Revisiting Living in Limbo to Illustrate a Pastoral Psychological Understanding of Transition from Military to Civilian Life
The transition from military to civilian life includes a multitude of challenges for service members and their significant others. This transfer from one context to another can include, but is not limited to, a need for an identity shift, cultivation of an alternate mind-set, social reorientation, a search for employment, grief and sadness due to the loss of camaraderie, and/or experiences of alienation and estrangement from civilian society. Although the social sciences dominate this research field and dub it ‘transition,’ the ambiguity of the process can be further advanced through pastoral psychology. This article rethinks and reinterprets qualitative data to develop a pastoral psychological understanding of veterans through Capps and Carlin’s lens of living in limbo. This pastoral psychological construct embraces the ambiguity of the transition to civilian life and addresses it as a potentially complex and acute limbo situation. This construct can resonate with both veterans and significant others while also assisting pastors in providing care and counseling.
Abstract: Novel and automated means of opioid use and relapse risk detection are needed. Unstructured electronic medical record data, including written progress notes, can be mined for clinically relevant information, including the presence of substance use and relapse-critical markers of risk and recovery from opioid use disorder (OUD). In this study, we used natural language processing (NLP) to automate the extraction of opioid relapses, and the timing of these occurrences, from veteran patients' electronic medical record. We then demonstrated the utility of our NLP tool via analysis of pre-/post-COVID-19 opioid relapse trends among veterans with OUD. For this demonstration, we analyzed data from 107,606 veterans OUD enrolled in Veterans Health Administration, comparing a pandemic-exposed cohort (n = 53,803; January 2019-March 2021) to a matched prepandemic cohort (n = 53,803; October 2017-December 2019). The recall of our NLP tool was 75% and our precision was 94%, demonstrating moderate sensitivity and excellent specificity. Using the NLP tool, we found that the odds of opioid relapse postpandemic onset were proportionally higher compared to prepandemic trends, despite patients having fewer mental health encounters from which to derive instances of relapse postpandemic onset. In this research application of the tool, and as hypothesized, we found that opioid relapse risk was elevated postpandemic. The application of NLP Methods: to identify and monitor relapse risk holds promise for future surveillance, risk prevention, and clinical outcome research.