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Persistence and Patterns of Combat-Related Posttraumatic Stress Disorder (PTSD), Medical, and Social Dysfunction in
Steven D Stellman1, Anica Pless Kaiser, Brian N Smith
1From the Department of Epidemiology, Mailman School of Public Health , Columbia University, New York, New York (S.D.S.); National Center for PTSD Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts (A.P.K.); VA New England Geriatric Research Education and Clinical Center, Boston, Massachusetts (A.P.K.); Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts (A.P.K., B.N.S., A.S.); National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts (B.N.S.); Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts (A.S.); Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts (A.S.); and Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York (J.M.S.).
Objectives:
We examined long-term patterns of posttraumatic stress disorder (PTSD) and behavioral outcomes in Vietnam veterans.
Methods:
A random sample of 12,400 veterans was surveyed in 1984, 1998, and a deployed subset (n = 729) in 2020. Outcomes included PTSD, psychological well-being, health functioning, and disability.
Results:
Four PTSD patterns emerged over 35 years: current PTSD (9.1%, rising to 15.5% in heavy combat), prior PTSD (9.7%), subthreshold PTSD (25.2%), and never PTSD (56.0%). A strong combat-PTSD dose-response relationship persisted across time points. Veterans with current PTSD showed the worst outcomes; those with subthreshold or prior PTSD had intermediate outcomes, while never-PTSD veterans fared best. Community support mitigated adverse effects.
Conclusions:
Findings highlight the enduring impact of combat, with PTSD and related dysfunction affecting veterans even below clinical thresholds, leaving many ineligible for Department of Veterans Affairs (DVA) programs.
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