Assistance dogs for military veterans with PTSD: A systematic review, meta-analysis, and meta-synthesis

Abstract

Psychiatric assistance dogs for military veterans with posttraumatic stress disorder (PTSD) currently make up over 19% of assistance dog partnerships globally. We conducted a systematic review of the literature relating to these partnerships, with specific aims to (1) summarize their characteristics, (2) evaluate the quality of existing evidence, and (3) summarize outcomes. A total of 432 records were independently screened (Cohen’s kappa = 0.90). Of these, 41 articles (29 peer-reviewed publications and 12 unpublished dissertations) met inclusion criteria. Data extraction was conducted to address the research aims, including a meta-analysis (quantitative outcomes) and meta-synthesis (qualitative outcomes). All peer-reviewed publications on the topic of psychiatric assistance dogs for veterans with PTSD were published within the last five years. The majority of included articles were quantitative (53%), 41% were qualitative, and 6% employed mixed methods. Mean methodological rigor scores were 80% for peer reviewed articles and 71% for dissertations, where higher scores represent more rigorous methodology. Quantitative articles reported significant improvements in the domains of PTSD severity, mental health, and social health. Impacts on physical health and global quality of life appear inconclusive. Meta-analysis (9 articles) revealed that partnership with an assistance dog had a clinically meaningful, significant, and large effect on PTSD severity scores (g = −1.129; p<0.0001). Qualitative meta-synthesis identified two third order constructs: (1) Impact on the individual: mental & physical health and (2) Impact beyond the individual: building relationships & connection. This synthesis of increasingly prevalent research on assistance dogs for veterans with PTSD provides support for the impact of this complementary and integrative health intervention on PTSD symptom severity, and signs of meaningful improvements in adjacent domains including mental and social health. Gaps between quantitative and qualitative findings, along with the need to report greater demographic detail, highlight key opportunities for future research.

Psychiatric service dog placements are associated with better daily psychosocial functioning for military veterans with posttraumatic stress disorder.

“…In fact, unwanted public attention and access denials have previously been identified as among the greatest drawbacks of service dog partnerships (Nieforth, Rodriguez, et al, 2022; Yarborough et al, 2018). For veterans with PTSD, service dog partnership can reveal a handler’s status as an individual with a disability, which can in turn lead to stigma and discrimination (Leighton et al, 2022). In light of our current findings, it may be that veterans find these negative public experiences sufficiently uncomfortable that they are deterred from attempting to go into the community; in fact, a veteran from this same sample shared that unwanted attention in public made them want to leave home even less (Nieforth et al, 2021).…”

“…This finding supports the concept of a service dog as a social buffer-a phenomenon wherein a dog's presence can help buffer the effects of negative social exchanges, previously described in both service and pet dog literature (Aydin et al, 2012;O'Haire et al, 2015;Scotland-Coogan, 2019). In contrast, the use of the social greeting ("make a friend") task (initiated by the handler) was associated with more pleasant social interactions, underscoring the service dog's further role as a social bridge capable of facilitating positive social engagement (Davis al., 2004;Leighton et al, 2022). Collectively, these findings identify a need for further research to determine if veterans are using the service dog's trained tasks to counteract unpleasant interactions or facilitate and enhance positive interactions, incorporating greater temporal granularity (i.e., the ability to identify which came first, the interaction or the task usage).…”

“…Although many interventions focus solely on an individual’s mental health, research indicates that more holistic interventions incorporating both emotional and social functioning (i.e., psychosocial functioning) may be preferable (Sherman et al, 2015). Preliminary research indicates that psychiatric service dog placements may benefit veterans’ psychosocial functioning (Leighton et al, 2022). However, existing studies have measured psychosocial functioning at a single time point with retrospective wording (e.g., “In the past 2 weeks…”).…”

Current Perspectives on the Challenges of Implementing Assistance Dogs in Human Mental Health Care

“…Acknowledgment that dogs are sentient animals, having intrinsic value beyond their consideration as properties, equipment or working aid has been somewhat mirrored in advances to legislation and politics globally (e.g., Australia, European Union, New Zealand, Canada, United States and United Kingdom) [ 89 , 90 , 91 ]. Service or assistance dogs are permanently housed with individuals with disabilities to aid in their day-to-day life [ 5 ] and their welfare must be a principal consideration moving toward a greater degree of concern [ 92 , 93 ]. Concerns such as absence of a day-to-day routine, lack of sufficient “time off”, being overweight, and (un)intentional harm and mishandling of the dog by recipients/owners must be addressed.…”

“…In the widest sense, they are a versatile group of working dogs that are trained or proficient to assist humans with different types of impairment [ 3 ]. The past decade has been characterized by a significant increase in both dogs serving humans with a mental illness [ 4 ] and studies that sought to measure the effects on human health outcomes [ 5 ]. Notwithstanding these dogs’ doubtless value, research on their legal status including terminology, definition, authorization as well as their repertoire of trained behaviors and overall welfare has been scarce [ 3 ].…”