The impact of a civic service program on biopsychosocial outcomes of post 9/11 U.S. military veterans
Introduction
Among American military veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF), post-traumatic stress disorder (PTSD) and depression are common diagnoses (Vaughan et al., 2014). PTSD and depression are associated with increases in unhealthy behaviors (Tanielian and Jaycox, 2008), medical services use (Schnurr and Jankowski, 1999), and negative impacts on family and social functioning (Cohen et al., 2010, Tanielian and Jaycox, 2008). In addition to health concerns, veterans reintegrating into civilian life following deployment, disability, or completion of military service, potentially face numerous hurdles. These hurdles include personal, professional, and financial challenges such as changes in family roles, rebuilding social networks, and unemployment, which may exacerbate symptoms. Unfortunately, many veterans with mental health symptoms do not seek treatment. In a national survey of OEF/OIF veterans, almost half of those with a positive PTSD or depression screen reported no mental health care use within the prior year (Tanielian and Jaycox, 2008). Research on health care barriers and preferences of OEF/OIF veterans with PTSD shows that negative treatment beliefs and stigma remain barriers to care. Alternatively, these same veterans express a desire for community services that are integrated, person-centered, and holistic (Crawford et al., 2015). These findings highlight that this generation of veterans may be interested in promoting health in new ways, more so than by engaging in traditional mental health care, to overcome challenges.
Volunteering has produced positive outcomes in civilians’ mortality rates, mental health, and social outcomes (Jenkinson et al., 2013). In one study, 40% of American adults who volunteered in the past year showed improvements in well-being: happiness, life satisfaction, self-esteem, mastery, health, and depression (Thoits and Hewitt, 2001). In older adult studies, volunteers significantly reduced their depression and mortality rates (Lum and Lightfoot, 2005, Musick et al., 1999, Musick and Wilson, 2003) with concomitant increases in wellbeing with increased volunteering (Morrow-Howell et al., 2003). Given these findings (Cooperation for National and Community Service CNCS, 2007), it could be posited that individuals who are leaving the military due to disability or retirement, might also benefit. However, there is currently no research on the effects of volunteering as a health promotion intervention among veterans. To our knowledge, this is the first national study of formal volunteering among U.S. military veterans who previously served in Iraq and Afghanistan and who participated in a formal civic service program after completing their career in the military service.
We undertook a preliminary study to explore the biopsychosocial outcomes of participation in a national civic service program on OEF/OIF veterans. Using the stress-diathesis model to guide our selection of measures (Zubin and Spring, 1977), biopsychosocial outcomes were defined as physical, mental, and psychosocial functioning. Civic service was defined as participation in a formal, structured, and stipended volunteer program (McBride and Sherraden, 2007). Based on the results of previous literature, we hypothesized that civic service would (1) increase self-reports of purpose in life, self-efficacy, and social support, and (2) decrease reports of social isolation and loneliness, emotional health difficulties, and depressive symptoms among participants. However, given the complex psychosocial and health issues facing returning veterans and that PTSD and depression are characterized by avoidance and dysphoria, we proposed that civic service would not impact reports of overall health, physical health difficulties, or PTSD symptoms. With regard to the complexity of health issues and PTSD, we note that returning veterans have varying degrees of co-occurring conditions, polytrauma, and chronic illnesses that may require ongoing surgery, rehabilitation, and therapy to resolve. Consequently, we proposed that overall health, physical health difficulties, and PTSD might remain unchanged without specifically targeted health and mental health interventions. However, with depression, the behavioral activation of going to volunteer each week with specific tasks and a purpose to contribute to the organization might naturally alleviate some of the dysphoric symptoms. Finally, we explored whether experiencing symptoms of PTSD and depression would impact the ability of participants to benefit from civic service in terms of purpose in life, self-efficacy, social support, and social isolation and loneliness. Due to the dearth of literature on the effects of these diagnoses on civic service, no a priori hypotheses were developed.
Section snippets
Study design and intervention
Using an observational cohort design, we evaluated the impact of a civic service program administered by The Mission Continues, a national nonprofit organization in the U.S. The health promotion intervention evaluated in this study, the Fellowship Program, involved adults who previously served in the U.S. military after September 11, 2001 (subsequently referred to as post-9/11/01-era veterans) who volunteered for 20 h per week for 26 weeks at a local nonprofit organization in their hometown.
Results
Table 1 shows that the sample was predominantly male, under 40 years of age, married and slightly more than half identified as Caucasian. At the time of this study between February 2011 and March 2014, approximately 88% of the sample reported that they served on an overseas deployment for which they received hazardous duty pay and the mean time from their last deployment was 5.88 years (SD=2.49). Half of the sample screened positive for probable PTSD (50.6%) and over a fifth (23.5%) for
Discussion
To our knowledge, this was the first investigation of the biopsychosocial impact of a civic service program on a large sample of community-dwelling returned U.S. military veterans. Overall, self-report measures across nine constructs within health, mental health, and psychosocial domains indicated that participating in this formal civic service program significantly improved veterans’ health and well-being upon completion of the program. The greatest impact within the mental health domain was a
Acknowledgments
We thank Aaron Scheinberg, Oliver Gould, and Olivia Obicheta (The Mission Continues) for their collaboration and dedication to this research effort. All authors were involved in the analysis and interpretation of data, drafting the article, revising it critically for important intellectual content, and provided final approval of the version to be published.
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Formerly affiliated with Washington University, George Warren Brown School of Social Work, Saint Louis, MO, USA.