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Journal of Military and Veterans' Health Volume 26 Number 2 April 2018 Journal of Military and Veterans’ Health A History of Australian Navy Health Sailor Uniforms and Ranks (Part 1) RY ME A DI IT C L I Tobacco Use in a National Sample of United States Service Member and Veteran Students I N M E A N S A I S O S A C L I A The Dark Night of the Veteran’s Soul A T R I T O S N U A IN C. The Journal of the Australasian Military Medicine Association Medibank’s Garrison Health Services Delivering a national, integrated healthcare service to the Australian Defence Force Through Medibank’s extensive network, Garrison Health Services provides seamless access to quality healthcare for the 60 000+ permanent and 20 000+ reservist uniformed ADF personnel— from point of injury or illness to recovery. The health of the ADF is central to everything we do. medibankhealth.com.au/garrisonhealthservices Image courtesy of Dept of Defence Table of Contents Letter to the Editor HMAS Westralia remembered ������������������������������������������������������������������������������������������������������������������������6 Obituary Vale: Air Vice Marshal Eric Hay Stephenson AO, OBE �����������������������������������������������������������������������������������7 Short Communication Veterans’ attitudes towards discussing sexual practices and sexual orientation with therapists ������������������� 10 Historical Articles A History of Australian Navy Health Sailor Uniforms and Ranks (Part 1) ����������������������������������������������������� 14 Original Articles Tobacco Use in a National Sample of United States Service Member and Veteran Students ������������������������� 25 The Dark Night of the Veteran’s Soul – Understanding the Impact of Spiritual Wounds for Australian Veterans���������������������������������������������������������������������������������������������������� 35 Gulf War Illness in the 1991 Gulf War and Gulf Era Veteran Population: An Application of the Centers for Disease Control and Prevention and Kansas Case Definitions to Historical Data ������������������������������������������������������������������������������������������������� 43 The Effects of the Incompatible “Soldier” Identity Upon Depression in Former Australian Army Personnel ��������������������������������������������������������������������������������������� 51 The Psychological Adjustment Experience of Reintegration Following Discharge from Military Service: A Systemic Review ��������������������������������������������������������������������� 60 Front Cover Title: The Isurava Battlefield 70 years on� Photo courtesy of Dr Barry Reed Volume 26 Number 2; April 2018 Journal of Military and Veterans’ Health EDITORIAL BOARD CDRE Andy Robertson, CSC, PSM (Editor in Chief) Associate Professor Martin Richardson (Deputy Editor) Maj Gen Prof Dr Mohd Zin Bidin (Ret’d) BRIG Anne Campbell Dr Ian De Terte CDRE Michael Dowsett Dr Helen Kelsall COL Prof Peter Leggat, AM Benjamin Mackie Tyler C Smith, MS, PhD Dr Darryl Tong Australasian Military Medicine Association PATRON STATEMENT OF OBJECTIVES RADM Jenny Firman The Australasian Military Medicine Association is Surgeon General Australian Defence Force Reserves an independent, professional scientific organisation of health professionals with the objectives of: COUNCIL • Promoting the study of military medicine President GPCAPT (Retd) • Bringing together those with an interest in Geoff Robinson, NSC military medicine Vice President Dr Nader Abou-Seif • Disseminating knowledge of military medicine • Publishing and distributing a journal in military Secretary Dr Janet Scott medicine Treasurer CMDR Ian Young • Promoting research in military medicine Council Members CDRE Andrew Robertson Membership of the Association is open to doctors, Dr Peter Hurly dentists, nurses, pharmacists, paramedics and Rachelle Warner anyone with a professional interest in any of the disciplines of military medicine� The Association is Past President Dr Greg Mahoney totally independent of the Australian Defence Force� Public Officer Ms Paula Leishman JMVH is published by the Australasian Military Medicine Association 227 Collins Street Hobart Tas 7000 Australia Ph: +61 3 62347844 Email: [email protected] ISSN No. 1835-1271 Journal of Military and Veterans ealth Editorial Battle of the Atlantic On 24 May 1943, Grand Admiral Karl Donitz withdrew Naomi Searle, who has his U-boats from the north Atlantic, signalling the been doing this role for end of the Battle of the Atlantic� During that month, the last three years, is 41 U-boats were lost to escort ships and patrolling leaving the Journal for aircraft� While they continued to operate until the the wilds of London, and, end of the war, the U-boats were never to pose a on behalf of the Editorial significant