Introduction: This integrative review studies the psychological impact of body disfigurement on veterans who are injured in military service. More than 1.7 million veterans spanning different military service periods report having disfiguring scars related to their service. Methods: The analysis utilized studies published between 2014 and 2024 in the PubMed, Cumulative Index to Nursing and Allied Health Literature, ProQuest, Psychology and Behavioral Sciences Collection, and Scopus databases to identify common psychological impacts, coping strategies, and adaptations among military veterans. Nineteen studies were of moderate-to-high quality based on the Joanna Briggs Institute checklist. Results: Two themes were identified from the included studies: Situational Awareness, with subthemes of Rallying the Family, Dealing with Feelings, Working on Relationships, and Rediscovering Who You Are; and After-Review Actions, with subthemes of Soldiering On and Growing Stronger after Tough Times. Findings suggested that not only does body disfigurement contribute to psychological and relational issues, but resilience, family support, and post-traumatic growth are not just beneficial but essential to the healing of veterans. Conclusion: Nurses help veterans build resilience through support groups, family involvement, and emotional support. Future research should include longitudinal studies to understand the effects that apparent body injuries have on veterans over time.
BlakeyS. M.DillonK. H.WagnerH. R.SimpsonT. L.BeckhamJ. C.CalhounP. S.ElbogenE. B. (2022). Psychosocial well-being among veterans with posttraumatic stress disorder and substance use disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 14(3), 421–430. https://doi.org/10.1037/tra0001018
2.
BlankenshipJ. C.DollJ. A.LatifF.TruesdellA. G.YoungM. N.IbebuoguU. N.VallabhajosyulaS.KadavathS. M.MaestasC. M.VetrovecG.WeltF. (2023). Best practices for cardiac catheterization laboratory morbidity and mortality conferences. JACC: Cardiovascular Interventions, 16(5), 503–514. https://doi.org/10.1016/j.jcin.2022.10.017
3.
ChinD. L.ZeberJ. E. (2020). Mental health outcomes among military service members after severe injury in combat and TBI. Military Medicine, 185(5–6), e711–e718. https://doi.org/10.1093/milmed/usz440
4.
ChristensenJ.LangbergH.DohertyP.EgerodI. (2018). Ambivalence in rehabilitation: Thematic analysis of the experiences of lower limb amputated veterans. Disability and Rehabilitation, 40(21), 2553–2560. https://doi.org/10.1080/09638288.2017.1342281
DaltonM. K.ManfulA.JarmanM. P.KoehlmoosT. P.WeissmanJ. S.CooperZ.SchoenfeldA. J. (2023). Long-term mental health trajectories of injured military servicemembers: Comparing combat to noncombat-related injuries. Annals of Surgery, 277(3), 506–511. https://doi.org/10.1097/SLA.0000000000005165
7.
DangD.DearholtS.BissettK.AscenziJ.WhalenM. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
8.
DyballD.BennettA. N.SchofieldS.CullinanP.BoosC. J.BullA. M. J.WesselyS.StevelinkS. A. M.FearN. T., & ADVANCE study. (2022). Mental health outcomes of male UK military personnel deployed to Afghanistan and the role of combat injury: Analysis of baseline data from the ADVANCE cohort study. The Lancet Psychiatry, 9(7), 547–554. https://doi.org/10.1016/S2215-0366(22)00112-2
9.
EndsleyM. R. (1988). Design and evaluation for situation awareness enhancement. Proceedings of the Human Factors Society Annual Meeting, 32(2), 97–101. https://doi.org/10.1177/154193128803200221
ErbesC. R.FergusonJ.YangK.Koehler-McNicholasS.PolusnyM. A.HafnerB. J.HeinemannA. W.HillJ.RichT.WalkerN.WeberM.HansenA. (2022). Amputation-specific and generic correlates participation among veterans with lower limb amputation. PLoS ONE, 17(7), e0270753. https://doi.org/10.1371/journal.pone.0270753
12.
FreysteinsonW. M.MellottS.CeliaT.DuJ.GoffM.PlescherT.AllamZ. (2018). Body image perceptions of women veterans with military sexual trauma. Issues in Mental Health Nursing, 39(8), 623–632. https://doi.org/10.1080/01612840.2018.1445327
13.
