The National Health and Resilience in Veterans Study: A Narrative Review and Future Directions

Abstract

United States (U.S.) veterans are substantially older than their non-veteran counterparts. However, nationally representative, population-based data on the unique health needs of this population are lacking. Such data are critical to informing the design of large-scale outreach initiatives, and to ensure the effectiveness of service care delivery both within and outside of the Veterans Affairs healthcare system. The National Health and Resilience in Veterans Study (NHRVS) is a contemporary, nationally representative, prospective study of two independent cohorts (n = 3,157 and n = 1,484) of U.S. veterans, which is examining longitudinal changes, and key risk and protective factors for several health outcomes. In this narrative review, we summarize the main findings of all NHRVS studies (n = 82) published as of June 2020, and discuss the clinical implications, limitations, and future directions of this study. Review of these articles was organized into six major topic areas: post-traumatic stress disorder, suicidality, aging, resilience and post-traumatic growth, special topics relevant to veterans, and genetics and epigenetics. Collectively, results of these studies suggest that while a significant minority of veterans screen positive for mental disorders, the majority are psychologically resilient. They further suggest that prevention and treatment efforts designed to promote protective psychosocial characteristics (i.e., resilience, gratitude, purpose in life), and social connectedness (i.e., secure attachment, community integration, social engagement) help mitigate risk for mental disorders, and promote psychological resilience and post-traumatic growth in this population.

Prevalence, risk and protective factors associated with suicidal ideation during the COVID-19 pandemic in U.S. military veterans with pre-existing psychiatric conditions

“…A total of 4069 veterans completed the Wave 1 (median completion date: 11/21/2019) survey prior to the first documented COVID-19 cases in the US and 3078 (75.6%) completed a 1-year follow-up Wave 2 (median completion date: 11/14/2020) survey. Wave 1 survey will be referred to “pre-pandemic survey” and Wave 2 survey will be referred to “peri-pandemic survey.” Details of the study, including the recruitment protocol, has been described previously ( Fogle et al, 2020 ). Briefly, the NHRVS sample was drawn from KnowledgePanel®, a survey research panel of more than 50,000 U.S. households maintained by Ipsos, a survey research firm.…”

“…To address the aforementioned gaps in knowledge, we analyzed data from the National Health and Resilience in Veterans Study (NHRVS; Fogle et al, 2020 ) to examine pre-pandemic, COVID-related, and changes in risk and protective factors associated with peri-pandemic SI. We additionally evaluated interactions between COVID-19 infection and age, and significant protective factors, in predicting SI in this population.…”

Introduction to the special section: Resilience for physical and behavioral health.

“…Resilience can be defined as the process of adapting well and even growing in the face of adversity, stress, or trauma (American Psychological Association, 2014). Some individuals are more resilient than others, and individuals can become more resilient over time (Fogle et al, 2020; Isaacs et al, 2017; Zolkoski & Bullock, 2012). Adverse life events require resilience to overcome, such as family and relationship problems, serious health problems, workplace and financial stressors, and losses of loved ones.…”

Thank You for Hearing My Voice – Listening to Women Combat Veterans in the United States and Israeli Militaries

“…Military service, particularly the service of combat soldiers, may pose a variety of threats and hence may inflict damage on both body and mind, with the literature on combat trauma indicating that combat does indeed leave a lasting impression on individual’s minds ( van der Kolk, 2012 ; Homan et al, 2019 ; Fogle et al, 2020 ; Harel-Shalev and Daphna-Tekoah, 2020 ). After military service, former military personnel may develop post-traumatic stress disorder (PTSD) or other related psychiatric conditions, which may impair their adaptation to a new post-military, civilian life ( Grimell, 2018a , p. 193).…”