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Cited by 96Posttraumatic Stress Disorder ResearchTraumatic Brain Injury ResearchEducation and Military Integration

Self-reported PTSD symptoms and social support in U.S. military service members and veterans: a meta-analysis

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Blais, Rebecca K., Tirone, Vanessa, Orlowska, Daria, Lofgreen, Ashton, Klassen, Brian, Held, Philip, Stevens, Natalie, Zalta, Alyson K.·2021·European Journal of Psychotraumatology
DOI 10.1080/20008198.2020.1851078PMC PMC8725779
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Abstract

Background: The mental health burden of posttraumatic stress disorder (PTSD) is high in U.S. military samples. Social support is one of the most robust protective factors against PTSD and a recent meta-analysis indicates that this relationship is even stronger in military samples compared to civilian samples. Yet no meta-analyses have explored factors impacting this association in veterans and military service members (VSMs).Objective: The current meta-analysis examined demographic, social support, and military characteristics that may moderate the relationship of PTSD severity and social support among U.S. VSMs.Method: A search identified 37 cross-sectional studies, representing 38 unique samples with a total of 18,766 individuals.Results: The overall random effects estimate was −.33 (95% CI: −.38, −.27, Z = −10.19, p <.001), indicating that lower levels of social support were associated with more severe PTSD symptoms. PTSD measures based on the Diagnostic and Statistical Manual (DSM)-III had a larger effect size than measures based on DSM-IV or DSM-5. The social support source was a significant moderator such that support perceived from non-military sources was associated with a larger effect size than support perceived from military sources. This finding held after accounting for covariates. Deployment-era, timing of social support, and age were also significant moderators, but were no longer significantly associated with effect size after adjusting for covariates. Although previous meta-analyses have shown social negativity to be more impactful than positive forms of social support, there were too few studies conducted to evaluate social negativity in moderator analyses.Conclusion: Results suggest that social support received from civilians and in the home environment may play a greater protective role than social support received from military sources on long-term PTSD symptom severity. The literature on social support and PTSD in U.S. VSMs would be strengthened by studies examining the association of social negativity and PTSD symptoms.

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  • Harmful effects of negative social reactions on psychopathology, including PTSD symptoms, are more impactful than the salubrious effects of positive forms of social support.

    “Several meta-analyses have shown that harmful effects of negative social reactions (e.g. blame, treating the person differently, social constraint, making demands) on psychopathology, including PTSD symptoms, are more impactful than the salubrious effects of positive forms of social support (Blais et al., 2021; Dworkin et al., 2019; Zalta et al., 2021).”

    From The association between social support and posttraumatic stress symptoms among survivors of betrayal trauma: a meta-analysis (2021) · cites this paper as Blais et al., 2021

    The Abstract reports that previous meta-analyses found social negativity more impactful than positive support, and the Discussion says this paper's single negative-support study had its largest effect size. But the Results state that only one study measured social negativity, so this meta-analysis could not test that comparison. Its evidence concerns associations with PTSD symptoms, not causal effects on psychopathology more broadly. (LLM, conf=0.87)

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Authors
Blais, R. K., Tirone, V., Orlowska, D., Lofgreen, A., Klassen, B., Held, P., Stevens, N., & Zalta, A. K.
Affiliations
  • Utah State University (US)
  • Rush University Medical Center (US)
  • Western Michigan University (US)
  • University of California, Irvine (US)
Corresponding author
Blais, Rebecca K.
ORCID
Venue
European Journal of Psychotraumatology
Publisher
Informa UK Limited
Published
2021-01
Volume
12
Issue
1
Pages
1851078-1851078
ISSN
2000-8066 (ISSN-L)
DOI
10.1080/20008198.2020.1851078
PMC
PMC8725779
OpenAlex
W3127101632
Cited by
96
References
9
Citations by year
2026: 17 · 2025: 21 · 2024: 21 · 2023: 22 · 2022: 10 · 2021: 4 · 2020: 1
FWCI
1.89
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Psychotraumatology (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Digital Commons - USU (Utah State University) (submittedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
Funders
  • National Center for Advancing Translational Sciences of the National Institutes of Health (5KL2TR002387-03)
  • Wounded Warrior Project, and the Boeing Company
  • National Institute of Mental Health (K23 MH103394)
  • NIH (K23 MH103394, 5KL2TR002387-03)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Social Sciences › Education › Education and Military Integration
Keywords
post-traumatic stress disorder, posttraumatic stress symptoms, social support, military personnel, veterans, protective factors, sources of social support, civilian support, PTSD symptom severity, deployment
MeSH terms
Humans, Military Personnel, Social Support, Stress Disorders, Post-Traumatic, United States, Veterans, Self Report

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