The Challenges of Afghanistan and Iraq Veterans' Transition from Military to Civilian Life and Approaches to Reconnection

Need for Recovery and Work-Family Conflict in the Armed Forces: A Latent Profile Analysis of Job Demands and Resources

Building on the Job Demands-Resources model, this study aims to investigate the interaction between job characteristics and work-related stress indicators in a sample of 211 Italian Armed Forces personnel. Using Latent Profile Analysis (LPA), three distinct profiles emerged based on job demands (workload and perception of performing high-risk work) and resources (relationships with colleagues and supervisors, perceived meaningfulness of work, and feedback received on quality of work). The first profile, characterized by high demands and low resources, was associated with higher levels of work-family conflict and need for recovery (an indicator of perceived fatigue at the end of the workday). The second profile, characterized by high resources and low demands, showed the lowest levels of both need for recovery and work-family conflict, while the third profile showed average scores on demands, resources, and outcome variables. These findings are in line with the chosen theoretical framework and prompt several reflections on work-related well-being in the armed forces and what can promote it. Stemming from the results is the importance of organizational interventions designed to protect employees' well-being and support their effective functioning. Such interventions are particularly critical within the armed forces context, where operational performance has a direct impact on the safety and well-being of citizens.

Preliminary validation of the Barriers to Employment and Coping Efficacy Scales for Veterans with a mental health condition (BECES-V) - assessing barriers and self-efficacy to returning to work

PURPOSE

Released Veterans with mental health conditions are three times more likely than civilians to experience limitations in work reintegration. Various tools have been developed to assess barriers impacting the return-to-work (RTW) process for Veterans transitioning to civilian life. The Barriers to Employment and Coping Efficacy Scales for Veterans (BECES-V) was designed to assess perceived barriers and self-efficacy among Veterans as they reintegrate the workplace following a prolonged absence.

METHODS

This study offers a preliminary validation of the BECES-V tool, specifically investigating: the dimensions of RTW obstacles while considering the literature and employing concept mapping procedure, the salient RTW obstacles experienced by Veterans with mental health conditions transitioning from military to civilian workplaces in Canada and the USA, and the strongest dimensions of RTW obstacles and self-efficacy, using logistic regression analyses. The study involved 92 Veterans who completed the BECES-V.

RESULTS

Health-related limitations and adaptability difficulties were salient in both countries; self-efficacy to overcome work-life balance difficulties, as well as mental health and military stigmatization, emerged as the strongest predictors of RTW. Utilizing BECES-V may help identify Veterans at increased risk for prolonged RTW, allowing rehabilitation professionals to address individualized obstacles and self-efficacy for successful RTW.

Camaraderie Among US Veterans and Their Preferences for Health Care Systems and Practitioners

Importance

Unlike convenience, cost, and quality, camaraderie with other similar patients has not been reported as a prominent patient consideration when choosing a health care system or practitioner. As the Veterans Affairs (VA) Health System expands choice of practitioners for its enrollees, it is important to identify ways to promote veteran camaraderie in community care settings.

Objective

To determine whether camaraderie with other veterans is important to veterans using the VA Health System.

Design, Setting, and Participants

In 2019, a web-based survey was administered to veterans who reported using VA health care. The survey included questions about cultural factors, such as camaraderie, practitioners' understanding of veterans, trust of VA caregivers, and a scenario-based question to ascertain whether veterans would choose VA or private health care if cost and distance were equivalent. Data analysis was performed from November 2024 to January 2025.

Exposure

Using the VA health care system.

Main Outcomes and Measures

The primary outcome was the importance of camaraderie in selecting a health care system or practitioner, measured as the percentage of veterans who reported positive ratings on relevant survey items.

Results

In this survey study of 652 veterans, the majority were male (486 veterans [74.54%]). Respondents were categorized into 3 age groups: 18 to 34 years (246 veterans [37.73%]), 35 to 64 years (320 veterans [49.08%]), and 65 years and older (86 veterans [13.19%]). In total, 52.41% of respondents rated camaraderie and being around other veterans as important; this increased to 75.88% among veterans aged 18 to 34 years and to 65.35% for those aged 35 to 64 years. For those aged 65 years and older, only 35.75% felt it was important. When asked whether they would choose VA or a private sector health system if cost and travel distance were equal, 69.00% of respondents indicated they would choose VA. The risk-adjusted model demonstrated those who valued being around veterans at VA were 2.24 times more likely (95% CI, 1.81-2.77) to choose VA.

Conclusions and Relevance

In this survey study of 652 veterans, camaraderie was important to most of these VA Health System users, especially younger veterans. As VA provides more choice of practitioners to its enrollees, it will be important to consider ways to preserve veterans' ability to affiliate with other veterans in community care settings, especially for younger veterans who are often challenged in transitioning from military service to civilian life.

Returning home from a full-scale armed conflict: A rapid review of short post-deployment psychological practices

After a full-scale armed conflict, tens of thousands of service members, including professional warfighters and reservists, return home facing an increased risk of PTSD and other mental disorders, as well as various reintegration difficulties that can impact their well-being, social relationships, and quality of life. Numerous countries and armed forces have developed post-deployment adaptation programs (PDAPs) and interventions to mitigate these risks. A rapid review was conducted to synthesize the research literature on rapid and short-term psychological support practices during the post-deployment homecoming phase of a full-scale armed conflict. The aim was to identify practices with scientific support when the homecoming phase is limited to a maximum of three days and that could be offered on a scalable basis to all returning service members. Several PDAPs and interventions were identified. The role of psychoeducation, help-seeking, and social support as other supportive practices was also assessed, suggesting possible interventions and online measures to increase these behaviors in the homecoming population.

A systematic review of military-to-civilian transition, The role of gender

BACKGROUND

The military-to-civilian transition can be a challenging period for many service members; however, recent research suggests that female ex-service personnel (veterans) confront additional complexities during reintegration into civilian life. This systematic review aimed to identify and synthesise findings across qualitative studies exploring the impact of gender on this transition process.

METHODS

Peer-reviewed literature was drawn from a multi-database search, limited to qualitative studies. The studies included either female veterans or both male and female veterans aged 18 years or older who had previously served in the Armed Forces within the Five Eyes (FVEY) countries (Australia, Canada, New Zealand, the United Kingdom, and the United States). We used a Framework Analysis approach to guide the synthesis of the qualitative data. An assessment of study quality was conducted using the Joanna Briggs Institute (JBI) Qualitative Critical Appraisal Checklist for Qualitative Studies. The study protocol is registered with the Open Science Framework (registration: osf.io/5stuj).

RESULTS

In total, 10,113 articles were screened after the removal of duplicates, 161 underwent full-text review, with 19 meeting the eligibility criteria. The review identified eleven themes split across individual's experience whilst serving and after transitioning out of the military service. Both male and female veterans discussed a period of acculturation when they joined service and adapted to military norms, culture and identity. Female veterans faced additional challenges at this stage centred on the conflict between feminine norms and the military masculine ideal. Upon leaving service both male and female veterans experienced a loss of military identity and purpose, and dissonance with civilian norms illustrating a military-civilian divide. For female veterans, adjustments and adaptations learned in the military clashed with civilian feminine norms and stereotypically male veteran culture. Female veterans also struggled with the legacies of gender inequality, discrimination, and sexual assault which affected their development of a female veteran identity and affected the provision of services designed to meet their needs as a female. Despite these challenges, female veterans' expressed pride in their service and accomplishments.

