Warriors' Healing: Examining the Interconnectivity of Spirituality and Combat Posttraumatic Stress Disorder: A...

This scoping review examined the bidirectional impact of spirituality on active duty military service members and Veterans with combat-related Posttraumatic Stress Disorder (PTSD). The rationale for this work was to characterize how spirituality influences this population, considering moderators such as social support and resilience, as well as social determinants of health (SDoH), adverse childhood experiences, and family religious experiences in order to (1) explore the associations between spirituality and PTSD outcomes, (2) screen for spirituality and religiosity, (3) provide integrated care models that incorporate spiritual guidance, and (4) where possible, work to address modifiable factors.

Objective: To characterize the impact of spirituality on active duty military and Veterans with combat-related PTSD. Eligibility Criteria:Articles were included if they examined active duty military or Veterans diagnosed with combat-related PTSD and assessed spirituality. Sources of Evidence: A systematic search was conducted on July 23, 2024, across Academic Search Premier, APA PsycINFO, APA PsycArticles, Atla Religion, CINAHL Ultimate, Cochrane Central Register of Controlled Trials, MEDLINE, and SocINDEX. Charting Methods: Data extraction followed the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and was conducted using Covidence. A data extraction template was developed to compare study aims, population, eligibility criteria, combat exposure, PTSD and mental health diagnoses, spiritual and religious variables, and validated measures. The template also captured pre- and post-deployment factors, including spirituality before combat exposure, educational, marital status, and other demographic or social variables. Key outcomes included PTSD symptom severity, posttraumatic growth, moral injury, and resilience. Moderators such as positive social factors, SDoH, adverse childhood experiences, and service era were also recorded. Studies were grouped thematically and geographically to identify patterns across military populations and research frameworks.

A total of 59 studies met inclusion criteria, with 50 (84.7%) being cross-sectional, reflecting the predominance of observational research. Randomized controlled trials accounted for 3 (5.1%), although cohort studies were limited to 4 (6.8%). Research primarily focused on U.S. Veterans, with limited global representation from Bosnia and Herzegovina, Canada, Croatia, Iran, Mexico, and Sri Lanka. The most commonly used measures followed a framework of combat exposure, moral injury, PTSD, spirituality, and posttraumatic growth. Mixed associations between religious/spiritual (R/S) factors and mental health were observed. Positive religious coping, organizational religious activities, and religious service attendance generally predicted better mental health, whereas negative religious coping and spiritual struggles consistently predicted worse mental health. However, paradoxical findings were also observed, such that greater intrinsic religiosity and pre-military religious commitment predicted worse posttraumatic outcomes in some studies.

Spirituality was variably associated with PTSD severity but more consistently linked to moral injury, resilience, and posttraumatic growth. Given the limited number of studies and variability in findings, it is not possible to draw definite conclusions about associations between R/S and combat-related PTSD at this time. Findings highlight the need for longitudinal and interventional studies and support development of spiritually integrated, culturally informed care models to improve outcomes for diverse military and Veteran populations.