Toward a veteran-centric view on community (re)integration.

Abstract

INTRODUCTION Research on postdeployment health is critical to inform the development and dissemination of health services for Veterans. Since September 11, 2001, more than 2.2 million men and women have served in Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) [1]. In contrast with prior conflicts, servicemembers experienced more repeat tours, greater perceived level of danger due to the continuous risk of unconventional means of warfare, and diverse military cultures serving together [2]. The effects of these circumstances on Veterans' lives over time are not clear; however, as early as 2007, Resnik and Allen observed that a significant number were at risk of poor community upon returning from deployment [3]. Following a comprehensive review of the literature, this guest editorial provides a synopsis of the current state of research related to community (re)integration in OIF/OEF/OND servicemembers and Veterans that can serve to advance the science. It includes discussion of advances in defining and measuring community (re)integration, stakeholder response, and emerging needs. THE CHALLENGES Approximately 44 percent of returning servicemembers and Veterans reported a range of difficulties readjusting to postdeployment status [1]. Coming home is an immersive experience, involving all realms of life and influencing health and well-being [4]. Many servicemembers and Veterans encounter the interrelated and simultaneous tasks of processing combat experiences while reentering a civilian life that has changed in their absence. Difficulty with community is associated with worse overall mental health [5]. Comorbid mental health disorders such as posttraumatic stress disorder (PTSD), anxiety, depression, and alcohol and substance abuse that resulted from or were exacerbated by combat exposure have been reported [2]. Increased rates of suicide and a changing face of homeless Veterans have been noted in recent literature [6-7]. Resuming predeployment life roles can be especially challenging for servicemembers and Veterans who sustained physical injury, an unfortunate reality in this cohort where traumatic brain injury (TBI) and motor vehicle accidents are common [8]. The disability associated with physical and psychological injury is far reaching, affecting self-care, employment, education, relationships, marriages, finances, home, and civic and community life [8-10]. The reality that issues can exist in isolation or in combination further complicates the transition back and increases the likelihood that no two experiences are identical. DEFINING (RE)INTEGRATION The terms community and community reintegration are frequently used interchangeably in the literature, even within the same article. For over 30 years, health service providers and researchers have attempted to define these terms [11]. Though usually in reference to rehabilitation outcomes, elements of each are relevant and applicable when discussing the transition from deployment to home. Community integration has been described as participation in life roles [10] and the return of individuals to their age-, sex-, and culturally appropriate role functions [3]. Community has been used to describe a return to participation in life roles following discharge from an institution where one was separated from normal community living and then returns to life in a community. It has also been used to describe repatriation from a foreign county [10]. Reistetter and Abreu described as an adaptation process that is multidimensional, dynamic, personal, and culturally bound [12]. The ultimate goal of any rehabilitation effort is to help those who have been injured adjust to life in the community [11]. While rehabilitation may not seem immediately relevant to those without physical injury, adjustment to life in their community is a reasonable goal for all who are transitioning postdeployment. …