The Long-term Impact of Post-traumatic Stress Disorder on Veterans’ Mental and Physical Health Outcomes

 

Abstract

Background: Post-Traumatic Stress Disorder (PTSD) is a complex psychological disorder that is connected to mental devastation arising from experiencing a disturbing or violent event. As an intense psychological disorder, the prevalence of PTSD in human psychiatric conditions has been linked to several factors, including military experiences. Research indicates that the pressures connected to exposure to conflict and trauma from their military service may put veterans at a higher risk of getting PTSD.

Objective: This study aims to ascertain how PTSD affects the mental and physical outcomes of veterans and their functioning in critical facets of post-service lifestyles.

Method: A literature review method was used in this study and 6 studies were selected as the data for this study from the databases CORE and JSTOR. All the studies used in this research utilised the primary data collection method and this was to ensure the accuracy and reliability of the results in this literature review.

Results: Three themes were generated from the studies which are; PTSD, depression, and substance abuse. From the studies reviewed, it was shown that veterans with PTSD also suffer from depression and to suppress their symptoms, they mostly resort to substance abuse which always makes the situation worse for them. This is even higher amongst female military veterans who suffer from military sexual trauma (MST).

Conclusion: This study covered the effects of PTSD on the physical and mental health of veterans and recommended customized support systems and interventions for these veterans to improve mental health outcomes. Also, this study explored specific difficulties encountered by female soldiers as well as the distinct risk factors that lead to the onset of PTSD and the difficulties veterans encounter when adjusting from the military to civilian life.

 

List of Abbreviations

CORE: Connecting Repositories

VA: Department of Veteran Affairs

JSTOR: Journal Storage

MoD: Ministry of Defence

MST: Military Sexual Trauma

NHS: National Health Service

NIHR: National Institute for Health Research

NIMH: National Institute of Mental Health

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PTSD: Post Traumatic Stress Disorder

WHO: World Health Organisation

 

CHAPTER ONE: INTRODUCTION

Introduction

Post-Traumatic Stress Disorder (PTSD) is a complex psychological disorder that is connected to mental devastation arising from experiencing a disturbing or violent event (Rakitzi, 2023). As an intense psychological disorder, the prevalence of PTSD in human psychiatric conditions has been linked to several factors, including military experiences (Inoue et al., 2021). Research indicates that the pressures connected to exposure to conflict and trauma from their military service may put veterans at a higher risk of getting PTSD. Depending on the location of duty, PTSD affects veterans at a rate of 11–30% (Muller et al., 2017). Studies reveal that 30% of Vietnam War veterans, 10% of Gulf War veterans, 15% of Iraq veterans, and 11% of troops returning from Afghanistan experience PTSD (Knowles et al., 2018). Traumatic or stressful life events can cause post-traumatic stress disorder (PTSD), which can affect a person’s ability to function socially, physically, and psychologically. According to Sippel et al. (2017), intrusive thoughts that replay the event, avoiding situations that could trigger it, hyperarousal or alertness, and unfavourable changes in mood and cognition that can lead to anger and aggression are all signs of PTSD. A smooth transition from the military to civilian life may be hampered by veterans with trauma exposure and PTSD who are more prone to sleep disorders, mood swings, reckless behaviour, substance abuse, and isolation (Kintzle et al., 2018).

Combat exposure is one of the main risk factors for developing PTSD. Numerous studies have shown that veterans’ health and psychological issues are significantly predicted by their exposure to conflict because of the increased risk of physical harm, psychological trauma, and other stresses associated with war (Buttner et al., 2017). The physical discomfort, PTSD, and depression experienced by veterans were the main topics of a new study that looked at the relationships between exposure to combat and physical and psychological health. According to the research, veterans who had been in battle experienced more intense pain, which led to higher levels of PTSD and depression symptoms than soldiers who had not been in combat (Kintzle et al., 2018). While this condition severely impacts the mental wellness and effectiveness of persons challenged with PTSD (Waheed et al., 2019), it becomes more crucial to understand the lasting impact of PTSD on veterans as former military servicemen with a high preponderance of exposure to violent situations. Accordingly, this research seeks to establish the prevalence of PTSD among servicemen, including its causes, severity, and particularly its long-term impacts on the physical and mental health outcomes of veterans.

Current Understanding

Post-Traumatic Stress Disorder is a critical part of a number of psychological disorders that are classified as an intense psychiatric condition (Mann & Marwaha, 2023). As a significant psychological disorder, PTSD affects the mental wellness of persons coping with its impacts, which include significant disturbances in the emotional composure (mood), behaviours (attitude), and cognitive functioning (thinking) of persons with PTSD (WHO, 2022). Given this distressing psychological condition of PTSD as a psychiatric condition, it is noted that PTSD arises as a consequence of exposure to violent or traumatic events that intrude on the cognitive, behavioural, and emotional composure of persons who cope with the lasting effects of the incidents (Miao et al., 2018). According to Lancaster (2016), PTSD as a psychiatric condition is psychologically disturbing through the symptomatic impacts of uncontrollable thoughts and flashbacks of the disturbing events, as well as intense anxiety that culminates in nightmares as a result of the exposure to the terrifying events.

Coping with the intrusive consequences of this condition, it is maintained that PTSD affects the lifestyles of people coping with its impacts (Bryant, 2019). As a psychological condition that is connected to the aftermath of exposure to terrifying situations, PTSD affects the lifestyle of people coping with its effects by constantly struggling with isolating behaviours, hyperarousal conditions, and intrusive thoughts, which can trigger mental stress related to depression, shock, mental distress, guilt, and nervousness (Bryant, 2019). Therefore, this interconnected mental stress critically intrudes on the mental wellness of persons coping with the impact of this psychological condition, given its nature as a complex psychiatric condition.

As a critical psychological condition triggered by exposure to terrifying events related to human abuses or assaults, natural disasters, accidents, and military aggressions amongst others, PTSD is reported to have resulted in a decline in the mental stability of approximately 256 million people globally (WHO, 2013). While it is estimated that PTSD accounts for about 3.6% of global psychological disorder reported cases in the last decade, with a reported case of about 7% of veterans or ex-servicemen drawn from this population (WHO, 2013). Therefore, noting that military personnel are tasked with the responsibility of repelling aggressions, their exposure to traumatic combat conditions is unarguable (Osgood et al., 2018). It is further argued that the constant factor of combat situations in military services and the possibilities of encountering and managing life-threatening situations, such as captivity and torture, surviving sniper attacks, ambushes, casualties from improvised explosive devices, and exposure to artillery fire, among other distressing effects of combat situation, develop combat trauma in service (Kelber et al., 2019)  and makes it imperative to undertake and unravel the impact of this psychological conditions on veterans.

Gap in Existing Knowledge

There are some existing literature that supports the exposure of veterans to post-traumatic stress disorder-related conditions (Wisco et al., 2019; Tripp et al., 2020; and Armenta et al., 2018) which affect their mental and physical health outcomes. Also, several studies have maintained that the characteristic nature of combat conditions intensifies the chances of veterans’ exposure to distressing war effects (Raza et al, 2023). As positioned by Blakey et al. (2021), it is argued that the enduring psychological burdens of combat, incidents of hostage, and challenges of survivability in harsh terrain significantly impact veterans’ quality of life and well-being (Kitzle et al., 2018). Corroborating the position presented by Kitzle et al. (2018), it is also maintained that since PTSD is developed as a consequence of exposure to violent or traumatic events, which are characteristic of the combat situation that servicemen are designated for, veterans during active must have been exposed to these situations, which might intrude their cognitive, behavioural, and emotional functioning (Castro-Vale et al., 2020).