GettingsR. D.KirtleyJ.Wilson-MenzfeldG.OxburghG. E.FarrellD.KiernanM. D. (2022). Exploring the role of social connection in interventions with military veterans diagnosed with post-traumatic stress disorder: Systematic narrative review. Frontiers in Psychology, 13, Article 873885. https://doi.org/10.3389/fpsyg.2022.873885
14.
GholizadehS.RiceD. B.Carboni-JiménezA.KwakkenbosL.BoruffJ.KrishnanA.MalcarneV. L.ThombsB. D., & Scleroderma Patient-centered Intervention Network (SPIN) Body Image Patient Advisory Team. (2021). Effects of cosmetic and other camouflage interventions on appearance-related and psychological outcomes among adults with visible differences in appearance: A systematic review. BMJ Open, 11(3), Article e046634. https://doi.org/10.1136/bmjopen-2020-046634
15.
GoldbergS. B.RiordanK. M.SunS.KearneyD. J.SimpsonT. L. (2020). Efficacy and acceptability of mindfulness-based interventions for military veterans: A systematic review and meta-analysis. Journal of Psychosomatic Research, 138(1), 110232. https://doi.org/10.1016/j.jpsychores.2020.110232
16.
HabibA.StevelinkS. A. M.GreenbergN.WilliamsonV. (2018). Post-traumatic growth in (ex-) military personnel: Review and qualitative synthesis. Occupational Medicine, 68(9), 617–625. https://doi.org/10.1093/occmed/kqy140
17.
HaslamS. A.HaslamC.CruwysT.JettenJ.BentleyS. V.FongP.SteffensN. K. (2022). Social identity makes group-based social connection possible: Implications for loneliness and mental health. Current Opinion in Psychology, 43(1), 161–165. https://doi.org/10.1016/j.copsyc.2021.07.013
18.
HatunO.ŞirinA. (2022). The experience of veterans with disabilities: A grounded theory study on coping with trauma and adapting to a new life. Military Psychology, 34(4), 455–468. https://doi.org/10.1080/08995605.2021.2007001
HendrickA.BinksE.FergusonN.Di LemmaL. (2024). Unveiling the influence of competitive sports on the sense of self and identity of disabled veterans: A systematic review and mixed-methods synthesis. Identity, 24(3), 194–212. https://doi.org/10.1080/15283488.2024.2346257
21.
HensonC.TruchotD.CanevelloA. (2021). What promotes post-traumatic growth? A systematic review. European Journal of Trauma & Dissociation = Revue Europâeenne Du Trauma et de La Dissociation, 5(4), Article 100195. https://doi.org/10.1016/j.ejtd.2020.100195
22.
HynesC.ScullionL.LawlerC.SteelR.BolandP. (2021). The impact of in-service physical injury or illness on the mental health of military veterans. BMJ Military Health, 169(e1), e51–e54. https://doi.org/10.1136/bmjmilitary-2020-001759
23.
KeelingM.SharrattN. D. (2023). (Loss of) the super soldier: Combat injuries, body image, and veterans’ romantic relationships. Disability and Rehabilitation, 45(2), 209–219. https://doi.org/10.1080/09638288.2022.2026499
24.
KeelingM.WilliamsonH.WilliamsV.KiffJ.HarcourtD. (2021). Body image concerns and psychological wellbeing among injured combat veterans with scars and limb loss: A review of the literature. Military Behavioral Health, 9(1), 1–10. https://doi.org/10.1080/21635781.2020.1792013
25.
KeelingM.WilliamsonH.WilliamsV. S.KiffJ.EvansS.MurphyD.HarcourtD. (2023). Body image and psychosocial wellbeing among UK military personnel and veterans who sustained appearance-altering conflict injuries. Military Psychology, 35(1), 12–26. https://doi.org/10.1080/08995605.2022.2058302
26.
KitchinerN. J.LewisC.RobertsN. P.BissonJ. I. (2019). Active duty and ex-serving military personnel with post-traumatic stress disorder treated with psychological therapies: Systematic review and meta-analysis. European Journal of Psychotraumatology, 10(1), Article 1684226. https://doi.org/10.1080/20008198.2019.1684226
27.
