Physical and Mental Health Costs of Traumatic War Experiences Among Civil War Veterans
Pizarro J, Cohen Silver R and Prause JA;
Commented by , 20 Feb 2006
Traumatic war experiences have major consequences on the physical and mental health of soldiers who are exposed to combat.
Aims of the study
To examine the physical and mental health consequences of traumatic war experiences in veterans of the American Civil War.
The authors matched military records of 17,700 Civil War veterans to their post-war medical records. Early age at enlistment, being a prisoner of war, being wounded, and percentage of soldiers having died in a recruit’s company were identified as traumatic war experiences.
Physician-diagnosed disease, including cardiac, gastrointestinal, and nervous disease, number of unique ailments within each disease, and mortality were recorded as outcome measures.
All of the following conferred a higher mortality risk and a greater risk of developing signs of physical and nervous disease:
- serving in a company in which more soldiers were killed
- being wounded
- being a prisoner of war
- having enlisted at an early age
Professor Pull's comments
This is an archival examination of the physical and mental health consequences of traumatic war experiences seen more than 130 years ago.
Veterans from the Civil War who had been exposed to traumatic experiences during that war had a higher mortality risk and increased signs of cardiac, gastrointestinal, and nervous disease.
A major strong point of the study is that the diagnoses of physical disease were based to a large extent on medically reliable signs as assessed and recorded by physicians and not (or to a much lesser extent) on symptom self-reports.
The results echo findings from combat effects in World War II and in the Vietnam War.
Boscarino (ref. 1) examined the causes of death among Vietnam veterans approximately 30 years after their military service. Findings indicated that adjusted post-war mortality for all-cause, cardiovascular, cancer, and external causes of death was associated with PTSD, with hazards ratios of 2.2, 1.7, 1.9, and 2.3 respectively.
Boscarino and Chang (ref. 2) found that Vietnam veterans with PTSD were significantly more likely to have abnormal electrocardiographic results. In particular, PTSD was associated with atrioventricular (AV) conduction defects and infarctions. The PTSD associations for AV conduction defects and infarctions held, even after controlling for current anxiety and depression.
Elder and Shanadan (ref. 3) investigated the health effects of experiences during World War II among veterans by examining how well-being changed across the post-war years. Combat in World War II predicted that in the 15 years after the war, a subject would experience physical decline or death.
Kang et al. (ref. 4) assessed the risk of selected cardiovascular diseases and posttraumatic Stress Disorder among Former World War II Prisoners of War. Former POWs had statistically significant increased risk of PTSD, and those POWs with PTSD also had statistically significant increased risks of cardiovascular diseases including hypertension and chronic ischemic heart disease when compared to both non-POWs and POWs without PTSD.
The reasons for an increased morbidity and mortality after traumatic war experiences are however unclear. They may be related to biological, psychological, or behavioral factors associated with PTSD. Further investigation is warranted to clarify this issue.
1. Boscarino JA. Posttraumatic Stress Disorder and Mortality Among U.S. Army Veterans 30 Years After Military Service. Annals of Epidemiology 2005 [Epub ahead of print].
2. Boscarino JA and Chang J. Electrocardiogram abnormalities among men with stress-related psychiatric disorders: implications for coronary heart disease and clinical research. Annals of Behavioral Medicine 1999; 21; 227-234
3. Elder GH Jr, Shanahan MJ and Clipp EC. Linking combat and physical health: the legacy of World War II in men's lives. American Journal of Psychiatry 1997; 154; 330-336
4. Kang HK, Bullman TA and Taylor JW. Risk of Selected Cardiovascular Diseases and Posttraumatic Stress Disorder among Former World War II Prisoners of War. Annals of Epidemiology 2005; [Epub ahead of print].