Loneliness and Social Isolation of Military Veterans: Systematic Narrative Review
Abstract: Loneliness and social isolation are being increasingly recognized as influencing both physical and mental health. There is limited research carried out with military veterans and, to date, there is no review of existing evidence. To synthesize and examine the evidence exploring aspects of social isolation and loneliness of military veterans, using a systematic narrative review strategy. A database search was carried out utilizing relevant search criterion. Seven databases were searched for publications with no date restrictions. Articles were included if they involved veterans and either social isolation or loneliness. The initial search returned 484 papers, after exclusions, removal of duplications, and a reference/citation search, 17 papers remained and were included in this review. The retrieved papers examined four areas of loneliness and social isolation: prevalence of loneliness in the veteran population, experiences related to military service as impacting loneliness or social isolation, the relationship between mental health and loneliness or social isolation, and interventions to combat loneliness and social isolation. Differences between the experiences of younger and older veterans were also highlighted. It is evident that military veterans present unique experiences of loneliness and social isolation, especially older veterans. This requires specific attention outside of campaigns targeted at the nonmilitary population.
Abstract: Disordered eating is a prevalent and relevant health concern that remains understudied among U.S. military veterans. Avoidant/restrictive food intake disorder (ARFID) is a newly recognized feeding and eating disorder characterized by overly restrictive eating due to (a) picky eating, (b) lack of appetite, and (c) fear of aversive consequences related to eating. The Nine-Item ARFID Screen (NIAS) is a recently developed ARFID screening tool with initial validation studies demonstrating psychometric support. However, the psychometric properties of the NIAS have not been investigated in a veteran sample. To advance our understanding of ARFID screening tools that may be appropriate for use in veterans, the present study examined the factor structure of the NIAS using survey data from a large national sample of recently separated veterans (N = 1,486). Measurement invariance across key subgroups was tested in addition to exploring differential associations between the NIAS and related constructs. Results suggested that a three-factor model provided an excellent fit of the data and demonstrated scalar invariance across self-identified men and women, race and ethnicity, and sexual and gender minority (SGM) identity. Some subgroups had higher latent means on the picky eating (women, SGM, non-Hispanic Black), appetite (women, SGM), and fear (women) factors. The NIAS had some overlap with another measure of disordered eating and was moderately correlated with psychosocial impairment and mental health. Overall, the NIAS may be a useful screening tool for ARFID in veterans, given support for the three proposed subscales and equivalence across diverse identities.