Association Between Perceptions of Military Service and Mental Health Problems in a Nationally Representative Sample of United States Military Veterans

Objective: In this study, we examined the prevalence of positive and negative perceptions of military service, associations between these perceptions and other demographic and military-related factors, and the extent to which endorsement of positive and negative perceptions of military service are associated with current mental health problems among United States veterans. Method: We analyzed data from the National Health and Resilience in Veterans Study (NHRVS), a nationally representative survey of 1,484 United States military veterans, 564 of which reported combat exposure. We assessed perceptions of the effects of military service using a scale developed by Elder and Clipp (1989). Results: Results showed that desirable effects of service (53.6-86.5%) were more frequently endorsed than undesirable effects (9.5%-48.1%), and that combat-exposed veterans (11.5%-59.7%) were more likely to endorse undesirable effects of service than veterans without combat exposure (4.0%-40.7%). We also found that undesirable effects of service predicted significantly higher odds of probable current mental health disorders (OR = 1.08, 95% CI [1.04, 1.12]), and current suicidal ideation (OR = 1.09, 95% CI [1.05, 1.13]), even after conservative adjustment for possible confounding variables. Desirable effects of service predicted significantly lower odds of current suicidal ideation (OR = 0.96, 95% CI [0.93, 0.99]). Conclusion: Taken together, results of this study suggest that perceptions of military service are associated with suicidal ideation and other mental health conditions. In addition, assessing veterans' perceptions of their service could be used as a method to identify possible at-risk veterans who may benefit from mental health services and resources. Clinical Impact Statement Perceptions of military service are linked to mental health problems among a nationally representative sample of United States military veterans. This study was the first to examine the prevalence of veteran perceptions about desirable and undesirable effects of military service. The findings of this study shed light on the differences in perceptions between combat and noncombat veterans, and on associations between perceptions and mental health; they also suggest that veterans' perceptions of their service could be used to identify possible at-risk veterans who may benefit from mental health services and resources.