Impact of Perceived Social Support on Mental Health,Quality of Life,and Disability in Post

Abstract

This study examined the impact of perceived social support on mental health and psychosocial functioning in combat veterans after military deployment, including veterans with post-traumatic stress disorder (PTSD) and veterans with comorbid PTSD and alcohol use disorder. Veterans (n = 139; female = 23) completed self-report and clinician-administered measures of social support, mental and physical health, functional impairment, and quality of life. The cohort was divided into high, medium, and low perceived social support based on averages of the total score from the Multidimensional Scale of Perceived Social Support. Relative to the low perceived social support group, the high perceived social support group reported fewer symptoms of PTSD, anxiety, and depression. The high perceived social support group also reported a more diverse and embedded social network, less disability, and better quality of life. Of note, the high and low perceived social support groups did not differ on age, gender, education, race ethnicity, or combat trauma exposure. These findings highlight that perceived social support may play an important role in the treatment of postwar veterans as they transition back to civilian life.

Keywords

health care veterans reserve component consequences

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References

Althubaiti

(2016). Information bias in health research: Definition, pitfalls, and adjustment methods. Journal of multidisciplinary healthcare, 9, 211–217. https://doi.org/10.2147/JMDH.S104807

Avery

McDevitt-Murphy

(2014). Impact of combat and social support on PTSD and alcohol consumption in OEF/OIF veterans. Military Behavioral Health, 2, 217–223. https://doi.org/10.1080/21635781.2014.891433

Barrett

T. W.

Mizes

J. S.

(1988). Combat level and social support in the development of posttraumatic stress disorder in Vietnam veterans. Behavior Modification, 12, 100–115. https://doi.org/10.1177/01454455880121005

Barroso

(2019, September 10). The changing profile of the U.S. military: Smaller in size, more diverse, more women in leadership. https://www.pewresearch.org/fact-tank/2019/09/10/the-changing-profile-of-the-u-s-military/

Beattie

M. C.

Longabaugh

(1999). General and alcohol-specific social support following treatment. Addictive Behaviors, 24(5), 593–606. https://doi.org/10.1016/S0306-4603(98)00120-8

Benjamini

Hochberg

(1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, Series B (Methodological), 289–300. www.jstor.org/stable/2346101

Blake

D. D.

Weathers

F. W.

Nagy

L. M.

Kaloupek

D. G.

Gusman

F. D.

Charney

D. S.

Keane

T. M.

(1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90. https://doi.org/10.1007/BF02105408

Bonanno

G. A.

(2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59(1), 20–28. https://doi.org/10.1037/0003-066X.59.1.20

Bonanno

G. A.

Mancini

A. D.

Horton

J. L.

Powell

T. M.

LeardMann

C. A.

Boyko

E. J.

Wells

T. S.

Hooper

T. I.

Gackstetter

G. D.

Smith

T. C.

(2012). Trajectories of trauma symptoms and resilience in deployed US military service members: Prospective cohort study. British Journal of Psychiatry, 200(4), 317–323. https://doi.org/10.1192/bjp.bp.111.096552

10.

Boscarino

J. A.

(1995). Post-traumatic stress and associated disorders among Vietnam veterans: The significance of combat exposure and social support. Journal of Traumatic Stress, 8, 317–336. https://doi.org/10.1002/jts.2490080211

11.

Brewin

Andrews

Valentine

(2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68(5), 748–766. https://doi.org/10.1037/0022-006X.68.5.748

12.

Bryan

C. J.

Heron

E. A.

(2015). Belonging protects against post-deployment depression in military personnel. Depression and Anxiety, 32, 349–355.

13.

Brymer

Jacobs

Layne

Pynoos

Ruzek

Steinberg

Vernberg

Watson

(2006). Psychological first aid: Field operations guide (2nd ed.). Department of Veteran Affairs. https://www.ptsd.va.gov/professional/treat/type/PFA/PFA_V2.pdf

14.

Carter

S. P.

DiMauro

Renshaw

K. D.

Curby

T. W.

Babson

K. A.

Bonn-Miller

M. O.

(2016). Longitudinal associations of friend-based social support and PTSD symptomatology during a cannabis cessation attempt. Journal of Anxiety Disorders, 38, 62–67. http://dx.doi.org/10.1016/j.janxdis.2016.01.008

15.

