Introduction: Research suggests that stigma, social support, and posttraumatic stress disorder (PTSD) are related, although the nature of relations among these constructs remains unclear, particularly among military Veterans. This study investigated the extent to which perceived social support at two relevant time frames (during deployment and current) moderated the relationship between self-stigma and PTSD severity, wherein self-stigma was assessed using a questionnaire that queried attitudes and beliefs about a Veteran seeking mental health care. Methods: The present sample included 58 U.S. military Veterans who had served combat deployments as part of Operation Enduring Freedom and Operation Iraqi Freedom (79.3% men, 20.7% women; 46.6% Black/African American, 41% white). The authors tested the potential moderating effects of both unit support and current social support on the relationship between PTSD severity and self-rated stigma. Results: Generally, self-stigma was significantly positively correlated with PTSD severity and inversely correlated with social support. Current support significantly moderated the relationship between PTSD and stigma, including job-related stigma and anticipated discrimination. Post hoc tests showed a significant positive association between PTSD severity and self-stigma for participants at low and moderate levels of current support, but there was also a non-significant relationship for participants reporting the highest level of current support. Unit support was not a significant moderator. Discussion: These findings suggest that although PTSD severity and self-stigma are significantly correlated, this relationship may be moderated by current social support. Among Veterans with limited support, PTSD severity is more strongly associated with self-stigma, which is a significant barrier to care.
Introduction: The transition from military service to civilian life can affect Veterans’ well-being. The Veterans Affairs Canada cultural and social environment (CSE) domain reflects society’s dominant values, beliefs, and attitudes toward Veterans that influence their post-service well-being, including public perceptions, employer attitudes, and service-related characteristics at release (branch, rank, sex). A systematic review was conducted to identify instruments that measure the CSE domain. Methods: MEDLINE, EMBASE, PsycINFO, PTSDpubs, AgeLine, Sociological Abstracts and Social Sciences Abstracts databases were systematically searched to October 17, 2024 for studies reporting on instruments measuring CSE well-being. The risk of bias of eligible studies and psychometric properties of included instruments were evaluated using the COnsensus-based Standards for the Selection of Health Measurement Instruments tool. Three Veteran partners, members of the Canadian Armed Forces, reviewed and assessed the clarity and applicability of relevant instruments. Results: Seven instruments were eligible. Of these, four (57%) demonstrated sufficient structural validity, five (71%) internal consistency, two (29%) cross-cultural validity, one (14%) test-retest reliability, and six (86%) hypothesis testing for construct validity. The Social Well-Being Scale Short Form, Social Production Function Instrument for the Level of well-being Short Form, Deployment Risk and Resilience Inventory 2 and Neighbourhood Thriving Scale (NTS) demonstrated better psychometric properties than the other measures. The Veteran partners indicated that the NTS was the most relevant for capturing Veterans’ CSE well-being, despite being limited in context. Discussion: Among the four most promising instruments, the NTS demonstrated the greatest potential for measuring CSE; however, it requires validation among Veterans.
Introduction: The Road to Mental Readiness (R2MR) program has been collecting matched pre- and post-training data on key performance indicators from its mental health education packages with Canadian Armed Forces (CAF) members since 2017. Methods: For the current study, we conducted a large-scale outcome evaluation by aggregating the data from the program to determine the overall impact that R2MR training has had on its outcomes and to assess whether its effectiveness is moderated by the type of training received. Participants were 2,824 CAF members who had received deployment, occupation, or career R2MR training from 2017 to 2024 and for whom we had matched pre- and post-training data. Outcomes included objective and subjective measures of R2MR key concept knowledge, confidence in detecting mental health issues, confidence in supporting others with mental health concerns, intentions to seek mental health help when needed, and stigma. Results: Across all groups, we found a small pre-post training increase in objective knowledge and stronger pre-post training changes in subjective knowledge, confidence in detecting mental health issues, and intentions to seek help. No significant changes were observed for confidence in supporting others and stigma. We also found that the career training (basic training) group experienced greater pre-post changes in their confidence in detecting mental health issues compared to the deployment training group. Discussion: Overall, R2MR training appears to be having the intended effect on some key outcomes, including knowledge of taught skills, confidence in detecting one’s own mental health issues, and intentions to seek care when needed. However, the curriculum could more effectively target stigma and confidence in supporting others.
