Staff Perspective: Social Isolation in Veterans - A Deadly Oxymoron
“There is a difference between solitude and isolation. One is connected and one isn’t. Solitude replenishes, while isolation diminishes.”-Henry Cloud
Every year over 200,000 veterans separate from military service leaving them with a significant number of decreased social supports, leading many to experience social isolation. Social isolation defined, is a pervasive absence of intimate contact with, and support from others; but felt, is a sensation that is hard to shake. For many of us, we lived it day in and day out during the COVID-19 pandemic, feeling more like a repeat of the 2020 film “Two Distant Strangers” produced by Van Lathan, Jesse Williams, and Sean Combs (to name a few), than our introduction to the new decade. While we were fortunate to have returned to a routine of somewhat normalcy or at least a new normal, many veterans experiencing social isolation continue to grapple with its detrimental impacts.
Social isolation destroys you slowly, from the inside out, which is why researchers have termed it as “a silent killer” and with over 43% of veterans reporting feeling socially isolated on almost a daily basis, there is room to sound the alarm. Social isolation comes in many forms including decreased amounts of social support systems, racism (whether observed, experienced, or systemic), discrimination, including (agism/sexism/gender bias), governmental policies, perceived feelings of inferiority and judgement, inability to find meaning in new roles, technological divides, and self-isolation. Social exclusion, the process through which individuals or groups are wholly or partially excluded from full participation in the society they live, is a sub-component of social isolation, and it impacts marginalized communities of color at profound rates. There is a strong linkage between social isolation, depression, and suicide.
Veterans who suffer from social isolation are at an increased risk for suicide (21%), heart disease (29%), stroke (32%), emergency room visits (57%), and increased risk for hospitalization (68%) over their civilian counterparts. The Center for Disease Control and Prevention estimated a $219 billion-dollar price tag for heart disease alone in (2015). Additionally, veterans aged 50 and older, and those separated from the military for less than a year, comprised a higher mortality rate.
As practitioners, it is important to not only understand the diagnosis, but the root causes and like medicine, you wouldn’t treat a cold in the same manner you would treat a respiratory infection. While veterans experiencing social isolation may have similar symptoms of different mental health diagnosis, the human connection is what ultimately guides us in distinguishing the differences.
According to the psychological sense of community theory by McMillan & Chavis; membership, influence, integration, fulfillment of needs, and shared emotional connections are vital to an individual’s sense of belonging. In laymen’s terms, most veterans suffering from social isolation want to feel included and understood, valued, receive some type of personal investment, and a be provided with a sense of emotional safety.
From a research lens, the CDC also advocates for the adoption of culture into public health systems and improved cultural competence among health care professionals to assist in the reduction in health disparities and overall general health.
Here are a few ways that providers can contribute, even with limited time:
- Recognize the patient as the expert on their life
- If you need to have multiple staff in the room, Request permission prior to the staff entering (so patients don’t feel ambushed or coerced into saying yes)
- Ask the patient how they would like to be addressed and remember or make a note for the next visit (Pronouns She/Her, Him/His, Them/They)
- Inquire about basic needs and provide referrals if necessary (social worker/community partners/financial)
- Communicate with the patient about the impact of the current political/cultural climate on mental and physical well-being
- Acknowledge any gaps related to culture (military/children/culture/gender/race/etc.)
- Normalize feelings of isolation and ask about any connection to their tribe/community (social supports)
- Offer additional options in conjunction with medication (ex. high blood pressure/medicine AND exercise/Depression-therapy AND connections to community and/or veteran organizations)
- Always thank the patient for being courageous enough share private & vulnerable info with a stranger
Social Isolation doesn’t have to be a Deadly Oxymoron, but there is much work to be done.
“United we are rock, divided we are sand”-African Proverb
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Katrice Byrd, DSW, LCSW is a Military Social Worker with the Center for Deployment Psychology (CDP). She is co-chair of the North Carolina National Association of Social Worker’s Legislative Committee and is passionate about serving the village through research, policy, and programmatic changes.
References:
African Proverbs Page (2020, November 11.). African Proverb: United we are rock. Divided we are sand Facebook. https://www.facebook.com/africanproverbspage/posts/4624084070998347.
Byrd, K.L. (2019). Grand challenges selection paper: Eradicating social isolation of veterans. Unpublished manuscript, University of Southern California.
