Difficulty Adjusting to Civilian Life after Military Transition: The Impact on Current Physical and Mental Health Status in Pre and Post 9/11 Veterans

Background & Purpose: Transition from the military includes a series of adjustments including changes in location, career, relationships, family roles, support systems, social networks, community and culture. It is assumed that this transition has tremendous implications for post-service well-being and functioning. However, little has been done to examine the impact of difficulty adjusting to civilian life on current functioning in those who have transitioned out of the military. The purpose of this study was to explore the association between civilian adjustment difficulties and current physical and mental health status in pre and post-9/11 veterans.

Methods: Data for this study were obtained from two cross-sectional, needs assessment surveys conducted in 2014 among veterans living in Southern California (n=2,227).  A recruitment strategy was employed that included utilizing collaboration with national, state, county, and local organizations that work with veterans to obtain a nonprobability sample.  The survey assessed veterans’ needs across various aspects of life (e.g. health, housing, and employment) including whether they felt they had difficulty adjusting to civilian life.  The current study utilized measures of PTSD (PCL), depression (PHQ-9), and physical health symptoms (PHQ-15). Odds ratios (ORs) were used to examine associations between difficulty adjusting to civilian life after military transition and physical and psychological health outcomes in pre and post-9/11 veterans.

Results: Forty-six percent (n=505) of pre-9/11 veterans and 54% (n=601) of post-9/11 veterans indicated difficulty adjusting to civilian life. Pre-9/11 veterans who reported adjustment difficulty were four times more likely to have significant physical health problems, six times more likely to meet the diagnostic cut off for clinically significant PTSD, and four times more likely to meet the diagnostic cut off for clinically significant depression (ORs = 4.21, 6.03, 4.33, respectively). Post-9/11 veterans who reported adjustment difficulty were almost three times more likely to have significant physical health problems, four and a half times more likely to meet the diagnostic cut off for clinically significant PTSD, and three times more likely to meet the diagnostic cut off for clinically significant depression (ORs = 2.87, 4.50, 3.14, respectively).  

Conclusions & Implications: Regardless of whether participants served pre or post-9/11, veterans in the sample who reported difficulty adjusting to civilian life were more likely to have current significant physical health symptoms, PTSD and depression. This indicates transition experiences are associated with current health and well-being. Interesting, although the association was demonstrated in both groups, it appeared stronger in the pre-9/11 group, indicating the impact of difficulty transitioning may not ameliorate itself over time. The study findings reveal that the transition period may be a critical time point for intervention aimed at preventing negative physical and psychological health outcomes. Developing specific interventions aimed at reaching transitioning veterans may prove to be a new way forward in framing supportive services for veterans. However, future research must continue to examine how adjustment difficulties manifest themselves and create vulnerability to physical and psychological health issues.