Underpinning the life-threatening nature of military combat which veterans must have been exposed to, Zimmerman (2018), states that combat conditions involvewitnessing captivity and torture by warring enemies, surviving sniper attacks, ambushes, casualties from improvised explosive devices, and exposure to artillery fire. Accordingly, it is maintained by Patel and Youssef (2022) that surviving these life-threatening conditions can cause the survivors to panic and distressing attacks while experiencing uncontrollable thoughts or flashbacks from these disturbing events. These conditions, therefore, develop combat trauma in servicemen, and more importantly, veterans after service disengagement, which put them at the risk of coping with serious mental and physical health conditions (Chargualaf and Elliot, 2019). Equally, it is argued that PTSD as complex situations or episodes that develop in individuals who have experienced anguishing events is a more prevalent and severe reality among servicemen owing to their experience with the sudden loss of comrades, experiencing threatening survival situations and bearing the predicaments of shifting to civilian life, heighten the effects of this psychological disorder among veterans (Weronica-Maciejewska, 2023). Also, Wingo et al., (2022), put in that experiencing the challenges of high-stress terrains, the protracted nature of conflicts, and long-term deployment all tend to trigger the effects of disillusionment, which leaves the imprint of trauma that develops into post-traumatic stress disorders among combatants after service.

Consequently, in terms of the veteran’s susceptibility to PTSD due to the nature of the service condition, studies have indicated that PTSD interferes with the physical and mental health outcomes of veterans (Luciano and McDevitt-Murphy, 2017). It is noted that one of the critical influences of PTSD on veterans’ is its intrusion on their physical health outcome (Vandiver, 2023). In a study of PTSD effects on veterans returning from Operation Iraqi Freedom, an increased level of diverse physically burdened medical conditions such as high levels of smoking, non-fatal heart disease, cancer, arthritis, and other physical conditions like persistent musculoskeletal pain and traumatic brain injury interfere with the physical well-being of some veterans after serving in highly stressful combat areas of Iraqi and Afghanistan (Asnaani, et al., 2014). It is also noted that PTSD increases veterans’ susceptibility to the physical health risks of metabolic disorders and cardiovascular disease (Hoerster et al., 2019). Wolfe (2017) argued that PTSD causes social isolation in veterans and as a result of the difficulty in connecting with others, most veterans often adopt unhealthy lifestyles and risky behaviours, such as leading a sedentary lifestyle, smoking, and alcoholism, all of which develop multiple negative physical and mental health outcomes.

While these studies provide different perspectives and positions on the nature of service, and scope of combat conditions that increase the prevalence of PTSD and related physical and mental challenges among veterans, it is noted that there are significant limitations on the long-term impact of PTSD on the noted veterans’ mental and physical health outcomes. While a number of these studies focus on combatant veterans, there is the need to establish a wider study that focuses on several veterans, and the related service trauma that interferes with their physical or mental health well-being. Also, noting that some studies connected veterans’ struggles with PTSD with some physical health issues related to chronic pain and cardiovascular disease, it is equally important to establish a study that clarifies the underlying connection between PTSD and these physical health issues in veterans post-service period life engagement to develop a consistent intervention that helps in managing these physical risks and develop an effective intervention for quality lifelong functioning. Critically, since studies have also shown that PTSD causes mental depression and affects the physical health and well-being of veterans, it is crucially important that a study address how these challenges affect veterans’ quality of post-service family and work life dynamics to examine and develop a possible intervention for quality treatment effectiveness and lifelong support. These highlighted gaps in existing studies, therefore, underpin the basis of this research study.

Aims and Objectives

Aim:

Accordingly, this current study aims to ascertain how PTSD affects the mental and physical outcomes of veterans and their functioning in critical facets of post-service lifestyles.

Objectives:

• To examine the enduring impact of PTSD on the mental health outcomes of veterans
• To analyse the sustained consequences of PTSD on the physical health outcomes of veterans
• To identify how PTSD-induced mental and physical health outcomes of veterans affect the daily life functioning and lifestyle of veterans.

 

CHAPTER TWO: METHODS

Literature Search

Two database searches were conducted to locate the relevant literature. CORE was used for the initial search. A collection of approximately 255 million open-access collected research outputs is made searchable by CORE (Connecting Repositories). Every output has limited re-use limitations and is available for free access and download. CORE works closely with digital libraries and institutional repositories to deliver exceptionally good services (Shearer et al., 2023). Even though there are several resources available, the relevant materials were filtered and used based on the subject when a search criterion was entered. Two searches were performed while keeping the main terms from the research topic. ‘The long-term effects of post-traumatic stress disorder (PTSD) on veterans’ mental and physical health outcomes’ were the subject of the first search, and ‘The long-term effects of PTSD on retired soldiers’ psychological and physical well-being’ were the subject of the second search. 19,803 results were found using the first search terms that were entered above. After that, two inclusion criteria were used to reduce the number of findings to 13,012 by excluding research conducted in any language asides the English language and restricting papers from 2014 to 2023. While taking into account the inclusion and exclusion criteria that are listed in the section below, the titles and abstracts were proofread. Articles one to four were found using this first search. Figure 1 provides a flow chart for this literature search.

Journal Storage (JSTOR) was the source of the second search. More than 12 million scholarly journals are available in 75 distinct subject categories on JSTOR (JSTOR, 2020). The keywords “Impact of PTSD on Veterans’ Mental and Physical Health Outcome” were entered for the JSTOR literature search, obtaining 189 results from the open contents. A date range filter from 2014 to 2023 was applied, producing 97 results. Following the addition of the English-only filter, the number of results was further reduced to 63, from which articles five and six were derived. The data collection process for articles one to six are illustrated in a PRISMA checklist below (Figure 2).

Inclusion and Exclusion Criteria

When creating top-notch research procedures, defining inclusion and exclusion criteria for study participants is a routine, mandatory practice. According to Patino and Ferreira (2018), inclusion criteria are the salient characteristics of the target population that the researchers will utilise to address their research issue. Geographical, clinical, and demographic traits are typical inclusion criteria. On the other hand, exclusion criteria are characteristics of possible study participants that match the inclusion criteria but have extra traits that can hinder the study’s progress or raise the possibility of an adverse outcome. Typical exclusion criteria comprise attributes of qualified subjects that significantly raise the likelihood that they will not be found for follow-up, that they will miss data collection appointments, that they will provide erroneous data, that they have co-occurring conditions that could skew the study’s findings, or that they will be more vulnerable to adverse events (best applicable to research evaluating interventions) (Patino and Ferreira, 2018).

When conducting a literature review, establishing inclusion and exclusion criteria is crucial. By using inclusion criteria, the best articles related to the selected topic can be found. When establishing inclusion and exclusion criteria, articles should include justification to guarantee that the criteria are determined by the study’s needs and not the researcher’s preferences (Aveyard, 2014). The time range which is from 2014 to 2023 was one of the primary inclusion criteria, as was already noted. This was included to guarantee that the articles were not overly dated while yet enabling access to a broad variety of topics. An additional criterion for inclusion was if the study focused on the effects of PTSD on the physical and mental health of veterans. In addition, only open-access and English-published studies were used in this analysis to facilitate simple access to the entire work and enhance comprehension of the researcher’s conclusions. Studies that didn’t fit this description were therefore not included in the analysis.

Overview of Chosen Articles

Figure two provides an overview of the six selected papers detailing the study aims, methodology, main findings and origin.

