Methods of Repeated Monitoring of Stress and Stress-Related Mental Health Outcomes in Military Personnel and Veterans: A Systematic Review.

Abstract

Military personnel and veterans are exposed to high levels of stress throughout their military careers and following separation and are susceptible to stress-related psychopathology. The objective of this systematic review is to evaluate research on the repeated monitoring of stress and stress-related mental health outcomes in these populations (PROSPERO ID#CRD42024587783; Funding: US Department of Veterans Affairs). Systematic searches of three databases (APA PsycInfo, PubMed, PTSDPubs) were conducted from inception until September 30, 2025. Inclusion criteria were military or veteran samples, self-report or clinician-rated stress, depression, anxiety, trauma-related distress, or mood measures, repeated monitoring within a 4-week timeframe, and original peer reviewed research. Each study was assessed for risk of bias with an empirically supported critical appraisal checklist. Data were synthesised by three authors (A.M., E.H., and N.M.M.). Of the 61 included studies, most were in majority male (94.9%), White (82.6%), and veteran-only (67.2%) samples. Traditional self-report measures were the most used assessment type (32.7%), followed by ecological momentary assessment (26.2%). Most studies monitored posttraumatic stress disorder (PTSD) (52.5%) and depressive (44.3%) symptoms, with fewer studies measuring stress (31.1%) and anxiety (11.5%). Approximately a quarter (26.2%) measured stress and stress-related mental health outcomes concurrently. Most studies measuring mood were completed in samples with a primary focus on PTSD (63.2%). Although repeated assessment in military and veteran populations provides important insight into changes in stress and stress-related outcomes, studies together were limited by inconsistencies in methodology. We highlight potential contributions in methodology to capture risk and resilience and improve outcomes for these populations. TRIAL REGISTRATION: This systematic review was pre-registered: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024587783.