“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
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Combat Exposure
Combat Exposure
Service members are exposed to traumatic events during war. If you were deployed to a combat zone, you may have been in life-threatening situations. Or, you may have seen injury or death, been in a serious accident or handled human remains. Learn what research shows us about the link between level of combat stress and PTSD.
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Stressors
Combat Service members 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 Service members, 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 long periods. Almost half of those who served in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) were Guard and Reservists.
Another cause of stress is military sexual trauma (MST). This is sexual assault or threatening sexual harassment that occurs in the military. It can happen to Service members of any gender identity. MST can occur during peacetime, training, or war.
Mental Health Effects of Serving in Afghanistan and Iraq
The wars in Afghanistan and Iraq were 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 Service members. 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 having served in OEF/OIF affect mental health?
Research on OEF/OIF Veterans suggests that 1 or 2 out of every 10 troops (or 10% to 18%) are likely to have PTSD after they return. In addition to PTSD, OEF/OIF Service members are at risk for other mental health problems. Although studies vary widely in terms of methods used, estimates of depression in returning troops range up to 1 of every 4 (or from 3% to 25%). Excessive drinking and use of tobacco among OEF/OIF Veterans may also be problematic. Service members also report concerns over conflicts with others.
Some research focuses on how the response to war stressors changes over time. PTSD symptoms are more likely to show up in returning OEF/OIF Service members after a delay of several months. Using a brief PTSD screen — a few questions that help someone understand if a person has symptoms of PTSD — Service members were assessed at their return and then again six months later. Service members were more likely to have a positive screen &emdash; that is, they showed more PTSD symptoms — at the later time.
On the other hand, many Service members who screened positive (had more PTSD symptoms) at their return showed fewer PTSD symptoms after 6 months. Overall, it should be noted that most returning Service members screened negative for PTSD at both time points.
What increases the risk of PTSD in OEF/OIF Service members?
Research studies have found that certain factors make it more likely that OEF/OIF Service members will develop PTSD. These factors include:
- Longer deployment time or multiple deployments
- 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 (TBI)
- Lower rank
- Lower level of education
- Low morale and poor social support within the unit
- Not being married
- Family problems
- Being a member of the National Guard or Reserves
- Prior trauma exposure
- Female gender
- Hispanic ethnicity
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