Facilitating the transition home after military deployment: a systematic literature review of post-deployment adaptation programmes.

Background: Many countries pay special attention to the transition of their military personnel from deployment to home via post-deployment adaptation programmes (PDAPs). Objective: This systematic review aims to provide a structured analysis of structure, process, and outcomes based on available empirical evidence for PDAPs. Methods: A systematic literature search was performed to identify original peer-reviewed studies on PDAP in six databases (MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, PTSDPubs, and OpenGrey). The overall risk of bias of the articles was assessed using GRADE guidelines. The literature was analysed in its description of PDAP structure, process, and outcomes. In addition, when effects were reported, these were extracted. Results: The search resulted in 1535 unique records that were screened for eligibility; 16 articles were included, of which only three showed low risk of bias according to GRADE. Few studies clearly described and investigated PDAP structure elements (i.e. combat exposure), process elements (i.e. who delivered the intervention), and other outcome elements (i.e. adjustment issues). Most articles included some form of third location decompression (N = 10; psychoeducation and time to rest and relax on a location that is not in the mission theatre or at home) and Battlemind (N = 4; interactive training focusing on how to adapt skills and cognitions after deployment at home). The results suggest positive mental health effects and satisfaction of these two types of PDAP, although the evidence is poor. Conclusions: Empirical, high-quality evidence for PDAP is scarce. In addition, the existing literature reveals a lack of systematic method in describing the goals of PDAP and the ways of achieving these. This leads to incomparability between studies and hinders the building of a knowledge base on PDAPs. A structure is proposed for describing the structure, process, and outcomes of PDAPs with measured effects. HIGHLIGHTS:High -quality evidence for post-deployment adaptation programmes is scarce.Programme structure, process, and aims with measured effects are not delineated.Positive mental health effects are reported for Battlemind and third location decompression.