Back to Home PageASSESSMENT OF DEPLOYMENT-RELATED EXPERIENCES
AMONG GULF WAR VETERANS
Rita E. Samper, Daniel W. King, Lynda A. King, & Dawne S. Vogt
Dan (1968, B troop) and Lynda work for the National Center for PTSD in Boston, and Rita currently serves as their research assistant. Dawne was the project coordinator for the study reported here. In addition, GEN (Ret) Glenn Otis served as a consultant on this project.
The study was supported by the collaborative Department of Defense/Department of Veterans Affairs Research Program on Military Operational Stress-Related Illnesses (PG DoD-087).
In the years following the 1990-1991 Gulf War (Gulf War I), approximately 13% of the 700,000 men and women who were deployed to the Persian Gulf region have reported a variety of physical and mental health problems. Complaints include, but are not limited to, fatigue, headache, skin rash, muscle and joint pain, gastrointestinal distress, sleep disturbances, and memory loss
. These symptoms, taken collectively, have come to be known as "Gulf War Illnesses" or "Gulf War Syndrome." In 1994, the Department of Defense, along with a number of other government and research agencies, invited the future study of deployment-related stressors that may have played a role in the occurrence of health complaints among Gulf War I veterans. In response to this call for research, we proposed to develop an inventory to assess characteristics of individuals that would put them at risk for stress-related health problems as well as characteristics of resiliency to such problems. Until now, the majority of Gulf War I studies assessing war-related stressors have used measures developed for previous generations of veterans, such as Vietnam veterans. We were interested in measures of risk and resilience that would apply not only to the first Gulf War, but could potentially be used to assess veterans of future deployments.
To better understand the unique experiences of Gulf War I veterans, we first conducted focus groups at both the Boston and the San Diego VA Medical Centers. We had a total of six focus groups and 33 participating Gulf War I veterans. In Boston, we conducted four focus groups: one group of male veterans who were deployed to the Gulf from active duty units, one group of male veterans who were activated for Gulf War I duty from the National Guard or Reserves, one group of only female Gulf War I veterans, and one group of veterans that was mixed by pre-deployment duty status and gender. In San Diego, we conducted two focus groups with male veterans who were deployed from active duty units at the time of the conflict. All participants were from the enlisted ranks. Members of each focus group were asked to speak freely and openly about their deployment experiences. They were guided by a series of topics, general questions, and more specific questions that explored different aspects of their deployment experiences. By the sixth focus group, issues that had been raised in previous groups were resurfacing and there was little new information gained. Thus, we found that six groups were enough to obtain sufficient information regarding Gulf War I experiences.
What we learned from our focus groups was valuable in helping us develop a survey that asked a large collection of questions about Gulf War I experiences. Questions covered topics related to combat experiences, perceived threat of harm or death while in the war zone, the difficult living and working environment, how well prepared veterans felt they were for their deployment, exposure to experiences occurring after instances of combat (aftermath or clean-up experiences), concerns about family, friends, and (especially for National Guard and Reserves) careers back home, the amount of support from other members in the unit, and the presence or lack of both general and sexual harassment.
In assembling our survey, we tried to pay special attention to the inclusion of language that was used by Gulf War I veterans themselves. For example, several focus group participants referred to nuclear, biological, and chemical agents as "NBCs" and we integrated this acronym into our survey questions, along with the full spelling of the term for those who might be unfamiliar with the acronym. Focus group participants also used the term "camaraderie" when asked about their interpersonal relationships with others in their military groups, and so we included this term into questions about social support in the war zone. In addition, we presented this preliminary survey to several Gulf War I veterans for their review. These veterans then gave us feedback about the relevance of the questions, themes that we may have overlooked, and the appropriateness of the language and terminology.
