Introduction. The relationships among military service, combat intensity and long-term health effects were investigated in a cohort of 6,355 Vietnam-era American Legionnaires who were recruited in 1984 and followed through 1998. First, the effect of Vietnam service on coronary heart disease (CHD) risk was assessed among 3,781 veterans who responded to both questionnaires. Next, the effect of serving in Vietnam and combat exposure was investigated as risk factors for the mortality of the cohort. Finally, potential threats to the validity of this study were evaluated.Methods. Military service and lifestyle factors were assessed by questionnaires in 1984 and 1998. Vital status in 1998 was determined and causes of death were ascertained through the National Death Index. Cox proportional hazards modeling was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for CHD incidence and mortality in relation to service location and combat exposure, adjusting for age, smoking, alcohol consumption, body mass, and hypertension. Response bias and reliability of self-reported data were examined.Results. Serving in Vietnam was associated with an increased hazard of developing heart disease (HR=1.37, 95% CI: 1.09, 1.73), after controlling for independent risk factors. Vietnam veterans experienced a 50% higher mortality than non-Vietnam veterans during 14-year follow-up (HR=1.48, 95% CI= 1.13 - 1.93), which increased with combat intensity after adjustment for other risk factors, (low combat: HR 1.17, 95% CI 0.79 - 1.73; medium combat HR=1.51, 95% CI 1.05 - 2.17; high combat HR=1.82, 95% CI 1.20 - 2.76). A stronger relationship was observed by level of combat for CHD mortality (low combat: HR =1.48, 95% CI 0.75 - 2.95; medium combat HR= 2.01, 95% CI 1.06 - 3.79; high combat HR= 2.27, 95% CI 1.08 - 4.79). Results showed that non-respondents differed only slightly from respondents for important variables potentially related to exposures and chronic disease outcomes. Furthermore, veteran self-report was moderately to highly reliable when measured over a 14 year period.Conclusions. Vietnam veterans are still experiencing higher rates of adverse health effects, even more than thirty years after their military service. These data support a long term and independent adverse effect of military service in Vietnam on cardiovascular health.

The major part of the existing research on psychological effects on participating in war or residing in a war zone shows negative effects on the person’s mental health. However not all research, from an international perspective, shows the same results. Since we haven’t found any research regarding Swedish conditions and there has been a recent implementation of a decision from the Supreme Commander regarding commanded international service for all staff within the Swedish armed forces, the question has now become more relevant. This essay intends to examine how the direct contacts with warring counterparts have contributed to a change in Swedish soldier’s perception of their own aggression levels. High levels of aggression may be included in various types of mental illness, particularly in post-traumatic stress. Furthermore, perceived aggression levels in relation to involvement in direct fighting and combat exposure is investigated. The result demonstrates a clear increase in perceived aggression levels after the intervention, albeit from low levels. There was also an increase in perceived aggression in relation to the degree of personal combat exposure. / En överväldigande del av befintlig forskning kring psykologiska effekter av att delta i krig och stridszon påvisar en hel del negativa effekter för psykisk hälsa. Inte all forskning, internationellt sett, pekar mot samma håll. Då vi inte funnit några undersökningar avseende svenska förhållanden, och dessutom kan konstatera en implementering av ÖB Beslut gällande kommenderad utlands-tjänstgöring för samtlig personal inom de Svenska utlandsstyrkorna, gör att frågan nu blivit aktuell. Denna uppsats ämnar undersöka svenska soldaters upplevda förändringar av egna aggressionsnivåer efter insats i Afghanistan. Höga aggressionsnivåer kan ingå vid olika typer av psykisk ohälsa, bland annat vid posttraumatisk stress. Vidare undersöks upplevda aggressionsnivåer i relation med inblandning i direkta stridigheter och stridszon. Resultatet påvisar en klar ökning av upplevda aggressionsnivåer efter insats, om än från låga nivåer. Dessutom klargjordes ökningen i upplevd aggression i relation till grad av personlig stridsexponering.

Seventy percent of service members identify as religious, and an accumulation of evidence supports the protective role religiosity may play in buffering mental health outcomes; therefore, it is important to examine if religion acts as a buffer for these individuals. Guided by religious coping theory, this study examined whether religiosity moderated the effect of combat exposure on depression in a sample of U.S. Army Soldiers (N=10,666). Data were drawn from the All Army Study (AAS) component of the larger Army Study to Assess Risk and Resilience in Servicemembers (STARRS) dataset. Using moderated path analysis, findings suggest that religiosity moderated the association between combat exposure and depression, such that higher levels of religiosity were associated with a lower impact of combat exposure on depression. Implications for military helping professionals include identifying leverage points for intervention such as during reintegration, particularly for Soldiers who identify religion to be important to them.

