Differences in functional and structural social support among female and male veterans and civilians.

Abstract

Social support is an important correlate of health behaviors and outcomes. Studies suggest that veterans have lower social support than civilians, but interpretation is hindered by methodological limitations. Furthermore, little is known about how sex influences veteran-civilian differences. Therefore, we examined veteran-civilian differences in several dimensions of social support and whether differences varied by sex. We performed a cross-sectional analysis of the 2012-2013 National Epidemiologic Survey of Alcohol and Related Conditions-III, a nationally representative sample of 34,331 respondents (male veterans = 2569; female veterans = 356). We examined veteran-civilian differences in functional and structural social support using linear regression and variation by sex with interactions. We adjusted for socio-demographics, childhood experiences, and physical and mental health. Compared to civilians, veterans had lower social network diversity scores (difference [diff] = -0.13, 95% confidence interval [CI] -0.23, -0.03). Among women but not men, veterans had smaller social network size (diff = -2.27, 95% CI -3.81, -0.73) than civilians, attributable to differences in religious groups, volunteers, and coworkers. Among men, veterans had lower social network diversity scores than civilians (diff = -0.13, 95% CI -0.23, -0.03); while among women, the difference was similar but did not reach statistical significance (diff = -0.13, 95% CI -0.23, 0.09). There was limited evidence of functional social support differences. After accounting for factors that influence military entry and social support, veterans reported significantly lower structural social support, which may be attributable to reintegration challenges and geographic mobility. Findings suggest that veterans could benefit from programs to enhance structural social support and improve health outcomes, with female veterans potentially in greatest need.