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Health Services Research & Development

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2009 HSR&D National Meeting Abstract

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National Meeting 2009

3060 — The Impact of Killing in War on Mental Health Symptoms and Related Functioning

Maguen S (SFVAMC), Metzler TJ (SFVAMC), Litz BT (VA Boston Healthcare System), Seal KH (SFVAMC), Knight SJ (SFVAMC), Marmar CR (SFVAMC)

Objectives:
This study characterizes the types of circumstances during which veterans report taking a life in war and the mental health outcomes associated with killing.

Methods:
Using data from the National Vietnam Veterans Readjustment Study (NVVRS), a nationally representative sample of Vietnam era veterans, we describe experiences of taking a life in the war zone. In addition, we examine mental health disorders and problems associated with killing, such as Post-traumatic Stress Disorder (PTSD), dissociation symptoms, functional impairment, and violent behaviors, after adjusting for sociodemographic and combat-related variables (excluding killing).

Results:
About half of Vietnam veterans reported that they had killed or believed they had killed one or more enemy combatants during the war; 13% reported either killing or injuring non-enemy combatants such as women and children. Killing in the war zone was independently associated with PTSD, dissociation symptoms, functional impairment, and violent behaviors. Conversely, general combat experiences were not significantly associated with these mental health outcomes in the final models.

Implications:
These findings highlight the profound impact that taking another life in the context of combat can have on veterans, and the importance of continuing to focus on this area as our service members return from deployments in which their duties require them to take another life as part of their service. One of the implications of these findings is that killing in and of itself may be a crucial ingredient in the development of PTSD, above and beyond general combat experiences. It also highlights the importance of shifting from a traditional focus on personal life threat and loss to a broader focus, which includes specifically assessing for killing experiences as part of any comprehensive mental health and readjustment plan following deployment.

Impacts:
These findings have important implications for evaluation and treatment of veterans who have killed in war, and can serve as a template to further investigate these questions as we welcome back a new generation of soldiers and prepare to meet their mental health needs as they adjust back to civilian life.


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