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

Lorraine Smith‐MacDonald · Jill M. Norris · Shelley Raffin‐Bouchal · Shane Sinclair

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Religion, Spirituality, and Psychology Posttraumatic Stress Disorder Research Workplace Spirituality and Leadership

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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. DISCUSSION: 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.

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References

2009Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.2010Systematic reviews: CRD's guidance for undertaking reviews in health care 2009Moral injury and moral repair in war veterans: A preliminary model and intervention strategy 2004A Process for Systematically Reviewing the Literature: Providing the Research Evidence for Public Health Nursing Interventions 2006Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme 2006Mental Health Problems, Use of Mental Health Services, and Attrition From Military Service After Returning From Deployment to Iraq or Afghanistan 2007Longitudinal Assessment of Mental Health Problems Among Active and Reserve Component Soldiers Returning From the Iraq War 2005Religious coping and psychological adjustment to stress: A meta-analysis

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