Veteran Reintegration Research: What 28 Studies on Social Connection Found

A 2022 systematic narrative review in Frontiers in Psychology examined 28 studies of interventions for military veterans with PTSD and asked one question: what role does social connection play? The interventions ranged from assistance animals and drumming groups to civic service, yoga and a welcome-home ceremony for Vietnam veterans. The authors concluded that interventions with a direct focus on social connection may mitigate loneliness and social isolation in veterans with PTSD. This article walks through what the review covered, what it found, where the evidence is thin, and where to find comparable activities in the UK and US.

Who wrote it and what they did

The authors are Gettings, Kirtley, Wilson-Menzfeld, Oxburgh, Farrell and Kiernan. They searched six databases, screened 202 initial hits and included 28 studies in a systematic narrative review published on 8 July 2022. Only English-language papers were included.

The interventions the review covered

The paper categorises 21 of the 28 studies by type. The table gives those counts and what the review reports for each type.

The paper also covers a 1991 qualitative study by Obenchain and Silver in which Vietnam veterans attended a "Welcoming Home" ceremony. The review reports that the ceremony gave veterans a chance to address social isolation and alienation through affirmation. It gives no sample size or numerical outcome for that study.

The six themes

1. Rethinking the diagnosis of PTSD.
2. Holistic interventions.
3. Peer support.
4. Social reintegration.
5. Empowerment through purpose and community.
6. Building trust.

The discussion says that holistic interventions able to mitigate experiential loneliness and social isolation share a direct focus on social reintegration and engagement, psychosocial functioning and building trust, along with peer support, group cohesiveness and empowerment through purpose and learning new skills. On peer support, the review describes an accepting, non-judgmental environment and links it to military "fictive kinship", which helps veterans re-engage and re-motivate each other.

Where the evidence is thin

• Geography. Twenty-one studies were US-based, two were from the UK, two from Israel, two from Australia and one from Denmark.
• Size. Many studies used small cohorts with limited statistical power and moderate effect sizes.
• Quality. The authors chose not to apply a quality-appraisal tool such as CASP.
• Measurement. Some studies relied on self-reported PTSD instead of clinical assessment, and few reported a six-month follow-up.
• Counting. The abstract says 11 studies directly address social isolation and 2 address loneliness, and the discussion says 15 of 28 address loneliness and isolation. The paper does not explain the difference.

A broader check supports the main direction. Mercier and colleagues' 2023 scoping review of peer support covered 101 publications and found positive associations with social integration in 26 of 39 publications that measured it. Study quality was not appraised in that review either, and 27 publications were pilots. Both reviews describe encouraging patterns and neither proves what works best.

How to read a review like this

Five questions help when you meet any study that claims an intervention reduces isolation, whether it concerns breakfast clubs, drumming circles or a new app.

1. Where was it run? Most of this evidence comes from the US, so UK readers should look for local replication.
2. How many people took part? Small groups produce unstable results.
3. Did anyone appraise quality? This review chose not to, which leaves the weighting of strong and weak studies to the reader.
4. What was measured? Self-reported symptoms and clinical assessment are different measures.
5. What happened after six months? Few of these studies followed participants that far.

The smaller studies still carry information. Dobalian and colleagues interviewed nine combat veterans who volunteered with Team Rubicon and reported in 2017 that positive mental health outcomes were associated with peer support in the team and with applying military skills. A sample of nine supports hypotheses and falls short of a population estimate.

What to take from it

Three practical points follow from the review.

• Activity type varies widely. The 28 studies used dogs, drums, canvases and ceremonies. No single activity dominates the findings.
• Shared features recur. The discussion highlights peer support, group cohesion, trust, purpose and learning new skills.
• Connection can be a goal in itself. The authors call for bespoke interventions that target loneliness directly.

The same review appears in our article on veteran loneliness after service, which sets out the UK and US prevalence data.

Where to find comparable activities

The table pairs review categories with real groups. Matching is approximate, since the studies tested specific programmes and the groups below run their own activities. No evaluation cited here tests any of these groups against loneliness outcomes, apart from the small Team Rubicon study noted.

The review also covered music, art and museum programmes. This article does not list a group for those categories because none was verified.