Military people leave for war and come back home change in several ways. Some changes are visible through the human eye, including amputation, shrapnel wounds, or gunshots. For many others, their injuries are more profound than the human eye can see. Their injuries present as mental health disorders and could be the most frightening and dangerous injuries a veteran can have. As the US marks two decades of continuous war in the Middle East, media and researchers have raised professional and public concern for mental health issues among veterans and service members. Depression is cited among the most common mental health challenges veterans face. Some studies suggested that about 14-16% of US military personnel deployed in Iraq and Afghanistan have depression and PTSD (Inoue, Shawler, Jordan, & Jackson, 2021). Existing literature on prevalence and causes of depression among the United States male veterans and potential intervention approaches are reviewed in this paper.
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Liu, Collins, Wang, Xie, and Bie (2019) studied the prevalence and pattern of depression among US veterans and observed in over two-period that about 16.3% of veterans and services men spent half of their days having little energy or feeling tired. Besides, 15% of veterans reported challenges finding sleep or sleeping too much closely every day (9.1%) or half of the days (6.4%). According to the researchers, depression prevalence among veterans peaked between 2011 and 2012 at 12.3 percent. A report by Kramarow (2012) comparing health of veterans versus nonveterans indicated that among men from the ages of 25 years to 64 years, 16 percent of veterans reported poor or fair health, relative to 10 percent of nonveterans. Among men ages 45 to 54 years, a high percentage of veterans, 17%, reported poor health than nonveterans, 12%. In their study, Reavis, Henry, Marshall, & Carlson (2020) found that veterans males aged between 18 years and 25 years were more likely to experience major depressive episodes than other age groups. About 9% of male veterans aged 18-25 years reported major depressive incidents for the past year in 2019. Gould, Rideaux, Spira, & Beaudreau (2015) examined the prevalence of elevated depression and anxiety for veterans 50 years and older. The study sampled 6577 male veterans (49%) and nonveterans (51%) aged 50 years and older and established that veterans were more unlikely to experience elevated depression than nonveterans. Only 11% of the veterans, compared to 12.8% nonveterans, experienced elevated depression. The studies suggest that younger cohorts have higher symptoms of depression than older cohorts.
In the United States and globally, population research has depicted an intricate life-course portrait of causes of mental health among veteran populations, including stressors associated with a military, preservice predisposition, military-to-civilian transitions, and post-service life (Thompson, VanTil, Zamorski, Garber, Dursun, Fikretoglu, & Pedlar, 2016). Mental health among veterans is linked to various socioeconomic and demographic factors. Feeling unhappy in unfavorable conditions such as military environments and operational settings is cited as one of the reasons for the increased incidences or occurrence of depression and related symptoms among the veterans. The relationship suggests an association between activity abnormalities, thoughts and mood with occupational or social environment (Wang, Ursano, Gifford, Dinh, Farooq, Broshek, & Fullerton, 2020). On the one hand, a veteran, particularly younger ones, may not have interest in their job; hence, they are likely to develop unpleasant thoughts and moods, including sadness, despair, grief, and worry, making them prone to depression (Hu, Chu, Urosevich, Hoffman, Kirchner, Adams, & Boscarino, 2020). The military forces suffer from sleep disorders, concentration, physical exertion, nutrition, weight changes, and anorexia because of job sensitivity and classified activities. These emotions and behaviors over time may adversely affect the mood of such professionals, exposing them to depression (Liu et al., 2019).
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Studies have also suggested an interconnection between depression and physical wellbeing among military personnel. Veterans with physical injuries or impairments have exhibited high rates of depression, 9.7% to 46.4%, alongside psychological distress up to 36%. Male veterans’ mental health was linked to substance abuse and homelessness (Stevelink, Malcolm, Mason, Jenkins, Sundin, & Fear (2015). Besides, homelessness is linked to poor health status, physical disability, and substance abuse. Study shows that substance abuse is prevalent among veterans and is linked to increased occurrences of psychiatric and trauma conditions, alongside increased suicide rates and mortality (Wang et al. 2020). Military service personnel are offered structured comprehensive health care when still serving in the forces. However, such health care becomes unavailable as one transitions from the service to civilian life, except for veterans who have ongoing health care needs associated with their military duties (Thompson et al., 2016). The study has shown that many of the Vietnam veterans do have their health care needs acknowledged until many years after transitioning to civilian life for several reasons, including failure to seek help in time and delay in the onset of mental health complications (Oster, Morello, Venning, Redpath, & Lawn, 2017). Failure to seek medical health on time can lead to deterioration in physical and mental health among the veterans, consequently triggering depression.
Location of deployment is also linked to poor mental health, including incidences of depression among veterans. Study shows that deployment to the Gulf War was linked to higher risks of mental and physical health challenges compared to veterans of other conflicts. Veterans of the Gulf War have twice higher chances of experiencing depression and other mental health complications compared to non- Gulf War veterans (Blore, Sim, Forbes, Creamer, & Kelsall, 2015). A significant percentage of Gulf War veterans have reported higher rates of multi-symptom conditions, including chronic fatigue, fibromyalgia, and symptoms of numbness, alongside pain in the joints, heart, and back (Oster et al. 2017). Such conditions combined can cause distress and predisposes the veterans to symptoms of depression.
Loneliness and social isolation post-military service are also associated with depression among veterans. Research shows that social isolation and loneliness are preventable issues that impact veterans of all ages. Military-specific organizations globally begin to acknowledge and aim to manage veterans’ social isolation and loneliness (Williams, Allen-Collinson, Hockey, & Evans, 2018). Several possible military service-associated reasons have been proposed as to why loneliness and social isolation might be salient in veterans’ lives. Military men experience challenges and frictions transitioning to civilian lives, threatening identity and requiring effort to develop a post-service identity. Besides, military services involve much geographical mobility, making it challenging for service members to develop roots in any place. The shift from soldierly to civilian life also disrupts the strong bonds and friendships developed during the service and can impact social isolation and loneliness (Wilson, Hill, & Kiernan, 2018), triggering depression. Hayley, Hakim, and Albert (2021) noted that social isolations and loneliness were highly linked to depression. The researchers observed in their study that veterans who had previously sought psychological health treatment were five times more prospective for readmission to the healthcare facility if they were at greater risk of loneliness and social isolation.
The link between veterans’ mental, social, and physical wellbeing shows the need to provide veterans with health care programs restructured and incorporated across these domains. This is essential for prevention mechanisms and early establishment of veterans susceptible to developing complications along with mental, social, and physical wellbeing (Currier, McDermott, & McCormick, 2017). This study has also shown that Veterans are hesitant to seek help concerning their mental health, further highlighting the need for policymakers, healthcare professionals, and services providers to have a structured process that can help them identify and respond to the health care needs of veterans in time. A study by Reed, Masters, & Roeger (2016) explores the “Australian Defense Force Post-discharge GP Health Assessment,” a structured assessment to enhance early detection of mental, social, and physical health problems among veterans and initiate a prompt intervention. The program aims to assist veterans to access primary care post-service. Further study on this type of structure’s potential impact and application in other jurisdictions like the United States is critical.
Overall, this rapid literature review indicates a high prevalence of depression among US male veterans. Several factors are linked to the high prevalence of depression among veterans, including stressors associated with the military, loneliness and social isolation, preservice predisposition, military-to-civilian transitions, and post-service civilian life. There is also a high association between veterans’ mental, social, and physical wellbeing suggesting the need to provide veterans with health care programs restructured and integrated across these domains.