Combat Veterans Have Poorer Quality Of Life

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Military combat is associated with lingering detrimental effects on veterans’ quality of life that may cancel the benefit of their once-healthier status compared to non-veterans, researchers reported at the American Heart Association’s 10th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

“Veterans with no exposure to combat reported better health and functional status than men who had no military experience. However, combat veterans did not exhibit the more favorable long-term quality of life and functional health levels of their non-combat veteran counterparts,” said Anna M. Johnson, Ph.D., lead author of the study and an epidemiology researcher at the University of North Carolina in Chapel Hill.

“Instead, the combat veterans reported status similar to non-veterans. This suggests that combat exposure is associated with impairment in long-term quality of life and well-being among men that counteracts or overcomes the more favorable baseline health these men had when they entered the military.”

The investigators studied the link between combat stress and quality of life among 5,347 men who took part in the national Atherosclerosis Risk in Communities (ARIC) study of heart disease risk.. Twenty percent were African American 80 percent were Caucasian and their ages ranged from 52 to 75 when outcomes were measured in 1996-98.

Health and military status was based on responses to eight questions in follow-up interviews in 2001–02. Men were classified as non-veterans (NV, 38 percent), veterans with no combat exposures (NCV, 40 percent), and veterans with one or more combat exposures (CV, 22 percent). The veterans had served during World War II, the Korean War and Vietnam Conflict eras. The study found:

* Non-veterans were 37 percent more likely than non-combat veterans to report poor or fair health vs. good or excellent health, even after adjusting for age, race, health insurance, father’s education, adult education, income and occupation.

* Combat veterans were 31 percent more likely to report poor or fair health than non-combat veterans, even after adjusting for demographic factors, era and duration of service.

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* In adjusted models, non-veterans and combat veterans both were 75 percent more likely to report inability to walk half a mile unassisted compared to non-combat veterans.

* Results were either unchanged or modestly reduced but statistically unchanged when combat veterans who reported having been wounded or missing in the course of service were removed from analysis.

“Healthy warrior effect or healthy soldier effect describes the fact that healthier persons are more likely to be eligible and selected for participation in the military,” Johnson said. “Those selected must meet physical and mental requirements of the armed forces, and they have a significantly lower mortality rate than is found in the general population.”

However, combat exposure negatively affects veterans’ mental health, risk of all-cause mortality and short-term cardiovascular health, Johnson said. “The psychosocial stress experienced by veterans who have engaged in active combat is a uniquely traumatic stressor that can have positive as well as negative consequences and can have both short-term and long-term effects. And the long-term impact of combat stress is not well understood.”

About 65 percent of American men older than age 55 served in World War II or the Korean conflict, and about a quarter of all older men were exposed to military combat at some time in their lives.

“With active service populations involved in conflicts in the Middle East since the early 1990s, new groups of American men and women continue to be exposed to combat-related stress,” she said. “Given the pervasiveness of combat exposure in our community, it is important to understand the long-term effects it has on the individuals who experience it.”

While the researchers did not include veterans who served in wars more recent than Vietnam, Johnson said, “there is reason to believe that combat exposures today would be similar in some if not many ways to those in other conflicts.”

Researchers should continue to search for “pathways to prevention” by uncovering possible mechanisms through which stress can influence long-term health and well-being, she said.

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