 

Table 1: Overview of Selected Studies

Article No.	Author(s), Year, Title	Research question/aim/objectives	Sample method/sample size	Methodology	Main Findings/Conclusions	Advantages of the study	Limitations of the study	Origin
1	Flack, V. (2018). Reintegration Among Combat Veterans Suffering From Psychological Conditions	The purpose of this study was to provide information on mental health and clinical professionals on the stressors of reintegration and the availability of support services for combat veterans.	Snowball sampling was used to identify the 10 family members and 16 combat veterans who made up the sample.	A qualitative research design was employed in this study.	The life experiences of combat veterans and their families were investigated in this study. I decided to focus on mental health practitioners, coordinators, and physicians who work with our armed forces. In addition, further research should be done on regulatory agencies, mental health professionals, PTSD, psychological trauma, traumatic brain injury, domestic abuse, and drug addiction disorders. Combat veterans and their families should undoubtedly have more access. After leaving a combat zone, they ought to be able to properly reintegrate. The survey participants conveyed the conviction that serving others “was their duty.” Veterans faced difficulties and pressures that had a variety of effects on how well they functioned psychologically. Veterans of battle had probably encountered a wide range of physical and mental difficulties	In addition to identifying the treatments and supports available to combat veterans after their deployment, this study aimed to determine whether the availability of social services is a reliable indicator of a combat veteran’s likelihood of successfully reintegrating into society. The successful reintegration of a combat veteran into the family and community following their service in OEF and OIF is supported by such a prediction.	This study had some limitations. Firstly, there was a limited sample. Qualitative samples are usually small, though. Second, the study’s conclusions are specific to the population it was conducted on and should not be applied to other populations. Documentation related to mental health care is confidential and private. Furthermore, confidential conversations between clients and therapists are safeguarded. It’s possible that family members and combat veterans were unwilling to discuss the care they received during their experiences.	USA
2	Goetter, E.M., Hoeppner, S.S.,  Khan, A.J., Charney, M.E., Wieman, S., Venners, R.,  Avallone, K.M., Rauch, S.A., and Simon, N.M. (2020). Combat-Related Posttraumatic Stress Disorder and Comorbid Major Depression in U.S. Veterans: The Role of Deployment Cycle Adversity and Social Support	The current study aimed to better understand the role of pre-, peri-, and postdeployment adversity and social support and their simultaneous associations with clinician– diagnosed comorbid MDD and self-reported depression severity in veterans with a primary diagnosis of combat-related PTSD.	There were 223 main PTSD-affected veterans (86.9% of whom were male).	A quantitative cross-sectional study design was used for this study.	Within a treatment-seeking sample of veterans with combat-related PTSD, we aimed to investigate which pre-, peri-, and post-deployment risk and resilience factors were associated with the existence of comorbid MDD and depression symptom severity in the current study. The data demonstrating the high prevalence of this comorbidity is further supported by the fact that more than two-thirds of our sample reported having experienced a recent major depressive episode. Furthermore, the degree of significant depressive symptoms was linked to worries about life and family disturbances during deployment and social support following deployment. Less convincingly, there was also an independent and positive correlation between the severity of depression symptoms and overall harassment experienced during deployment.	In veterans with a primary diagnosis of combat-related PTSD, this study examined the effect of pre-, peri-, and post-deployment adversity and social support and their simultaneous relationships with clinician-diagnosed comorbid MDD and self-reported depressive severity.	Initially, cross-sectional data were used, and a retrospective report on deployment risk and resilience elements was consulted. They were unable to determine which risk and resilience characteristics, the diagnosis of depression, and the intensity of depressive symptoms were causally related. Moreover, there is an overlap between the symptoms of PTSD and depression; investigating the dynamic interaction between these symptoms over time was not possible with cross-sectional analysis.  Finally, testing opposing theories for the co-occurring conditions of depression and PTSD was not the goal of this study.	USA
3	Kurtz, E. (2016). An Etiological Model of Posttraumatic Stress Disorder in Female OEF/OIF/OND Veterans: Adding Military Sexual Trauma as a Risk Factor	The primary aim of this study was to explore whether MST adds to the prediction of PTSD diagnosis in female veterans above the contribution of combat exposure, premilitary trauma history, social support, and postmilitary trauma, and whether MST interacts with other risk and protective factors to predict PTSD diagnosis for female veterans.	Through the Department of Veterans Affairs (VA) VISN 6 Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), 202 female veterans and active duty military members participated in a multi-site research project whose data were evaluated.	This study used a quantitative research approach.	Results show that when MST is integrated into a model that includes war and the aftermath of battle experiences but excludes social support, pre- or post-military trauma, or both, it directly affects the diagnosis of PTSD. Additionally, when exposure to war and the aftermath of battle experiences are excluded from the model, the results show that MST has a direct and indirect impact on PTSD symptoms through social support. Results, however, indicate that MST only has a substantial indirect effect through social support on PTSD symptoms, not a significant direct effect, when all risk and protective factors are included in the model. Notably, the model results imply that MST is directly impacted by premilitary trauma (interpersonal and total premilitary trauma), but not by social support.	Combat trauma showed a high direct influence on symptoms of post-traumatic stress disorder (PTSD), but the effects of MST and the aftermath of battle trauma were partially mediated by social support, respectively. Treating female OEF/OIF/OND veterans with deployment-related PTSD can be more targeted, effective, and subtle if these distinctions are better understood.	Firstly, the cross-sectional approach used in the study posed limitations. The small sample size of this study was another drawback. The possibility of numerous equivalent models or non-equivalent but equally well-fitting alternative models for the data is one of the main drawbacks of structural equation modelling (SEM). The fact that each variable in the study represents a homogeneous group of people yet individual experiences within each variable may vary is another study drawback. Finally, there were limitations to the study’s MST measurement methodology.	USA
4	Stanton, K. (2018). Combat exposure and mental health outcomes: the incremental impact of gender harassment on women veterans	The present study investigated the incremental impact of gender harassment on the association between combat exposure and posttraumatic stress disorder (PTSD), depression, and problem drinking in female veterans	600 women who had been deployed to Afghanistan or Iraq and were living in Veterans Integrated Service Network 1 (VISN 1; New England) made up the participant pool.	This study adopted a quantitative approach	Combat exposure was found to be a significant predictor of both PTSD and problem drinking using logistic regression analysis. The odds ratios for PTSD and problem drinking were 2.00 times and 1.88 times higher, respectively, to be categorized as present for every unit increase in war exposure. Even after accounting for gender harassment, these results held, with odds ratios of 1.83 and 1.76, respectively. Depression and PTSD were significantly predicted by gender harassment. The odds ratios for PTSD and depression were 1.77 times and 1.80 times higher, respectively, to be categorized as present for every unit increase in gender harassment. With odds ratios of 1.55 and 5.90, respectively, these results held significance even after adjusting for combat exposure. PTSD, problem drinking, and depression were shown to be 3.56, 3.81, and 6.19 times more common in individuals who reported gender harassment and combat exposure, respectively, than in those who simply reported combat exposure, according to subsequent relative risk analyses.	This study is beneficial given its conclusions help put the effects of gender harassment on the psychological health of female veterans in perspective.	Firstly, group comparisons between military branches or service member rankings were not possible due to the sample’s design. Furthermore, the original data collection was limited to identifying barriers to healthcare for women, making it unable to investigate the prevalence and potential incremental effects of gender harassment on men’s mental health functioning. Therefore, whether taking into account male service members or variations within branches and ranks, the results’ generalizability may be limited.	UK
5	Tanielian, T., Hansen, M.L., Martin, L.T.., Grimm, G., and Ogletree, C. (2016). Understanding Postdeployment and Postmilitary Mental Health Problems (From the book;  Supporting the Mental Health Needs of Veterans in the Metro Detroit Area)	To examine post-deployment and post-military mental health problems, especially PTSD, depression, and substance misuse.	The journals and papers utilized in this study were gathered using a random sampling method.	This study used a qualitative research methodology that involved gathering secondary data.	Understanding post-deployment and postmilitary mental health issues, as well as possible short- and long-term consequences, is made easier by the substantial foundation this study provides. The information provided does not specifically address mental health issues among veterans in the greater Detroit area, but there isn’t much data to imply that the likelihood or severity of mental health issues would vary under different circumstances.	This study examined some of the more well-established risk factors for depression, substance abuse, and PTSD, primarily from literary works of veterans of the Iraq and Afghanistan eras.	The study’s primary limitation was its overemphasis on a specific demographic, which limited its generalizability.	USA
6	Schaeffer, B.J. (2020). A Qualitative Study of Rural Veterans Treatment Court: Participants Lived Experiences and Perspectives	The purpose of this study is to examine the photo(s), and your experiences and perspectives. I want to know and understand how veterans make sense of their experiences with the CJS and VTC and how their prior military service influences this experience.	In this study, a purposive homogenous sample of 10 VTC participants made up the sample size.	To demonstrate, understand, interpret, and analyze the veteran’s perspective and experience, the why and how of the relationship between military service and crime, patterns, categories, and thematic representation in relation to the phenomenon of interest, this study used a qualitative methodological approach that made use of photo-elicitation interviews (PEI) and interpretive phenomenological analysis (IPA) techniques.	A deeper comprehension of the lived experiences and perspectives of the participants and the VTC program was made possible by the themes and sub-themes that emerged from the study interviews. From the semistructured interviews, five themes and four sub-themes surfaced. The following appeared as the main themes: 1) patriotism; 2) purpose; 3) conflicting identities; 4) reconciliation; and 5) positivism; lesser themes included 1) betrayal; 2) overflow; 3) stigma; and 4) traumas. With patriotism as its focal point, the concepts combined to form a composite identity. The sub-themes serve as counterpoints to the composite identity, elucidating how veterans view the issues, traumas, and stressors that precipitated their engagement with the criminal justice system.	Veterans of the armed forces in the United States are both residents of prisons and litigants in federal, state, and local courts. Their engagement in the courts and Criminal Justice System (CJS) is a major public concern and a national issue. Due to their status as a significant subgroup within the court and CJS, military veterans are a vulnerable, disenfranchised population that requires greater understanding. The purpose of the study is to understand participants’ impressions of the Veteran Treatment Court (VTC) and help them make sense of their involvement in the judicial system through a purposeful analysis of their lived experiences and perspectives.	First, one rural county VTC program is represented in the purposive homogeneous sample of data that was gathered. The findings may not apply to other rural or urban judicial jurisdictions with VTC in other parts of the United States, given the study’s rural population and geographic location. Second, PEI and IPA methodologies were used in the investigation. While IPA has been the subject of numerous studies about veterans, neither rural nor urban VTC programs have been the subject of PEI. Third, a sample of Caucasian VTC participants was the only group on which the study was focused. Lastly, it is unclear how far the findings may be applied to other justice-involved veterans (JIV) in jails, prisons, parole, probation, civil cases, or non-JIV.	USA

