Military to civilian questionnaire: A measure of postdeployment community reintegration difficulty among veterans using Department of Veterans Affairs medical care

Abstract

The primary objective of this study was to describe the development, reliability, and construct validity of scores on the Military to Civilian Questionnaire (M2C-Q), a 16-item self-report measure of postdeployment community reintegration difficulty. We surveyed a national, stratified sample of 1,226 Iraq and Afghanistan veterans who used U.S. Department of Veterans Affairs (VA) medical care; 745 completed the M2C-Q and validated mental health screening measures. All analyses were based on weighted estimates. The internal consistency of the M2C-Q was .95 in this sample. Factor analyses indicated a single total score was the best-fitting model. Total scores were associated with measures theoretically related to reintegration difficulties including perception of overall difficulty readjusting back into civilian life (R(2) = .49), probable PTSD (d = 1.07), probable problem drug or alcohol use (d = 0.34), and overall mental health (r = -.83). Subgroup analyses revealed a similar pattern of findings in those who screened negative for PTSD. Nonwhite and unemployed veterans reported greater community reintegration difficulty (d = 0.20 and 0.45, respectively). Findings offer preliminary support for the reliability and construct validity of M2C-Q scores.

Toward a Veteran-centric view on community (re)integration

“…Many servicemembers and Veterans encounter the interrelated and simultaneous tasks of processing combat experiences while reentering a civilian life that has changed in their absence. Difficulty with community reintegration is associated with worse overall mental health [5]. Comorbid mental health disorders such as posttraumatic stress disorder (PTSD), anxiety, depression, and alcohol and substance abuse that resulted from or were exacerbated by combat exposure have been reported [2].…”

“…While rehabilitation may not seem immediately relevant to those without physical injury, adjustment to life in their community is a reasonable goal for all who are transitioning postdeployment. Whereas the Department of Defense does not have a uniform definition of reintegration, its postdeployment programs emphasize areas including relationships, employment or schooling, access to benefits, healthcare, and housing; in other words, domains relevant to full participation in community life [5]. Though variance in definition exists, the consensus of the articles included in this review of the literature reveals that similar to the goals of TBI rehabilitation, servicemembers and Veterans who have successfully (re)integrated postdeployment are productive participants at home, their place of work or school, and within their community [13].…”

“…The CRIS has been validated for use in person and via telephone [8] and has a computer-adapted version [14]. Sayer et al reported that most reintegration measures are intended for those with neurological disorders and might not be relevant to those without physical handicaps or specialized rehabilitation needs, prompting the development of the Military to Civilian Questionnaire [5]. This tool was designed to assess specific community reintegration problems faced by OIF/ OEF combat Veterans and may be useful in research protocols.…”

“…This tool was designed to assess specific community reintegration problems faced by OIF/ OEF combat Veterans and may be useful in research protocols. Additional outcomes research and validation for use in clinical settings is needed [5].…”

“…This includes, but is not limited to, those with nontraditional family structures [1], those whose identification or help-seeking is limited by stigma [25], and those from racial and ethnic minority backgrounds who may face additional difficulties with (re)integration [5,27]. Further, exploration of the variance in experience between Active Duty and National Guard/Reserve Veterans [5,[28][29], between returning male and female servicemembers [5,28,30], and assessment of the community (re)integration needs of those Veterans who are not patients in rehabilitation settings [5] is also recommended.…”