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Differences in functional and structural social support among female and male veterans and civilians

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Social support is an important correlate of health behaviors and outcomes. Studies suggest that veterans have lower social support than civilians, but interpretation is hindered by methodological limitations. Furthermore, little is known about how sex influences veteran–civilian differences. Therefore, we examined veteran–civilian differences in several dimensions of social support and whether differences varied by sex.

Methods

We performed a cross-sectional analysis of the 2012–2013 National Epidemiologic Survey of Alcohol and Related Conditions-III, a nationally representative sample of 34,331 respondents (male veterans = 2569; female veterans = 356). We examined veteran–civilian differences in functional and structural social support using linear regression and variation by sex with interactions. We adjusted for socio-demographics, childhood experiences, and physical and mental health.

Results

Compared to civilians, veterans had lower social network diversity scores (difference [diff] = − 0.13, 95% confidence interval [CI] − 0.23, − 0.03). Among women but not men, veterans had smaller social network size (diff = − 2.27, 95% CI − 3.81, − 0.73) than civilians, attributable to differences in religious groups, volunteers, and coworkers. Among men, veterans had lower social network diversity scores than civilians (diff = − 0.13, 95% CI − 0.23, − 0.03); while among women, the difference was similar but did not reach statistical significance (diff = − 0.13, 95% CI − 0.23, 0.09). There was limited evidence of functional social support differences.

Conclusion

After accounting for factors that influence military entry and social support, veterans reported significantly lower structural social support, which may be attributable to reintegration challenges and geographic mobility. Findings suggest that veterans could benefit from programs to enhance structural social support and improve health outcomes, with female veterans potentially in greatest need.

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Acknowledgements

Dr. Gray and Dr. Hoerster were supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development Program (CDAs 16–154 and 12–263). Dr. Campbell was supported by VA Office of Academic Affiliations’ Advanced Fellowship in Health Services Research and Development (TPH 61–000-23). Dr. Fortney was supported by a VA Research Career Scientist Award (RCS 17–153). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

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Author notes

  1. Sarah B. Campbell, Kristen E. Gray are co-primary authors

Authors and Affiliations

  1. US Department of Veterans Affairs (VA) Puget Sound Health Care System, Research and Development Service, 1660 S Columbia Way, S-152, Seattle, WA, 98108, USA

    Sarah B. Campbell, Kristen E. Gray, Katherine D. Hoerster & John C. Fortney

  2. US Department of Veterans Affairs (VA) Puget Sound Health Care System, Mental Health Service, 1660 South Columbian Way, S-116, Seattle, WA, 98108, USA

    Sarah B. Campbell, Katherine D. Hoerster & Tracy L. Simpson

  3. Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, USA

    Sarah B. Campbell, Katherine D. Hoerster, John C. Fortney & Tracy L. Simpson

  4. Department of Health Services, University of Washington, 1959 NE Pacific Street, Box 357660, Seattle, WA, 98195, USA

    Kristen E. Gray

  5. US Department of Veterans Affairs (VA) Puget Sound Health Care System, Center of Excellence in Substance Addiction Treatment and Education, 1660 S. Columbian Way, Seattle, WA, 98108, USA

    Tracy L. Simpson

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  1. Sarah B. Campbell
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Correspondence to Sarah B. Campbell.

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This was a secondary data analysis and does not contain clinical studies or patient data.

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Campbell, S.B., Gray, K.E., Hoerster, K.D. et al. Differences in functional and structural social support among female and male veterans and civilians. Soc Psychiatry Psychiatr Epidemiol 56, 375–386 (2021). https://doi.org/10.1007/s00127-020-01862-4

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