Identifying psychological outcomes in families of Five Eyes alliance armed forces Veterans: A systematic review

LAY SUMMARY Military service can affect the psychological health and well-being of ex-service members and their families. Most research prioritizes active duty families or Veterans, with spouses/intimate partners and adult children of Veterans often overlooked. This study reviewed all previous research on the psychological health of Veteran families within the Five Eyes alliance countries of Australia, Canada, New Zealand, the United Kingdom, and the United States. It found spouses/intimate partners had higher rates of anxiety, depression, and posttraumatic stress disorder (PTSD) compared to national rates and were more likely to feel distress when their Veteran partner had mental health issues. Adult children were at higher risk for anxiety, depression, alcohol/substance misuse, and PTSD compared to national rates. Four themes identified were: personal feelings and internal emotions, Veteran-oriented, help and support, and acting as a unit. Due to the scarce available research, further studies are needed to address psychological outcomes among military Veteran families.

Compounding Effects of Traumatic Brain Injury, Military Status, and Other Factors on Pittsburgh Sleep Quality Index: A Meta-analysis

ABSTRACT Introduction Traumatic brain injury (TBI) or concussion is a known risk factor for multiple adverse health outcomes, including disturbed sleep. Although prior studies show adverse effects of TBI on sleep quality, its compounding effect with other factors on sleep is unknown. This meta-analysis aimed to quantify the effects of TBI on subjective sleep quality in the context of military status and other demographic factors. Materials and Methods A programmatic search of PubMed database from inception to June 2020 was conducted to identify studies that compared subjective sleep quality measured using Pittsburgh Sleep Quality Index (PSQI) in individuals with TBI relative to a control group. The meta-analysis included group-wise standard mean difference (SMD) and 95% CI. Pooled means and SDs were obtained for TBI and non-TBI groups with and without military service, and meta-regression was conducted to test for group effects. Exploratory analysis was performed to test for the effect of TBI, non-head injury, military status, sex, and age on sleep quality across studies. Results Twenty-six articles were included, resulting in a combined total of 5,366 individuals (2,387 TBI and 2,979 controls). Overall, individuals with TBI self-reported poorer sleep quality compared to controls (SMD = 0.63, 95% CI: 0.45 to 0.80). Subgroup analysis revealed differences in the overall effect of TBI on PSQI, with a large effect observed in the civilian subgroup (SMD: 0.80, 95% CI: 0.57 to 1.03) and a medium effect in the civilian subgroup with orthopedic injuries (SMD: 0.40, 95% CI: 0.13 to 0.65) and military/veteran subgroup (SMD: 0.43, 95% CI: 0.14 to 0.71). Exploratory analysis revealed that age and history of military service significantly impacted global PSQI scores. Conclusions Poor sleep quality in TBI cohorts may be due to the influence of multiple factors. Military/veteran samples had poorer sleep quality compared to civilians even in the absence of TBI, possibly reflecting unique stressors associated with prior military experiences and the sequelae of these stressors or other physical and/or psychological traumas that combine to heightened vulnerability. These findings suggest that military service members and veterans with TBI are particularly at a higher risk of poor sleep and its associated adverse health outcomes. Additional research is needed to identify potential exposures that may further heighten vulnerability toward poorer sleep quality in those with TBI across both civilian and military/veteran populations.

The Electoral Impact of Military Experience: Evidence From U.S. Senate Elections (1982–2016)

The belief that a military veteran candidate receives an electoral benefit at the polls based on a history of military service remains a widely held assumption in American politics. However, this assumption of a veteran electoral bonus has rarely been studied by scholars and the limited literature displays mixed results. This article presents the findings of a new study that addresses the mixed results in the literature and presents evidence that demonstrates that certain types of military veteran candidates do gain a veteran bonus in congressional elections. This advantage over nonveterans is conditioned by party, the type of race, and the nature of military service. By analyzing general election races for the United States Senate over 34 years (1982–2016), the study uncovers support for Democratic candidates with military service receiving an electoral bonus at the polls. This electoral bonus is most widely enjoyed by Democratic veterans in open Senate races and with experience in deployed warzones. The key findings suggest that previous conclusions in the literature with respect to establishing a veteran bonus in congressional elections should be reexamined to expand the time period of analysis, restructure the characterization of military experience beyond a binary variable, and include both House and Senate elections.