Spirituality and Mental Well-Being in Combat Veterans: A Systematic Review.

Abstract

Many veterans experience significant compromised spiritual and mental well-being. Despite effective and evidence-based treatments, veterans continue to experience poor completion rates and suboptimal therapeutic effects. Spirituality, whether expressed through religious or secular means, is a part of adjunctive or supplemental treatment modalities to treat post-traumatic stress disorder (PTSD) and is particularly relevant to combat trauma. The aim of this systematic review was to examine the relationship between spirituality and mental well-being in postdeployment veterans. Electronic databases (MEDLINE, PsycINFO, CINAHL, Web of Science, JSTOR) were searched from database inception to March 2016. Gray literature was identified in databases, websites, and reference lists of included studies. Study quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool and Critical Appraising Skill Programme Qualitative Checklist. From 6,555 abstracts, 43 studies were included. Study quality was low-moderate. Spirituality had an effect on PTSD, suicide, depression, anger and aggression, anxiety, quality of life, and other mental well-being outcomes for veterans. "Negative spiritual coping" was often associated with an increase mental health diagnoses and symptom severity; "positive spiritual coping" had an ameliorating effect. Addressing veterans' spiritual well-being should be a routine and integrated component of veterans' health, with regular assessment and treatment. This requires an interdisciplinary approach, including integrating chaplains postcombat, to help address these issues and enhance the continuity of care. Further high-quality research is needed to isolate the salient components of spirituality that are most harmful and helpful in veterans' mental well-being, including the incorporating of veterans' perspectives directly.