, disability severity has been selected as a key characteristic for analysis in this report.

In this report, family type refers to the structure of a family living in a household together, and whether other related or unrelated individuals are present.

The composition of a family can play a significant role in the social connectedness of an individual, as it provides important insights on the informal social support provided by family, and those they live with (AIHW 2022d). For example, living alone and not being in a relationship with a partner are substantial risk factors for both social isolation and loneliness (Flood 2005; Lauder et al. 2004; Relationships Australia 2011; AIHW 2021). 

Compared to other household compositions and relationship status’, single parents experienced the highest rate of social isolation. Among single parents, males experienced almost twice the rate of social isolation as females (38% and 18% respectively). In addition to single parents, single adults without children also reported high rates of social isolation (15% males and 13% females), as well as couples with children and couples without children (7% for both males and females) (AIHW 2021).

AIHW analysis of the 2016 Census indicated that ex-serving ADF members lived alone or were single parents at rates similar to the broader Australian population (AIHW 2022d). However, research suggests that veterans with dependent children may be at disproportionately higher risk of increased PTSD rates and symptom severity following combat trauma exposure (Janke-Stedronsky et al. 2015), with veteran single parents at particularly heightened risk (Creech and Misca 2017). Given the well-established relationship between PTSD, social isolation and loneliness among veterans (Wilson et al. 2018), the composition of veteran families was selected as an important variable to explore in the context of social connectedness in this report.

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