Combat and Trajectories of Physical Health Functioning in U.S. Service Members

Abstract

Introduction: Previous research has demonstrated that different forms of mental health trajectories can be observed in service members, and that these trajectories are related to combat. However, limited research has examined this phenomenon in relation to physical health. This study aims to determine how combat exposure relates to trajectories of physical health functioning in U.S. service members.Methods: This study included 11,950 Millennium Cohort Study participants who had an index deployment between 2001 and 2005. Self-reported physical health functioning was obtained 5 times between 2001 and 2016 (analyzed in 2017), and latent growth mixture modeling was used to identify longitudinal trajectories from these assessments. Differences in the shape and prevalence of physical health functioning trajectories were investigated in relation to participants' self-reported combat exposure over the index deployment.Results: Five physical health functioning trajectories were identified (high-stable, delayed-declining, worsening, improving-worsening, and low-stable). Combat exposure did not influence the shape of trajectories (p=0.12) but did influence trajectory membership. Relative to personnel not exposed to combat, participants reporting combat exposure were more likely to be in the delayeddeclining, worsening, and low-stable classes and less likely to be in the high-stable class. However, the high-stable class (i.e., the most optimal class) was the most common trajectory class among not exposed (73.0%) and combat-exposed (64.5%) personnel.Conclusions: Combat exposure during military deployment is associated with poorer physical health functioning trajectories spanning more than a decade of follow-up. However, even when exposed to combat, consistently high physical health functioning is the modal response.

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“…The effects of stress on long-term physical and mental health can take many years to become manifest. Military combat deployment [ 23 , 24 ] and elevated symptoms of posttraumatic stress disorder (PTSD) in civilians have been associated with increased risk of hypertension, myocardial infarction, and stroke [ 25 , 26 ]. Longitudinal trends show that the likelihood of developing multiple physical symptoms over time is higher for those who were deployed in combat than those without combat experience [ 27 ].…”

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“…Furthermore, the disproportionate rate of psychiatric disorders and presence of GWI among Gulf War veterans has also been linked to combat exposure. Specifically, combat exposure has been associated with both PTSD and MDD (Kimbrel et al., 2015; King et al., 2006; Luxton et al., 2010; Toomey et al., 2007) and has been shown to contribute to symptoms of GWI (Porter et al., 2019; Sheffler et al., 2016; R. F. White et al., 2016). Consequently, combat exposure, NBCs, GWI, and PTSD are important considerations regarding the mental and physical well‐being of Gulf War veterans.…”

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“…The veteran health and mortality advantage that is present in early-to midlife, however, does not appear to be as strong, or present at all, among those who served longer, were exposed to combat or environmental hazards, acquired a service-connected disability, or served during a particular war era (Landes et al, 2017(Landes et al, , 2018(Landes et al, , 2019Porter et al, 2019;Sheehan et al, 2015;Taylor et al, 2015;Wilmoth et al, 2010Wilmoth et al, , 2018. In addition, the early life health advantage some veterans experience does not appear to persist into later life (e.g., Wilmoth et al, 2010).…”

“…However, the link between combat exposure and later‐life health was largely due to concomitant traumatic experiences, such as exposure to dead combatants (Taylor et al., 2016). Finally, among individuals deployed between 2001 and 2006, those who saw combat had worsening trajectories of health over a 15‐year period than those who did not (Porter et al., 2019).…”