CONCLUSIONS

Any effort to improve the military-to-civilian transition should take account of the legacy of gender discrimination, especially within the military service, and the potential mismatch between historical civilian female norms and the more traditionally masculine norms of military life.

DISCLOSURES

This project was supported by a grant from the Forces in Mind Trust (FiMT) 2202.

Structure in transition: The role of structure in facilitating workplace efficacy and belonging for military veterans and civilians

Employment transitions necessitate a degree of uncertainty and lack of control, which may present a challenge to succeeding and belonging at a new organization. The present research tests ideas derived from compensatory control theory which posits that people may seek external structure to help exert control over their lives when they experience a lack of control in an important life domain - and that this can aid in their goal pursuit. Across three studies, we explore whether the perception of a higher degree of organizational structure can help employees compensate for uncertainty and lack of control and facilitate transitioning employees' occupation self-efficacy and sense of belonging in a new work environment. This research focuses on military veterans, who face significant challenges during their separation from military service and transition to civilian employment, as an exemplar of the people experiencing employment transitions more generally, and compares them (in two studies) with civilian participants. Across three studies, two using simple correlational methods, one using an experimental methodology with veterans and civilians, we find consistent evidence that when transitioning employees perceive greater structure at their organization, this facilitates increased feelings of occupational self-efficacy which, in turn, promotes greater feelings of belonging at work. When people perceive greater structure in their environment, people feel more efficacious and a greater sense that they belong at work. The results are discussed in the context of compensatory control theory, addressing the challenges of transitioning employees, and in particular, transitioning military veterans.

Contextual predictors of belongingness in military and veteran students on university campuses

Objective: Prior research demonstrated that military/veteran students report lower belongingness than civilian students, but the reasons why remain unclear. We investigated the impact of demographic characteristics, state and local politics, and school-specific veteran resources on reported belongingness. Participants: Participants included 104,162 students (2,814 military/veteran) who completed a survey for the Healthy Minds Study between 2014 and 2018. Methods: A combined mixed effect model and models stratified by military status to determine differences in belongingness between military/veteran students and civilian students. Results: Unadjusted models indicated military/veteran students reported lower belongingness than civilian students (b = -0.10, p < . 001). However, adjusting for demographic characteristics and state and school attributes reduced this effect (b = -0.04, p = .001). Conclusion: We were able to demonstrate that military/veteran students' reduced belongingness is largely due to the demographic differences among military/veteran students rather than aspects of the school or political leanings.

Courage, camaraderie and compassion: a qualitative exploration into UK military veterans' experiences of self-compassion within the context of alcohol use disorders and recovery

INTRODUCTION

UK veterans are at increased risk of mental health and alcohol use disorders (AUDs), experiencing specific challenges such as combat exposure and re-integration which may contribute to treatment barriers. Experiences of shame and AUDs, which may precede or become exacerbated during military service, may be mitigated by self-compassion (SC). This study sought to understand how UK veterans make sense of their SC experiences within the context of their relationships with alcohol and recovery.

METHODS

Interpretative phenomenological analysis was used to interpret the SC experiences of five ex-military veterans (one female). Semistructured face-to-face interviews were audio-recorded and transcribed verbatim, with a double hermeneutic approach used to interpret meaningful issues which influenced participants' self-perceptions in relation to their alcohol use and wider social world.

RESULTS

Two key themes were identified. 'Searching for Safety', which illustrated veterans' SC sense-making within the context of their evolving lifeworld and alcohol use, and 'Healing with Honour' which reflected the significance of purpose and identity within experiences of recovery and SC. Findings were interpreted through the lens of the six bipolar elements of SC, which identified SC as salient within veterans' experiences of AUD and recovery. Although experiences of SC were sometimes perceived as challenging or incongruent to military identity, this was influenced by positive reframing and meaning-making, supported by compassionate narratives and informed trusted relationships.

CONCLUSIONS

Veterans' AUD recovery and support-seeking may be impacted by the experience of SC and enhanced by the early implementation of acceptable and feasible interventions which draw on veterans' unique military identities and experience. This may include compassion-focussed interventions which reframe SC as fierce SC, peer support models and educational strategies which support healthcare professionals to understand and identify veterans' military experiences.

Use of Go-Beyond as a Self-Directed Internet-Based Program Supporting Veterans' Transition to Civilian Life: Preliminary Usability Study

BACKGROUND

The transition from military service to civilian life presents a variety of challenges for veterans, influenced by individual factors such as premilitary life, length of service, and deployment history. Mental health issues, physical injuries, difficulties in relationships, and identity loss compound the reintegration process. To address these challenges, various face-to-face and internet-based programs are available yet underused. This paper presents the preliminary evaluation of "Go-Beyond, Navigating Life Beyond Service," an internet-based psychoeducational program for veterans.

OBJECTIVE

The study aims to identify the reach, adoption, and engagement with the program and to generate future recommendations to enhance its overall impact.

METHODS

This study exclusively used data that were automatically and routinely collected from the start of the Go-Beyond program's launch on May 24, 2021, until May 7, 2023. When accessing the Go-Beyond website, veterans were asked to complete the Military-Civilian Adjustment and Reintegration Measure (M-CARM) questionnaire, which produces a unique M-CARM profile of results specifying potential areas of need on the 5 domains of the measure. Users were then automatically allocated to Go-Beyond modules that aligned with their M-CARM profile. Additionally, quantitative and qualitative data were collected from a survey on aesthetics, interactivity, user journey, and user experience, which was optional for users to complete at the end of each module.

RESULTS

Results show a conversion rate of 28.5% (273/959) from the M-CARM survey to the Go-Beyond program. This rate is notably higher compared with similar internet-based self-help programs, such as VetChange (1033/22,087, 4.7%) and resources for gambling behavior (5652/8083, 14%), but lower than the MoodGYM program (82,159/194,840, 42.2%). However, these comparisons should be interpreted with caution due to the limited availability of published conversion rates and varying definitions of uptake and adoption across studies. Additionally, individuals were 1.64 (95% CI 1.17-2.28) more likely to enroll when they express a need in Purpose and Connection, and they were 1.50 (95% CI 1.06-2.18) times more likely to enroll when they express the need Beliefs About Civilians, compared with those without these needs. The overall completion rate for the program was 31% (85/273) and modules' individual completion rates varied from 8.4% (17/203) to 20% (41/206). Feedback survey revealed high overall user satisfaction with Go-Beyond, emphasizing its engaging content and user-friendly modules. Notably, 94% (88/94) of survey respondents indicated they would recommend the program to other veterans, family, or friends.

CONCLUSIONS

The Go-Beyond program may offer promising support for veterans transitioning to civilian life through digital technology. Our study reveals insights on user engagement and adoption, emphasizing the need for ongoing evaluation to further address the diverse needs of military personnel. Future research should explore predictors of engagement, the addition of peer or facilitator support, and the use of outcome measures for effectiveness assessment.

The civil employment experiences of amputee veterans: The case of Turkey

Military veterans who became disabled due to conflict-related trauma face various challenges in finding and maintaining employment in civilian life. This study aims to understand the transition processes of disabled veterans in Turkey into civilian employment, as well as their experiences in maintaining and sustaining employment during this process. A qualitative research design was used in the study. Data were collected through in-depth interviews with 24 amputee veterans. The most commonly reported issues were placement in unsuitable jobs, lack of civilian work experience, differences between military and civilian cultures, and biases. Many veterans struggle to integrate into civilian work life.