Next we administered the questionnaire to a national sample of 357 Gulf War I veterans. The goal was to achieve a sample that varied on war-zone experiences. Approximately half of the participants reported being 40 years of age or younger at the time of the survey; the other half reported being older than 40. The majority (76%) classified themselves as White; 20% were African American/Black; the remaining 4% were American Indian/Alaskan Native (2%), Pacific Islander (1%), and Asian (1%). Approximately 5% were of Hispanic ethnicity. Most participants (75%) had served in the Army during the war; 10% were in the Navy, 9% were in the Air Force, 5% were Marines, and 1% was in the Coast Guard. Prior to deployment to the Gulf region, 51% had been active duty personnel and 49% were National Guard or Reserve personnel. The split on gender was 78% men, 22% women. Of those veterans who were successfully located and contacted by telephone, 92% chose to participate.
What did we learn from this national survey about the deployment experiences of Gulf War I veterans? One interesting finding was that 36% of survey participants felt that they had been well prepared for deployment, while 17% felt that they were not well prepared for deployment. The remainder (47%) were rather neutral, reporting that they felt neither well prepared nor ill prepared for Gulf War duty. Regarding social support from fellow unit members in the war zone, 21% felt that they were very close to fellow unit members, 48% felt that they were neither very close to nor very distant from other members of the unit, and the remaining 31% felt that they were not close to other unit members. An overwhelming 80% of participants indicated that they experienced difficult living and working conditions during the deployment. Overall, those deployed from active duty units reported significantly more exposure to difficult living and working conditions than those deployed from National Guard/Reserve units. For example, more of those from active duty units reported having poor quality food than National Guard/Reservists. This was also true when asked about living conditions. A higher percentage of those from active duty reported living in unsanitary living conditions than those from National Guard/Reserve units. The most common problem in everyday life, reported by both active duty and National Guard/Reserve personnel, was dealing with the uncomfortable climate. Additionally, National Guard/Reserve personnel, when compared to their active duty peers, felt that they had less access to such amenities as clean clothes, showers, and bathrooms when they needed them, and less opportunity to get sufficient rest and relaxation. Regarding concerns about life and family disruptions, 40% of the total group of veterans reported that they were, in fact, "a little bit" concerned about such disruptions; 7% were "moderately" concerned.
Veterans reported that their most common combat experiences were receiving hostile incoming fire from artillery, rockets, mortars, or bombs (50.4% reported this experience); participating in combat missions or patrols (43.7%); participating in an invasion that involved naval and/or land forces (35.8%); and encountering land or water mines and/or booby traps (33.7%). Men understandably reported having more exposure to these situations than women. We also compared those deployed from active duty units and National Guard/Reserve units and found that the active duty personnel reported more exposure to combat. For example, 54% of those from active duty units versus 46% National Guard/Reserves reported receiving hostile fire from artillery, rockets, mortars, or bombs. As for aftermath of battle situations, the most commonly experienced were seeing people begging for food (55.0%); seeing refugees who had lost their homes and belongings as a result of battle (52.4%); seeing homes and villages that had been destroyed (51.8%); and seeing the bodies of dead enemy soldiers (46.5%). Again, men reported more exposure to these situations than women. There was not a significant difference in exposure to aftermath of battle situations between National Guard/Reservists and active duty.
Regarding perceived threat while in the war zone, participants were asked to agree or disagree with the statement "I felt safe." Across all respondents, 35% disagreed with this statement, 18% agreed, and 47% neither agreed nor disagreed with the statement. Interestingly, both those from active duty units (97%) and National Guard/Reserve units (85%) were worried that the enemy would use NBCs. Another finding worthy of note is that 51% of those deployed from active duty units and 32% of those deployed from National Guard/Reserve units felt that the vaccinations they were given would cause them to be sick. Lastly, over half (55%) of those from active duty units were concerned that the equipment they were given to protect them from NBCs would not work properly; 43% of National Guard/Reserves had similar concerns.
About half (51%) of the women who responded to the survey reported at least one instance of sexual harassment during the deployment to the Gulf region. The most commonly reported incident, by 32% of women, was having unit leaders or other unit members make crude and offensive sexual remarks directed at them, either publicly or privately.