threat again� The U-boats highlighted Board, I would like to the potential of submarines in naval warfare, which thank for all her efforts, has carried through to today� While Australia did support and patience not have a large part in the Battle of the Atlantic, it over that time� We all did have a role� HMAS Nestor, one of 5 Australian wish her well in her next N-class destroyers, sank U-127 in December 1941 endeavour� We would also and the Royal Australian Air Force’s 461 and 462 like to welcome Ebony Squadrons were involved in attacking U-boats in Abblitt into this role� the Bay of Biscay in mid 1943� The cooperation and Our second issue of 2018 addresses a range of coordination of Allied ships with Allied aircraft was diverse areas� Spiritual wounds, soldier identity, an important factor in defeating the U-boat offensive� reintegration following discharge and Gulf War Understanding the military experiences of our serving Illness, are addressed in four excellent articles� members and veterans is a key factor in delivering There is also a focus on public health, with articles appropriate health services to this group� The on tobacco use and sexual health looking at these papers that we publish in the Journal are focused areas� Finally, there is an interesting historical on the impacts of military experiences on members perspective on Naval uniforms� and veterans, and how we can manage any adverse We continue to get a good range of articles, but other impacts from that service� To that end, I would like military and veterans’ health articles are always very to highlight the important role of Associate Editors welcome and we would encourage all our readers to in identifying reviewers with the subject matter consider writing on their areas of military or veterans’ expertise to review the diverse papers, the Reviewers health interest� Our themes are now available for both in their constructive comments on the respective 2018 and 2019 to allow for authors to research and articles, and, importantly, the Authors, who consider develop their articles – we certainly welcome articles the comments in refining and improving their in these areas but welcome any articles across the articles� All of these people are critical in building a broader spectrum of military health� We would also Journal like ours into a useful addition to the medical encourage authors who are preparing to present at literature, and I would like to thank them all� the AMMA Conference in October to consider writing There is a further person, often unnoticed in this up their presentations early for publication in the process, who ensures that the Journal is published, Journal� the Editorial Board stays on track and the website Dr Andy Robertson, CSC, PSM is updated� This is our managing editor in Hobart� Editor-in-Chief Volume 26 Number 2; April 2018 Page 5 Letter to the Editor Dear Editor, HMAS WESTRALIA REMEMBERED May 2018 marks 20 years since the multiple fatality from the Navy, primarily due to PTSD resulting fire in HMAS Westralia during a training exercise off from the fire� This study only looked at those still the coast of Western Australia� It should serve as a in the Navy after 6 years—with speculation that this reminder of the dangers inherent in military service figure may be conservative, as the sample may have including training exercises� For those of us in the overly represented those who were still well enough health professions the fire in HMAS Westralia should to remain in the Navy, and not included those who also lead us to reflect on the long-term mental health may have been most affected and who had to leave impacts for those involved in such incidents� The fire the service in the years following the fire� There were in HMAS Westralia resulted in the immediate deaths also at least seven publicly reported legal cases of four of our personnel and the management of a by personnel claiming significant mental health further four personnel treated for injuries—with both problems arising from their involvement, from the 94 immediate and long-lasting impact on the injured and survivors� The fire in HMAS Westralia came at a time their family and friends� However, it also resulted in when PTSD was known and understood in the Royal significant and long-lasting mental health problems Australian Navy (RAN), a structured response was for other personnel involved� A review of about half provided, and a mental health screening program of the personnel from HMAS Westralia who were was in place� Reflecting on the fire in Westralia still in the Navy 6 years after the fire suggested that should remind us of the need to be vigilant for the nearly one in five reported significant symptoms of potential long-term mental health care needs of post-traumatic stress disorder
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