Scoping review of veterans' disclosure of mental health concerns or medical conditions in the workplace and other settings: study protocol

INTRODUCTION

Veterans deal with 'unobservable' medical or mental health conditions, such as post-traumatic stress disorder, at higher rates than the general population. Disclosure of such conditions is important to provide social, emotional, medical and mental health support, but veterans may face challenges when deciding whether to disclose conditions, including fear of stigma or discrimination. Safe disclosure in the workplace is particularly important, as it allows employees to gain accommodations and enables employers to manage workplace health and safety effectively. The objective of this study is to investigate the state of the literature on veterans' disclosure of mental health concerns or medical conditions and identify how it has been studied in the workplace context.

METHODS AND ANALYSIS

To conduct the scoping review, several databases will be searched between 10 November 2023 and September 2024 including PubMed, Scopus, Embase, Web of Science, PsycInfo, CINAHL and Cochrane Library, as well as theses databases. Sources will be uploaded to Covidence where two investigators will independently conduct title/abstract and full-text screening, with any conflicts resolved to consensus via discussion with a third investigator. Studies will be included if they are empirical, original research, focused on veterans and disclosure of mental health concerns or medical conditions and written in English. After inclusion, study information will be extracted including key findings about contexts, correlates, processes and outcomes of disclosure in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

ETHICS AND DISSEMINATION

The scoping review will provide insight into the state of the literature on veterans' disclosure of mental health or medical conditions, particularly in the workplace. Ethical approval is not required as the scoping review will be informed by publicly available data. Findings may be shared through journal articles or conference presentations, and recommendations will be provided to inform future research aimed at improving disclosure processes and outcomes. The scoping review has been pre-registered (https://osf.io/uxrjp).

Later-life social network profiles of male war survivors in Vietnam: Implications for health behaviors

Emerging research emphasizes early-life war exposure as a key determinant of later-life health in older adults from low- and middle-income countries (LMICs). Yet, the linkages between war exposure, social networks, and later-life health behaviors have received little attention. Using data from the 2018 Vietnam Health and Aging Study, we investigate how early-life war experiences relate to the social networks and health behaviors of 1195 Vietnamese men aged 60+ who survived the Vietnam War (1965-1975). We utilize latent class analysis to identify men's network types and examine the associations between military service, war trauma, PTSD, and later-life network profiles. Furthermore, we assess the linkages between war experiences and risky health behaviors (physical inactivity, frequent alcohol and tobacco consumption) and the moderating effect of social networks on these behaviors. Our findings reveal that exposure to wartime malevolent living conditions, as opposed to direct war violence, and recent PTSD symptoms are linked to lower support levels in respondents' network profiles. Moreover, although diverse and supportive networks correspond to a reduced risk of physical inactivity, they are associated with higher risks of frequent alcohol consumption and are marginally associated with tobacco use. Importantly, social network profiles moderate the relationship between PTSD symptoms and the risk of frequent alcohol consumption. This evidence underscores the need for policymakers to consider the historical and social contexts of LMICs when deploying social support as a health intervention.

Military to civilian cultural transition experiences of retired military personnel: A systematic meta-synthesis

Military organizations often demonstrate contrasting features compared to civilian ones, including indoctrination of military identity and mind-set. Therefore, on returning after retirement, military personnel undergo acculturation to reconnect to the civilian world. Many military retirees face difficulty readjusting in multiple professional and personal life domains, and report decreased life satisfaction due to this transition. The present review conducted a thematic meta-synthesis of 28 studies that had qualitatively assessed military to civilian transition experiences. The aim was to understand the military-civilian culture gap and identify the challenges faced during this transition. The analysis led to six themes - "Military Institutionalization, Military-Civilian Cultural Contrast, The Three S's of Transition Challenges - Stereotypes, Skills, and Support, The Losses of Identity, Reconnecting with Family, Friends, and Civilian Counterparts, and Facilitators in Transition - Covering the Military-Civilian Gap." Based on these findings, the review further presents possible intervention suggestions for retirement adjustment and future research direction.

Impact of life-threatening military incidents during deployments abroad on the relationships between military personnel and their families

Introduction

The influence of deployments on family relationships has hardly been investigated. Following a recently proposed new research strategy, military personnel with and without deployment-related life-threatening military incidents during deployment were compared. The hypothesis was that partner and family relationships of military personnel who experienced such an event would deteriorate more.

Methods

This study included N = 255 military personnel who had a romantic partner (n = 78 of them had children) when deployed to Afghanistan. Of these, n = 68 military personnel experienced a deployment-related critical event during the deployment, n = 187 did not. Partnership quality was assessed using a semi-structured pre- and post-deployment interview.

Results

The partner relationships of military personnel who experienced a deployment-related life-threatening military incident during deployment broke up significantly more often. The partner relationships of all military personnel deteriorated significantly, with greater deterioration after deployment in the group who faced such incidents. These results were independent of age, rank or number of previous deployments. In addition, there was a significant deterioration in the relationships between all military personnel and their children with greater deterioration after deployment in the group who faced such incidents.

Conclusion

Life-threatening military incidents during a deployment abroad appear to have a considerable influence on the quality and stability of the partner and family relationships of military personnel. These findings can be used to inform the development of specific pre- and post-deployment measures and training.

STEP-Home transdiagnostic group reintegration workshop to improve mental health outcomes for post-9/11 Veterans: Design, methods, and rationale for a randomized controlled behavioral trial

BACKGROUND

Many post-9/11 U.S. combat Veterans experience difficulty readjusting to civilian life after military service, including relationship problems, reduced work productivity, substance misuse, and increased anger control problems. Mental health problems are frequently cited as causing these difficulties, driven by unparalleled rates of mild traumatic brain injury, posttraumatic stress, and other co-occurring emotional and physical conditions. Given the high prevalence of multimorbidity in this cohort, acceptable, non-stigmatizing, transdiagnostic interventions targeting reintegration are needed. The STEP-Home reintegration workshop has the potential to significantly improve skills to foster civilian reintegration, increase engagement in VA services, and improve mental health outcomes in Veterans with and without diagnosed clinical conditions.

METHODS/DESIGN

Ongoing from 2019, a prospective, two-site, randomized trial of 206 post-9/11 U.S. military Veterans randomized to receive either 12 sessions of the STEP-Home transdiagnostic reintegration workshop (SH; Active Intervention) or Present Centered Reintegration Group Therapy (PCRGT; Active Control Intervention). Primary outcomes are reintegration, anger, and emotional regulation post-intervention and at 3-months post-intervention. Secondary outcomes include measures of mental health, functional and vocational status, and cognition.

CONCLUSION

This study addresses an important gap in transdiagnostic interventions to improve civilian reintegration in post-9/11 Veterans. STEP-Home is designed to promote treatment engagement and retention, opening the door to critically needed VA care, and ultimately reducing long-term healthcare burden of untreated mental health illness in U.S. Veterans.

TRIAL REGISTRATION

Clinicaltrials.gov: D2907-R.

A qualitative study of military service members undergoing medical separation

OBJECTIVE

Little research explores military perspectives on medical disability-related transition. A qualitative study sought to understand transition experiences of United States military Service members found unfit for duty following medical and physical evaluation boards (MEBs and PEBs).

METHODS

Confidential telephone interviews were conducted with 25 current and prior Service members. Participants were asked to share their experiences before, during, and after the MEB and PEB processes. Interview questions explored (1) health conditions that prompted the medical disability evaluation, (2) reactions to being recommended for separation, (3) transition-related stress and challenges, and (4) coping strategies. Salient themes were identified across chronological narratives.

