A Review of Military Health Research Using a Social–Ecological Framework

OBJECTIVE: We aim to contextualize the growing body of research on the sequelae of military service in the wars in Afghanistan and Iraq. We employ a social-ecological (SE) framework for the taxonomy of military health research and classify risk as arising from the individual, family, community, and the institutional levels. We intend for this review to inform enhanced health promotion efforts in military communities. DATA SOURCE: Articles reviewed were extracted from Web of Science, PubMed, and Scopus. INCLUSION AND EXCLUSION CRITERIA: Research focused on somatic and psychological sequelae of combat deployment published from 2001-the year the war in Afghanistan began-through the end of 2014. We excluded studies of non-US military personnel, other systematic reviews, meta-analyses, book chapters, and theoretical papers. DATA EXTRACTION: We examined and summarized the aims, participants, methods, study design, SE framework tier, risk factors, and health outcomes. DATA SYNTHESIS: Studies were categorized according to SE tier, whether they focused on somatic, behavioral, or psychological outcomes, and by risk factor. RESULTS: Of the 352 peer-reviewed papers, 84% focused on war's sequelae on the index military personnel, and 75% focused on mental or behavioral health outcomes-mostly on post-traumatic stress disorder. We find comparatively little research focusing on the family, community, or institutional tiers. CONCLUSIONS: We know relatively little about how family and community respond to the return of personnel from combat deployment; how family resources affect the health of returning military personnel; and how a war's persistence presents challenges for federal, state, and local agencies to meet military health-care needs. Such work is especially salient as US troops return home from war-particularly in communities where there are substantial military populations.