Abstract
BackgroundEvidence-based treatments for service-related health conditions such as posttraumatic stress disorder (PTSD), depression, and traumatic brain injury (TBI) are not effective for all veterans. Equine-assisted interventions are emerging as an additional treatment modality, but little is known regarding the safe and effective delivery of these interventions. This study aimed to describe the following features of the body of literature concerning equine-assisted interventions among veterans: 1) veterans who have participated in equine-assisted interventions; 2) specific characteristics of equine-assisted interventions in veterans; and 3) the specific characteristics of research on equine-assisted interventions in veterans.MethodsWe conducted a systematic mapping review of peer-reviewed literature reporting on equine-assisted interventions among veterans between 1980 and 2017. Searches of nine databases yielded 3336 unique records, six of which met the inclusion criteria and were reviewed. Data relevant to the study aims were extracted and analyzed.ResultsEquine-assisted interventions among veterans disproportionately targeted psychosocial outcomes and yielded promising results. The detailed methods of EAI varied in the reported studies, ranging from communicating with the horse to mounted exercises. There was also great diversity in outcome measurement. The state of theoretical development regarding the mechanisms by which equine-assisted interventions benefit the veteran population is currently underdeveloped. Studies provided insufficient detail with respect to the description of the intervention, reasons for attrition, and the dose-response relationship.ConclusionsScientific development of equine-assisted interventions targeting psychosocial outcomes among veterans is warranted to establish their efficacy. Targeted outcomes should be expanded, including outcomes more closely aligned with the nature of polytraumatic injuries. Future research must also emphasize the theoretical development of equine-assisted interventions for veterans and thoroughly describe the participants, components of the intervention, factors contributing to attrition, and optimal dose-response relationships.
Highlights
Evidence-based treatments for service-related health conditions such as posttraumatic stress disorder (PTSD), depression, and traumatic brain injury (TBI) are not effective for all veterans
Due to psychological and physical trauma incurred during combat deployments, an influx of veterans has returned to the civilian community with polytraumatic injuries or complex conditions characterized by unpredictable combinations of two or more health-related diagnoses [2]
The implementation of equine-assisted interventions for veterans would be supported by a greater understanding of both the factors contributing to attrition and the dose-response relationship
Summary
Evidence-based treatments for service-related health conditions such as posttraumatic stress disorder (PTSD), depression, and traumatic brain injury (TBI) are not effective for all veterans. Due to psychological and physical trauma incurred during combat deployments, an influx of veterans has returned to the civilian community with polytraumatic injuries or complex conditions characterized by unpredictable combinations of two or more health-related diagnoses [2] Those deployed to combat zones tend to experience high rates of traumatic brain injury (TBI, 10–20%), posttraumatic stress disorder (PTSD, 5.6–30.5%), and depression (5.6– 16%), which tend to co-occur and pose serious threats to veterans’ cognitive and emotional functioning [3, 4]. Veterans report that cognitive and emotional impairments associated with these conditions foster a tendency to avoid community-based activities in the community given the presence of others [11, 12] and that physical symptoms (e.g., pain or fatigue) disrupt veterans’ participation in typical patterns of activity [11, 13]
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