RESULTS

Participants expressed that debilitating physical (e.g., injury) and/or mental (e.g., post-traumatic stress disorder) illnesses prompted their medical evaluation. In response to the unfit for duty notice, some participants reported emotional distress (e.g., anxiety, anger) connected to uncertainty about the future. Other participants reported relief connected to a sense of progression toward their medical disability claim status. Transition stress included the length of the MEB/PEB process, impact of the COVID-19 pandemic on the process, financial stress, impact on family life, and compounded effect of these stressors on emotional distress, including depression and suicidal thoughts. Participants reported using adaptive (e.g., psychotherapy) and maladaptive (e.g., excessive drinking) strategies to cope with stress.

CONCLUSION

Preliminary reports of emotional distress and transition stress following unfit for duty notices highlight the need for increased support and interventions to facilitate adaptive coping strategies during this vulnerable period.

No Women's Land: Australian Women Veterans' Experiences of the Culture of Military Service and Transition

Women's experiences of military service and transition occur within a highly dominant masculinized culture. The vast majority of research on military veterans reflects men's experiences and needs. Women veterans' experiences, and therefore their transition support needs, are largely invisible. This study sought to understand the role and impact of gender in the context of the dominant masculinized culture on women veterans' experiences of military service and transition to civilian life. In-depth qualitative interviews with 22 Australian women veterans elicited four themes: (1) Fitting in a managing identity with the military; (2) Gender-based challenges in conforming to a masculinized culture-proving worthiness, assimilation, and survival strategies within that culture; (3) Women are valued less than men-consequences for women veterans, including misogyny, sexual harassment and assault, and system failures to recognize women's specific health needs and role as mothers; and (4) Separation and transition: being invisible as a woman veteran in the civilian world. Gendered military experiences can have long-term negative impacts on women veterans' mental and physical health, relationships, and identity due to a pervasive masculinized culture in which they remain largely invisible. This can create significant gender-based barriers to services and support for women veterans during their service, and it can also impede their transition support needs.

Transition Needs Among Veterans Living With Chronic Pain: A Systematic Review

INTRODUCTION

A third of Canadian Armed Forces veterans report difficulty adjusting to post-military life. Moreover, an estimated 40% of Canadian veterans live with chronic pain, which is likely associated with greater needs during the transition from military to civilian life. This review explores challenges and transition needs among military personnel living with chronic pain as they return to civilian life.

METHODS

We searched MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science from inception to July 2022, for qualitative, observational, and mixed-method studies exploring transition needs among military veterans released with chronic pain. Reviewers, working independently and in duplicate, conducted screening and used a standardized and pilot-tested data collection form to extract data from all included studies. Content analysis was used to create a coding template to identify patterns in challenges and unmet needs of veterans transitioning to civilian life, and we summarized our findings in a descriptive manner.

RESULTS

Of 10,532 unique citations, we identified 43 studies that reported transition challenges and needs of military personnel; however, none were specific to individuals released with chronic pain. Most studies (41 of 43; 95%) focused on military personnel in general, with one study enrolling individuals with traumatic brain injury and another including homeless veterans. We identified military-to-civilian challenges in seven areas: (1) identity, (2) interpersonal interactions/relationships, (3) employment, (4) education, (5) finances, (6) self-care and mental health, and (7) accessing services and care.

CONCLUSIONS

Military personnel who transition to civilian life report several important challenges; however, the generalizability to individuals released with chronic pain is uncertain. Further research is needed to better understand the transition experiences of veterans with chronic pain to best address their needs and enhance their well-being.

Veteran Cultural Competence Training: Initial Effectiveness and National-Level Implementation

OBJECTIVE

Because service professionals often lack cultural competence in working with veterans, veterans often perceive such professionals as "not understanding." The authors developed, evaluated, and implemented Veteran Cultural Competence Training (VCCT), combining educational and experiential components in an in-person training focused on building awareness, knowledge, and skills to better work with veterans.

METHODS

Study 1 was a type 1 effectiveness-implementation hybrid trial examining VCCT effectiveness in a sample of social service professionals (N=41) compared with a matched comparison group (N=41) via the Multicultural Counseling Self-Efficacy Scale-Veteran Form (MCSE-V) instrument. In study 2, the authors used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to conduct a type 2 effectiveness-implementation hybrid trial and implemented VCCT with an expanded population (N=312) during eight training sessions in three U.S. states.

RESULTS

Results from study 1 indicated that VCCT significantly increased self-efficacy of trainees in veteran cultural competence compared with the matched group (p<0.001). In study 2, the RE-AIM framework highlighted the importance of building coalitions and utilizing implementation facilitation to maintain fidelity. The within-group effectiveness of VCCT was statistically significant and maintained across settings and professions (p<0.001), and trainees were satisfied with VCCT. Maintenance analysis revealed expansion of VCCT after implementation in terms of the number of training sessions (N=9), regions hosting the training (N=5), staff hired (N=13), and trainee applications (N=1,018).

CONCLUSIONS

VCCT effectively increases self-efficacy in veteran cultural competence. Gains appeared across different professions, demographic characteristics, and locations. Participation in VCCT may increase professionals' competence in understanding veteran culture, thereby potentially improving veteran services.

Directional associations between posttraumatic stress disorder symptoms and cannabis use in young adults: Uncovering variation by sex, race, and ethnicity

OBJECTIVE

Prevalence rates of cannabis use and PTSD vary, with men reporting greater cannabis use than females, females reporting higher rates of PTSD than males, and race and ethnic minority persons reporting higher rates of both cannabis and PTSD compared to non-Hispanic White individuals. This study extends our understanding of directional associations between cannabis use and PTSD from early to late young adulthood (18-26 years old) using two theoretical models: symptom-driven pathway and substance-induced pathway.

METHOD

Participants provided yearly data for 14 years, and the present study utilized data from Waves 9 through 14. Those endorsing Criterion A in at least one wave of data collection (n = 1,454) were included in the analytic sample. We used autoregressive latent trajectory with structured residuals to understand reciprocal associations for the full sample, as well as by sex and race or ethnicity.

RESULTS

For the full sample, we noted support for both symptom-driven and substance-induced pathways during early young adulthood (18-20) but only support for a symptom-driven pathway during late young adulthood (21-26). Males showed the same pattern as the full sample; however, for females, only a symptom-driven pathway during late young adulthood was found. For race and ethnic minority participants, we showed full cross-lagged effects during both early and late young adulthood and no associations for non-Hispanic White individuals.