 

Ethics and Consent

While using human subjects in literature review research, ethics must come first and consent must be obtained. Compliance with legal and ethical norms is ensured by ethics, which also guarantees that the study is conducted in a way that respects the welfare and rights of the participants. Nonetheless, permission ensures that subjects are informed about the study’s objectives and methods and willingly agree to participate (Poth, 2021).

Participant rights, anonymity, and privacy are highly valued in research ethics, according to NESH (2021). To make sure the study complies with ethical standards, researchers must get approval from an ethics committee or review board. To ensure that the research meets with ethical norms, the committee assesses the study’s possible dangers and benefits. To perform ethical research, a written consent form needs to be obtained. Volunteers must be provided with all relevant information regarding the research, including its objectives, procedures, potential risks, and benefits. They ought to have the freedom to inquire and determine whether or not to participate after conducting independent research. According to Smilowska and Pietrzykowski (2021), consent can either be obtained orally or through written agreements, depending on the requirements of the study and ethical guidelines. All the studies used in this research ensured proper research ethics were followed and adhered to. By placing a high focus on ethical conduct and consent in literature review studies involving individuals, authors can contribute to the development of a reliable and responsible body of knowledge. It increases the credibility of the study’s findings and protects each participant’s well-being. Ultimately, using ethical research practices safeguards the well-being of participants and promotes truthfulness, morality, and dignity within the scientific community.

Chapter Overview

This chapter conducted a literature search for the studies that would be included in this study and evaluated the inclusion and exclusion criteria that would be adhered to in selecting these studies. 6 studies were selected following the criteria given and outlined in a tabular format. Research ethics and consent were also examined in this chapter which would then move on to the next chapter where the results of this study are to be examined.

CHAPTER THREE: RESULTS

When conducting a literature review, it is crucial to take into account the structure and outcomes of the evidence pyramid, as proposed by Rosner (2012). This framework offers a systematic approach to assess and incorporate information from diverse sources. The importance of the findings within a literature review lies in their capacity to guide decision-making and formulate conclusions. These findings can include data, qualitative observations, or a blend of both thus representing the results of specific investigations, tests, or trials. Through a comprehensive analysis and comparison of these data points, researchers can unveil patterns, identify trends, and establish connections that enhance our comprehension of a particular subject (Federico et al., 2016). Furthermore, the hierarchy of evidence is visually depicted as a pyramid, illustrating the credibility and quality of various types of evidence. It categorizes evidence based on factors such as sample size, statistical power, bias, and study design to ascertain its level of significance. Employing this pyramid aids researchers in ensuring that their conclusions are underpinned by reliable data. Studies with higher levels of evidence, such as meta-analyses and systematic reviews at the pinnacle, randomized controlled trials, cohort studies, case-control studies, cross-sectional studies, and expert opinions at the base, are usually prioritized. This prioritization is due to their larger sample sizes, better control for confounding factors, and thus their perceived reliability (St John et al., 2017; Xuan et al., 2020). In the pursuit of a comprehensive literature review, adopting the hierarchy of the evidence pyramid is very essential. This approach ensures a thorough evaluation of evidence by considering information from various levels of the pyramid (Downie et al., 2023). Throughout this chapter, we delve into these aspects with a focus on the six selected publications. Variables such as sample size, response rate, sampling techniques, generalizability, and data reliability are discussed to provide a holistic understanding. The combination of these factors contributes to the strength and trustworthiness of our conclusions.

Quantitative and Qualitative

When delving into complex phenomena such as the enduring impacts of post-traumatic stress disorder (PTSD) on the mental and physical health of veterans (Miao et al., 2018), the selection of research methods holds a very significant importance. Qualitative research, in particular, involves a comprehensive exploration of the meanings, perspectives, and experiences associated with a specific topic. Practitioners of this method often employ observations, open-ended interviews, and textual data analysis to gain a nuanced understanding of the research question. Qualitative research methodologies prove invaluable in shedding light on the intricate nature of veterans’ experiences while examining the long-term effects of PTSD on their mental and physical well-being. Open-ended interviews emerge as a powerful tool, enabling researchers to gather detailed narratives that illuminate the specific challenges, coping mechanisms, and life transformations encountered by veterans with PTSD (Freytes et al., 2017). This approach facilitates the recognition of patterns and themes that quantitative methods might overlook, offering a profound understanding of the diverse experiences, emotions, and thoughts of veterans in this context.

On the other hand, quantitative research involves the collection and analysis of data to identify trends and relationships. This method utilizes analysis, surveys, and questionnaires to provide evidence and quantify variables. By offering measurements and statistical data on the frequency and intensity of symptoms related to PTSD long-term health outcomes, as well as the effectiveness of different therapies, this method can complement qualitative approaches (Barone et al., 2019). Researchers employing quantitative methods can identify overarching patterns, establish connections, and draw conclusions about the impacts on physical health outcomes by gathering standardized data from a larger group of veterans. Moreover, mixed research methodologies incorporate both quantitative and qualitative approaches to gain a comprehensive understanding of a research topic. This strategy allows researchers to validate findings, gain a nuanced perspective, and triangulate data. By integrating interviews with surveys, scholars can validate qualitative findings, identify statistical trends, and establish cause-and-effect relationships (Seawright, 2016). The combination of these methods enhances the reliability and credibility of the study’s conclusions. While mixed and quantitative research methods have their benefits, the qualitative research method is the optimal choice for this particular topic. Understanding the subjective experiences and personal stories of veterans is crucial since PTSD is a complex psychological condition that impacts individuals uniquely. This form of research is vital for comprehending veterans’ experiences with PTSD and its long-term effects on both mental and physical health (Miao et al., 2018). Qualitative methods capture feelings and context, shedding light on the nuances surrounding PTSD. They offer flexibility in data collection, enabling researchers to explore specific aspects deeply. Strategies like open-ended interviews, as seen in Flack (2018), Taniellan et al. (2016), and Schaffer (2020), build trust with participants and uncover rich insights into their experiences. In contrast to quantitative studies, qualitative approaches, as seen in the selected articles, provide a detailed understanding of how PTSD impacts veterans’ physical and mental health. The blend of qualitative and quantitative methods in the chosen papers, considering factors like data collection and analysis, reflects their appropriateness. Some articles explicitly explain the rationale behind their chosen research methods.