The current study used a sample of service members and veterans to explore the association of combat exposure and perceptions of the family system using a moderated mediation model. Combat veterans over the age of 18 with a family of creation (N = 154) completed an online survey through which they were administered a background information questionnaire, the Combat Experiences subscale of the Deployment Risk and Resilience Inventory – 2, the Moral Injury Events Scale, the PTSD Checklist for DSM-5, the Patient Health Questionnaire, the Beck Anxiety Inventory, the McMaster Family Assessment Device, and the Dyadic Adjustment Scale – Revised. Results of six moderated mediation analyses revealed that exposure to potentially morally injurious events (pMIEs) moderated the relationship between (1) combat exposure and couple relationship satisfaction and (2) combat exposure and family functioning, both via PTSS, anxious symptoms, and depressive symptoms. To our knowledge, the empirical models presented in this paper are the first to model the role of pMIEs in SMV literature, and provide a foundation for other models to emerge moving forward. Implications and limitations are discussed.

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Potential risk factors for development of Post-Traumatic Stress Disorder (PTSD) are still unclear. One potential risk factor for the development of PTSD is an individual’s cardiovascular reactivity and recovery in response to stressor tasks. The current study was conducted with 763 Army National Guard and Army Reserve soldiers. Participants completed a stressful induction along with self-report measures prior to deployment. Post-deployment, self-report measures were completed to assess PTSD symptomatology and experiences related to deployment and combat. Multiple regression was used to determine the ability of blood pressure response to stress to predict PTSD symptoms immediately and one-year after return from deployment. Results indicated that soldiers who had a less reactive systolic blood pressure response to and recovery from stressor tasks reported more PTSD symptomatology immediately after and one year after return from deployment. These results suggest that soldiers who develop PTSD after deployment have less pre-deployment emotion regulation ability.

Background. The current study was conducted to increase understanding of factors that promote or deter post-combat adaptation. In total, five research questions were posed and tested, leading to examination of how difficulties with emotion regulation, post-deployment coping self-efficacy (PDCSE), and disrupted worldview work in-concert to influence post-combat adaptation (as measured by PTSD severity, depression severity, and quality of life perceptions). Methods. The final sample included cross-sectional data for 123 OEF/OIF veterans who were referred for assessment and/or treatment in an outpatient clinic in a Veterans Affairs Medical Center. Path analysis, employing bootstrapping re-sampling, was used to test hypotheses, yielding metrics for model fit, direct effects, and hypothesized indirect effects. Results. Overall findings demonstrated that each of the models tested were a good fit for explaining post-combat adaptation outcomes, with the final integrated model (including combat exposure, difficulties with emotion regulation, PDCSE, and negative worldview) explaining 49% of the variance in PTSD, 60% of the variance in depression severity, and 42% of the variance in quality of life, respectively. Findings across all models demonstrated that emotion dysregulation played a significant role in promoting worse post-combat adaptation, and that this effect primarily worked through alterations in PDCSE and negative worldview. Conclusions. This study concludes with interpretation of findings via theory and the extant literature. Future research and intervention implications are discussed, including the need to focus post-combat therapies on altering PDCSE and negative worldview, and more broadly, on factors that diminish meaningful life for combat veterans. / Ph. D.

Participation in Peace Support Operations (PSOs) is one of the most common military duties assigned to present-day Western soldiers. Previous research concerned with the psychological effects of these missions on the individual soldier has focused on issues of mental health and how to ensure military effectiveness. This study takes a different perspective, and examines how PSOs affect the political psychology of the peace soldier, asking: how and to what extent do the sociopolitical psychological orientations of the individual soldier change as a consequence of peace support operations? The study combines theory from clinical, social, and personality psychology to construct a framework for understanding how and why the values and the attitudes toward violence of the soldier may be affected by PSO deployments. It is argued that although combat exposure may cause changes in attitudes and values, these variables will overall remain stable across the deployment. Stability is predicted to be the norm due to the importance of certain attitudes and values to the soldierly identity, and owing to the good person-environment fit that the deployment provides for the soldiers. It is also argued that the individual’s personality traits will predict levels of change and stability. Empirically, two Swedish contingents deployed to northern Afghanistan under the auspices of NATO’s ISAF mission are analyzed. Change and stability are examined by combining statistical analyses of surveys with in-depth interviews carried out at both the pre- and post-deployment stages. As hypothesized, the study finds that both values and attitudes exhibit high levels of stability across the mission. Contrary to expectations the soldiers’ experiences of combat exposure had little to no effect on attitudes and values. Combat exposure was, however, limited during the deployments studied. Finally, the individual’s personality traits are identified as being relatively potent factors for inducing change and stability. By demonstrating that low-exposure PSOs have only minor effects on the sociopolitical psychological orientations of soldiers, the study advances knowledge of the political psychology of the peace soldier and provides additional contributions to the fields of value and personality psychology. Among other things, the study demonstrates the stability of values in a very challenging environment, and how personality traits affect change and stability in values.