The Experience of Social Alienation in Patients with Chronic Cancer-Related Pain: A Qualitative Study.

Intimate partner violence (IPV) is a serious public health problem yielding significant long-term health effects and costs to individuals, families, and society. Defined as threatened or actual physical, sexual, or psychological abuse from a current or former partner, IPV has been linked to a range of physical and mental health challenges including depression, anxiety, posttraumatic stress disorder (), traumatic brain injury, poorer physical health (), suicide, and homicide (). High rates of IPV have been documented among military and veteran populations, with past-year rates (pooled across sex) of IPV use (i.e., perpetration; 43.9% in ) and IPV experience (i.e., victimization; 43.0% in ) nearly eight times larger than those documented in the general U.S. public (IPV use: 6% []; IPV experience: 5% []). Furthermore, particularly high rates (; ; ) and frequencies () of IPV have been documented among veterans relative to currently serving military personnel. Researchers and theorists posit the period surrounding separation from military service (i.e., the military-to-civilian transition) is a vulnerable period characterized by a range of stressors, including financial strain, low social support, housing instability, and underemployment (; ). These transition-related stressors have been theorized to increase the risk of poor outcomes among veterans who have recently separated from military service (), although that premise has not been investigated empirically. Such research is challenging to conduct because it can be difficult to engage a representative sample of those who are currently serving and veterans using a common study design. The present study leverages existing data from the Millennium Cohort Family Study, a large, population-based cohort of service members and their spouses followed both during and after military service. Informed by military transition theory (), the present study aimed to examine associations between transition-related stressors and IPV to evaluate whether stressors theoretically related to the military-to-civilian transition account for observed differences in IPV prevalence between currently serving and veteran couples. Military transition theory () offers a framework for understanding the challenges experienced by service members upon separation from military service. According to this theory, the process of separating from military service involves a period of adjustment when service members acclimate to a less structured civilian culture, accompanied with changes in relationships, work contexts, and identities. During this transition, veterans lose access to many military benefits, such as full-time employment, housing, medical care, and other military support services (; ). Employment difficulties (e.g., unemployment) and subsequent financial difficulties, housing instability (), and loss of social support () have been theorized to pose risks during this transition period (). Relatively few efforts have been made to examine transition-related stressors and their associations with veterans’ outcomes. found that Army veterans were more likely than currently serving soldiers to experience disruptions in close interpersonal relationships, employment, and financial stability, all of which were positively associated with suicide attempt behaviors. In an expansion of military transition theory, Markowitz and colleagues (2021) found that unmet needs—unemployment, housing instability, financial instability, and barriers to educational and health care benefits—were positively associated with risky health behaviors (i.e., aggression, substance use, reckless driving) among veterans who recently separated from military service. Although many of these stressors have been linked to IPV in the general U.S. population (; , ; ), they have yet to be thoroughly examined among service members and veterans in the context of transition-related stress.