defined conditions with increasing combat exposure (p = 0.029). The impact of combat on PTSD and other psychiatric disorders is discussed in Chapter 5.
PTSD is associated with increased reports of poor physical health in veterans and civilian populations, regardless of how physical health is determined, that is, through physical examination or self-reports (Baker et al. 1997; Barrett et al. 2002a; Beckham et al. 1998; Schnurr and Jankowski 1999; Sloan et al. 2005). That has been seen in studies of male and female Vietnam veterans (Beckham et al. 1998; Boscarino 1997; Kulka et al. 1990; Taft et al. 1999; Zatzick et al. 1997a,b), Gulf War veterans (Baker et al. 1997), and World War II and Korean War veterans in the VA Normative Aging Study (Schnurr and Spiro 1999). Several researchers have attempted to identify links between war-zone exposures and physical health of veterans (Friedman et al. 1995; Taft et al. 1999; Wolfe et al. 1994). In each case, PTSD was the major mediator between war-zone exposure and poor physical health; the presence of PTSD was a better predictor of poor health than was being in a war zone. People with PTSD also tend to engage in poor behavioral practices, such as increased alcohol consumption and smoking, which in turn put them at risk for other health problems (Friedman et al. 1995).
Asmundson et al. (2002) studied the effects of PTSD on health in 1187 Canadian men deployed to war zones for UN peacekeeping missions and compared them with the health of 669 Canadians who had served in the military but had never been deployed. According to the PTSD Checklist-Military Version, 11% of the deployed and 3% of the nondeployed troops met the screening criteria for current PTSD. Those with PTSD had more self-reported poor health than those without PTSD regardless of deployment status. PTSD symptoms also contributed to depression, which in turn, resulted in even more poor health. PTSD was also predictive of alcohol use, however, the latter, unlike depression, was not associated with poorer health beyond that associated with symptoms of PTSD alone.
In a study of 107 Harvard graduates who fought in World War II discussed above (Lee et al. 1995), symptoms of PTSD in both 1946 and 1988 were correlated significantly (p < 0.001) with combat exposure and with the number of physical symptoms experienced by the veterans during their combat exposure; however, the PTSD symptoms were not associated with any premorbid vulnerabilities, such as low socioeconomic status or childhood emotional problems. Combat exposure was also a predictor of later poor health: 59% of those with both heavy combat and PTSD were chronically ill or dead by the age of 65 years, compared with only 39% of those without heavy combat experience.
World War II veterans (70-74 years old) who had participated in secret military tests of mustard gas during the war were assessed for current PTSD in 1996 using the PTSD Checklist (Schnurr et al. 2000). Veterans with PTSD had significantly higher rates of the following self-reported illnesses than veterans without PTSD: coronary heart disease, pulmonary disease, dermatologic conditions, ophthalmologic diseases, GI disorders, sexual dysfunction, and urologic disorders. Veterans with PTSD also had greater pain and fatigue, greater impairment in physical and psychosocial functioning, and were more likely to have lifetime disability, including lifetime VA psychiatric disability. Health care use was also significantly higher for veterans with PTSD.
The VA Normative Aging Study, begun in 1963, consists of 2280 men, 95% of whom are World War II or Korean War veterans. At study entry, 84% of the veterans reported combat exposure; in 1990, using the Combat Exposure Scale, 79% reported combat exposure. In 1990,