Centers for Disease Control and Prevention. (2017, April 25). Practical strategies for culturally competent evaluation. Atlanta, Georgia.https://www.cdc.gov/dhdsp/docs/cultural_competence_guide.pdf.
France, D. (2019, January 10). Isolation, solitude & veteran mental health. http://veteranmentalhealth.com/isolation.
Healthy Places by Design. (2021). Socially connected communities: Solutions for social isolation. https://healthyplacesbydesign.org/wp-content/uploads/2021/03/Socially-Connected-Communities_Solutions-for-Social-Isolation.pdf.
Hornbostel, M., Fales, A., Borger, C., Genoversa-Wong, K., Orji, C., Hintze, W., Noftsinger, R., Cecere, W., Herbison, R., & Chung, J. (2019). 2019 Wounded Warrior Annual Warrior Survey: Report of Findings. https://www.woundedwarriorproject.org/media/gyvp3ns1/2019-annual-warrior-survey.pdf.
Howard, S., Shirin, S., & Snell, C.L. (2020). Social isolation among young Black Women: Implications for social work. Social Work Education, 39(7), 957-970. https://doi.org/10.1080/02615479.2020.1767565.
McMillan, D.W., & Chavis, D.M. (1986). Sense of community: A definition and theory. American Journal of Community Psychology, 14(1), 6-23. https://www.researchgate.net/publication/235356904_Sense_of_Community_A_Definition_and_Theory/link/59e65cc6aca2721fc227a799/download.
Minimalist quotes. (2021). Minimalist quotes. https://minimalistquotes.com/henry-cloud-quote-231479/.
Olson, M.D. (2020). The influence of social exclusion on posttraumatic stress reactions in older adult veterans. Social Work, 65(2),123–130. https://doi.org/10.1093/sw/swaa008.
Russell, K., Hunter, C. & Shrank, W.H. (2020, February 4). The social determinants of suicide in the military. Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/hblog20200130.419838/full/.
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (2020). Healthy people 2030: Social Determinants of Health. https://health.gov/healthypeople/objectives-and-data/social-determinants-health.
U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. (2020, September 8). Heart disease statistics and maps. https://www.cdc.gov/heartdisease/facts.htm.
United States Department of Veterans Affairs. (2016). Office of Public and Intergovernmental affairs: VA releases report on nation’s largest analysis of veteran suicide. https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2807.
“There is a difference between solitude and isolation. One is connected and one isn’t. Solitude replenishes, while isolation diminishes.”-Henry Cloud
Every year over 200,000 veterans separate from military service leaving them with a significant number of decreased social supports, leading many to experience social isolation. Social isolation defined, is a pervasive absence of intimate contact with, and support from others; but felt, is a sensation that is hard to shake. For many of us, we lived it day in and day out during the COVID-19 pandemic, feeling more like a repeat of the 2020 film “Two Distant Strangers” produced by Van Lathan, Jesse Williams, and Sean Combs (to name a few), than our introduction to the new decade. While we were fortunate to have returned to a routine of somewhat normalcy or at least a new normal, many veterans experiencing social isolation continue to grapple with its detrimental impacts.
Social isolation destroys you slowly, from the inside out, which is why researchers have termed it as “a silent killer” and with over 43% of veterans reporting feeling socially isolated on almost a daily basis, there is room to sound the alarm. Social isolation comes in many forms including decreased amounts of social support systems, racism (whether observed, experienced, or systemic), discrimination, including (agism/sexism/gender bias), governmental policies, perceived feelings of inferiority and judgement, inability to find meaning in new roles, technological divides, and self-isolation. Social exclusion, the process through which individuals or groups are wholly or partially excluded from full participation in the society they live, is a sub-component of social isolation, and it impacts marginalized communities of color at profound rates. There is a strong linkage between social isolation, depression, and suicide.
Veterans who suffer from social isolation are at an increased risk for suicide (21%), heart disease (29%), stroke (32%), emergency room visits (57%), and increased risk for hospitalization (68%) over their civilian counterparts. The Center for Disease Control and Prevention estimated a $219 billion-dollar price tag for heart disease alone in (2015). Additionally, veterans aged 50 and older, and those separated from the military for less than a year, comprised a higher mortality rate.
As practitioners, it is important to not only understand the diagnosis, but the root causes and like medicine, you wouldn’t treat a cold in the same manner you would treat a respiratory infection. While veterans experiencing social isolation may have similar symptoms of different mental health diagnosis, the human connection is what ultimately guides us in distinguishing the differences.
