Well-being of US military Veterans

Abstract: The National Academies of Science, Engineering, and Medicine recently published a report that suggests a transition from a reactive disease-oriented medical care system to one that prioritizes disease prevention, health, and well-being. The report evaluated and made recommendations for the US Department of Veterans Affairs’ national implementation of a Whole Health initiative, which emphasizes a person-centered, values-based approach to health and well-being. To help inform this initiative, this cross-sectional survey study analyzed data from a nationally representative sample of US veterans to examine ratings and correlates of well-being. A total of 2435 veterans participated in the 2022 National Health and Resilience in Veterans Study (NHRVS). This study followed the AAPOR reporting guidelines, and participants provided electronic informed consent. The ethics committee of VA Connecticut Healthcare System approved the NHRVS. Well-being was assessed using the 12-item Flourishing Measure, which assesses 6 domains of well-being—happiness and life satisfaction, mental and physical health, meaning and purpose, character and virtue, close social relationships, and financial and material stability (Cronbach α = 0.91). Ratings range from 0 to 10 (higher scores indicate higher well-being) and are averaged to yield an overall measure of well-being. Analyses of variance were conducted between June 10 and 12, 2023, to compare well-being ratings by age, sex, and race and ethnicity. Pearson correlations (Bonferroni-corrected α = .05/33 = .002) and multivariable linear regression (2-sided P < .05) were then conducted to identify significant correlates of well-being. Interaction terms were incorporated into this analysis to evaluate the potential role of protective psychosocial characteristics (eg, purpose in life) in moderating associations between negative correlates of well-being (eg, physical health conditions). Analyses were conducted using SPSS, version 29. The sample of 2435 veterans had a mean (SD) age of 63.3 (13.9) years and was predominantly male (n = 2177 [92.3%, weighted]) and White, non-Hispanic (n = 2027 [79.5%, weighted]). Younger, female, and Hispanic veterans had the lowest well-being scores, with the largest magnitude difference observed between veterans aged 65 years or older (mean age, 74.5 years) and veterans aged 21 to 54 years (mean age, 44.1 years) (effect size difference, Cohen d = 0.77). The strongest correlates of well-being were protective psychosocial characteristics (β = 0.41), physical health conditions (β = −0.14), and greater age (β = 0.19). Purpose in life moderated the negative association of the number of physical health conditions with well-being (β = 0.25; P < .001). Among veterans with a greater number of physical health conditions, those with a higher purpose in life scored substantially higher (effect size difference, Cohen d > 1.80) than those with lower purpose in life. To our knowledge, this study is the first to examine ratings and correlates of well-being in a nationally representative sample of US veterans. The positive age gradient in well-being ratings aligns with a recent study using the same scale in the general US adult population. This finding could also be explained in part by greater life stressors (eg, burnout, financial instability)4and prevalence of trauma and psychiatric disorders among younger veterans. Furthermore, lower well-being ratings among female and Hispanic veterans may be partly explained by these subpopulations being overrepresented among younger veterans. A composite measure of protective psychosocial factors (ie, purpose in life, grit, resilience) was the strongest correlate of well-being, and purpose in life moderated the negative association of physical health conditions with well-being. Furthermore, having fewer physical health difficulties and greater emotional stability and social connectedness were strongly correlated with overall well-being, which suggests that interventions targeting these clinical and psychosocial factors may have potential utility in enhancing well-being in veterans. Limitations of this study include the cross-sectional design and the use of self-reported measures. Further research is needed to examine whether correlates of well-being may differ between veterans and nonveterans and whether Whole Health interventions designed to increase meaning and purpose in life may help bolster well-being among veterans.