Reliability

Reliability is a vital factor in research and is independent of the study being qualitative or quantitative. To guarantee that the results are precise, reliable, and repeatable, refers to the consistency and dependability of the findings. The goal of both qualitative and quantitative research projects is to gather trustworthy data, despite the fact they do so in different ways (Matheson, 2019). Firstly, reliability is necessary for proving the validity of study findings. The results obtained are not valid or trustworthy if the data are not reliable. The goal of reliability for researchers is to ensure that their work adds to the body of knowledge and can serve as a foundation for future research or decision-making (Chetwynd, 2022). Secondly, when results are reliable, other researchers can carry out comparable investigations and come to comparable conclusions, confirming the validity of the first study. Replicability guarantees that study findings are not singular occurrences but rather can be reliably observed in various settings and among various demographics. Thirdly, extrapolating results to a bigger population or wider context requires credible study findings. Researchers’ work becomes more applicable and relevant when data is reliable and consistent because they can safely adapt their findings to other contexts (Chetwynd, 2022).

As previously stated, the goal of qualitative research is to thoroughly investigate and understand complicated phenomena. Techniques like focus groups, observations, and interviews are frequently used in this process. Even though subjective interpretations are frequently linked to qualitative research, reliability is still necessary to guarantee the validity of the data (Leung, 2015). Reliability in qualitative research is typically attained through triangulation, a process that involves confirming findings by incorporating multiple researchers, methodologies, or data sources. Cross-referencing information from various sources is also important to verify data accuracy, reduce bias, and enhance the overall authenticity of the study (Cypress, 2017). To add to this, reflexive researchers actively acknowledge their preconceptions, biases, and potential impacts on the research process. Continual self-assessment of their role, ideals, and assumptions is performed to ensure these factors do not compromise the reliability of their findings. This reflexive approach promotes openness and strengthens the overall credibility of qualitative research (Rose and Johnson, 2020). In quantitative research, reliability is established through statistical analysis and numerical data to assess hypotheses and identify correlations between variables. Measurement, consistency, and accurate data gathering are essential for reliability in this type of research (Nyika, 2018). Standardized measurement instruments like surveys and questionnaires, which undergo testing and validation to minimize measurement errors and enhance data accuracy, are crucial for ensuring consistency and dependability. Additionally, employing appropriate sampling techniques, such as random sampling, contributes to the robustness of the findings. Techniques like stratified or simple random sampling help researchers choose a representative sample, allowing for confident conclusions and contributing to the body of knowledge (Duckett, 2021). For example, Goetter et al. (2020) demonstrated good construct validity and test-retest reliability in their quantitative study using the Clinician-Administered PTSD Scale. Stanton (2018) also presented strong psychometric data, including internal consistency reliability, discriminant validity, and criterion-related validity, using the DRRI-2 in a different quantitative analysis. Falck (2018) established dependability for qualitative reliability through member verification. Therefore, prioritizing reliability in study design and execution contributes to expanding knowledge and forms a robust foundation for future research and decision-making.

Sampling Methods

Sampling is a crucial research method that enables researchers to collect data from a smaller group within the population, selected to ensure representativeness and generalizability (Palinkas et al., 2013). Also known as judgmental sampling, purposive sampling involves handpicking participants based on specific criteria relevant to the study’s goals. This method is often employed in qualitative research to gather rich and diverse data from volunteers with particular traits or experiences (Palinkas et al., 2013). Contrary to this, random sampling gives every person in the target population an equal chance of being chosen, ensuring impartial participation. Commonly used in quantitative research, it enables researchers to draw statistical conclusions about the entire population, enhancing generalizability and reducing selection bias (Taherdoost, 2016). The snowball sampling method is also referred to as chain referral sampling and is a non-probability technique that is usually used in qualitative research, especially in hard-to-reach or hidden populations. In this method, initial participants are chosen based on set criteria and then asked to recommend others who also meet the same criteria. This approach helps researchers to reach individuals who are difficult to identify using conventional methods (Kirchherr & Charles, 2018). For example, Falck (2018) employed snowball sampling with 16 combat veterans and 10 family members. It’s important to note that purposive sampling is particularly valuable in qualitative research for selecting participants with specific backgrounds, experiences, or viewpoints. Schaffer (2020) employed this approach with 12 veterans from the VTC program to ensure representative and pertinent data. On the other hand, random sampling is commonly used in quantitative research to guarantee sample representativeness, as seen in Stanton’s (2018) study, allowing valid statistical conclusions and broader population extrapolation.

While sampling methods offer advantages, it is also essential to recognize their limitations. Purposive sampling may introduce bias due to subjective participant selection. Random sampling might be impractical in certain contexts, and snowball sampling may introduce bias if the participants refer to individuals with similar traits. To ensure valid, reliable, and generalizable findings, researchers must carefully consider the pros and cons of each method, choosing an appropriate sampling method based on the research goals and context.

Data Collection Methods

An important step in research projects is collecting data. This is because it sets the foundation for the analysis and a meaningful conclusion (Paradis et al., 2016). Depending on the study’s purpose, the researchers can employ different techniques to collect the data. The aim of quantitative research in this context is to understand the intricacies of human behaviour, experiences, and perceptions. According to Busetto et al. (2020), in this type of research, interpretive methods are usually used to capture detailed and contextual information. Falck (2018), Schaffer (2020), and Tanielian et al. (2016) also applied this method in the studies that were selected for this literature review.

Some of the data collection methods used in qualitative studies include:

1. Interviews: The use of semi-structured or structured approaches to gather detailed information is seen here. The researchers do this by conducting in-depth interviews to explore the participants’ experiences and viewpoints.
2. Observation: Researchers also use observational methods to directly observe and record behaviours, interactions, and activities in natural settings. Here, participant observation involves the researcher immersing themselves fully in the research situation to get accurate responses.
3. Focus Groups: Here, a mediator guides a small group of participants in a discussion. This allows the exploration of common experiences, viewpoints, and attitudes collectively among the participants (Busetto et al., 2020).

Also, quantitative research aims to measure and evaluate numerical data to identify statistical significance, patterns, and relationships (Maida et al., 2022). Studies in this literature review by Goetter et al. (2020), Kurtz (2016), and Stanton (2018) adopted the quantitative research methodology.

Common quantitative data collection methods include:

1. Surveys/Questionnaires: Researchers use surveys or questionnaires to gather details about specific variables. Closed-ended questions with predetermined response options often ensure that the data collection stays consistent.
2. Experiments: Experimental approaches in this case involve changing variables to measure cause-and-effect connections. Researchers carefully control variables and randomly assign people to experimental and control groups to understand how independent variables impact dependent variables.
3. Secondary Data Analysis: In this case, researchers analyze already existing datasets, such as public records or survey data. They do this to identify responses to the study questions. This method is usually accepted because it is cost-effective and allows extensive data analysis to be carried out (Maida et al., 2022).

It is worth noting that both qualitative and quantitative research methodologies offer their unique insights. While qualitative methods function to provide an in-depth and contextual understanding of the experiences of the participants, quantitative methods allow large-scale data analysis and the establishment of statistical relationships. Having said this, the researchers must carefully choose a data collection strategy that is strictly based on the objectives of the study and the nature of the phenomenon that is under investigation in order to ensure the reliability of their findings.

Sample Size

In a research study, the sample size is usually the total number of participants or observations that play important roles in the design of the study. The impact of the study size functions to significantly influence the usefulness of the results, both in qualitative and quantitative investigations. This is seen especially in terms of their representativeness (Vasileiou et al., 2018). When it comes to quantitative research, larger sample sizes are generally preferred. The primary purpose of this is to enhance statistical reliability. This is to allow findings to be more confidently applied to the general population. Larger samples are also considered particularly advantageous for precisely identifying minor effects thus supporting the goal of establishing cause-and-effect relationships (Andrade, 2020). When there is a larger pool of participants, it helps to contribute to the generalizability of the results and further strengthens the external validity of the study. On the other hand, the focus of qualitative studies is on the in-depth exploration of complex phenomena and this often necessitates smaller sample sizes. In qualitative research, the emphasis is typically on the richness and depth of the data. The goal of this is to prioritize participant quality over quantity (Hennink & Kaiser, 2022). Researchers aim for data saturation, a point where new participants no longer provide substantially new information. As a result, qualitative studies now usually have smaller sample sizes thus enabling the researchers to delve deeply into the opinions of the participants and their different experiences (Vasileiou et al., 2018).