Introduction: Given that suicidal ideation is a key risk factor for future suicidal behaviour, socio-economic and psychosocial factors that influence the critical transition period between suicidal ideation, plans, and attempts in the military should be examined. This study assessed correlates of remission and progression (i.e., worsening) of suicidality in a 16-year prospective, nationally representative sample of Canadian Armed Forces members and Veterans. Methods: The 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (n = 2,941) is a follow-up of respondents of the 2002 Canadian Community Health Survey – Canadian Forces Supplement. The reporting of suicidal ideation (SI) in 2002 was used to create three groups in 2018: 1) remission (no SI, suicidal plans [SP], or suicidal attempts [SA] “since last interview”), 2) persistence (SI “since last interview”, but not SP or SA), and 3) progression (SP and/or SA “since last interview”). Results: Relative to SI persistence, all six mental disorders examined in 2018 were negatively associated with SI remission (odds ratio [OR] range = 0.29-0.42) or positively associated with SI progression (OR range = 3.69-5.92). Coping styles and deployment had statistically significant associations with remission, while military environmental command, military rank, physical health conditions, and traumatic exposure were significantly associated with progression. Discussion: Potential interventions could focus on developing psychological strategies to enhance resilience to trauma, fostering strategies that allow individuals to receive appropriate treatment for their mental disorders and physical health conditions, and promoting problem-focused coping styles.
Introduction: The transition from military to civilian life represents a significant challenge for Canadian Armed Forces (CAF) Veterans, with approximately 39% experiencing difficulties. Veterans living with chronic pain face unique challenges during this transition, with impacts on their physical, mental, and social well-being. This study aims to explore the experiences and needs of Veterans living with chronic pain during their transition to civilian life and examine the implications of chronic pain on various life domains. Methods: This qualitative and exploratory study investigated the effects of chronic pain on CAF Veterans’ transitions to civilian life. Two three-hour focus groups were held with Veterans (n = 8) to explore their experiences with pain and its impacts on their social functioning during their transition to civilian life. Data were analyzed using thematic analysis. Results: Participants reported stigmatization of pain during military service, challenges in accessing civilian health care, significant emotional and relational impacts of chronic pain, and the importance of adaptive coping strategies. Participants also highlighted the need for peer support programs and specialized chronic pain clinics to facilitate the transition to civilian life and improve Veterans’ quality of life. Discussion: Chronic pain significantly complicates CAF Veterans’ transitions to civilian life by affecting various life aspects and adjustment processes. Findings underscore the need for enhanced access to civilian health care and Veterans Affairs Canada services, alongside preventive interventions, to support Veterans’ well-being and facilitate successful transitions.
Introduction: Moral injury, external demands and expectations conflicting with individuals’ moral beliefs, and subsequent recovery processes have received increasing attention in military research. Existing scholarship has either adopted an agency-centred perspective, emphasizing coping strategies, emotional regulation, and therapeutic repair, or foregrounded the organizational, institutional, and political conditions shaping recovery. Methods: This article develops a conceptual analysis grounded in Giddens’s structuration theory to examine moral injury and recovery as outcomes of the dynamic and mutually constitutive interplay between individual agency and social structures. Results: From this structuration perspective, military contexts are understood as evolving environments that both shape and are shaped by service members’ everyday practices. Moral injury is reconceptualized not only as an episodic clash between fixed personal values and external demands but also as increasing moral misalignment between soldiers and military institutions. Discussion: This recursive view reframes moral injury recovery as a process distributed across individuals and structures rather than as located solely within the individual or produced by the institution. The article concludes by outlining implications for research and intervention, calling for research that explicitly addresses the mutual constitution of agency and structure in advancing the understanding of moral injury recovery in military settings.
Introduction: This paper investigates systemic barriers that hinder access to Canadian Veteran home care services, specifically impacting women, Indigenous peoples, rural populations, and unpaid family caregivers. Methods: A qualitative policy analysis was conducted using academic literature, government publications, and international policy documents to evaluate Canada’s Veteran Independence Program (VIP). Results: The evaluation reveals critical gaps within the VIP regarding gender sensitivity, rural accessibility, caregiver support, and cultural safety for Indigenous Veterans. Furthermore, comparative analyses of care models from the United States, Australia, and New Zealand demonstrate that alternative frameworks successfully prioritize inclusivity, flexibility, and localized delivery. Discussion: Based on these findings, the study advocates for a reimagined Canadian home care framework that integrates gender-responsive planning, rural outreach, Indigenous-led services, and structured caregiver support. Although the research is limited by its reliance on secondary data, it provides actionable insights for policy reform to foster equity and independence across Canada’s diverse Veteran populations.
Introduction: Chronic pain is more prevalent among Veterans than in the civilian population. While web- or app-based chronic pain self-management programs are increasingly available and show positive outcomes, it remains unclear if and how they are adapted to meet Veterans’ unique needs. This scoping review aimed to document the presence and nature of military cultural adaptations in these programs and to assess how such adaptations influence key user outcomes. Methods: We included studies focused on Veterans and military members with chronic pain who participated in a web- or app-based self-management program. We aimed to examine how cultural adaptations were described and whether any influence on user experience, engagement, satisfaction, motivation, or cultural relevance perceptions was reported. To do so, we conducted a comprehensive search of major databases (MEDLINE, CINAHL, Embase, PsycINFO) and grey literature for English and French studies published since 2010. Results: Of the 248 sources screened, we included nine studies from the United States and two from Canada. Ten reported Veteran-intended interventions, but only one outlined the adaptation process. We identified various adaptation components (e.g., including Veteran narratives, shortening modules), although most were superficially described. No studies assessed the specific effects of adaptations, aside from participants’ perceptions of cultural relevance. Discussion: Detailed reporting on adaptation processes, resulting tailored components, and effects is lacking. The understanding of what constitutes military cultural tailoring in digital programs is still evolving. Future research could consider actively involving Veterans early in the process and systematically evaluating the added value of military cultural adaptations.
