Scars: The Long-term Effects of Combat Exposure on Health

Abstract

Although the effects of combat exposure on mental health receive a good deal of attention, less attention has been directed to the long-term effects of combat exposure on physical health, apart from combat injuries. Using the 2010 National Survey of Veterans, the author evaluates the long-term effects of combat generally, as well as more specific dimensions of combat experience, including exposure to the dead and wounded. The results indicate that combat exposure increases the likelihood of poor health and disability years later, though exposure to the dead and wounded is even more powerful and accounts for the entire unadjusted relationship between combat service and health. Furthermore, only a small part of the relationship between combat and health is attributable to service-connected disabilities. More of the relationship can be explained by social and behavioral processes subsequent to combat. Relative to veterans who were not exposed to the dead or wounded, veterans with combat exposure are more likely to smoke, less likely to be married, and more likely to report being unprepared for the transition to civilian life. Together these factors explain a large part of the relationship between combat and health, even more than is explained by service-connected disabilities. The effects of feeling unprepared on physical health are as large as those of exposure to combat. The results encourage greater appreciation of combat exposure as a source of stress proliferation, with ongoing implications for health channeled through experiences in civilian life.