Loneliness and Social Isolation of Military Veterans: Systematic Narrative Review
Abstract: Loneliness and social isolation are being increasingly recognized as influencing both physical and mental health. There is limited research carried out with military veterans and, to date, there is no review of existing evidence. To synthesize and examine the evidence exploring aspects of social isolation and loneliness of military veterans, using a systematic narrative review strategy. A database search was carried out utilizing relevant search criterion. Seven databases were searched for publications with no date restrictions. Articles were included if they involved veterans and either social isolation or loneliness. The initial search returned 484 papers, after exclusions, removal of duplications, and a reference/citation search, 17 papers remained and were included in this review. The retrieved papers examined four areas of loneliness and social isolation: prevalence of loneliness in the veteran population, experiences related to military service as impacting loneliness or social isolation, the relationship between mental health and loneliness or social isolation, and interventions to combat loneliness and social isolation. Differences between the experiences of younger and older veterans were also highlighted. It is evident that military veterans present unique experiences of loneliness and social isolation, especially older veterans. This requires specific attention outside of campaigns targeted at the nonmilitary population.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.