LewisC.RobertsN. P.SimonN.BethellA.BissonJ. I. (2019). Internet-delivered cognitive behavioral therapy for post-traumatic stress disorder: Systematic review and meta-analysis. Acta Psychiatrica Scandinavica, 140(6), 508–521. https://doi.org/10.1111/acps.13079
28.
LiuJ. J.EinN.ForchukC.WanklynS. G.RaguS.SaroyaS.NazarovA.RichardsonJ. D. (2023). A meta-analysis of internet-based cognitive behavioral therapy for military and veteran populations. BMC Psychiatry, 23(1), 223. https://doi.org/10.1186/s12888-023-04668-1
29.
LockwoodC.MunnZ.PorrittK. (2015). Qualitative research synthesis: Methodological guidance for systematic reviewers utilizing meta-aggregation. International Journal of Evidence-Based Healthcare, 13(3), 179–187. https://doi.org/10.1097/XEB.0000000000000062
30.
MarchandW. R.SandovalK.LacknerR.ParkerS. C.HerrmannT.YabkoB.VelasquezT.LewisL.ButlerJ. (2021). Mindfulness-based interventions for military veterans: A systematic review and analysis of the literature. Complementary Therapies in Clinical Practice, 42(1), 101274. https://doi.org/10.1016/j.ctcp.2020.101274
31.
McGillG.WilsonG.CaddickN.ForsterN.KiernanM. D. (2021). Rehabilitation and transition in military veterans after limb loss. Disability and Rehabilitation, 43(23), 3315–3322. https://doi.org/10.1080/09638288.2020.1734875
32.
MercierJ.-M.HosseinyF.RodriguesS.FriioA.Brémault-PhillipsS.ShieldsD. M.DupuisG. (2023). Peer support activities for veterans, serving members, and their families: Results of a scoping review. International Journal of Environmental Research and Public Health, 20(4), Article 3628. https://doi.org/10.3390/ijerph20043628
33.
MoolaS.MunnZ.TufanaruC.AromatarisE.SearsK.SfetcuR.CurrieM.LisyK.QureshiR.MattisP.MuP. (2020). Systematic reviews of etiology and risk. In JordanZ.LockwoodC.PillaB.PorrittK.AromatarisC. (Eds.), Joanna Briggs Institute reviewer’s manual (Vol. 5, pp. 217–269). The Joanna Briggs Institute. https://doi.org/10.46658/JBIMES-24-01
34.
MoradiY.DowranB.SepandiM. (2021). The global prevalence of depression, suicide ideation, and attempts in the military forces: A systematic review and meta-analysis of cross-sectional studies. BMC Psychiatry, 21(1), 510. https://doi.org/10.1186/s12888-021-03526-2
35.
MurrayC. D.HavlinH.MolyneauxV. (2024). Considering the psychological experience of amputation and rehabilitation for military veterans: A systematic review and metasynthesis of qualitative research. Disability and Rehabilitation, 46(6), 1053–1072. https://doi.org/10.1080/09638288.2023.2182915
36.
NgaageM.AgiusM. (2018). The psychology of scars: A mini-review. Psychiatria Danubina, 30(Suppl. 7), 633–638. https://doi.org/https://hrcak.srce.hr/263021
37.
ReichmannJ. P.BartmanK. R. (2018). An integrative review of peer support for patients undergoing major limb amputation. Journal of Vascular Nursing, 36(1), 34–39. https://doi.org/10.1016/j.jvn.2017.10.002
RunyanH.HerbertL.KnightJ.ToddS.WashingtonL.ThompsonM. O. (2023). Lived experiences of combat-related amputees: A phenomenological study. Journal of Loss & Trauma, 28(6), 554–567. https://doi.org/10.1080/15325024.2022.2129839
40.
SarwerD. B.SiminoffL. A.GardinerH. M.SpitzerJ. C. (2022). The psychosocial burden of visible disfigurement following traumatic injury. Frontiers in Psychology, 13, Article 979574. https://doi.org/10.3389/fpsyg.2022.979574
41.
