Background

The U.S. Department of Veterans Affairs has begun to shift from a disease-oriented healthcare model to one that prioritizes subjective well-being [1]. This new model, referred to as Whole Health, is defined as “an approach to care that empowers and equips a person to take charge of their health and well-being and live their life to the fullest” [1]. Accordingly, understanding subjective perceptions of health and well-being (i.e., “What matters to you?” instead of “What is the matter with you?”) is critical to health promotion [2].

Happiness, one of the core components of subjective well-being [3], has been linked to health behaviors such as physical activity and healthy eating [4], better physical and mental health outcomes [5–7], and lower mortality risk [8]. To date, while several studies examined related psychological constructs such as quality of life and social well-being among veterans [9, 10], no known study has examined levels and correlates of perceived happiness in this population, which can help inform more person-centered, preventative healthcare approaches.

In the current study, we analyzed data from the National Health and Resilience in Veterans (NHRVS), which surveyed a nationally representative sample of US veterans, to (1) examine levels of happiness; (2) identify and quantify key correlates of happiness; and (3) characterize psychosocial factors that moderate strong negative correlates of happiness.

Methods and materials

Results

The mean level of happiness in veterans was 5.41 (SD = 1.40; range = 1–7).

Table 1 summarizes sample characteristics and results of analyses. Results of a multiple linear regression revealed that happiness scores were positively associated with older age, combat veteran status, greater perceptions of the military having a positive effect on one’s life, extraversion, agreeableness, emotional stability, protective psychosocial characteristics (post-hoc analysis: purpose in life, β = 0.33, p<0.001; optimism, β = 0.11, p<0.001; resilience, β = 0.06, p<0.001; curiosity, β = 0.04, p = 0.001; gratitude, β = 0.04, p = 0.002), and social connectedness (post-hoc analysis: received social support, β = 0.08; secure attachment, β = 0.06, both p’s<0.001), and negatively associated with White, non-Hispanic race/ethnicity, college graduate or higher education, adverse childhood experiences, cumulative trauma burden, current psychological distress (post-hoc analysis: current major depressive disorder (MDD) symptoms, β = -0.16, p<0.001), and conscientiousness.

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Table 1. Sample characteristics and results of bivariate correlation and multiple regression analyses predicting happiness scores (n = 4,069).

https://doi.org/10.1371/journal.pone.0313609.t001

RIA results revealed that the majority (>75%) of explained variance in happiness scores was accounted for by higher purpose life (19.9% RVE), lower MDD symptoms (11.7%), higher optimism (10.7%), emotional stability (8.8%), resilience (8.2%), received social support (6.9%), secure attachment style (5.8%), and curiosity (5.6%; Fig 1).

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Fig 1. Results of relative importance analysis of factors associated with happiness scores in U.S. military veterans.

MDD = major depressive disorder. Error bars represent 95% confidence intervals.

https://doi.org/10.1371/journal.pone.0313609.g001

As shown in Fig 2, significant interactions were observed between MDD symptoms and optimism (F(3, 4024) = 1285.95; Fig 2A); emotional stability (F(3, 4016) = 1027.70; Fig 2B); and resilience (F(3, 4017) = 1185.87; Fig 2C), all p’s<0.001. Specifically, among veterans who screened positive for MDD, veterans with higher levels of optimism (Cohen’s d = 1.10, 95%CI = 0.80–1.41), emotional stability (d = 0.80, 95%CI = 0.49–1.12), and resilience (d = 0.51, 95%CI = 0.25–0.78) had higher happiness scores.

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Fig 2. Results of interaction analyses.

MDD = major depressive disorder. Error bars represent 95% confidence intervals. Dashed line represents mean happiness score in the full sample.

https://doi.org/10.1371/journal.pone.0313609.g002

Discussion

To our knowledge, this is the first study to examine the level and correlates of happiness in a nationally representative sample of US veterans. On average, veterans reported mean happiness scores of 5.41/7, which while lower than mean SHS scores observed in community-based US adult (mean = 5.62, t = 2.19, p = 0.03) and retired US adult (mean = 5.62, t = 3.79, p<0.001) samples [11], were small magnitude differences (both d’s = 0.17).

Purpose in life was the strongest correlate of happiness, consistent with prior work demonstrating its associations with mental health outcomes in veterans [13, 14]. Given its link to adaptive cognitive and behavioral processes (e.g., psychological flexibility; [15]), interventions to promote purpose in life [16] may help increase happiness in veterans. Such interventions also resonate with VA’s Whole Health initiative, which places an emphasis on purpose in life in enhancing well-being [1].

Among veterans who screened positive for MDD, those who were more optimistic, emotionally stable, and resilient reported higher levels of happiness, despite their scoring lower relative to veterans without MDD. These adaptive characteristics may promote happiness by facilitating adaptive coping strategies such as positive reframing [17]; fostering positive emotions and buffering stress [18]; and lowering emotional reactivity to stressors [19], even among veterans with clinically significant MDD symptoms. While interventions leveraging these factors [20–22] may help promote happiness in veterans, further research is needed to evaluate their effectiveness among veterans with MDD.

Limitations of this study include the cross-sectional design, use of a single-item measure of happiness, and reliance on self-report measures. Further studies that employ longitudinal and qualitative study designs [23, 24] and employ multi-dimensional measures of happiness [11, 25] are needed to provide a richer understanding on how participants perceive and experience happiness.

Despite these limitations, results provide preliminary insight into potential directions for Whole Health interventions designed to promote happiness and subjective well-being in veterans. Further research is needed to replicate these findings in other veteran samples; evaluate dimensions of happiness and other aspects of well-being (e.g., hedonic vs. eudemonic well-being [26]) evaluate the effectiveness of prevention and treatment efforts in targeting modifiable factors such as purpose in life in promoting happiness and overall well-being in this population.

Supporting information

Acknowledgments

The authors thank the veterans who participated in the National Health and Resilience in Veterans Study.