In essence, the choice of sample size depends on the research approach, topic, and the desired level of depth or generalizability. Researchers must carefully consider these factors to ensure the validity and applicability of their findings.

Respondent Rate

Polit and Beck (2014) describe the concept of response rate, which is used to compare the number of study participants to the number of participants that were originally scheduled for the study. Parahoo (2014) expands on this by stating that lower response rates raise the possibility of bias and erroneous, non-generalizable results. Since many of the data-gathering techniques used in qualitative research necessitate the researcher’s presence, such as during an interview, the response rate is probably higher than it is in quantitative research techniques (Corbin and Strauss, 2015). On the other hand, although slightly dated, Fincham (2008) suggested that to guarantee that issues like study bias are minimized, a response rate of at least 60% should be acquired for quantitative research. More recently, Polit and Beck (2014) argue that a response rate of 50% is sufficient to ensure research bias does not impact the results.

Hennegan et al. (2018), despite the high sample size of 474 had a response rate was 30.2%, therefore proving a slight limitation of the study due to the potential introduction of bias. Similarly, Gold et al (2014), there was a high response rate of 609 individuals, but this was only 44% of the original 1400 who were invited to participate not reaching the recommended 50% as outlined by Polit and Beck (2014). For Crawley et al. (2013), 189 participants were initially enlisted, and 162 people made up the final sample, yielding an 85.7% response rate. Therefore, concluding that despite a smaller sample in comparison to Gold et al (2014) and Youngblut and Brooten (2018), there was a higher response rate therefore reducing the risk of introducing bias. Booker et al. (2021) claim that the response rate can be improved for studies by doing more. Here, it was claimed that researchers can perform tasks like sending follow-up letters, checking on participants’ study completion, or offering incentives. Nordling (2023) suggested caution to avoid it seeming like a bribe or pressuring people, and that incentives can significantly boost response rates if done right. The data collection method used can also impact the response rate (Wu et al., 2022). Different techniques may affect participants’ willingness to take part. For example, online surveys are considered convenient and tend to attract more participants, while in-person interviews or postal surveys might have lower response rates due to inconvenience or lack of interest (Holtom et al., 2022). In the same vein, the simplicity and clarity of the data collection method can also influence the rates of responses. If the instructions are hard to understand or are time-consuming, the study might have a lower completion rate (Wu et al., 2022). Hence, researchers must carefully assess the data collection process to optimize response rates and ensure quality findings.

After exploring six selected papers, three main themes emerged. They include PTSD, Depression, and Substance Abuse.

Theme One

Among the six publications that were looked into, PTSD was the first theme to be seen.  It has been established that stressful or traumatic events that might have happened in the past can lead to PTSD which is a mental health disorder (Kubala, 2023; NHS, 2018). Symptoms of PTSD include, but are not limited to feelings of isolation, lack of sleep, anger, guilt, and recurring flashbacks (NHS, 2018). All the six papers this study reviewed discussed how war or deployment impacts veterans and leads to PTSD symptoms eventually. For example, Flack’s (2018) study focused on the challenges that veterans face when trying to come back into the reality of civilian life while dealing with accrued mental health issues. His study explored the lives of war veterans with anxiety, depression, PTSD, and other mental health problems. The study looked at how these issues affect their ability to come back into society, maintain relationships, and find jobs. Flack’s research highlighted the significant and long-lasting effects of trauma on combat veterans. In his research, he found out that PTSD became a major obstacle to successful reintegration which eventually caused social isolation, difficulty making friends, and challenges adjusting to civilian life. Similarly, Goetter et al. (2020) found that exposure to traumatic events and the multiple deployments that were experienced during the deployment cycle were linked to a high prevalence of severe depression and combat-related PTSD in veterans. However, research suggests that social support can help prevent the onset of severe depressive disorder and PTSD. In the same vein, Kurtz’s (2016) study concentrated on understanding how female veterans of the armed forces ended up getting PTSD. The focus of this study was on Military Sexual Trauma (MST) serving as a risk factor for PTSD development among female veterans. The goal was to explain why female veterans develop PTSD, taking into consideration the challenges they face in the military especially related to MST. It is important to note that MST refers to any sexual harassment or assault experienced during military service which in turn impacts female service personnel with potential long-term psychological effects. According to the findings of this study, MST is a significant risk factor for the development of PTSD in female veterans. Kurtz’s model showed that MST acts as a stressor and that this leads to physiological and psychological reactions being triggered which in turn leads to the onset of PTSD symptoms. His model highlighted the importance of considering individual characteristics in these situations. Some of them include coping techniques and pre-existing mental health issues. The purpose of this was so that the impact of MST on PTSD onset could be very much understood. In another study by Stanton (2018) which focused on female soldiers, PTSD was again identified as a common issue among these veterans. The results showed that exposure to one combat alone had a significant psychological impact and that the likelihood of developing PTSD increased when gender harassment was added.

Additionally, Tenielian et al. (2016) drew their focus to the mental health challenges faced by veterans in the Metro Detroit area of Michigan in the United States of America. The findings of their study showed a prevalence of PTSD among those who returned from service. Their study delved into the causes, symptoms, and consequences of PTSD while throwing more light on how military service impacts mental health. After critically analyzing the different life stories of the veterans, the research went on to highlight the complexity of PTSD. Here, the urgent need for comprehensive support networks to address these mental health concerns was recommended. In Schaeffer’s (2020) study, it was revealed that PTSD was prevalent among rural veterans who were enrolled in a treatment court. After the in-depth interviews and analysis of these groups of people, his research identified the different traumatic experiences faced by the rural veterans that eventually led to the development of PTSD. This study pointed out that being in battle, witnessing violence, and facing life-threatening situations are potent triggers for PTSD symptoms in military personnel. The participants in this study also shared their struggles with PTSD-related avoidance behaviours, nightmares, hyperarousal, and intrusive recollections. Here, the research emphasized how severely PTSD affects relationships, mental health, and overall well-being. Each of these studies provided valuable insights into the perspectives and life experiences of each of these individuals while emphasizing the challenges they encountered and the dire need for specialized PTSD care and therapies in rural areas .

Theme Two

Depression was the second theme identified across the six papers that were reviewed. The World Health Organization (2020), posits that depression is usually characterized by persistent sadness and apathy or pleasure in once enjoyable activities. They also posited that it affects approximately 264 million individuals worldwide. In the study done by Goetter et al. (2020), it was seen that co-occurring disorders of PTSD and major depressive disorder (MDD) are more common in war veterans compared to each disorder alone. This leads to higher levels of distress and greater social and economic consequences. A secondary analysis of a trial involving 223 American soldiers with battle-related PTSD was carried out and it was revealed that about 69.5% of them also had mental disorders. The study identified factors linked to depression in veterans, such as concerns about harassment and family disruptions during deployment, alongside lower assessments of social support post-deployment. It was seen that these factors predicted more severe self-reported symptoms of depression. The study also emphasized the importance of therapies and how they enhance social support and facilitate effective post-deployment reintegration. According to the findings of the study, this is to reduce the mental health burden on veterans with comorbid MDD and combat-related PTSD. Additionally, Stanton (2018) showed that exposure to combat is a known risk factor for mental health issues, including depression. The brutality and loss experienced during military service were said to possibly have a lasting psychological impact. The focus of Stanton’s study here was on how battle exposure could affect the mental health of female veterans. In addition to the impacts of battle exposure alone, his study showed the additional influence of gender harassment on the mental health of female veterans. According to him, female veterans exposed to both battle and gender harassment had higher depression rates than those who only experienced combat. This suggests that, for this particular population, gender harassment significantly influences depression (Stanton, 2018).

