U.S. military veterans face unique stressors, such as combat, and experience various health conditions, like post-traumatic stress disorder (PTSD), that can negatively affect multiple aspects of functioning.
For more than a decade, the U.S. Department of Veterans Affairs has been implementing its Whole Health initiative, a holistic, personalized approach to health care that aims to sustain functioning and enhance well-being in veterans.
To help inform the ongoing delivery of Whole Health, a new study led by National Center for PTSD and Yale researchers analyzed data from a large, population-based sample of U.S. military veterans to identify factors — both positive and negative — associated with mental, physical, psychosocial, and cognitive functioning. The results were published online August 9 in JAMA Network Open.
“We have a general understanding of factors that can adversely affect functioning, such as chronic medical conditions, sleep problems, and PTSD symptoms. There is also evidence that positive psychological traits, such as purpose in life and optimism, can help bolster functioning. However, little is known about whether certain vulnerability or resilience factors matter more for specific kinds of functioning, or whether they interact to shape functioning,” said lead author Ian C. Fischer, PhD, clinical psychologist and postdoctoral fellow with Yale's Department of Psychiatry and the National Center for PTSD.
The authors found that physical disability, total number of medical conditions, and insomnia were most strongly associated with physical functioning. For mental, psychosocial, and cognitive functioning, positive psychological traits and insomnia were most strongly associated.
The authors also found that certain positive psychological traits also attenuated the strong negative effect of insomnia on mental, psychosocial, and cognitive functioning. Specifically, among veterans with clincal insomnia, those who also reported high levels of purpose in life reported levels of functioning similar to those without insomnia.
“There are several evidence-based strategies that can help strengthen one’s sense of purpose in life. Psychological treatments such as acceptance and commitment therapy can help, but there are also less formal strategies," Fischer said. "For example, taking a moment to clarify your values and take stock of what’s most important, identifying what makes you feel most alive, and participating in community events — these are all activities that can help to cultivate a greater sense of purpose. As the German philosopher Fredrich Nietzsche observed, having a ‘why’ to live for can help us deal with almost any ‘how.’"
Other study authors included Peter J. Na, MD, MPH, who is affiliated with the VA Connecticut Healthcare System and Yale School of Medicine; David B. Feldman, PhD, who is affiliated with Santa Clara University; Alex Krist, MD, who is affiliated with Virginia Commonwealth University; Harold Kudler, MD, who is affiliated with Duke University and Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Dilip Jeste, MD, who is affiliated with the Global Research Network on Social Determinants of Mental Health and Exposomics; and Robert H. Pietrzak, PhD, MPH, who is affiliated with the National Center for PTSD and Yale School of Medicine.