Our national survey of Gulf War I veterans has been extremely useful in helping us to identify some common experiences of modern-day military deployments. A version of the questionnaire now is being used in a study of men and women deployed to Iraq from Ft. Hood, Texas for the most recent Gulf War. Our ultimate goal is to use the information that we gather to better understand how different deployment experiences affect long-term health and well-being and to better inform services that can be offered to military personnel upon return. In a future brief article, we will profile the physical and mental health of our Gulf War I sample of veterans.
General Life Adjustment in a National Sample of Vietnam Veterans:
Recent Research Findings
Dan King, Molly Keehn, and Lynda King
Dan served with B troop in 1968. Dan and Lynda work for the National Center for PTSD in Boston, and Molly currently serves as their research assistant. The study reported here was supported by a grant from the Massachusetts Veterans Epidemiology Research and Information Center
General Life Adjustment in a National Sample of Vietnam Veterans:
Recent Research Findings
In recent years, a tremendous amount of research has been conducted on Vietnam veterans and their adjustment to life after the war. Most of this research has focused on negative consequences of military service such as posttraumatic stress disorder (PTSD), depression, substance abuse, conduct problems, and family discord. While this research is important to understand these problems and aid in the creation of effective treatment methods, it may only tell part of the story. In fact, a recent article in the Boston Globe commemorating the 25th anniversary of the end of the war pointed out that Vietnam veterans who adjusted well and are successful pervade modern society.
Thus, while some Vietnam veterans have experienced distress, many others have successfully confronted their wartime experiences and learned from them. Three researchers, James Tedeschi and Lawrence Calhoun from the University of North Carolina and Crystal Park from the University of Miami, have used the term "posttraumatic growth" to refer to growth and improved functioning after exposure to highly stressful or traumatic events. The idea of "posttraumatic growth" is in line with a recent trend in psychology that involves shifting the focus of research from factors that relate to psychological problems to factors that relate to psychological health, well-being, and life adjustment. While this area of research has been largely ignored in the past, it is important because it helps researchers understand why some people facing extreme stress stay healthy while others do not.
We have recently been studying the long-term adjustment of Vietnam veterans while subscribing to the ideas of "positive psychology." Rather than focusing only on the negative consequences of the war experience, such as PTSD or depression, we are concentrating on indicators of positive life adjustment. Through this research we hope to document what factors lead war veterans to function normally and productively following military service.
To study the long-term positive life adjustment of Vietnam veterans, we are using information from the National Vietnam Veterans Readjustment Study. This study was commissioned by Congress in the mid-1980s mainly to determine the rates of PTSD in the Vietnam veteran population. The study involved extensive face-to-face interviews, over 4 hours in length, with more than 3,000 male and female (mostly registered nurses) Vietnam theater veterans (those who served in Vietnam during the war), Vietnam era veterans (those who served elsewhere during the Vietnam War) and nonveterans (those who never served in the military). While the interview questions emphasized psychological problems, the interviewers did ask about a range of positive outcomes.
One part of our current research is to see how Vietnam theater veterans score on a variety of different indices of positive life adjustment. We have four different measures of satisfaction:
In addition, we also included a measure of achievement:
We have found that, for the most part, veterans who fought in the Vietnam theater reported that they are satisfied with their lives. The average rating on the measure of general life satisfaction for both men and women was about 3.5 on a 5-point scale, which ranged from 1 (not satisfied) to 5 (very satisfied). For marital and parenting satisfaction, the average was close to 4 on a 5-point scale for both genders. In the case of job satisfaction, which was measured on a scale from 1 (not satisfied) to 4 (very satisfied), the average reported satisfaction was 3.33. The results also indicate that the average response regarding the highest level of educational attainment for Vietnam theater veterans was 5.00 for men, which represents some college or specialty training, and almost 6.00 for women, representing an average educational attainment of college completion. Both men and women were fairly well educated. In fact, the results indicated that all of the female theater veterans, and 91% of the male veterans achieved at least a high school degree, and 59% of the female theater veterans and 19% of the male theater veterans reported having attained at least a college degree or higher at the time the survey was conducted. It should be noted that the female theater veterans were for the most part registered nurses when they served in Vietnam, which helps explain the discrepancy between male and female educational attainment.
