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Mental Health and Well-Being of Military Veterans During Military to Civilian Transition: Review and Analysis of the Recent Literature

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Mental Health and Well-Being of Military Veterans During Military to Civilian Transition: Review and Analysis of the Recent Literature April 11, 2016 Mental Health and Well-Being of Military Veterans during Military to Civilian Transition: Review and Analysis of the Recent Literature. R2CL / PVVC – Road to Civilian Life / Parcours Vers la Vie Civile Prepared for: Canadian Institute for Military and Veteran Health Research & Scientific Authority, Veterans Affairs Canada Prepared by: Duncan M. Shields, PhD, Adjunct Professor, UBC Faculty of Medicine. David Kuhl, MD, PhD, Professor, UBC Faculty of Medicine. Kevin Lutz, PhD, (Cand.), Educational and Counselling Psychology, UBC. Jesse Frender, MA, Independent Mental Health Therapist. Niki Baumann, MLIS, Librarian, College of Physicians and Surgeons of BC. Phillip Lopresti, BA, Research Assistant, Kinesiology, Faculty of Education, UBC. Abstract A review of the literature on military personnel’s transition from military to civilian life (MCT) was conducted, as part of Veterans Affairs Canada (VAC) five-year Road to Civilian Life (R2CL) research program. The objective was to synthesize current knowledge about supporting Canadian Armed Forces (CAF) members/Veterans undergoing the transition out of their military service and back into civilian life. An emerging consensus among international experts suggests that the circumstances of the transition peri-release period (from 6 months prior to approximately 2 years after release) may play a particularly important role in long-term transition “success” in terms of post-service functioning, community engagement or participation, and well-being. A search was carried out in December 2015 for English language documents and articles published from 2000 to the present through ten digital library catalogues as well as for government technical reports, committees’ reports, and results from expert panels. An initial base-set of 901 document abstracts were reviewed by the two primary investigators resulting in 417 references being retained for more substantive review, and a final 306 articles identified for inclusion. In this report, annotated results are presented for the 306 articles according to their primary research domain. Existing literature reviews are identified and reviewed. Current conceptual frameworks for military to civilian transition are also identified and presented. Strengths and gaps in the literature are noted and recommendations are given for future research. Recommendations include addressing the need for better coordination of research efforts, language, and priorities within and between nations. An agreed upon conceptual framework is required to inform knowledge gap analysis, as is an accepted taxonomy for organizing the research. It is recommended that a formalized international research institute be established to facilitate dialogue and collaboration. 2016 Military to Civilian Transition i Table of Contents Abstract .......................................................................................................................................................... i Dedication ..................................................................................................................................................... v Acknowledgements ....................................................................................................................................... v Executive Summary ...................................................................................................................................... vi 1. Introduction ............................................................................................................................................. 1 2. Background .............................................................................................................................................. 2 3. Objectives ................................................................................................................................................. 3 4. Research Questions .................................................................................................................................. 4 5. Methodology ............................................................................................................................................ 5 5.1. Identification Phase .......................................................................................................................... 5 Step 1. Computerized Database Search ............................................................................................... 5 Step 2. Comparison with Previous Reviews ......................................................................................... 7 Step 3. Government Publications and Research Articles Identified by VAC Research Directorate ..... 8 Step 4. Searches for Work of Identified Experts in the Field of Military Health and/or MCT ............. 8 Results of the Combined Searches – The Initial Base-Set ..................................................................... 8 5.2. Screening Phase ................................................................................................................................ 8 5.2.1. Inclusion/Exclusion Criteria ........................................................................................................ 8 5.2.2. Preliminary Cull Results .............................................................................................................. 9 5.3. Eligibility Phase................................................................................................................................ 10 5.4. Included Documents ....................................................................................................................... 10 6. Introduction to the Findings .................................................................................................................. 12 6.1. Terms in the Transition Research ................................................................................................... 12 6.1.1. Terms for Those Who Have Served .......................................................................................... 12 6.1.2. Terms Referring to the Process of Leaving the Military........................................................... 13 6.2. Key Concepts in MCT Research ....................................................................................................... 14 6.2.1. Well-being ................................................................................................................................ 14 6.2.2. Institutionalization ................................................................................................................... 14 6.2.3. Reverse Culture Shock ............................................................................................................. 15 6.2.4. Identity ..................................................................................................................................... 15 6.2.5. Personal Narratives .................................................................................................................. 15 6.2.6. Gender/Military Masculinity .................................................................................................... 16 2016 Military to Civilian Transition ii 6.3. Conceptual Models of Military to Civilian Transition ...................................................................... 16 6.4. Literature Reviews .......................................................................................................................... 27 6.4.1. Canada ...................................................................................................................................... 28 6.4.2. United Kingdom ....................................................................................................................... 29 6.4.3. Australia ................................................................................................................................... 29 6.4.4. United States of America ......................................................................................................... 30 7. Annotated Bibliography ......................................................................................................................... 31 7.1. Research concerning the Social or Environmental Context and Determinants .............................. 33 7.1.1. Retirement ............................................................................................................................... 33 7.1.2. Finances.................................................................................................................................... 34 7.1.3. Employment ............................................................................................................................. 35 7.1.4. Education ................................................................................................................................. 42 7.1.5. Families .................................................................................................................................... 48 7.1.6. Social Support/Community Reintegration ............................................................................... 55 7.1.7. Deployment/Post-Deployment ................................................................................................ 61 7.1.8. Health Service Determinants/ Improving Access, Support and Culturally-Appropriate
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