Theme Three

The third theme identified in the examination of how PTSD affects troops physically was substance abuse. In this context, substance abuse refers to the excessive use of drugs or alcohol that leads to both physical and psychological dependence. It usually includes the habitual consumption of substances in a manner that negatively impacts one’s overall well-being, health and relationships. Substance abuse has been shown to pose various challenges, including impaired judgment, addiction, health issues, financial difficulties, legal complications, and social isolation (Bjork & Thomson, 2020). In a study done by Tanielian et al. (2016), light was shed on the several factors that contribute to substance misuse among veterans. Exposure to battle trauma, increased levels of stress, and the presence of mental health conditions such as depression and PTSD were identified as huge contributors. The transition from military to civilian life also emerged as a critical challenge for veterans and was seen to potentially exacerbate the risk of substance abuse. This alone made them more susceptible to substance use. Stanton (2018) also found a connection between military exposure and various mental health conditions including substance misuse, depression, and PTSD. It was observed that gender harassment worsens the already stressful conditions for female veterans occurring in the Veterans Affairs (VA) healthcare system or during their active service. His findings revealed that substance abuse, often used as a coping strategy to deal with the psychological pain from combat exposure and gender harassment, was strongly influenced by gender harassment in the development of mental health problems. Women veterans eventually tend to turn to substances like alcohol or drugs to numb their feelings, reduce anxiety, or manage PTSD symptoms, potentially leading to an addiction cycle and worsening mental health.

CHAPTER FOUR: DISCUSSION

Analysis of Theme 1

As mentioned earlier, the first theme that emerged was PTSD. All the reviewed studies discussed the impact of war or deployment on veterans. According to findings, this eventually led to PTSD symptoms as well as significant mental and physical implications. A traumatic experience can trigger post-traumatic stress disorder (PTSD). Tanielian et al. (2016) provided valuable insights into the mental health challenges faced by veterans during the transition from military to civilian life in their book, “Supporting the Mental Health Needs of Veterans in the Metro Detroit Area.” The challenges encompassed issues such as insomnia, mood swings, reckless behaviour, drug abuse, and social isolation. Kintzle et al. (2018) and Inoue et al. (2023) further highlighted the impact of PTSD on mental health outcomes. Goetter et al. (2020) looked into the relationship between comorbid major depression and combat-related PTSD among US veterans. Here, they shed light on deployment cycle adversities like exposure to traumatic events and the role of social support acting as a buffer against negative outcomes. Kurtz (2016) also developed an etiological model that highlighted military sexual trauma (MST) as a risk factor for PTSD among female veterans. This study emphasized the need for gender-specific strategies in treating PTSD due to the unique challenges faced by female soldiers. Kehle-Forbes et al. (2017) supported this notion, and Stanton’s (2018) study further explored the increasing effects of gender harassment on the mental health outcomes of women veterans. Stanto’s study revealed the intersectionality of factors contributing to PTSD in this group. Flack (2018) focused on assisting combat veterans, particularly those with PTSD, in reintegrating into society. His study highlighted the challenges that were seen in maintaining relationships and securing employment that sometimes led to social isolation as well as its effect on their mental health. This emphasized the importance of tailored support systems and interventions for better mental health outcomes. Schaeffer’s study (2020) explored the experiences of rural veterans in treatment courts. He documented the struggles with PTSD-related symptoms and highlighted the significant impact on relationships and overall well-being. This study underscored the importance of understanding diverse settings when addressing mental health outcomes in veterans.

When looked at together, these studies contribute to a comprehensive understanding of PTSD, and emphasizes the need for personalized interventions. It also takes into consideration various factors such as gender, social support, reintegration challenges, and specific traumas experienced during military service. They collectively highlight the complex nature of PTSD and its profound effects on the mental and physical health outcomes of veterans.

Analysis of Theme 2

Here, it can be seen that veterans often experience depression. Depression was shown to significantly impact both their physical and mental well-being, and that it usually coexists with post-traumatic stress disorder (PTSD). The studies conducted by Stanton (2018) and Goetter et al. (2020) provide strong contributions to the understanding of the theme of depression used in this study. Their studies highlighted the delicate interaction between depression and PTSD. This thus emphasizes the importance of thorough treatment for both disorders to improve veterans’ overall health.

Stanton’s (2018) research highlights the gender-specific challenges faced by female veterans. He recognized the overall effect of gender-based harassment in worsening depression in the context of being exposed to combat. This finding emphasizes the need to identify and address the specific stressors that female veterans encounter in war and post-military environments. This point was supported in a study by Haskell et al. (2010). In the same vein, the study done by Goetter et al. (2020) talks on the co-occurrence of depression and PTSD in veterans and highlights the impact of social support and deployment cycle adversity on the development of comorbid severe depression. Their study also highlights the importance of developing interventions that consider the complexity of veterans’ experiences and the relationships between depression and PTSD.

Analysis of Theme 3

This theme demonstrated how exposure to scary events while serving in the military might cause PTSD which is very common in veterans. Concern and a great deal of research are directed towards the long-term consequences of PTSD on their mental and physical health. It is important to remember that comprehending the complexities of PTSD and how it affects veterans requires knowledge of substance addiction. This is because the co-occurrence of substance abuse and PTSD offers a range of difficulties. Veterans who suffer from PTSD symptoms frequently turn to drugs, alcohol, and tobacco as coping mechanisms. Substance abuse then exacerbates the intensity of PTSD symptoms and eventually leads to a harmful cycle where both problems reinforce one another, thereby making the treatment and recovery more difficult. Research conducted by Tanielian et al. (2016) and Stanton (2018) has shown more light on the severe implications of drug abuse on the well-being of veterans struggling with PTSD. Substance addiction exacerbates mental health challenges for veterans, and contributes to adverse physical health outcomes which include compromised immune systems, liver disease, and cardiovascular issues. As mentioned earlier, Stanton’s (2018) study looked into the cumulative effects of gender harassment on mental health outcomes and the exposure of female veterans to battle while Tanielian et al. (2016) investigated the mental health challenges encountered by veterans post-military duty and deployment, underscoring the need to comprehend the intricacies of these issues. This comprehensive analysis recognizes substance addiction as a significant component, given the frequent co-occurrence of substance abuse and PTSD. Being able to identify the complex relationship between these conditions is crucial for creating an effective therapy and support networks. This will in turn enhance the long-term health outcomes of veterans that struggle with the lingering consequences of PTSD and substance abuse.

Limitations of the Study

• Limited Control Over Data Collection

One of the primary limitations of using secondary data is lack of control over the process of data collection. The methods that were used in the original studies are what the researchers tend to rely on. This can sometimes be disadvantageous as they might not be perfectly in line with the particular goals of the literature review.

• Potential for Biases and Inconsistencies

Due to the disparities in study design used, respondent demographics, and collection of data techniques among the sources, there might be bias or inconsistencies in secondary data. This may make it a bit strenuous to integrate the data and come to conclusions that can be termed reliable

• Incomplete or Unavailable Data

Conducting a literature review with secondary data can highlight certain dire circumstances. This can be seen where the selected studies lack certain data points or all the necessary variables for the investigation. This could limit the analysis’s breadth and ability to adequately address certain research questions.

• Heterogeneity in Study Designs

The variety in approaches may make it a bit impossible to directly compare and synthesize findings. Usually, this can have an effect on the quality of the literature review.

• Lack of Standardization

A potential limitation to the combination of results could be the lack of standard assessment tools and measurements across the original research. In this case, there may be differences in how PTSD is defined and assessed as well as the health outcomes thus making it challenging to draw broad inferences from the secondary data provided.