CONCLUSIONS

Results indicate that both men and individuals from minoritized racial and ethnic groups are more likely to report heightened PTSD symptomology, maladaptive coping, and worsening symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evidence-based treatment for posttraumatic stress disorder decreases suicidal ideation by reducing perceived burdensomeness among veterans in an outpatient program

Evidenced-based posttraumatic stress disorder (PTSD) treatments generally reduce suicidal ideation (SI), and the interpersonal theory of suicide (ITS) may theoretically account for this finding. The ITS posits that SI stems from feeling like a burden (i.e., perceived burdensomeness) and a lack of belonging (i.e., thwarted belongingness). Previous research suggests that change in PTSD severity has a significant indirect effect on change in SI through changes in perceived burdensomeness, but not thwarted belongingness, among patients receiving residential PTSD treatment in a Veterans Affairs (VA) medical center; however, no research has investigated these associations in an outpatient VA setting with fewer confounding factors that might affect ITS constructs. Therefore, the current sample included veterans (N = 126) who completed PTSD treatment and pre- and posttreatment assessments in a VA outpatient clinic. Results from parallel models of multiple indirect effects suggest that change in PTSD severity was indirectly associated with change in SI through changes in perceived burdensomeness, B = 0.35, p < .001; β = .36, p < .001, SE = .10, 95% CI [.15, .54], but not thwarted belongingness, B = 0.14, p = .146; β = .14, p = .161, SE = .10, 95% CI [-.05, .33]. Additional models were examined using PTSD cluster scores for exploratory purposes. The results indicate that PTSD treatment reduces the perceived and objective burden of PTSD to decrease SI. Study findings support the importance of access to evidence-based care to treat PTSD and alleviate burdensomeness for suicide prevention.

Examination of the relationship between post-traumatic growth and social support and life satisfaction in wounded veterans in Turkey

AIM

This study aims to examine the effects of social support and life satisfaction on post-traumatic growth in wounded veterans in Turkey.

METHODS

1175 wounded veterans participated in the cross-sectional study. The sociodemographic questionnaire, the Post-Traumatic Growth Inventory, the Multidimensional Scale of Perceived Social Support, and the Satisfaction with Life Scale were used to collect data. Data were analyzed via SPSS.

RESULTS

The results of the study show that the mean age is 43.04 ± 7.36. The participants are low in education and socioeconomic level. The mean of the Post-Traumatic Growth Inventory score is 43.44 ± 21.18, the mean of the Multidimensional Scale of Perceived Social Support score is 50.01 ± 15.23, and the mean of the Satisfaction With Life Scale score is 9.86 ± 4.04. The results of the study show that there is a positive relationship between social support and life satisfaction and post-traumatic growth.

CONCLUSION

It can be suggested to develop psychosocial intervention strategies and service delivery systems to promote the life satisfaction, social support mechanisms of wounded veterans.

The transition to civilian life: Impact of comorbid PTSD, chronic pain, and sleep disturbance on veterans' social functioning and suicidal ideation

OBJECTIVE

Trauma-exposed veterans may be more likely to experience posttraumatic stress disorder (PTSD), chronic pain, and sleep disturbance together rather than in isolation. Although these conditions are independently associated with distress and impairment, how they relate to social functioning and suicidal ideation (SI) when experienced comorbidly is not clear.

METHOD

Using longitudinal data on 5,461 trauma-exposed U.S. veterans from The Veterans Metrics Initiative study and self-reported disorders, we assessed (a) the extent to which PTSD co-occurs with sleep disturbance and chronic pain (CP); (b) the relationship of PTSD in conjunction with sleep disturbance and chronic pain with later social functioning and SI; and (c) the extent to which social functioning mediates the impact of multimorbidity on SI.

RESULTS

At approximately 15 months postseparation, 90.5% of veterans with probable PTSD also reported sleep disturbance and/or CP. Relative to veterans without probable PTSD, veterans with all 3 conditions (n = 907) experienced the poorest social functioning (B = -.56, p < .001) and had greater risk for SI (OR = 3.78, p < .001); Social functioning partially mediated the relationship between multimorbidity and SI. However, relative to those with PTSD alone, sleep disturbance and CP did not confer greater risk for SI.

CONCLUSIONS

Although these findings underscore the impact of PTSD on functioning and SI, they also highlight the complexity of multimorbidity and the importance of bolstering social functioning for veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perspectives of homeless veterans living with substance use disorders (SUD) and mental illness

Upon returning home from the military, America's veterans face complex challenges such as homelessness and substance use disorders (SUD). Veterans who have experienced SUDs and homelessness are more likely to struggle with depression and suicidal behaviors. This study aims to understand homeless veterans' lived experiences of their everyday life and social interactions. We used semi-structured interviews to conduct a phenomenological study of 14 homeless veterans with known SUDs living in the Baltimore-Washington D.C. Metropolitan area. A Social-Ecological Model (SEM) was used to create themes, a priori, then used open coding analytic methods to identify emerging themes. Two-thirds of veterans used illicit drugs or abused alcohol, and nearly all reported a history of depression or anxiety. Suicidal behaviors were present in a third of all veterans. We found that veteran homelessness and substance use are strongly associated with emotional and physical trauma suffered while on active duty. Consequently, once homeless, a veteran's community may encourage and exacerbate SUDs, thus impeding a path toward sobriety. Homeless veterans who have struggled with SUDs and later experience a death in their family often relapse to substance use. Deeply exploring a veteran's relationships with family, friends, and their immediate community may reveal opportunities to address these issues using healthcare and community interventions.

Service and demographic factors, health, trauma exposure, and participation are associated with adjustment for former Australian Defense Force members

Approximately 50% of transitioning service members report difficulty adjusting to civilian life. However, there is limited research exploring factors that influence adjustment for former Australian Defence Force (ADF) members. The aim of this study was to investigate the influence of demographic and service-related characteristics, trauma exposure, health, and participation in meaningful occupations on adjustment for former ADF members. One hundred and ninety-eight former ADF members completed a voluntary, online survey containing validated self-report measures for adjustment, health, and exposure to combat and military sexual trauma. Participation in meaningful occupations was assessed using open-ended questions and a rating scale for frequency of participation. A more difficult adjustment was reported by participants who had completed operational service, reported exposure to combat and/or military sexual trauma, had poor physical health and were discharged for medical reasons. Other characteristics associated with a difficult adjustment included emotional distress, involuntary discharge, age category 30-49 years, final rank of Senior Noncommissioned Officer/Warrant Officer or below, and discharge 6-8 years previously. Employment, voluntary work and care, and social and community interaction were associated with an easier adjustment. Screening tools that consider health, age, deployment type, final rank, type of discharge and exposure to combat or military sexual trauma may be helpful to identify and refer high risk individuals to employment, rehabilitation or transition support programs.

Supporting servicemembers and veterans during their transition to civilian life using certified sponsors: A three-arm randomized controlled trial

Transitioning servicemembers and veterans (TSMVs) face difficulties throughout their reintegration to civilian life, including challenges with employment, poor social connection, and elevated risk for suicide. To meet the needs of this high-risk population, national initiatives have leveraged community-based interventions. Authors conducted a three-arm randomized controlled trial (n = 200) to evaluate two community-based interventions. The first, Team Red, White, and Blue (RWB), connects TSMVs to their community through physical/social activities. The second, Expiration Term of Service Sponsorship Program (ETS-SP) provides one-on-one certified sponsors to TSMVs who provide support during the reintegration process. TSMVs were assessed at baseline, 3, 6, and 12 months. The primary hypothesis was not supported as reintegration difficulties and social support were not significantly different for participants randomly assigned to the two community-based interventions (Arm-2/RWB and Arm-3/RWB + ETS-SP), when the data from the separate arms were collapsed and combined, compared to the waitlist. The results did support the secondary hypothesis as Arm-3/RWB + ETS-SP had less reintegration difficulties over 12 months and initially had more social support compared to Arm-2/RWB, which suggest that augmenting interventions with sponsors outperforms participation in community-based interventions alone. Overall, the results show some limitations of the studied community-based interventions, as implemented and researched within this study. The authors identified factors that may have contributed to the null findings for the primary hypothesis, which can be addressed in future studies, such as addressing the unique needs of TSMVs, enrolling TSMVs into interventions prior to military discharge, measuring and improving participation levels, and providing stepped-care interventions based on risk levels. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Contribution of veterans' initial post-separation vocational, financial, and social experiences to their suicidal ideation trajectories following military service

BACKGROUND

Veterans' success with navigating the challenges of transition from military service may contribute to their risk for suicidal outcomes. The concept of well-being can help to conceptualize and assess successful navigation of reintegration challenges and may serve as an optimal target for public health-oriented suicide prevention.