According to the psychological sense of community theory by McMillan & Chavis; membership, influence, integration, fulfillment of needs, and shared emotional connections are vital to an individual’s sense of belonging. In laymen’s terms, most veterans suffering from social isolation want to feel included and understood, valued, receive some type of personal investment, and a be provided with a sense of emotional safety.
From a research lens, the CDC also advocates for the adoption of culture into public health systems and improved cultural competence among health care professionals to assist in the reduction in health disparities and overall general health.
Here are a few ways that providers can contribute, even with limited time:
- Recognize the patient as the expert on their life
- If you need to have multiple staff in the room, Request permission prior to the staff entering (so patients don’t feel ambushed or coerced into saying yes)
- Ask the patient how they would like to be addressed and remember or make a note for the next visit (Pronouns She/Her, Him/His, Them/They)
- Inquire about basic needs and provide referrals if necessary (social worker/community partners/financial)
- Communicate with the patient about the impact of the current political/cultural climate on mental and physical well-being
- Acknowledge any gaps related to culture (military/children/culture/gender/race/etc.)
- Normalize feelings of isolation and ask about any connection to their tribe/community (social supports)
- Offer additional options in conjunction with medication (ex. high blood pressure/medicine AND exercise/Depression-therapy AND connections to community and/or veteran organizations)
- Always thank the patient for being courageous enough share private & vulnerable info with a stranger
Social Isolation doesn’t have to be a Deadly Oxymoron, but there is much work to be done.
“United we are rock, divided we are sand”-African Proverb
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Katrice Byrd, DSW, LCSW is a Military Social Worker with the Center for Deployment Psychology (CDP). She is co-chair of the North Carolina National Association of Social Worker’s Legislative Committee and is passionate about serving the village through research, policy, and programmatic changes.
References:
African Proverbs Page (2020, November 11.). African Proverb: United we are rock. Divided we are sand Facebook. https://www.facebook.com/africanproverbspage/posts/4624084070998347.
Byrd, K.L. (2019). Grand challenges selection paper: Eradicating social isolation of veterans. Unpublished manuscript, University of Southern California.
Centers for Disease Control and Prevention. (2017, April 25). Practical strategies for culturally competent evaluation. Atlanta, Georgia.https://www.cdc.gov/dhdsp/docs/cultural_competence_guide.pdf.
France, D. (2019, January 10). Isolation, solitude & veteran mental health. http://veteranmentalhealth.com/isolation.
Healthy Places by Design. (2021). Socially connected communities: Solutions for social isolation. https://healthyplacesbydesign.org/wp-content/uploads/2021/03/Socially-Connected-Communities_Solutions-for-Social-Isolation.pdf.
Hornbostel, M., Fales, A., Borger, C., Genoversa-Wong, K., Orji, C., Hintze, W., Noftsinger, R., Cecere, W., Herbison, R., & Chung, J. (2019). 2019 Wounded Warrior Annual Warrior Survey: Report of Findings. https://www.woundedwarriorproject.org/media/gyvp3ns1/2019-annual-warrior-survey.pdf.
Howard, S., Shirin, S., & Snell, C.L. (2020). Social isolation among young Black Women: Implications for social work. Social Work Education, 39(7), 957-970. https://doi.org/10.1080/02615479.2020.1767565.
McMillan, D.W., & Chavis, D.M. (1986). Sense of community: A definition and theory. American Journal of Community Psychology, 14(1), 6-23. https://www.researchgate.net/publication/235356904_Sense_of_Community_A_Definition_and_Theory/link/59e65cc6aca2721fc227a799/download.
Minimalist quotes. (2021). Minimalist quotes. https://minimalistquotes.com/henry-cloud-quote-231479/.
Olson, M.D. (2020). The influence of social exclusion on posttraumatic stress reactions in older adult veterans. Social Work, 65(2),123–130. https://doi.org/10.1093/sw/swaa008.
Russell, K., Hunter, C. & Shrank, W.H. (2020, February 4). The social determinants of suicide in the military. Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/hblog20200130.419838/full/.
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (2020). Healthy people 2030: Social Determinants of Health. https://health.gov/healthypeople/objectives-and-data/social-determinants-health.
U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. (2020, September 8). Heart disease statistics and maps. https://www.cdc.gov/heartdisease/facts.htm.
United States Department of Veterans Affairs. (2016). Office of Public and Intergovernmental affairs: VA releases report on nation’s largest analysis of veteran suicide. https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2807.