In civilian studies, socioeconomically disadvantaged populations are at greater risk for psychiatric and somatic disorders (Neeleman et al. 2001); those in the lowest social and economic strata have 2-3 times the risk of psychiatric disorders, especially depression and anxiety disorders, of those in the highest strata (U.S. Department of Health and Human Services 1999). Not surprisingly, similar relationships are apparent in veteran populations. Low income and lack of education are associated with chronic stress-related disorders—for example, anxiety disorders, major depression, and substance-use disorders—in Gulf War and Vietnam veterans (Black et al. 2004; Boscarino 1995; Brewin et al. 2000; Fiedler et al. 2006).
Low military rank (enlisted personnel vs officers) is also associated with greater risk of a stress-related disorder (Black et al. 2004; Fiedler et al. 2006; Kang et al. 2003; Kulka et al. 1990). Two studies found that being an officer or being college-educated reduced the risk of developing anxiety or depressive disorders after deployment by at least half (Black et al. 2004; Fiedler et al. 2006). Slusarcick et al. (2001) found that aboard a U.S. Navy hospital ship during the Gulf War, junior enlisted health-care providers had the highest levels of depression followed by junior officers, senior enlisted, and senior officers, in that order. By occupation, corpsmen were the most depressed, and physicians the least. However, Ikin et al. (2004) found that although Australian Gulf War-deployed veterans were at higher risk for any postwar anxiety disorder than were nondeployed veterans, the risk did not vary significantly by rank, whether officer or enlisted.
Social support has been linked to favorable mental-health outcomes (Bland et al. 1997; Regehr et al. 2001) especially among men (Solomon et al. 1987). Studies have shown that good social support is a protective factor against the onset of PTSD (Benotsch et al. 2000; Fontana and Rosenheck 1994b; Fontana et al. 1997).
Two meta-analyses found that lack of social support was the factor most strongly associated with the development of PTSD after a traumatic event for veterans of the Vietnam War and the Gulf War (Benotsch et al. 2000; Brewin et al. 2000; Fontana et al. 1997; Koenen et al. 2003; Ozer et al. 2003). Vietnam veterans with low levels of social support 10 years after the war had more symptoms of PTSD than those with high levels of social support; and when combined with high levels of combat exposure, those with low social support had far more symptoms of PTSD (Barrett and Mizes 1988). The role of social-support networks in the Vietnam-Era Adjustment Survey was explored in nursing and combat personnel (Stretch 1985, 1986; Stretch et al. 1985). The rates of PTSD were highest in men and women who had lacked positive social supports from family, friends, and society in general. Hispanic Vietnam veterans who were highly symptomatic for PTSD expressed fewer social contacts, more adverse social encounters, and smaller family and social networks (Escobar et al. 1983).
One study, conducted in 1978, explored the burden of war and social bonding in 149 veterans of World War II and the Korean War. Painful memories of war and symptoms of stress in later life were diminished through involvement with a supportive community of service mates and partners (Elder and Clipp 1988). Prospective studies reveal a downward spiral: as PTSD symptoms worsen, veterans lose more social support, the lack of which in turn exacerbates their PTSD symptoms (Benotsch et al. 2000).