Previous Research, Policies, and Practice

PTSD, a severe mental health issue, has been shown to be prevalent among veterans who have experienced some form of traumatic events during their military service. In order to develop effective support networks and interventions, it is important that we understand the long term effects of PTSD on the physical and mental health of veterans. Studies that have investigated the frequency of PTSD in veterans are everywhere.They revealed that veterans are more susceptible to this condition as a result of exposure to violence and trauma in the armed forces. Some studies have also shown how symptoms of PTSD can worsen over time and how this impacts the overall quality of life of these veterans. Research has also explored the presence of co-existing conditions like depression, substance misuse, and various physical health issues that are associated with PTSD among veterans. In order to provide adequate support, comprehensive care that caters to these co existing conditions must be considered. Assessment of the effectiveness of various PTSD interventions that include complementary therapies, medications, and psychotherapy has also been carried out by different studies. Many countries have also implemented policies to improve the access to mental health services for these veterans and allocating funds for specialized treatments. In some countries, veterans with PTSD may qualify for disability compensation. Governmental and non-governmental programs have also been created in order to address the needs of veterans with PTSD. Some of these programs include covering community reintegration, vocational rehabilitation, and mental health treatment. The importance of trauma-informed care is also gaining traction within clinical settings. Healthcare professionals have been seen to adopt holistic interventions, combining mental health support, physical rehabilitation, and lifestyle changes in order to address both the mental and physical health outcomes of PTSD. This integrated approach functions to provide a more empathetic and effective care for veterans dealing with PTSD. Peer support programs have gained traction as an effective practice for veterans with PTSD. These programs facilitate connections between veterans, providing a supportive environment where shared experiences can contribute to mental and physical well-being. By building upon the existing body of knowledge and leveraging global policies and practices, researchers and policymakers can work towards improving the lives of veterans grappling with the enduring effects of PTSD.

Researcher Reflection

The whole research experience has been a platform for improving my research skills and proficiency considering the different phases of the research work with the respective difficulties that were encountered, ranging from the onset to the end of the research. The major difficulty that I encountered during the research was the collection of the necessary secondary data seeing as there are tendencies for such data to be inconsistent, inaccurate, require thorough sorting and also not readily available and accessible to researchers. So I had to check across multiple sources and decided to focus on the two most reliable journal sources for this study which include CORE and JSTOR, and also use my already stated research objectives to guide the selection and evaluation of secondary data and most importantly the guide and counsel of my supervisor that provided insights that helped the interpretation of complex information and also made it easy to verify the accuracy of the data. However, the whole research process helped me value proper planning and time management when working on something like this because many delays could have been avoided if there had been a proper plan. I would end by saying that all of it drilled me into being better than I was before I conducted this research. I’m now conversant with sourcing and verifying secondary data which is a big plus for me as an academician.

 

CHAPTER FIVE: CONCLUSION

Final Conclusion

In conclusion, this study effectively explained the long-term effects of post-traumatic stress disorder (PTSD) on veteran’s mental and physical health outcomes, with major emphasis on the diverse impact of this condition. This research elaborately covers the effects of PTSD on the physical and mental health of veterans and the customized support systems and interventions for these veterans to improve mental health outcomes while also looking at depression and substance abuse as themes generated in this study. Also, this study explored specific difficulties encountered by female soldiers as well as the distinct risk factors that lead to the onset of PTSD and the difficulties veterans encounter when adjusting from the military to civilian life.

Practice Recommendations

It has been established that veterans affected by PTSD often struggle with severe mental health problems. It has also been said that these problems impact their overall well-being. In order to create effective interventions for these people, it is important that we understand the lasting effects of PTSD on their general wellbeing (Armenta et al., 2018).The US and UK now have some practice guidelines that aid in carrying out this type of research. This functions to offer insights in order to curb the adverse effects of PTSD on these veterans. A couple of US organizations and agencies have also issued practice guidelines that stems from research studies and focuses on the physical and mental health outcomes of veterans with PTSD (Krystal et al., 2017).

1. Department of Veterans Affairs (VA)

The VA emphasizes the following practice recommendations:

• Ethical Considerations: Ethical guidelines as well as obtaining informed consent from participants should be abided. This helps to ensure confidentiality and privacy (Harriss et al., 2019).
• Interdisciplinary Collaboration: If the complex nature of PTSD is to be discussed, interdisciplinary collaboration should be carried out(DeGraba et al., 2021).
• Longitudinal Studies: In order to assess the long-term effects of PTSD, the use of longitudinal study is advised (McGlinchey et al., 2017).

1. National Institute of Mental Health (NIMH)

The NIMH provides practice recommendations such as:

• Inclusion of Diverse Populations: Here, advocating for the inclusion of different populations of these veterans will in turn help to get a comprehensive understanding of the impact of
• Utilization of Advanced Assessment Tools: The use of advanced tools to measure the health outcomes of their general health is encouraged.
• Translation of Research Findings: If veteran care is going to be improved, the translation of research findings into clinical practice is highly encouraged.

 

The United Kingdom  has organizations and institutions that have been able to establish practice recommendations for research studies that focus on PTSD among veterans. They include:

1. Ministry of Defence (MoD)

The MoD highlights the following recommendations to be practiced:

• Collaboration with Veterans’ Organizations: In order to ensure that the research is aligned with the needs and experiences of veterans, collaboration with different veteran organization is encouraged (Wendleton et al., 2023)
• Community Engagement: Here, community engagement which in turn helps to promote trust and active participation among veterans in the research study is recommended.
• Dissemination of Findings: In this case, the importance of disseminating research findings with the goal of informing policy and practice within the healthcare system is encouraged greatly.

1. National Institute for Health Research (NIHR)

The NIHR provides the following recommendations:

• Patient and Public Involvement: Here, in order to ensure that the study addresses the core issues that veterans with PTSD face, advocating for patient and public involvement in the research process is important.
• Utilization of Real-world Data: To understand the long-term impact of PTSD on health outcomes of veterans in diverse settings, real time data is highly advised.
• Partnership with Healthcare Providers: For easier facilitation of the translation of research findings into clinical practice, it is advised that partnership with healthcare providers should be encouraged.

 

These suggestions and recommendations are encompassing. They include community involvement, interdisciplinary teamwork, inclusion of different populations, and the application of research findings in clinical practice. Through strict adherence to these recommended practices, researchers can increase our understanding of the impact of PTSD on veterans and help in providing valuable insights. This helps with the eventual creation of efficient interventions and networks for support that enhance their general welfare.

Researcher Recommendations

Based on this study, in order to enhance the health outcomes for military veterans with PTSD, depression, and substance abuse, the following recommendations should be enacted:

1.  Access to Specialized Care

The availability of different specialized treatment for PTSD, depression, and substance misuse for veterans should be looked into. This requires the expansion of the pool of mental health specialists that are skilled in treating trauma unique to veterans. It also requires specialized treatment plans inside the Veterans Affairs (VA) healthcare system.

1. Integrated Mental and Physical Health Services

It is essential to apply different  care approaches that simultaneously address the needs of mental and physical health. Coordinated efforts between mental health doctors, primary care physicians, and specialists can guarantee comprehensive support for veterans. This is good especially for those with comorbid conditions.

1. Community-Based Support initiatives

Community-based support programs are important aspects of improving the wellbeing of veterans. This literature review study highly recommends eenhancing community programs that include peer support, vocational rehabilitation, and recreational therapy. This in turn helps to foster meaningful engagement and social relationships.

1. Training for Healthcare Professionals

The medical professionals who should get training on how to identify and manage the unique challenges veterans with PTSD, depression, and substance addiction face are the primary care physicians. This initiative alone can improve the early detection of symptoms and the delivery of appropriate medical care.

1. Research and Innovation

When it comes to therapy for veteran mental health, it is important to encourage further research. The current assessment of this literature makes the case for ongoing support for research to delve into innovative therapeutic approaches, technologically enhanced interventions, and tailored plans that will in turn cater to the different needs of these veterans.

Final Words

The literature review has provided us a comprehensive understanding of how PTSD affects the mental and physical health of veterans. Hence, in order to address these effects, the findings of this study underlines the crucial importance of integrated and holistic care approaches as well as early intervention, and ongoing research efforts. Once we are able to understand and address these complex interactions among PTSD, mental health, and physical well-being, we can begin to try and enhance the quality of life as well as the overall health outcomes for those who have doggedly served their country. As we conclude this literature review study, it is clear that further advancements in clinical practice and research are necessary in order to support veterans in coping with the long term challenges that are posed by PTSD and to safeguard their well-being.