Abstract
BackgroundThe transition out of military service and subsequent reintegration to civilian life has been established as a period associated with an increased risk of psychological adjustment difficulties, psychiatric disorders and suicide risk, yet no tool exists to measure cultural and psychological adjustment following permanent separation from the military. This study describes the two-phase mixed-methods development and validation of the self-report Military-Civilian Adjustment and Reintegration Measure (M-CARM).MethodsIn Phase I, four focus groups (n = 20) and semi-structured one-on-one interviews (n = 80) enabled thematic analysis and generation of 53 initial items that were reviewed by an expert multidisciplinary panel (n = 12) and piloted for clarity and relevance in an Australian service-veteran sample (n = 11). In Phase II, psychometric properties of the 47 items resulting from Phase I were evaluated with online assessment of a convenience sample of transitioned Australian Defence Force veterans (n = 725). Analyses included exploratory and confirmatory factor analyses, as well as evaluation of test-retest reliability, internal consistency, and convergent, divergent and discriminant validity.ResultsExploratory factor analysis on a randomized split-half sample (n = 357), resulted in a 21-item, five-factor solution of Purpose and Connection, Help seeking, Beliefs about civilians, Resentment and regret, and Regimentation, explaining 53.22% of the variance. Confirmatory factor analysis (n = 368) verified this factor structure without modification (χ2 = 304.96, df = 160; CFI = .96, TLI = .94, NFI = .91, RMSEA = .05). Strong convergent, divergent and discriminant validity was demonstrated as M-CARM scores significantly correlated with related constructs assessed by standardised clinical measures as well as differentiated groups based on three binary reintegration items, with large effect sizes (d = > 1). Strong test-retest reliability for the total score (n = 186, r = .93) and excellent internal consistency (n = 725, a = .90) were also found.ConclusionsResults provide promising evidence the M-CARM is a valid, reliable measure of psychological and cultural reintegration to civilian life, with potential for considerable clinical and research application.
Highlights
The transition out of military service and subsequent reintegration to civilian life has been established as a period associated with an increased risk of psychological adjustment difficulties, psychiatric disorders and suicide risk, yet no tool exists to measure cultural and psychological adjustment following permanent separation from the military
Divergent and discriminant validity was demonstrated as Military-Civilian Adjustment and Reintegration Measure (M-CARM) scores significantly correlated with related constructs assessed by standardised clinical measures as well as differentiated groups based on three binary reintegration items, with large effect sizes (d = > 1)
The qualitative study echoed these findings as themes reiterated that military culture and differences with civilians, identity, purpose as well as belonging were central to psychological adjustment following military service
Summary
The transition out of military service and subsequent reintegration to civilian life has been established as a period associated with an increased risk of psychological adjustment difficulties, psychiatric disorders and suicide risk, yet no tool exists to measure cultural and psychological adjustment following permanent separation from the military. A U.S investigation found that up to 56% of Iraq and Afghanistan veterans receiving Veteran Affairs medical care reported substantial difficulties reintegrating, with 96% of the sample expressing interest in services to help readjust to civilian life [10]. Another U.S investigation surveying 1853 veterans found 44% of post-9/11 veterans and 25% of pre-9/11 veterans experienced reintegration difficulties. Veterans who reported difficulties indicated they experienced strained family relationships, angry outbursts, and “feeling that they don’t care about anything” [11] In another U.S study, up to 72% of veterans reported at least one significant readjustment stressor such as marital problems or financial issues [12]. A U.S study found these reintegration difficulties appear to persist, with up to 62% of veterans reporting difficulties, despite data being collected an average of six years after separation - demonstrating the importance of understanding reintegration difficulties beyond the transition period [15]
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