Psychological Resilience in US Military Veterans: Results from the 2019-2020 National Health and Resilience in Veterans Study

Following exposure to traumatic life events, most individuals are psychologically resilient, and experience minimal-to-no symptoms of posttraumatic stress, major depressive, or generalized anxiety disorders. To date, however, most research has focused on factors associated with adverse post-trauma mental health outcomes rather than understanding those associated with psychological resilience. In particular, little is known about factors associated with psychological resilience in veterans, despite their high rates of trauma exposure, such as combat and military sexual trauma. To address this gap, we used a discrepancy-based psychiatric resilience (DBPR) analytic approach to operationalize psychological resilience, and to identify modifiable health and psychosocial factors associated with resilience in a nationally representative sample of U.S. veterans (N = 4,069). DBPR scores were computed by regressing a composite measure of distress (posttraumatic stress, major depressive, and generalized anxiety disorder symptoms) onto measures of adverse childhood experiences, combat exposure, military sexual trauma, and cumulative potentially traumatic events (e.g., natural disaster, life-threatening illness/injury). Psychological resilience was operationalized as lower actual, relative to predicted, composite distress scores. Results revealed that greater emotional stability (22.9% relative variance explained [RVE]) and mindfulness (13.4% RVE), lower likelihood of lifetime histories of MDD or PTSD (12.8% RVE), greater purpose in life (11.9% RVE), and lower severity of somatic symptoms (10.8% RVE) explained the majority of the variance in resilience scores (total R-2 = 0.40). Taken together, results of this study illustrate the utility of a DBPR score approach to operationalizing psychological resilience to traumatic stress in U.S. veterans, and identify several modifiable health and psychosocial factors that can be targeted in prevention and treatment efforts designed to bolster resilience in this population.