Introduction: Research examining the needs of Canadian Armed Forces (CAF) members and Veterans often focus on mental health and combat experiences post-Afghanistan. However, studies examining the well-being, long-term health, and support needs of Veterans and military spouses following non-combat traumatic incidents are less common. To address this gap, we examined the well-being, health, and support needs of Veteran crewmen and military spouses two decades after Her Majesty’s Canadian Ship (HMCS) Chicoutimi submarine fire. Methods: We conducted qualitative in-depth, semi-structured interviews with surviving crewmen, Care and Custody Team (CCT), and spouses involved in the HMCS Chicoutimi submarine fire to gather multiple perspectives on the long-term impacts of this traumatic incident. Template analysis was used to identify key themes. Results: We identified five common themes: 1) peri-incident experiences, 2) long-term well-being, 3) access to care, 4) coping, and 5) purpose. Results suggested a variety of long-term physical health issues and mental health symptoms that had a negative effect on Veteran crewmens’ well-being and the well-being of their spouses. The study showcased how each population perceived support — or the lack thereof — from the CAF organization, Canadian Forces Health Services, and individuals (e.g., family, peers, and colleagues); it highlighted distinct coping strategies used by crewmembers, the CCT, and their spouses. Discussion: As the first study to examine long-term effects of trauma on CAF Veteran crewmen who experienced a disaster at sea, the study offers novel insights into the evolving care needs of Veterans, highlighting trauma’s impact on aging Veterans and their spouses over two decades.
Introduction: Post-deployment screening in the Canadian Armed Forces (CAF) is intended to facilitate early care for individuals experiencing mental health issues following deployment. The screening process involves a self-report questionnaire and an interview with a mental health care provider, who may then recommend follow-up care. However, gaps remain in our understanding of the factors associated with clinicians’ decisions to recommend follow-up care. Methods: We examined the associations between self-reported mental health problems, clinicians’ perceptions of concern for those problems, and recommendations for follow-up care by using data collected during CAF post-deployment screening (n = 14,957). Results: For those individuals with the highest severity scores for posttraumatic stress disorder (PTSD), depression, or anxiety, about 50% to 70% were indicated as having a major concern, while a further 20% to 25% were indicated as having a minor concern. Reassuringly, about 80% of those with a clinician-indicated major concern for PTSD, depression, anxiety, or substance use were recommended for follow-up care. The discrepancy between clinician impressions and recommendations for care was partially explained by whether the individual was already receiving care. Discussion: While the concordance between self-reported mental health and clinicians’ concerns, as well as between concerns and recommendations for follow-up care, were generally high, some inconsistencies remain. These findings underscore the need to better understand and improve the consistency and effectiveness of the screening process, and to further understand the factors underlying clinical decision making.
Introduction: Women Veterans are an increasingly larger percentage of U.S. and Canadian Veterans, 11%-15% of those who have served. They face many challenges, including poverty, military sexual trauma (MST), posttraumatic stress disorder (PTSD), and homelessness, and their trajectory into post-service difficulties is little researched and poorly understood. Methods: The authors conducted a large study of women Veterans from multiple service eras, well represented with respect to race and ethnicity, geographical region, branch of service, and so forth (N = 2,497). After identifying older Veterans with extensive years of service, they examine the influence of MST, PTSD, and their combination, as well as that of other variables, such as U.S. Department of Veterans Affairs (VA) eligibility and enrollment, on the risk for homelessness. Bivariate, trivariate, and multivariate logistic regression were used to analyze the prevalence of MST, PTSD, and homelessness by age categories. Results: At least 20% of women Veterans with 20 years or more of service had experienced homelessness. The influence of MST and PTSD, alone or together, was prominent. The model correctly predicts identification of homelessness more than 70% of the time, with a Cox and Snell R-2 of >0.2 or a Nagelkerke R-2 of 0.3. Discussion: The authors focus on the older sub-sample with extended years of service and contribute to the literature with data and commentary on aging women Veterans' lived experiences and responses to trauma. MST and PTSD are the most important predictors of homelessness. Policy and practice implications are discussed.
