COMMENTARY
Military Culture and the Transition to Civilian
Life: Suicide Risk and Other Considerations
James L. Pease, Melodi Billera, and Georgia Gerard
S uicide among active duty military members
and veterans has increased in the wake of the
two international conflicts (­RAND National
­Security ­Research ­Division, 2011), surpassing those
of the general population for the first time since
­Vietnam. Recent research has identified the period
of separation from the military as a period of elevated
risk, regardless of deployment history (­Reger et al.,
2015). Although the association between deployment
and suicide is not clear-cut, studies have shown that
the transition to civilian life for Operation Enduring
Freedom/Operation Iraqi Freedom (OEF/OIF)
­veterans who served in combat can be particularly
difficult, with over 50 percent describing the re­
adjustment to civilian life as a “real struggle” (­Morin,
2011a).
SOCIAL AND FAMILY SUPPORT
A successful transition is challenging to returning
soldiers for many reasons, including the disso-
nance between military and civilian cultures (­Elliott,
­Gonzalez, & ­Larsen, 2011). Returning from many
years of military service has similarities to the culture
shock experienced by immigrants when they first
arrive in the United States: “There is the disorienta-
tion, change of status, and a search for identity and
meaning” (­Coll, ­Weiss, & ­Yarvis, 2011, p. 488). These
adjustment issues may also be viewed within the con-
text of assimilating back into the individualistic U.S.
society, lacking the close bonds and collectivist value
system experienced in the military (­Bryan, ­Jennings,
­Jobes, & ­Bradley, 2012). This can potentially foster
feelings of separateness when veterans transition to
civilian life if the particular circumstances are such
that they lack a sufficient social support system, or if
they lack a shared experience with those systems. For
instance, a recent report by ­Pietrzak, ­Johnson,
­Goldstein, M­ alley, and S­ outhwick (2009) found that
social support for OEF/OIF veterans during the tran-
sition to civilian life was negatively associated with
suicidal ideation. ­Lemaire and ­Graham (2011) had
doi: 10.1093/sw/swv050  © 2015 National Association of Social Workers
similar findings in that sufficient social support could
buffer against post-deployment stressors that were
independently associated with suicidal ideation.
Another challenge to successful reintegration into
civilian life that service members face is relationship
difficulties with spouses, significant others, or chil-
dren (­Doyle & ­Peterson, 2005; ­Resnik et al., 2012).
­Resnik and colleagues (2012) reported that many
veterans returning from combat experience a sense
of isolation from their families and that they no lon-
ger “fit in.” Veterans may feel disconnected from their
families, out of place, or afraid that their families no
longer understand them (­Demers, 2011). Some fam-
ilies may believe that the veteran will be able to easily
reintegrate into the family’s norms and expectations,
which can increase feelings of isolation or alienation
(­Resnik et al., 2012). Being married while serving in
the military has also been identified as a factor associ-
ated with a more difficult reentry (­Morin, 2011b).
DEPLOYMENT-RELATED PSYCHOLOGICAL
AND PHYSICAL INJURIES
Veterans who have sustained psychological or physical
injuries often have difficulties resuming their social
roles and participating in community life (­Elliott et al.,
2011; ­Sayer et al., 2011). One of the most common
risks these veterans face are mental health issues such
as posttraumatic stress disorder (PTSD), substance use
disorders, depression, and anxiety (­Bagley, ­Munjas, &
­Shekelle, 2010; ­Coll et al., 2011; ­Doyle & ­Peterson,
2005; ­Resnik et al., 2012; ­Sayer et al., 2011). The
results of a Pew Research Center survey has suggested
that veterans who have been diagnosed with PTSD
are more likely to have difficulties reintegrating com-
pared with veterans who do not experience PTSD
symptoms (­Morin, 2011b). Further­more, many re-
turning veterans are being diagnosed with mild trau-
matic brain injury during service and can experience
subsequent symptoms such as depression, hopeless-
ness, anger, and feelings of burdensomeness (­Brenner,
­Homaifar, ­Adler, W
­ olfman, & K ­ emp, 2009).
83
FINANCES, EMPLOYMENT, AND EDUCATION
Other challenges on reintegration to civilian life in-
clude finances, employment, and education (­Doyle
&P ­ eterson, 2005; ­Elliott et al., 2011; ­Resnik et al.,
2012). Returning veterans are often in the prime
years of employability; therefore, employment is a
high priority among this cohort. Barriers to employ-
ment include insufficient education or specialized
military training that does not necessarily translate
to the civilian world.
ACCUMULATED RISK FROM MULTIPLE
DOMAINS
Taken together, the impact of multiple and dynamic
forces affects the reintegration into civilian life for
returning veterans. Physical and psychological inju-
ries, family, intimate and social relationships, fi-
nances, employment, and educational factors can
influence the reintegration process. When there are
hardships in multiple domains, the cumulative effect
on successful reintegration and transition can exac-
erbate functional impairment beyond that of any
single stressor alone. In extreme circumstances, the
risks that veterans encounter when reintegrating into
civilian life could potentially put them at a higher
risk for suicide, as prior scholarship has suggested
(for example, ­Brenner & ­Barnes, 2012). Although a
considerable amount of knowledge has been gained
about the risk factors for suicidal behavior among
returning OEF/OIF veterans, much remains to be
learned about how the transition to civilian life and
reintegration into society relates to mental health
problems and suicide risk. With the drawdown from
OEF/OIF, the issue is timely given that soldiers are
transitioning home at unprecedented rates (­U.S.