METHODS

The relationship between US veterans' psychosocial well-being and experiences of suicidal ideation (SI) during the first 3 years following military separation was evaluated using multinomial logistic regression predicting SI trajectories over time in a population-based, longitudinal, post-9/11 veteran cohort. At 3-months post-separation, veterans reported on their socio-material conditions, functioning, and satisfaction with respect to vocational, financial, and social domains. SI frequency was assessed at 3-, 9-, 15-, 21-, and 27-months post-separation using the Patient Health Questionnaire-9.

RESULTS

Veterans' vocational, financial, and social well-being were associated with their SI trajectories, even after accounting for mental health. Socio-material conditions, functioning, and satisfaction all emerged as important predictors of SI trajectories, although results varied across domains. Effects were largest for social well-being.

CONCLUSIONS

Suicide prevention efforts may benefit from a holistic approach that considers veterans' needs for support across their vocational, financial, and social well-being, inclusive of their socio-material conditions, functioning, and satisfaction within each domain.

Meaning(s) of transition(s) from military to civilian life at the intersection with mental health: implications for clinical settings

The experiences of military personnel moving into civilian life can be varied for the individual, families and communities. This paper aims to shed light on the various meanings of the multiple and "nested" transitions of military personnel to civilian life in the context of attending a mental health service in the UK. This was achieved through secondary analysis of semi-structured interviews with veterans who were engaging with a mental health service in the UK and a further interview with the mental health service lead. A thematic analysis was employed based on a descriptive phenomenological approach. Results indicate that an appropriate support infrastructure needs to be put in place for veterans prior to, during and after the transition to civilian life. The support appropriateness includes themes specific to connectedness to others, support service accessibility, mental health professionals' military culture awareness and mental health stigma. Although the findings suggest that community services need an awareness of veterans' specific needs, many of the themes are similar to those of the general population. Therefore, the need for an integrated healthcare system is essential in the transition of military service personnel to civilian life. Drawing on international evidence as well as the current findings, implications for policy and practice are highlighted throughout.

Prescription Opioid Misuse and Suicidal Behaviors Among US Veterans: A Cross-Sectional Study from the 2015-2019 National Survey on Drug Use and Health

Suicide continues to be a serious public health issue for the US veteran population as its prevalence has skyrocketed over the last 15 years. This cross-sectional study estimates the prevalence of suicidal behaviors and prescription opioid misuse among veterans and identifies associations between suicidal behaviors and misuse of prescription opioids using data from the National Survey on Drug Use and Health. The findings show that approximately 3.7% of all veterans in this sample experienced suicidal behaviors, while nearly 3.0% reported misusing prescription opioids. Veterans who misused prescription opioids had a much higher prevalence of suicidal behaviors (16.3%) than veterans who used prescription opioids without misuse (4.8%) and those who did not use prescription opioids at all (2.5%). Opioid misuse is strongly associated with suicidal behaviors among veterans. Immediate substance use and mental health screenings, upon first contact with a healthcare system, are imperative in preventing and reducing suicide rates within this vulnerable population.

Extreme sport as an intervention for physically injured military veterans: the example of competitive motorsport

PURPOSE

Physically or psychologically injured military veterans are motivated and benefited by physical activity or sport that may involve high levels of achievement. The aim of this study was to provide an in-depth insight into the impact of Competitive Motorsport (CM) on physically injured/disabled veterans' subjective well-being and in turn determine if it improves the quality of their lives.

METHODS

This is a qualitative study. Two sets of semi-structured interviews were conducted with 14 male British military veterans including a 6-month follow-up. All participants were subjected to a permanent, moderate or severe, physical injury/disability. Data were analysed in accordance with the principles of Thematic Analysis.

RESULTS/CONCLUSIONS

Five key elements (familiar environment, team spirit, adrenaline rush, competition and equality) made CM a unique experience for physically injured/disabled veterans. Various psychological and physical benefits were found, including an increased sense of accomplishment, opportunity to socialise in a non-clinical environment, embracement of body image and adoption of a healthier lifestyle. Since physical activity and sport are among growing research on alternative interventions for military veterans, they deserve serious consideration as part of the treatment regimens and rehabilitation programmes to improve physically inured/disabled veterans' physical and mental health.Implications for RehabilitationCompetitive Motorsport is an effective means of improving physical health and subjective well-being of physically injured/disabled military veterans.Multiple perceived psychological and physical benefits were identified over time, including motivation for living, embracement of body image and adoption of a healthier lifestyle.Competitive Motorsport deserves consideration as part of the treatment regimens and rehabilitation programmes to improve physically injured/disabled veterans' physical and mental health while facilitating transition to civilian life.

Social identity and the mental health and wellbeing of male veterans

BACKGROUND

Previous work has linked disruptions in one's social identity to increased levels of depression and suicide among veterans. This study examines the relationship between veteran social identity (as measured by the public and private regard subscales of the Warrior Identity Scale) and mental health and wellbeing among male veterans.

PARTICIPANTS AND PROCEDURE

Male veterans (N = 67) completed the Warrior Identity Scale as well as various measures of mental health and wellbeing.

RESULTS

The hypotheses were supported in that more positive views of one's social identity (i.e., more private regard) predicted significantly fewer post-traumatic stress disorder (PTSD) symptoms, less depression, suicidal ideation, anxiety, stress, and more perceived social support. More public regard, on the other hand, was related to more PTSD symptoms.

CONCLUSIONS

This research adds to the growing work on the importance of social identity (as measured by public and private regard) in predicting mental health symptomatology among male veterans, which may act as important risk factors in clinical settings.

Effects of Social Network Characteristics on Mental Health Outcomes Among United States Army Reserve and National Guard Soldiers

We sought to examine the relative salience of multiple social network structural characteristics (e.g., size, composition, quality, substance use) for understanding soldiers' mental health symptoms (anger, anxiety, depression, PTSD). Data are drawn from soldiers (N = 421) participating in the Operation: SAFETY study. Negative binomial regression models examined the relationship between ten social network characteristics and mental health outcomes, controlling for age, sex, years of military service, and deployment history. Greater number of close network ties was associated with fewer symptoms of anger, anxiety, and depression (ps < 0.05), but not PTSD. Having more illicit drug-using network ties was associated with greater severity of anxiety symptoms (p < 0.05). Finally, more days spent drinking with network members was related to higher levels of anger (p < 0.05). Interpersonal relationships that entail substance use are associated with greater anxiety and anger while a greater number of close ties is associated with fewer anger, anxiety, and depression symptoms.

Patient Sense of Belonging in the Veterans Health Administration: A Qualitative Study of Appointment Attendance and Patient Engagement

BACKGROUND

Health care systems have increasingly focused on patient engagement in efforts to improve patient-centered care. Appointment attendance is an integral component of patient engagement, and missed appointments are an ongoing problem for health care systems. Virtually no studies have examined how the sense of belonging is related to patient engagement within a health care system.

