Publication year
2013
Citation Title
The psychological costs of war: Military combat and mental health.
Journal Name
Journal of Health Economics
Journal Volume
32
Issue Number
1
Page Numbers
51-65
DOI
10.1016/j.jhealeco.2012.09.001
Summary
Differences in the likelihood of posttraumatic stress disorder (PTSD), depression, and suicidal ideation were compared in three different groups: Service members on Active Duty exclusively in the United States, Service members on Active Duty outside the United States in noncombat zones, and Service members on Active Duty outside the United States in combat zones. Findings indicate that Service members are most at risk for PTSD if they have been deployed in combat zones for over 12 months and if they have experience with enemy firefight or civilian casualties.
Key Findings
Service members deployed in a combat zone are 616% more likely to have PTSD than Service members deployed to noncombat zones overseas.
Those who have experienced enemy firefight have a 155% increase in likelihood of reporting suicidal thoughts, a 56% higher likelihood of reporting depressed affect, and a 141% higher likelihood of developing PTSD.
Service members with a longer deployment are more likely to experience PTSD; those who served more than 12 months in a combat zone have a 102% higher likelihood of having PTSD compared to those whose service was one to six months in length.
Service members who have been deployed to a combat zone have worse mental health outcomes than non-deployed Service members, non-Active Duty non-deployed Service members, and civilian control groups.
Implications for Program Leaders
Consider assessing exposure to enemy firefight and deployment length as they may be potential risk factors for developing PTSD, depression, or suicidal ideation for returning Service members
Develop lists of referrals that are responsive to Service members’ specific needs and experiences during each stage of the deployment cycle
Offer workshops during reintegration to help families and Service members adjust to the Service member’s return, especially when the deployment has included combat exposure
Implications for Policy Makers
Encourage the development and continuation of programs that can promote resilience in Service members, their partners, and children
Continue to support programs that address the unique challenges faced by deployed parents
Recommend training for community providers to educate them about unique factors that contribute to mental strain for Service members
Methods
Pre-existing data were used from the first four waves (1994-2008) of the National Longitudinal Study of Adolescent Health; wave 1 occurred while participants were adolescents, and wave 4 occurred in early adulthood (wave 4 age range, 24-33 years).
Questionnaires asked about demographic information, as well as information about military service. For those with deployment experience, questionnaires asked about frequency of engaging in enemy firefight, killing or injuring others, being wounded or injured, and witnessing the death or wounding of others.
All participants were given questionnaires about their mental health in three areas at all four time points: suicide ideation, PTSD, and depressive affect.
Participants
A total of 15,569 people completed surveys, which consisted of 14,589 civilians and 1,080 military.
Participants were predominantly White (70%), followed by Black (23.0%), Latino (16%), and other race (7%). Racial break-down for the military-only sample was comparable.
The full sample contained 47% males, compared to 79% of the military-only sample.
Six percent of the sample (n = 916) reported serving on Active Duty in the military. Of these, 47% (n = 429) report having been deployed in a combat zone and 45% (n = 416) report having engaged in enemy firefight.
Limitations
PTSD was assessed as a single-item indicator in which participants were asked if they had ever been diagnosed with PTSD. This may not capture participants who are experiencing symptoms of PTSD, but haven't been diagnosed.
The high correlation between length of deployment and frequency of experience with enemy firefight makes it difficult to determine which factor is driving the association with poor mental health outcomes.
The data gathered were cross-sectional and causation among the variables cannot be determined.
Avenues for Future Research
Measure differences in mental health due to deployment length and experience with enemy firefight to distinguish which has more adverse effects
Examine differences in mental health across the different branches of the military to try to replicate the findings
Replicate the study and conduct analyses to explore if there are cultural factors that impact PTSD among Service members
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
We exploit plausibly exogenous variation in overseas deployment assignment to estimate the effect of combat exposure on psychological well-being. Controlling for pre-deployment mental health, we find that active-duty soldiers deployed to combat zones are more likely to suffer from post-traumatic stress disorder (PTSD) than their counterparts deployed outside the United States in non-combat zones. Among those deployed to combat zones, those deployed to locales where they engage in enemy firefight or witness allied or civilian deaths are at an increased risk for suicidal ideation and PTSD relative to their active-duty counterparts deployed to combat zones without enemy firefight.
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