Mortality and postcombat disorders: U.K. veterans of the Boer War and World War I

Area of Science:

• Military Medicine
• Epidemiology
• Historical Health Outcomes

Background:

• Postcombat syndromes, including disordered action of the heart (DAH) and neurasthenia/shellshock, affected servicemen in the Boer War and World War I.
• Assessing long-term mortality risks associated with these conditions is crucial for understanding veteran health.
• Challenges in record preservation necessitate innovative approaches to historical cohort studies.

Purpose of the Study:

• To investigate and compare mortality rates between U.K. servicemen with postcombat syndromes and control groups.
• To determine if conditions like DAH and neurasthenia were associated with increased mortality.
• To explore potential factors influencing mortality differences, particularly for World War I DAH cases.

Main Methods:

• Comparative analysis of mortality rates using Cox proportional hazards models.
• Inclusion of randomly sampled veterans awarded pensions for DAH or neurasthenia/shellshock.
• Matching of study groups by rank and disability level, with control groups of gunshot-wounded ex-servicemen.

Main Results:

• No statistically significant difference in mortality rates was found between most postcombat syndrome groups and controls.
• A notable exception was observed for disordered action of the heart (DAH) cases in World War I, who showed a reduced life expectancy.
• Further comparison of WWI DAH cases against higher-disability controls also yielded no significant mortality difference.

Conclusions:

• Postcombat disorders from the Boer War and World War I were generally not linked to increased mortality.
• The reduced life expectancy in some World War I DAH cases remains unexplained, possibly due to assessment biases or administrative factors.
• Further research is needed to fully elucidate the long-term health impacts of specific combat-related psychological conditions.