PTSD in U.S. Veterans: The Role of Social Connectedness, Combat Experience and Discharge Status

Serving in the U.S. military provides a substantial opportunity for a sense of community, belonging and understanding. Re-establishing a new sense of community is essential for veterans transitioning out of the military and into civilian life. However, developing a new sense of connectedness is one of many challenges separating service members may face. Little is known about the role social connectedness may play in promoting positive transition outcomes. The purpose of this study was to explore the effect of combat exposure, non-honorable discharge status, and social connectedness on PTSD symptoms in individuals who have served in the U.S. military.        

Data used for this study were drawn from a community-based needs assessment involving veterans living in the San Francisco Bay Area. Multiple recruitment strategies were utilized to achieve representativeness of the veteran population in the San Francisco Bay Area. PTSD was measured by the Posttraumatic Stress Disorder Checklist 5 (PCL-5; Weathers et al., 2013). The 13-item short version of the Combat Experiences Scale (CES; Hoge et al., 2004) was used to measure combat experiences. Participants were also asked to choose one of eight possible discharge status. Those with an honorable discharge were separated from those with any other discharge status to form the non-honorable discharge group. Lastly, social connectedness was measured with The Social Connectedness Scale (Lee & Robbins, 1995), an 8-item measure scored on a 6-point Likert scale.

The final sample consisted of 722 veterans from the San Francisco Bay Area The sample reported high levels of PTSD symptoms (M = 36.07, SD = 21.6) and moderate levels of social connectedness (M = 32.15, SD = 13.27). Combat experiences, social connectedness, and PTSD symptoms were significantly correlated at the bivariate level, as were non-honorable discharge status and PTSD symptoms. In path analysis, the model was fully identified (N=722). As hypothesized, there were positive direct effects for combat experiences (b=0.36, p<0.001) and non-honorable discharge status (b=0.21, p<0.001) on PTSD symptoms. Social connectedness demonstrated a negative direct effect on PTSD symptoms (b=-0.41, p<0.001). In addition, both combat experiences (b=-0.13, p<0.05) and non-honorable discharge status (b=-0.14, p<0.05) demonstrated negative direct effects on social connectedness. There were also significant indirect effects for both combat experiences (b=0.05, p<0.05) and non-honorable discharge status (b=0.06, p<0.05) on PTSD through the social connectedness pathway. The total effect for combat experiences on PTSD was b=0.41, p<0.001. The total effect for non-honorable discharge status on PTSD was b=0.26, p<0.001.

Study findings have significant implications for considering PTSD in veterans. Both combat experiences and a non-honorable discharge status resulted in increased risk for PTSD. Identifying service members leaving the military with such risk factors should be identified early for intervention. This is particularly true for those with a non-honorable discharge status as these individuals may not have access to benefits that allow for mental health treatment. Results indicate social connectedness may be an important protective factor in the development of symptoms of PTSD indicating social connectedness to be a potential protective factor that can be targeted during and after the transition.