The Transition from Service to Civilian Life: Risk Factors, Psychometric Assessment and Intervention for Reintegration and Adjustment of Military Veterans.

Abstract

Background: Reintegration difficulties among military veterans transitioning to civilian life is appear common, with maladjustment linked to psychiatric illness and suicide. Despite this, substantial gaps in evidence-based assessments and interventions remain. This research describes the development and validation of the Military-Civilian Adjustment and Reintegration Measure (M-CARM), a post-separation assessment tool used to assess psychological adjustment and cultural reintegration to civilian life, as well as the Mental Readiness for Military Transition Scale (MT-Ready), a pre-separation tool developed to identify psychosocial factors predictive of post-separation adjustment and mental health. Demographic factors associated with adjustment among this population were identified and a novel intervention for veterans targeting adjustment and reintegration was developed and evaluated.

Methods: A two-phase multi-methods approach was employed across five studies. Phase I included interviews and focus groups with veterans (n = 60), partners (n = 20), and clinicians (n = 20). Thematic analysis informed item development, reviewed by an expert panel (n = 12) and piloted with current (n = 19) and ex-serving Australian Defence Force (ADF) personnel (n = 11). Phase II evaluated the psychometric properties of the M-CARM and MT-Ready using a prospective sample of ADF members (n = 345) and a cross-sectional sample of ex-serving members (n = 725). A qualitative sub-study (n = 35) explored employment challenges among veterans using thematic analysis. Finally, an eight-week group program incorporating cognitive-behavioural and acceptance and commitment therapy was evaluated for feasibility and acceptability in a non-controlled within-subjects longitudinal design with transitioned veterans (n = 24).

Results: The M-CARM demonstrated a five-factor structure (Purpose and Connection, Help Seeking, Beliefs about Civilians, Resentment and Regret, and Regimentation) across 21 items. The MT-Ready demonstrated a three-factor, 15-item structure (Future Focus and Optimism; Anger and Perceived Failure; Civilian Connections and Social Support). Confirmatory factor analysis via a split-half sample validated the M-CARM structure. Both measures demonstrated strong reliability and validity, and MT-Ready scores significantly differentiated post-separation outcomes including adjustment, PTSD, depression, anxiety, and quality of life. Veterans with higher odds of maladjustment included those unemployed or on a medical pension, single, male, from lower ranks and education, with higher PTSD symptoms, anger, feelings of failure and being unprepared for transition. Qualitative analysis revealed four themes in civilian employment challenges: starting over, mental health, interpersonal-cultural difficulties, and organisational differences. The program evaluation demonstrated high engagement, experience, usefulness, and improved adjustment. Strong retention (82.8%), completion (87.5%), and fidelity (89.6%) were also found. Significant improvements in M-CARM scores were found from pre-intervention to post-intervention (p = <.001), maintained at follow-up with large effect size.

Conclusion: This research provides evidence for the validity, reliability, and clinical utility of new tools to assess and predict psychological adjustment and cultural reintegration among military populations. Interventions should target high-risk groups including unemployed or medically discharged veterans with psychological symptoms and limited support. The program demonstrated promising feasibility and initial outcomes addressing the psychological and cultural barriers to reintegration and adjustment. Overall, the findings represent a substantial step toward practical, evidence-based support for transitioning military personnel, with implications for assessment, prevention, and intervention at both population and individual levels. Show more