Cohen

Willis

(1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. https://doi.org//10.1037/0033-2909.98.2.310

16.

Congressional Research Service. (2019, August 27). U.S. periods of war and dates of recent conflicts [Report]. https://fas.org/sgp/crs/natsec/RS21405.pdf

17.

Cox

D. W.

Bakker

A. M.

Naifeh

J. A.

(2017). Emotion dysregulation and social support in PTSD and depression: A study of trauma-exposed veterans. Journal of Traumatic Stress, 30, 545–549. https://doi.org/10.1002/jts.22226

18.

Daeppen

Yersin

Landry

Pécoud

Decrey

(2000). Reliability and validity of the alcohol use disorders identification test (audit) imbedded within a general health risk screening questionnaire: Results of a survey in 332 primary care patients. Alcoholism: Clinical and Experimental Research, 24, 659–665. https://doi.org/10.1111/j.1530-0277.2000.tb02037.x

19.

DeViva

J. C.

Sheerin

C. M.

Southwick

S. M

Roy

A. M.

Pietrzak

R. H.

Harpaz-Rotem

(2016). Correlates of VA mental health treatment utilization among OEF/OIF/OND veterans: Resilience, stigma, social support, personality, and beliefs about treatment. Psychological Trauma: Theory, Research, Practice, and Policy, 8, 310–331. https://doi.org/10.1002/da.22372

20.

Duax

J. M.

Bohnert

K. M.

Rauch

S. A.

Defever

A. M.

(2014). Posttraumatic stress disorder symptoms, levels of social support, and emotional hiding in returning veterans. Journal of Rehabilitation Research & Development, 51, 571–578. https://doi.org/10.1682/JRRD.2012.12.0234

21.

Dursa

E. K.

Reinhard

M. J.

Barth

S. K.

Schneiderman

A. I.

(2014). Prevalence of a positive screen for PTSD among OEF/OIF and OEF/OIF-era veterans in a large population-based cohort. Journal of traumatic stress, 27(5), 542–549. https://doi.org/10.1002/jts.21956

22.

Glanz

Rimer

B. K.

Viswanath

(2015). Health behavior: Theory, research, and practice (5th ed.). Jossey-Bass.

23.

Gros

D. F.

Flanagan

J. C.

Korte

K. J.

Mills

A. C.

Brady

K. T.

Back

S. E.

(2016). Relations between social support, PTSD symptoms, and substance use in veterans. Psychology of Addictive Behaviors, 30, 764–770. https://doi.org/10.1037/adb0000205adb0000205

24.

Hamilton

(1959). The assessment of anxiety states by rating. British of Medical Psychology, 32, 50–55. https://doi.org/10.1111/j.2044-8341.1959.tb00467.x

25.

Hoge

C. W.

Castro

C. A.

Messer

S. C.

McGurk

Cotting

D. I.

Koffman

R. L.

(2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 35, 13–22. https://doi.org/10.1056/NEJMoa040603

26.

Institute of Medicine. (2013). Returning home from Iraq and Afghanistan: Assessment of readjustment needs of veterans, service members, and their families. The National Academies Press. https://doi.org/10.17226/13499

27.

Kaniasty

Norris

F. H.

(2008). Longitudinal linkages between perceived social support and posttraumatic stress symptoms: Sequential roles of social causation and social selection. Journal of Traumatic Stress, 21(3), 274–281. https://doi.org/10.1002/jts.20334

28.

Keane

T. M.

Fairbank

J. A.

Caddell

J. M.

Zimering

R. T.

Taylor

K. L.

Mora

C. A.

(1989). Clinical evaluation of a measure to assess combat exposure. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1, 53. https://doi.org/10.1037/1040-3590.1.1.53

29.

Kehle

S. M.

Reddy

M. K.

Ferrier-Auerbach

A. G.

Erbes

C. R.

Arbisis

P. A.

Polusny

M. A.

(2011). Psychiatric diagnoses, comorbidity, and functioning in National Guard troops deployed to Iraq. Journal of Psychiatric Research, 45, 126–132. https://doi.org/10.1016/j.jpsychires.2010.05.013

30.