­Department of ­Veterans ­Affairs, 2014).
REINTEGRATION INTO CIVILIAN LIFE
Helping OEF/OIF/Operation New Dawn veterans
reintegrate into life at home and in their communities
and fully participate in life roles has become a prior-
ity for the Veterans Health Administration (­Resnik
et al., 2012). Reintegration can be conceptualized as
finding purpose in life; having interpersonal relation-
ships; being employed or in school; and having access
to housing, health care, and other benefits (­Sayer
et al., 2011). Furthermore, engaging in various roles
as an “independent, autonomous person, family
member, friend, spouse and/or intimate partner, par-
ent, civic and community member, student, and
member of the workforce” are considered important
84
markers of community reintegration (­Resnik et al.,
2012, p. 89). These intra- and interpersonal roles are
hallmarks of reintegration that incorporate the do-
mains of belonging, acceptance, connection to oth-
ers, and involvement in leisure and community
activities (­Sayer et al., 2011). Successful reintegration,
including a sense of belonging, is also considered a
protective factor against suicide risk ( ­Joiner, 2005).
CLINICAL IMPLICATIONS
Understanding the individual in his or her environ-
mental context is a hallmark of social work practice.
Suggestions for how this can be done include inquir-
ing about the branch in which the veteran served,
when and where the veteran was stationed or de-
ployed, what the veteran’s military occupational
specialty was, and if the veteran was ever in combat
(­Coll et al., 2011). These questions may help estab-
lish rapport and deepen the providers’ understanding
of the role of environmental factors in the transition
process. Conveying interest in the veteran experience
as well as addressing and normalizing the unique
conditions of returning service members may help
engagement in treatment (­Keats, 2010; ­Strom et al.,
2012).
Suicide prevention efforts should also meet the
veterans where they are and promote sensitivity to
the culturally diverse factors presented by veterans.
Traditional models of practice in suicide prevention
require the identification of those at risk. From the
perspective of the provider, this approach is important
and critical to identifying veterans at elevated risk.
However, it may be more successful in working with
a veteran to translate a discussion into terms that are
less disease focused and more consistent with military
values. For instance, utilization of positive psychology
techniques, health promotion approaches, and “up-
stream” practices has been suggested to help veterans
understand their military experiences as a source of
growth and recognize their strengths in adapting to and
succeeding in meeting challenges (­Britt, ­Castro, &
­Adler, 2005; ­Bryan et al., 2012). ­Bryan and colleagues
(2012) advocated for a reconceptualization of the
“prevention of injury and death” to the promotion
of ‘‘mental fitness,” which aligns with core aspects of
military culture. This framework could be applied to
suicide prevention strategies across all aspects of ser-
vices delivery systems, as it suggests the need for treat-
ment to be holistic, strengths based, and recovery
oriented (­Coll et  al., 2011). Reconsidering the
­prevention-only approach enables the adoption of
Social Work  Volume 61, Number 1  January 2016
 strengths-based, recovery-oriented models and health
promotion practices that can be less stigmatizing,
more acceptable, and more useful for veterans expe-
riencing suicidal thoughts and behaviors. Clinicians
challenging and changing their own approach is
much more feasible than trying to change the military
culture to align with the traditional system of mental
health (­Bryan et al., 2012).
For providers in private practice, ­Corrigan and
­Calabrese (2005) have suggested that empowerment
approaches and cognitive-based interventions have
been effective in reducing self-stigma. In addition,
­Dickstein, ­Vogt, H
­ anda, and ­Litz (2010) found that
cognitive-based approaches as well as acceptance and
commitment therapy were also effective in stigma
reduction (­Luoma, ­Kohlenberg, ­Hayes, ­Bunting, &
­Rye, 2008; ­MacInnes & ­Lewis, 2008). As such,
Dickstein and colleagues suggested that working
with individuals to reevaluate how legitimacy of ste-
reotypes, including “receiving treatment is a sign of
weakness,” can help those individuals feel empowered
and reduce their acceptance of the stereotype.
CONCLUSION
Mental health providers have been encountering an
increasing number of veterans during their transition
into civilian life. Veterans who have mental health
issues such as PTSD or substance use disorders may
have a more difficult time reintegrating than those
without mental health or substance use disorders.
Veterans may also experience relationship difficulties
with their spouse, partner, or other family members
and may feel a sense of disconnection from their
families. Furthermore, veterans may face financial,
employment, or educational challenges while tran-
sitioning into civilian life. For mental health provid-
ers, an understanding of military culture can facilitate
building a rapport and providing support. Values such
as honor, courage, loyalty, integrity, and commit-
ment serve as standards of conduct for military per-
sonnel and often reflect their worldview (­Coll et al.,
2011). Military culture may unintentionally instill
beliefs that help seeking is a sign of weakness, and
veterans may view themselves as a liability or burden
to others (­Bryan et al., 2012; ­Bryan & M
­ orrow, 2011;
­Sayer et al., 2009). Providers’ awareness of these po-
tential issues can equip them with tools to help re-
turning veterans in the therapeutic relationship, as
they navigate the process of reintegrating into civil-
ian life.
Pease, Billera, and Gerard / Military Culture and the Transition to Civilian Life: Suicide Risk and Other Considerations
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86 Social Work  Volume 61, Number 1  January 2016

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