{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T11:10:55Z","timestamp":1781089855733,"version":"3.54.1"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Rehabil. Sci."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Longitudinal research examining community reintegration among military veterans with invisible injuries remains limited, despite widespread recognition that post-separation adjustment encompasses multiple interconnected domains including mental health, physical health, social functioning, and overall well-being. This study investigated associations between changes in reintegration outcomes and changes in health-related quality of life, social support, and flourishing over a two-year period among U.S. military veterans with invisible injuries who separated from service within the previous five years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Seventy-five veterans diagnosed with invisible injuries (post-traumatic stress disorder, anxiety, depression, traumatic brain injury, or adjustment disorder) completed assessments at baseline, 6, 12, 18, and 24 months. Reintegration was measured using the Military to Civilian Questionnaire (M2C-Q) and Community Reintegration of Injured Service Members computer-adaptive test (CRIS-CAT). Health and well-being outcomes included the Veterans RAND Health Survey (VR-12), Patient Health Questionnaire-15 (PHQ-15), Multidimensional Scale of Perceived Social Support (MSPSS), and Secure Flourishing Index (SFI). Mixed-effects models examined associations between changes in reintegration measures and psychosocial outcomes while controlling for demographic characteristics and PTSD symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      M2C-Q scores remained stable across waves (F(4,236)\u2009=\u20091.73,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.14), while CRIS-CAT Participation scores improved significantly (F(4,238)\u2009=\u200910.10,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u2009.001). Improvements in community participation (CRIS-CAT) were positively associated with subsequent secure flourishing and physical health quality of life. Reductions in reintegration difficulties (M2C-Q) positively influenced social support, secure flourishing, somatic symptoms, and mental health quality of life. Social support and secure flourishing increased significantly between 6 and 24 months, while physical and psychological symptoms remained relatively stable throughout the study period.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Findings demonstrate that improvements in community participation and reductions in reintegration difficulties precede positive changes in psychosocial outcomes and physical symptoms. The relative stability of reintegration challenges alongside improvements in community participation suggests these constructs may represent distinct aspects of veteran adjustment. Results suggest the potential for interventions targeting community engagement and social connection during the critical transition period, emphasizing holistic approaches that address both functional participation and subjective reintegration experiences to enhance long-term veteran well-being.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fresc.2026.1720234","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T10:54:20Z","timestamp":1781088860000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Flourishing, social participation and reintegration difficulties: a 2-year cohort study of US military veterans with invisible injuries"],"prefix":"10.3389","volume":"7","author":[{"given":"Nicholas A.","family":"Rattray","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Geriatrics, Indiana University School of Medicine","place":["Indianapolis, IN, United States"]},{"name":"VA HSR Center for Health Information and Communication, Roudebush VAMC","place":["Indianapolis, IN, United States"]},{"name":"Center for Health Services Research, Regenstrief Institute","place":["Indianapolis, IN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mindy","family":"Flanagan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Geriatrics, Indiana University School of Medicine","place":["Indianapolis, IN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M.","family":"Frankel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Geriatrics, Indiana University School of Medicine","place":["Indianapolis, IN, United States"]},{"name":"VA HSR Center for Health Information and Communication, Roudebush VAMC","place":["Indianapolis, IN, United States"]},{"name":"Center for Health Services Research, Regenstrief 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