United States service members who served in the wars in Afghanistan and Iraq faced constant risk of injury and death during deployment, as well as repeated disruption of connections with family members and friends—often leading to difficult homecoming transitions. With the formal end of the war in Iraq in late 2011 and a continued disassembling of the large U.S. military presence, many veterans are currently transitioning back to civilian life.
“It is critical to understand and support their homecoming transitions,” says Jennifer Ahern, associate professor of epidemiology and Chancellor's Professor of Public Health at the UC Berkeley School of Public Health. Ahern recently led a qualitative study to examine the homecoming experience of Afghanistan and Iraq veterans, the findings of which were published in PLoS One, in July.
Previous research indicates that difficulties in transition to civilian life increase the risk of long-term problems, including homelessness and premature mortality. But there has not been much research on how to create interventions to support improved transitions for veterans, and what has been done mainly looked at past conflicts.
“There is some research from the Vietnam era, but it was a very different time,” says Ahern. “My sense was that these veterans’ experiences would be very different, that there would be new stories.”
Ahern chose to do an in-depth, small-scale qualitative study to lay the groundwork for future quantitative work. “We simply didn’t know enough to propose a quantitative study,” she says. “We needed to get a basic understanding of what this experience was like.”
She collaborated with then-PhD student Miranda Worthen, who is now faculty in the Department of Health Science and Recreation at San Jose State University, and Sheri A. Lippman, faculty in the Department of Medicine at UCSF, to develop and conduct in-depth interviews with 24 Afghanistan and Iraq veterans in 2009-2011 in California, including both men and women and a range of ages, race/ethnicities, and military service branches.
During the interviews veterans were asked to narrate their experiences, with probes for experiences with family, friends, other veterans, and the general community. Researchers then repeatedly reviewed the interviews for re-occurring themes. Using this inductive thematic analysis approach, Ahern and her team identified three overarching themes: “Military as family,” “Normal as alien,” “Searching for a new normal.”
“The interviews revealed things that quantitative studies could not have,” says Ahern. “For example, you might get a response on a quantitative social support scale that says ‘low support,’ but you wouldn’t know why. The interviews showed that it’s not because the family isn’t there or trying to be helpful, but because veterans just feel completely disconnected from the world they come back to.”
The researchers found that, during deployment, the military environment provided service members with structure and that they often perceived each other as ‘family.’ Once they returned home, civilian life no longer felt ‘normal’ but alien. The vast majority of veterans interviewed felt disconnected from people at home, including family and friends, who had not shared the experience of military service.
Moreover, many veterans felt they did not receive deserved support from the military and other institutions in the transition back to civilian life, which generated and exacerbated feelings of alienation and the lack of structure, meaning and purpose.
The study suggests that in order to ease the challenges of transition, peer support from other veterans may be a critical part, especially if veterans perceive the social support from family, friends, and institutions as ineffective. Peer support can offer help with practical issues—such as access to veterans’ benefits—as well as emotional support of sharing the military and transition experience.
“This work on the transition is so critical because it seems that veterans can navigate their way back into situations when they do feel part of their community and are supported and at a good place with work, education or whatever their next steps are,” Ahern says. “It is a transition that is such a moment of opportunity to provide what they need to head off a lot of negative long-term effects that we do see playing out from past generations of veterans. For the current generation we cannot completely prevent it, but we should try to mitigate it to the extent that we can. It feels like a very important societal responsibility.”
Other researchers involved in the study were Jackson Masters and Emily J. Ozer, both at the UC Berkeley School of Public Health, and Rudolf Moos, at the Stanford University of Medicine and the Department of Veterans Affairs Medical Center. Support for this study came from the Hellman Family Faculty Fund.
By Jasmin M. Huynh