Impact of combat exposure on mental health trajectories in later
                        life: Longitudinal findings from the VA Normative Aging Study.

Lee, Hyunyup; Choun, Soyoung; Spiro, Avron

doi:10.1037/pag0000334

Cited by 13 publications

(14 citation statements)

References 54 publications

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“…The ubiquity of these tales across time and place suggests that people are captivated by the issue of war’s impact on the soldiers who fight them and the communities to which they return. 1 This is no less true of scholars who have examined in great quantity and depth everything from the effects of combat experience on violence, domestic abuse, and criminal behavior (recent examples include Anderson & Rees, 2015; Cesur & Sabia, 2016; Gartner & Kennedy, 2018; MacManus et al, 2015; Teachman & Tedrow, 2016) to the physical and mental health effects of wartime service (recent examples include Griffith, 2019; Godfrey et al, 2015; Lee et al, 2019; Nassif et al, 2019) to how combat might impact the political attitudes and behavior of veterans (Blattman, 2009; Grossman et al, 2015; Horowitz & Stam, 2014; Teigen, 2006). Given the demanding tempo of military operations since 9/11—with the United States alone having deployed roughly 3 million troops over the last 20 years (Wenger et al, 2018)—it is particularly important to understand how war impacts veterans and how they, in turn, affect our society.…”

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confidence: 99%

Military Service, Combat Experience, and Civic Participation

Wilson

Ruger²

2020

Armed Forces & Society

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Military service is a highly social—and potentially socializing—experience. However, the long-term social effect of military service is a little-studied topic, and some have dismissed any direct impact of service on civic participation. Using data from a large, national survey, our estimates show, in contrast, that the likelihood and intensity of group participation is higher among veterans than other men and that combat veterans have the highest level of participation. Mettler argued that education funded through the GI Bill gave veterans both resources (“civic capacity”) and a desire to reciprocate to society (“civic predisposition”) for the generous benefits they received, but she did not allow for the possibility that service itself could also increase both civic capacity and predisposition. Furthermore, our estimates confirm that education is strongly associated with higher civic participation and that the association between military service and participation is largely independent of education.

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confidence: 99%

Military Service, Combat Experience, and Civic Participation

Wilson

Ruger²

2020

Armed Forces & Society

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“…Life course perspectives inform social and health outcomes among those who experienced childhood stress and disruption (Haas 2008;Hayward and Gorman 2004) and those who survived societal conflicts and crises such as World War II and the Great Depression (Elder 1985(Elder , 1994. Numerous scholars have shown that wartime and military service are critical "hidden" variables in the life course, underappreciated for their profound effects on health and aging in the lives of men (Lee et al 2019;Settersten 2006;Spiro, Schnurr, and Aldwin 1994;Ureña, Taylor, and Kail 2018;Wilmoth and London 2016). Many of these studies reveal the long-term physical, psychological, and social damage experienced by veterans attributable to combat participation, exposure to death, or other physical and psychological harms.…”

Section: Background War In the Life Course Cumulative Stressors And Health In Late Adulthoodmentioning

confidence: 99%

“…

The cohorts of men born in the early twentieth century encountered pronounced combat stressors in World Wars I and II, the Korean War, and the American War in Vietnam. 1 For many, the gravity of these stressors reaches "with a long arm" into older adulthood, contributing to posttraumatic stress disorder (PTSD), depression, and other forms of psychological distress for decades postconflict (Elder and Clipp 1989;Lee et al 2019). Although classic studies on war and health in the life course concentrate on American soldiers' experiences, armed conflict's enduring influence is global and is arguably most pronounced in developing, postconflict societies where wars of the twentieth and twenty-first centuries have been disproportionately waged (Jawad et al 2019).Military veterans' elevated risk of suicide, especially among American service members deployed to Iraq and Afghanistan, has garnered widespread scholarly and public attention (Bryan et al 2015;Giacomo 2019).

…”

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confidence: 99%

The Impact of Early Life War Exposure on Mental Health among Older Adults in Northern and Central Vietnam

et al. 2021

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Most Vietnamese young adults who experienced the American War were exposed to war-related violence, which can exert a lifelong impact. We analyze survey data collected among northern and central Vietnamese older adults in the 2018 Vietnam Health and Aging Study (N = 2,447) to examine the association between various war traumas, psychological distress, and suicidal ideation. Informed by life course and stress process perspectives, we use structural equation models with multiple mediators to analyze the relationship between mental health outcomes and five types of wartime stress exposure: loss of family and friends, witnessing death, malevolent living conditions, life threat, and moral injury. Our findings reveal enduring mental health impacts of war among survivors. Wartime stress exposure’s influence on mental health is mediated by recent comorbidities and stressful life events. Loss of family members, witnessing death, and malevolent living conditions during war are particularly salient risks for psychological distress.

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“… 8 - 13 Veterans in particular tend to have higher rates of depression anxiety and chronic pain due to combat experiences. 15 , 16 While current US guidelines recommend screening and treatment for depression, unhealthy alcohol, drug and tobacco use, guidelines do not include independent recommendations to screen for anxiety, pain, or other substance use. 17 , 18 Screening for all conditions that cluster with depression is unlikely to be feasible given provider-level as well as system-level time and resource constraints, 19 especially since an estimated 50% of adults with major depression still remain undiagnosed 20 despite the US Preventive Service Task Force (USPSTF) recommendation for depression in primary care.…”

Section: Introductionmentioning

confidence: 99%

Insights Provided by Depression Screening Regarding Pain, Anxiety, and Substance use in a Veteran Population

Stevens

Mazumdar

Khan

et al. 2020

J Prim Care Community Health

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Objective: We sought to quantify the extent to which a depression screening instrument commonly used in primary care settings provides additional information regarding pain interference symptoms, anxiety, and substance use. Methods: Veterans Aging Cohort Study (VACS) data collected from 2003 through 2015 was used to calculate odds ratios (OR) for associations between positive depression screening result cutoffs and clustering conditions. We assessed the test performance characteristics (likelihood ratio value, positive predictive value, and the percentage of individuals correctly classified) of a positive Patient Health Questionnaire (PHQ-9 & PHQ-2) depression screen for the identification of pain interference symptoms, anxiety, and substance use. Results: A total 7731 participants were included in the analyses. The median age was 50 years. The PHQ-9 threshold of ≥20 was strongly associated with pain interference symptoms (OR 21.6, 95% CI 17.5-26.7) and anxiety (OR 72.1, 95% CI 52.8-99.0) and yielded likelihood ratio values of 7.5 for pain interference symptoms and 21.8 for anxiety and positive predictive values (PPV) of 84% and 95%, respectively. A PHQ-9 score of ≥10 still showed significant associations with pain interference symptoms (OR 6.1, 95% CI 5.4-6.9) and symptoms of anxiety (OR 11.3, 95% CI 9.7-13.1) and yet yielded lower likelihood ratio values (4.36 & 8.24, respectively). The PHQ-9 was less strongly associated with various forms of substance use. Conclusion: Depression screening provides substantial additional information regarding the likelihood of pain interference symptoms and anxiety and should trigger diagnostic assessments for these other conditions.

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Impact of combat exposure on mental health trajectories in later life: Longitudinal findings from the VA Normative Aging Study.

Cited by 13 publications

References 54 publications

Military Service, Combat Experience, and Civic Participation

Military Service, Combat Experience, and Civic Participation

The Impact of Early Life War Exposure on Mental Health among Older Adults in Northern and Central Vietnam

Insights Provided by Depression Screening Regarding Pain, Anxiety, and Substance use in a Veteran Population

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