OBJECTIVE

To examine patient experiences in the Veterans Health Administration (VA) with outpatient appointment attendance to identify factors that affect sense of belonging and patient engagement.

RESEARCH DESIGN AND PARTICIPANTS

This study draws from qualitative data collected as part of a study to reduce missed appointments through use of enhanced appointment reminder letters. We conducted semistructured interviews with 27 VA patients with primary care or mental health clinic visits, using deductive and inductive analysis to develop themes. More than half of the participants were Vietnam veterans, 24 were over 40 years old, 21 were White, and 18 were men.

RESULTS

We identified 3 factors that influence sense of belonging within the VA: (1) feelings of camaraderie and commitment toward other veterans were relevant to patient experience in the VA; (2) interactions with all staff influenced the engagement a patient felt with a particular clinic, care team, and the VA; (3) personalized communication and messaging could humanize the VA and demonstrate its interest in engaging with veterans. Lastly, we found (4) sense of belonging appeared to promote appointment attendance and patient engagement.

CONCLUSIONS

There are multiple opportunities to strengthen patients' sense of belonging within the health care system that serves them. For veterans, strategies that build their sense of belonging may be a novel approach to increase appointment attendance and patient engagement in their health care.

Families serve too: military spouse well-being after separation from active-duty service

BACKGROUND AND OBJECTIVES

Transitioning from military to civilian life can be challenging for families, but most research focuses only on the service member. We applied a life course model to assess spouse well-being following this important transition.

DESIGN

Prospective, longitudinal survey of service members and their spouses.

METHODS

We captured three spouse well-being domains: psychological health, physical health, and family relationships. We identified differences between families who separated from service and those still affiliated (N = 4,087) and assessed baseline factors associated with spouse well-being after the family separated from service (N = 1,199).

RESULTS

Spouses of service members who had separated from the military (versus those who had not) reported poorer mental health and family relationship quality at baseline and follow-up. After controlling for baseline differences, spouses whose families transitioned experienced a greater increase in PTSD symptoms and a steeper decline in quality of marriage. Spouses of active-duty service members reported greater increases in work-family conflict. Among families who had transitioned, the most consistent predictor of positive outcomes was baseline well-being. Protective factors included having more psychological and social resources and less financial stress.

CONCLUSIONS

Several protective and risk factors identified in the study may inform programming for families transitioning from active duty.

Reculturation: A new perspective on military-civilian transition stress

Various forms of assistance are offered to help US Veterans achieve success in their post-military lives in recognition of their service. Despite the many successes, a significant number of Veterans continue to remain at risk for negative mental health outcomes, including suicidality and low levels of life satisfaction. These findings may be due to challenges arising from cultural identity dissonance. Problematic strategies used by Veterans to reduce this dissonance can result in a lack of belongingness, a key component in Joiner's Interpersonal Theory of Suicide. The authors suggest that research on the immigrant experience of acculturation may provide a new perspective to better understand issues of identity and sense of belonging in Veterans. Given that most Veterans return to the culture in which they grew up, the authors offer the term "reculturation." The authors propose clinical psychology focus on exploring the reculturation process of Veterans to support program engagement and suicide prevention.

Ex-military personnel's experiences of loneliness and social isolation from discharge, through transition, to the present day

OBJECTIVES

This study aimed to examine the unique factors of loneliness and social isolation within the ex-military population from discharge, through transition, to the present day.

DESIGN

A qualitative, Phenomenological approach was adopted.

METHODS

In-depth semi-structured interviews were carried out with 11 participants who had all served in the British Armed Forces and represented all three military services (Royal Navy; Army; Royal Air Force). Reflexive Thematic Analysis was used to analyse the data.

RESULTS

Three themes were generated-a sense of loss; difficulty in connecting in civilian life; and seeking out familiarity. The findings of this study were examined through the lenses of the Social Needs Approach and the Cognitive Discrepancy Model.

CONCLUSIONS

Individuals developed close bonds in the military through meaningful and prolonged contact, reducing feelings of loneliness and social isolation during their time in service. The sense of belonging was key to social connection, but transition out of the military severed existing relationships, and a lack of belonging hindered the development of relationships within the civilian community. This study has implications for service provision relating to ex-military personnel and future service leavers.

An evaluation of the veteran friendly practice accreditation programme

BACKGROUND

The Royal College of General Practitioners Veteran Friendly Practice Accreditation Programme launched in 2019, aiming to allow practices to better identify, treat and refer veterans, where appropriate, to dedicated NHS services.

AIM

Evaluate the effectiveness of the accreditation programme, focusing on benefits for the veteran, the practice and the delivery of the programme itself.

DESIGN & SETTING

The study evaluated the views of Veteran Friendly Accredited GP Practices across England.

METHOD

Mixed-methods study collecting data via an online survey from 232 accredited Primary Healthcare (PHC) staff and 15 semi-structured interviews with PHC Veteran Leads. Interviews were analysed using modified Grounded Theory.

RESULTS

99% (N=228) of respondents would recommend the programme, 77% (N=124) reported improved awareness and 84% (N=193) a better understanding of veteran's needs. 72% (N=166) identified benefits for veterans who were engaging more with PHC but participants felt more time was needed, largely due to the Covid-19 pandemic, to fully assess the impact of the programme on help-seeking behaviour. Challenges included identifying veterans already registered, promoting the accreditation process and ensuring all PHC staff were kept up to date with veteran issues.

CONCLUSIONS

The programme has increased signposting to veteran specific services and greater understanding of the NHS priority referral criteria for veterans. Recording of veteran status has improved and there was evidence of a better medical record coding system in PHC practices. These findings add to the limited empirical evidence exploring veteran engagement in PHC and demonstrate how accreditation results in better treatment and identification of veterans.

A temporal analysis of mental health symptoms relative to separation from the military

BACKGROUND

The transition from military to civilian life is a dramatic change that is often stressful for veterans. However, little is known regarding how mental health symptoms fluctuate in the period leading up to and following separation from the military.

METHODS

The current study examined posttraumatic stress disorder and depression symptoms reported on surveys completed within 1 year of military separation from 23,887 active duty Millennium Cohort Study participants. A series of general linear models and graphs stratified by demographic and military characteristics examined the association between time until/since separation and mental health symptoms.

RESULTS

Character of discharge had the most striking relationship between time until/since separation and mental health. Personnel with Honorable discharges did not differ in their level of mental health symptoms across the study period. In contrast, personnel with Other than Honorable/General discharges reported normal levels of mental health symptoms 1 year-prior to separation but reported progressively greater symptoms leading to separation which persisted through the remainder of study period.

CONCLUSIONS

This study suggests that additional outreach is needed for personnel with Other than Honorable/General discharges. However, for most other personnel, increased mental health symptomatology around military separation is not a normative phenomenon and any instance should be treated promptly.

Demographic and socioeconomic correlates of suicide deaths and nonfatal self-injury related hospital visits: An analysis of counties in New York State

For many years, suicide rates in U.S. general and veteran populations have steadily increased, stimulating research into suicide and nonfatal self-injury (NFSI). However, little research has examined community correlates of suicide and NFSI. This study used county data from New York State to identify community correlates of veteran and general population suicide deaths and general population NFSI-related hospitalization. In bivariate analyses, both suicide and NFSI-related hospitalization were associated with measures of social disintegration (i.e., smaller population size, larger male and/or White population) and socioeconomic disadvantage (i.e., higher disability rates disability, lower household incomes, more limited-English speaking households). In regression analyses, general-population suicide was independently associated with higher disability and veteran-suicide rates, whereas NFSI-related hospitalization was independently associated with lower household income. Findings attest the importance of low-cost, accessible, outpatient services and highlight social disintegration and socioeconomic disadvantage as salient, community risk factors for suicide and NFSI.