King

D. W.

Taft

King

L. A.

Hammond

Stone

E. R.

(2006). Directionality of the association between social support and posttraumatic stress disorder: A longitudinal investigation†. Journal of Applied Social Psychology, 36, 2980–2992. https://doi.org/10.1111/j.0021-9029.2006.00138.x

31.

Laffaye

Cavella

Drescher

Rosen

(2008). Relations among PTSD symptoms, social support, and support source in veterans with chronic PTSD. Journal of Traumatic Stress, 21, 394–401. https://doi.org/10.1037/adb0000205

32.

Lehavot

Der-Martirosian

Simpson

T. L.

Shipherd

J. C.

Washington

D. L.

(2013). The role of military social support in understanding the relationship between PTSD, physical health, and healthcare utilization in women veterans. Journal of Traumatic Stress, 26, 772–775. https://doi.org/10.1002/jts.21859

33.

Mikulincer

Ein-Dor

Solomon

Shaver

P. R.

(2011). Trajectories of attachment insecurities over a 17-year period: A latent growth curve analysis of the impact of war captivity and posttraumatic stress disorder. Journal of Social and Clinical Psychology, 30(9), 960–984. https://doi.org/10.1521/jscp.2011.30.9.960

34.

Milliken

C. S.

Auchterlonie

J. L.

Hoge

C. W.

(2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA, 298, 2141–2148. https://doi.org/10.1001/jama.298.18.2141

35.

Muralidharan

Austern

Hack

Vogt

(2016). Deployment experiences, social support, and mental health: Comparison of black, white, and Hispanic U.S. veterans deployed to Afghanistan and Iraq. Journal of Traumatic Stress, 26, 273–278. https://doi.org/10.1002/jts.22104

36.

Ozbay

Johnson

D. C.

Dimoulas

Morgan

C. A.

Charney

Southwick

(2007). Social support and resilience to stress: From neurobiology to clinical practice. Psychiatry (Edgmont), 4, 35–40.

37.

Ozer

E. J.

Best

S. R.

Lipsey

T. L.

Weiss

D. S.

(2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129(1), 52–73. https://doi.org/10.1037/0033-2909.129.1.52

38.

Parker

Igielnik

Barroso

Cilluffo

(2019, September 10) The American veteran experience and the post-9/11 generation. https://www.pewsocialtrends.org/2019/09/10/the-american-veteran-experience-and-the-post-9-11-generation/

39.

Pietrzak

R. H.

Goldstein

M. B.

Malley

J. C.

Rivers

A. J.

Southwick

S. M.

(2010). Structure of posttraumatic stress disorder symptoms and psychosocial functioning in veterans of operation enduring freedom and Iraqi freedom. Psychiatry Research, 178, 323–329. https://doi.org/10.1016/j.psychres.2010.04.039

40.

Pietrzak

R. H.

Johnson

D. C.

Goldstein

M. B.

Malley

J. C.

Southwick

S. M.

(2009a). Perceived stigma and barriers to mental health care utilization among OEF-OIF veterans. Psychiatric Services, 60(8), 1118–1122. https://doi.org/10.1176/ps.2009.60.8.1118

41.

Pietrzak

R. H.

Johnson

D. C.

Goldstein

M. B.

Malley

J. C.

Southwick

S. M.

(2009b). Psychological resilience and postdeployment social support protect against traumatic stress and depressive symptoms in soldiers returning from operations enduring freedom and Iraqi Freedom. Depression and Anxiety, 26, 745–751. https://doi.org/10.1002/da.20558

42.

Platt

Keyes

K. M.

Koenen

K. C.

(2014). Size of the social network versus quality of social support: Which is more protective against PTSD? Social Psychiatry and Psychiatric Epidemiology, 49(8), 1279–1286. https://doi.org/10.1007/s00127-013-0798-4

43.

Price

Gros

D. F.

Strachan

Ruggiero

K. J.

Acierno

(2013). The role of social support in exposure therapy for operation Iraqi freedom/operation enduring freedom veterans: A preliminary investigation. Psychological Trauma: Theory, Research, Practice, and Policy, 5(1), 93–100. https://doi.org/10.1037/a0026244

44.

