Combat Exposure - PTSD: National Center for PTSD
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PTSD: National Center for PTSD

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Combat Exposure

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Combat Exposure

During war, military Servicemembers are exposed to a number of potentially traumatic events. In addition to life threatening combat situations, Servicemembers may witness injury and death, be involved in serious motor vehicle accidents, or may handle human remains. Research has shown a strong link between level of combat stress and PTSD.

“When you experience something as extraordinary as what you may experience in combat, these things kind of stick with you, and they may live in a really dark place.”

Stacy L. Pearsall

U.S. Air Force
1998-2008

Stressors

Combat Servicemembers are at risk for death or injury. They may see others hurt or killed. They may have to kill or wound others. They are on alert around the clock. These and other factors can increase their chances of having PTSD or other mental health problems.

For many Servicemembers, being away from home for long periods of time can cause problems at home or work. These problems can add to the stress.

This may be even more so for National Guard and Reserve troops who had not expected to be away for so long. Almost half of those who served in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) have been Guard and Reservists.

Another cause of stress is military sexual trauma (MST). This is sexual assault or repeated, threatening sexual harassment that occurs in the military. It can happen to men and women. MST can occur during peacetime, training, or war.

Mental Health Effects of Serving in Afghanistan and Iraq

The wars in Afghanistan and Iraq are the longest combat operations since Vietnam. Many stressors face these Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) troops. One early study looked at the mental health of these Servicemembers. The study asked Soldiers and Marines about war-zone experiences and about their symptoms of distress. Soldiers and Marines in Iraq reported more combat stressors than Soldiers in Afghanistan. This table describes the kinds of stressors faced in each combat theater in 2003:

Combat Stressors Seeing dead bodies Being shot at Being attacked/ambushed Receiving rocket or mortar fire Know someone killed/seriously injured
Iraq Army 95% 93% 89% 86% 86%
Iraq Marines 94% 97% 95% 92% 87%
Afghanistan Army 39% 66% 58% 84% 43%

Soldiers and Marines who had more combat stressors had more mental health problems. Those who served in Iraq had higher rates of PTSD than those who served in Afghanistan.

Later research has confirmed that to date, troops who served in Iraq are more likely to report mental health problems than troops who served in Afghanistan. A body of research shows a strong link between level of combat stress and PTSD.

How Does Serving in OEF/OIF Affect Mental Health?

Research on OEF/OIF Veterans (1) suggests that 10% to 18% of OEF/OIF troops are likely to have PTSD after they return. In addition to PTSD, OEF/OIF Servicemembers are at risk for other mental health problems. Although studies vary widely in terms of methods used, estimates of depression in returning troops range from 3% to 25%. Excessive drinking and use of tobacco among OEF/OIF Veterans may also be problematic. Servicemembers also report concerns over conflicts with others.

Some research has looked at how the response to war stressors changes over time. PTSD symptoms are more likely to show up in returning OEF/OIF Servicemembers after a delay of several months. Using a brief PTSD screen, Servicemembers were assessed at their return and then again six months later. Servicemembers were more likely to have a positive screen - that is, they showed more PTSD symptoms - at the later time.

On the other hand, many Servicemembers who screened positive (had more PTSD symptoms) at their return showed fewer PTSD symptoms after six months. Overall, it should be noted that most returning Servicemembers screened negative for PTSD at both time points.

What Increases the Risk of PTSD in OEF/OIF Servicemembers?

Research studies have found that certain factors make it more likely that OEF/OIF Servicemembers will develop PTSD. These factors include:

  • Longer deployment time
  • More severe combat exposure, such as:
    • Deployment to "forward" areas close to the enemy
    • Seeing others wounded or killed
  • More severe physical injury
  • Traumatic brain injury
  • Lower rank
  • Lower level of schooling
  • Low morale and poor social support within the unit
  • Not being married
  • Family problems
  • Member of the National Guard or Reserves
  • Prior trauma exposure
  • Female gender
  • Hispanic ethnic group

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PTSD Information Voice Mail:
(802) 296-6300
ncptsd@va.gov
Also see: VA Mental Health

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