New research shows that veterans' mental health after leaving the military is shaped by more than just combat, with childhood trauma, deployment experiences and gender all influencing post-9/11 veterans' well-being, according to a team at Penn State.
"Many veterans manage the transition to civilian life successfully, but for others, it can be an extended and complicated process," said co-author Daniel F. Perkins, principal scientist at the Clearinghouse for Military Family Readiness at Penn State (Clearinghouse), a Social Science Research Institute co-funded faculty and professor of family and youth resiliency and policy in the College of Agricultural Sciences. "Our goal was to better understand how early life experiences, deployment factors and gender together shape mental health outcomes so that services can be better tailored to veterans' needs."
The research for this study, recently published in the Journal of Clinical Psychology, was collected as part of The Veterans Metrics Initiative, a large-scale, collaborative longitudinal study designed to evaluate the well-being of post-9/11 veterans throughout their transition to civilian life. Researchers tracked nearly 9,600 men and women who left active duty in late 2016 at six points over three years. Participants answered questions related to deployment histories, adverse childhood experiences and exposure to combat. In addition, they reported whether they had symptoms related to anxiety and depression.
The results revealed that while overall rates of psychological symptoms stayed relatively steady over the three-year period, specific factors predicted different mental health trajectories.
For instance, the length of deployments and the number of deployments impacted mental health symptom trajectories in different ways for males and females. Male veterans who served the longest tours reported experiencing worse mental health, while those who had more frequent, shorter deployments often reported fewer mental health symptoms. In fact, having multiple deployments was associated with a continued improvement in mental health over time in both men and women.
Adverse childhood experiences (ACEs), such as physical abuse, neglect or household substance misuse, were also strong predictors of poor mental health. Veterans with three or more ACEs consistently reported the highest levels of anxiety and depression.
Combat exposure raised risk across the board, but effects differed by gender. Women who had combat exposure showed a steep decline in mental health symptoms during the first year after their service; however, this reduction was followed by a rebound, which suggests their recovery was temporary. Men's symptoms, by contrast, tended to remain elevated throughout the study.
Furthermore, women reported experiencing higher rates of ACEs but fewer combat exposures than men, and their mental health symptoms often followed different patterns, highlighting the need for tailored interventions, the researchers said.
"These findings underscore that the transition to civilian life is not a single moment, but a process influenced by experiences across the life span," said lead author Mary M. Mitchell, research professor at the Clearinghouse. "By following veterans over three years, we were able to see how patterns emerge that would be invisible in a one-time survey."
Findings point to the importance of offering targeted support services early in veterans' transitions, the researchers said. For example, screening for ACEs may help clinicians identify veterans who are at greater risk of developing mental health challenges during their transition and could allow clinicians to connect at-risk veterans with specific supports before problems escalate.
The study also underscores the need for gender-responsive care, according to the team. Women veterans often show different symptom patterns and are more likely to have experienced trauma before entering the military, so directing them to personalized strategies could better support their transition to civilian life.
"This kind of long-term data helps us see the full picture of reintegration," said co-author Keith R. Aronson, director of the Clearinghouse, associate director of the Social Science Research Institute and research professor in the Department of Biobehavioral Health. "It reminds us that support for veterans can't stop after the first few months. Monitoring changes over time gives us the opportunity to intervene earlier and more effectively when new challenges arise."
This research was supported by the Henry M. Jackson Foundation for the Advancement of Military Medicine.