Ren

X. S.

Skinner

Lee

Kazis

(1999). Social support, social selection, and self-assessed health status: Results from the veterans health study in the United States. Social Science & Medicine, 48, 1721–1734. https://doi.org/10.1016/s0277-9536(99)00069-6

45.

Rohan

K. J.

Rough

J. N.

Evans

S. Y.

Meyerhoff

Roberts

L. M.

Vacek

P. M.

(2016). A protocol for the Hamilton rating scale for depression: Item scoring rules, rater training, and outcome accuracy with data on its application in a clinical trial. Journal of Affective Disorders, 200, 111–118. https://doi.org/10.1016/j.jad.2016.01.051

46.

Sacco

Bucholz

K. K.

Harrington

(2014). Gender differences in stressful life events, social support, perceived stress, and alcohol use among older adults: Results from a national survey. Substance Use & Misuse, 49, 456–465. https://doi.org/10.3109/10826084.2013.846379

47.

Saunders

J. B.

Aasland

O. G.

Babor

T. F.

de la Fuente

J. R.

Grant

(1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88(6), 791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x

48.

Sayer

N. A.

Noorbaloochi

Frazier

Carlson

Gravely

Murdoch

(2010). Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care. Psychiatric Services, 61, 589–597. https://doi.org/10.1176/ps.2010.61.6.589

49.

Seal

K. H.

Betenthal

Miner

C. R.

Sen

Marmar

(2007). Bringing the war back home: Mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Archives of Internal Medicine, 167, 476–482. https://doi.org/10.1001/archinte.167.5.476

50.

Shallcross

S. L.

Arbisi

P. A.

Polusny

M. A.

Kramer

M. D.

Erbes

C. R.

(2016). Social causation versus social erosion: Comparisons of causal models for relations between support and PTSD symptoms. Journal of Traumatic Stress, 29(2), 167–175. https://doi.org/10.1002/jts.22086

51.

Sheehan

D. V.

Harnett-Sheehan

Raj

B. A.

(1996). The measurement of disability. International Clinical Psychopharmacology, 11(Suppl. 3), 89–95. https://doi.org/10.1097/00004850-199606003-00015

52.

Sheehan

(2008). Assessing treatment effects in clinical trials with the Discan metric of the Sheehan Disability Scale. International Clinical Psychopharmacology, 23 (2), 70–83. https://doi.org/10.1097/YIC.0b013e3282f2b4d6

53.

Spoont

M. R.

Nelson

D. B.

Murdoch

Sayer

N. A.

Nugent

Rector

Westermeyer

(2015). Are there racial/ethnic disparities in VA PTSD treatment retention? Depression & Anxiety (1091-4269), 32, 415–425. https://doi.org/10.1002/da.22295

54.

Steenkamp

M. M.

Litz

B. T.

Marmar

C. R.

(2020). First-line psychotherapies for military-related PTSD. JAMA. Published online January 30, 2020. https://doi.org/10.1001/jama.2019.20825

55.

U.S. Department of Veterans Affairs, Office of Suicide Prevention. (2017). Facts About Veteran Suicide: August 2017. Retrieved from https://www.mentalhealth.va.gov/docs/VA-Suicide-Prevention-Fact-Sheet.pdf

56.

Watkins

L. E.

Sprang

K. R.

Rothbaum

R. O.

(2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, 258. https://doi.org/10.3389/fnbeh.2018.00258

57.

Wilcox

(2010). Social relationships and PTSD symptomatology in combat veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 2, 175–182. https://doi.org/10.1037/a0019062

58.

World Health Organization. (2004). The World Health Organization Quality of Life (WHOQOL)—BREF, 2012 revision. Author. http://www.who.int/iris/handle/10665/77773

59.

Zimet

G. D.

Dahlem

N. W.

Zimet

S. G.

Farley

G. K.

(1988). The Multidimensional Scale of perceived social support. Journal of Personality Assessment, 52, 30–41. https://doi.org/10.1207/s15327752jpa5201_2

Impact of Perceived Social Support on Mental Health,Quality of Life,and Disability in Post–9/11 U.S. Military Veterans

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