Changes in the health and broader well-being of U.S. veterans in the first three years after leaving military service: Overall trends and group differences

OBJECTIVES

Scholars have theorized that the initial period after military discharge may be a particularly vulnerable time for veterans. Yet, several recent studies raise the prospect that risk for poor adjustment may actually increase rather than decrease over time. The current study examined whether the U.S. military veteran population experiences improvements or declines in their health and broader well-being during the first three years after leaving military service and documented differences based on gender, military rank, and warzone deployment history.

METHODS

A population-based sample of 3733 newly separated veterans completed a survey within three months of separation (Fall 2016), followed by five additional surveys at six-month intervals. Weighted multilevel logistic regressions were conducted to examine changes in the proportion of veterans reporting good health and broader well-being over time.

RESULTS

Most aspects of veterans' health and broader well-being worsened over time, with a noteworthy increase in reporting of mental health conditions and a decline in veterans' community involvement. Declines in the proportion of veterans reporting good health and well-being were most notable for women, with smaller differences observed for other subgroups.

CONCLUSIONS

The finding that veterans experienced worsening health and broader well-being over time highlights the need for enhanced prevention and early intervention efforts to mitigate these declines. Findings also point to the importance of attending to the unique readjustment concerns of female veterans and other at-risk subgroups.

Transition from military to civilian: Identity, social connectedness, and veteran wellbeing

Military identity and a sense of social connectedness may help explain differences in contemporary veteran wellbeing following transition from military to civilian life. However, it is unclear how these constructs interrelate. The current study quantitatively explored the role of social connectedness in the relationship between military identity and subjective wellbeing among contemporary ex-serving Australian Defence Force veterans. To facilitate analyses, data from 358 veterans were used to first explore the suitability of the factor structure of the Warrior Identity Scale. Subsequently, the potential moderating and mediating effects of social connectedness in the relationship between military identity and wellbeing were explored via path analysis. Confirmatory factor analysis of the Warrior Identity Scale revealed support for the multidimensional construct of military identity, and a revised six-factor measurement model was found suitable for further path analysis. Consistent with past research, social connectedness positively related to quality of life and negatively related to psychological distress. There was no support for a moderation effect of social connectedness. However, results indicated military identity indirectly influenced wellbeing and distress via differential relationships with social connectedness. Specifically, private and public regard for the military and not feeling like an outsider positively related to social connectedness. In contrast, interdependence with other veterans, viewing the military as family, and the centrality of military identity negatively related to social connectedness. The results suggest nurturing the protective aspects of military identity and addressing inhibitory aspects of military identity may support a sense of social connectedness and wellbeing among ex-serving veterans.

Military self-stigma as a mediator of the link between military identity and suicide risk

US military Veterans are at greater risk for suicide than those who have never served in the US military. Recent federal calls include the need to investigate military-specific suicide risk and protective factors among military-affiliated populations. To date, no study has examined the link between military identity, self-stigma, and suicide risk. The current study used a nationally representative sample of post-Vietnam US military Veterans (N = 1,461) in order to determine relationships between military identity, self-stigma, and suicide risk. Idealism (OR = 0.86) with less odds of elevated suicide risk, whereas individualism (OR = 1.15) and military self-stigma (OR = 1.39) were associated with increased odds of elevated suicide risk. Military self-stigma was found to mediate the relationship between military identity components and suicide risk. Implications for conceptualization of military Veteran identity, suicide prevention, and future research are discussed.

Participation in occupations, health and adjustment during the transition from military service: A cross-sectional study

Participation in meaningful occupations is central to health, well-being, and adjustment during the transition from military service. The aim of the present study was to identify what occupations transitioning Australian Defence Force members participate in for the purpose of improving their health and well-being. A secondary aim was to identify if participation in various occupations was associated with better self-reported health and/or adjustment outcomes. One hundred and ninety-eight former Australian Defence Force members discharged on or after January 1, 2004 responded to a cross-sectional survey measuring adjustment, physical and mental health, and participation in occupations. Occupations were coded using the Time Use Classification system developed by the Australian Bureau of Statistics. An easier adjustment was reported by former service members who participated in employment-related activities, domestic activities, voluntary work and care activities, and social and community interaction (MD = -0.63 to -0.45, d = .37 to .52). Participation in employment-related activities, social and community interaction, and sport and outdoor activity was associated with better physical health (MD = 3.20 to 3.73, d = .34 to .40). Participation in employment-related activities was also associated with better mental health (MD = -3.75, d = .54). This research indicates that participation in occupation is a factor that may be utilized with former service members to positively influence health and adjustment during military transitions. Given differences in participation and outcomes among different sub-groups, it is recommended that occupation-based programs be tailored to individual preferences and transition needs.

The Enriched Life Scale (ELS): Development, exploratory factor analysis, and preliminary construct validity for U.S. military veteran and civilian samples

The U.S. military veteran serving nonprofit, Team Red, White & Blue (RWB), defined an "enriched life" as having physical, mental, and emotional health; supportive relationships; and a sense of purpose. Until now, no corresponding measure of an "enriched life" existed for the purposes of clinical assessment and research. The primary objective of this study was to explore the psychometric properties of the Enriched Life Scale (ELS) in veteran and civilian samples. Our secondary objective was to examine differences in ELS scores in subgroups of veterans who had combat deployments and service-related injuries. Veteran thought leaders working with social scientists developed the ELS and implemented exploratory factor analysis to determine the underlying dimensions of the "enriched life" construct. One thousand one hundred and eighty-seven veterans and 598 civilians participated in the study. This article describes the development of the ELS, reliability, exploratory factor analysis, and preliminary construct validity. The final ELS had 40 items and consisted of five constructs that were labeled "Genuine Relationships"; "Sense of Purpose"; "Engaged Citizenship"; "Mental Health"; and "Physical Health." Measures had high internal consistency (α = 0.82-0.94). Civilians scored higher than veterans on every ELS item, subscales, and total score, with small to large effect size differences noted between groups. In the veteran subsample, individuals with combat experience scored lower on every ELS subscale than those without combat experience (small effect sizes), as did veterans with service-related injuries in comparison to those without them (small to large effect sizes). This article establishes preliminary psychometric properties of the ELS-a promising instrument to measure an enriched life. Further study is currently underway to establish confirmatory factor analyses and explore extending its usage to diverse military and civilian samples.

"It's like a Brotherhood": Thematic analysis of veterans' identity processes in substance abuse recovery homes

This exploratory study aimed to understand how veterans' social identity influenced their experiences living in Oxford Houses (OH)-the largest network of substance use recovery homes in the United States. We conducted three focus groups, with 20 veterans who were current or former OH residents. Thematic analysis revealed several ways in which participants' veteran identity influenced their experiences living in OH, including: (1) thriving through OH organizational similarities with the military, (2) relationships with other OH residents, and (3) and growth and reintegration. The themes were interpreted using the Social Identity Theory and the Social Identity Model of Identity Change perspectives. Social identity processes were found to play an influential role in veterans' experiences in their recovery homes and reintegration into civilian life. Findings highlight the importance of veterans developing a community within a culturally congruent setting to facilitate their recovery from substance use disorders and adjustment to life post-military service.