SunderlinC.KennedyK.SehringK.BlairT.Atkinson-SmithC.PlumleyP.FoleyM. (2022). Supporting our troops—The use of peer support with veterans with mental health conditions: A systematic review. American Occupational Therapy Association, INSPIRE conference, March 31–April 3, 2022, San Antonio, Texas, Congresses and Conferences/Texas. American Journal of Occupational Therapy, 76(1), 1. https://doi.org/10.5014/ajot.2022.76S1-PO200
42.
ThayerV. B.FreysteinsonW.ThomasL. W. (2020). Transforming the experience of mirror viewing for individuals faced with disfiguring injuries. Clinical Nurse Specialist, 34(3), 132–136. https://doi.org/10.1097/NUR.0000000000000518
43.
Thompson-HollandsJ.StrageM.DeVoeE. R.BeidasR. S.SloanD. M. (2021). Development and initial testing of a brief adjunctive intervention for family members of veterans in individual PTSD treatment. Cognitive and Behavioral Practice, 28(2), 193–209. https://doi.org/10.1016/j.cbpra.2020.06.007
Van LommelK. (2015). Heroes and outcasts: Ambiguous attitudes towards impaired and disfigured Roman veterans. Classical World, 109(1), 91–117. https://doi.org/https://www.jstor.org/stable/24699912
VothM.ChisholmS.SollidH.JonesC.Smith-MacDonaldL.Brémault-PhillipsS. (2022). Efficacy, effectiveness, and quality of resilience-building mobile health apps for military, veteran, and public safety personnel populations: Scoping literature review and app evaluation. JMIR mHealth and uHealth, 10(1), Article e26453. https://doi.org/10.2196/26453
48.
WalkerL. E.PoltavskiyE.HowardJ. T.JanakJ. C.WatrousJ.AlcoverK.PetteyW. B. P.AmbardarS.MeyerE.GundlapalliA. V.StewartI. J. (2023). Suicide attempts and mental health diagnoses in combat-injured service members: A retrospective cohort study. Suicide & Life-Threatening Behavior, 53(2), 227–240. https://doi.org/10.1111/sltb.12938
49.
WalsheN. C.CrowleyC. M.O'BrienS.BrowneJ. P.HegartyJ. M. (2019). Educational interventions to enhance situation awareness: A systematic review and meta-analysis. Simulation in Healthcare: Journal of the Society for Medical Simulation, 14(6), 398–408. https://doi.org/10.1097/SIH.0000000000000376
50.
WeaverT. L.WalterK. H.ChardK. M.BoschJ. (2014). Residual injury, appearance-related concerns, symptoms of post-traumatic stress disorder, and depression within a treatment-seeking veteran sample. Military Medicine, 179(10), 1067–1071. https://doi.org/10.7205/MILMED-D-13-00414
51.
WellsM. J.OwenJ. J.McCrayL. W.BishopL. B.EellsT. D.BrownG. K.RichardsD.ThaseM. E.WrightJ. H. (2018). Computer-assisted cognitive-behavior therapy for depression in primary care: Systematic review and meta-analysis. The Primary Care Companion for CNS Disorders, 20(2), Article 17r02196. https://doi.org/10.4088/PCC.17r02196
52.
WenI.PriceL. E.SprayA. M.MarmarC. R. (2020). Mending broken bonds in military couples using emotionally focused therapy for couples: Tips and discoveries. Journal of Clinical Psychology, 76(5), 865–870. https://doi.org/10.1002/jclp.22921
WilsonG.HillM.KiernanM. D. (2018). Loneliness and social isolation of military veterans: Systematic narrative review. Occupational Medicine, 68(9), 600–609. https://doi.org/10.1093/occmed/kqy160
55.
WoodruffS. I.GalarneauM. R.McCabeC. T.LuuB. N.SackD. I.HanP. P. (2017). Body-region-specific injuries as predictors of psychosocial outcomes among those injured in combat: Results from the Wounded Warrior Recovery Project. Military Psychology, 29(6), 590–600. https://doi.org/10.1037/mil0000181
56.
ZhangT.YangJ.LiangN.PittsB. J.Prakah-AsanteK.CurryR.DuerstockB.WachsJ. P.YuD. (2023). Physiological measurements of situation awareness: A systematic review. Human Factors, 65(5), 737–758. https://doi.org/10.1177/0018720820969071
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