Introduction: This scoping review examines the health and well-being of older Canadian Veterans, a population facing distinct aging challenges shaped by military service. Methods: Guided by Arksey and O’Malley’s five-stage framework, we searched peer-reviewed and grey literature across six databases and multiple Canadian government sources. Eligible sources included journal articles, reports, book chapters, and editorials addressing Canadian Veterans aged 55+ years and their physical, mental, or overall well-being. From 2,229 identified sources, 68 were included. Data extraction captured study characteristics, concepts, participant details, and main findings. Results: Three themes were identified: 1) health and well-being across all Veteran ages, 2) interventions and programs, and 3) research specifically on older Veterans. Older Veterans experience higher rates of chronic physical conditions but often report greater social support and life satisfaction than younger Veterans. Mental health conditions, particularly PTSD, frequently co-occur with depression, anxiety, and chronic pain. Interventions exist but are rarely age-specific, limiting relevance for older adults. Research on older Veterans highlighted gaps in long-term care, dementia, caregiving, and experiences of equity-deserving sub-groups, including women, racialized, and LGBTQIA2S+ Veterans. Discussion: Findings underscore the need for age-specific, intersectional research adopting a life course perspective to understand aging within military contexts. Future work should prioritize inclusion of older Veterans to guide tailored health services, caregiver supports, and long-term care strategies. Addressing these gaps is essential to promote equitable, evidence-informed support for Canada’s growing population of older Veterans.
Canadian Veterans are an aging population, yet research that examines how women Veterans experience aging is limited. Given the need for high-quality evidence to inform health policy and practice, the lack of knowledge regarding aging women Veterans limits the ability to ensure that systems are designed to support this group as they age. This article discusses ways to support research capacity on aging women Veterans by drawing on insights from two existing bodies of research: civilian aging research and research on the health of women Veterans, primarily at mid-life. These two areas of scholarship offer insights that can support future research directed toward understanding the health and well-being of older women Veterans. The article submission builds on earlier calls for military and Veteran health researchers to adopt gendered and intersectional approaches that reflect the diverse realities of this population. Researchers, funders, and Veteran-serving organizations are urged to prioritize inclusive research that can inform policies and services designed to support the health and well-being of all women Veterans as they age.
Introduction: Rumination has been linked to worsened mental health outcomes, but its specific association with depressive symptoms among aging Veterans remains unclear. While social support may buffer adverse effects of rumination on well-being, it is not yet well understood which sources of social support are most effective. This study explored whether different sources of social support (spouse/partner, family, military friends, and civilian friends) moderate the association between rumination and depressive symptoms within an aging Veteran sample. Methods: Seventy U.S. Veterans aged at least 60 years, most of whom served during the Vietnam Era, were recruited nationally. Participants served in the army (n = 25), navy (n = 17), air force (n = 14), Marine Corps (n = 10), and coast guard (n = 4), and completed online surveys. Measures included the Ruminative Thought Style Questionnaire (RTS), the PROMIS Depression Short Form, and surveys of social support from various sources. Results: After controlling for age, sex, rank at separation, and number of deployments outside the United States, family support was associated with lower depressive symptoms. Rumination was associated with higher depressive symptoms, but it was also moderated by support from military friends. Specifically, rumination was associated with higher levels of depressive symptoms in the context of low and moderate — but not high — support from military friends. Discussion: Our findings highlight the protective role of military friendships in promoting Veterans’ mental health and well-being later in life, particularly regarding their use of rumination as a coping strategy.
Introduction: Knee osteoarthritis (KOA) is a burdensome disease among Veterans. Strength training (ST) can improve pain and function in KOA; however, increases in exercise load often result in increased pain. ST with blood flow restriction (ST+BFR) can use less exercise load and increase strength and function, but few studies have examined these effects among Veterans with KOA. This study explored the feasibility, acceptability, and safety of a ST+BFR intervention and explored differences in function, strength, and self-reported outcomes between groups of Veterans with KOA. Methods: This pilot randomized controlled trial compared ST+BFR with ST only among U.S. Veterans with mild to moderate KOA. Measures of feasibility and acceptability were collected. Safety was monitored via adverse events. Clinical outcome measures included physical function (six-minute walk distance, 30-second sit to stand, and 40-metre walk test), knee muscle strength (extensor and flexor), and self-reported pain and function. These outcomes were compared 10 weeks and six months from baseline using mixed-effects regression. Results: Of 33 Veterans, 29 completed the study (94% men). Nine mild adverse events occurred. Participants reported that the ST+BFR intervention helped improve functional strength and mobility and encouraged them to be more physically active. Both groups made significant improvements in physical function, knee muscle strength, and self-reported pain and function compared with baseline; however, no between-groups differences were observed. Discussion: A ST+BFR intervention was feasible, safe, and acceptable among mostly men U.S. Veterans with KOA. No differences were observed between groups. A larger randomized trial of this intervention appears justified.