We have also compared Vietnam theater veterans to Vietnam era veterans and nonveterans on all the measures of positive life adjustment. We have discovered that all three groups scored similarly on all measures of adjustment. Although the findings indicated statistically different levels of adjustment for those who served in the military (theater and era veterans combined) versus nonveterans, this difference was very small and has little practical significance. Thus, despite the well-recognized problems that a portion of Vietnam theater veterans face, on average, they have demonstrated resilience and adjusted well.
Another portion of our study on positive life adjustment focuses on how the experiences of veterans while in the war zone (for example, engaging in combat, poor living conditions, and fear of harm) have impacted their later life adjustment. Past research has shown that more exposure to such stressors of war is strongly related to negative outcomes, such as PTSD. We are interested in whether this relationship holds true for positive outcomes – that is, whether more exposure to stressful events in the war zone would cause people to be less satisfied with their lives and less accomplished with regard to educational achievement.
In general, there was little relationship between the war-zone stressors and positive life adjustment. When a relationship did exist, it was very small and most likely had no practical significance. This means that veterans who experienced a larger number of stressors in the war are not necessarily less satisfied or less accomplished than veterans who had a milder war experience.
In summary, our series of studies on positive aspects of life adjustment among Vietnam veterans supports the claim that many veterans have adapted well to life after the war and lead successful, rewarding, and satisfying lives. According to our study, veterans who served in Vietnam and veterans who served elsewhere during that time period were similar on our measures of satisfaction and achievement. Both of these groups scored only slightly lower than civilians on all measures. In addition, we found that exposure to stressors of war was only minimally related to later positive life adjustment. Hopefully, future research on Vietnam veterans will continue to subscribe to the ideas of "positive psychology" and help us to go even further in the process of understanding this population.
(Editors note:) This article by Dan King, Michael Suvak, Anne-Marie Miller, Lynda King
Dan King served with B-Troop in 1968. Michael Suvak currently works as his research assistant, and Anne-Marie Miller is a former research assistant. Dan, Michael, and Lynda are all on the staff of the National Center for PTSD in Boston.
Many people who experience a traumatic event during which they perceive a threat to their own life develop a characteristic set of symptoms known as posttraumatic stress disorder (PTSD). PTSD, as designated by the American Psychiatric Association, is a condition observed in persons who have been exposed to highly stressful situations that evoke feelings of "intense fear, helplessness, or horror." PTSD symptoms fall into three primary categories: re-experiencing, which includes nightmares and flashbacks; avoidance, which consists of emotional numbing, withdrawal from others, lack of feelings, and avoiding reminders of the traumatic event; and arousal, which often includes startle response and sleep difficulties. PTSD has also been associated with substance abuse, domestic violence (and other interpersonal issues that disrupt family functioning), and other psychiatric conditions such as depression. Many types of traumatic events can lead to PTSD. In addition to combat-related experiences, child abuse, natural disasters, sexual assault, and torture can trigger PTSD. PTSD has developed in a significant number of Vietnam veterans. The National Vietnam Veterans Readjustment Study estimated that 15.2 % of male Vietnam veterans currently have PTSD, and that 30.9 % have had PTSD at some point in their lives.
Combat-related PTSD has been mostly associated with Vietnam veterans. However, as World War II and Korean War veterans have aged and reached their "golden years," many have gone to Veterans Affairs Medical Centers for the treatment of PTSD-like symptoms that they had not experienced before. Why are veterans who have lived healthy and productive lives and not complained of PTSD symptoms for almost 50 years suddenly appearing with symptoms of stress that they relate to their combat experiences? This question has recently begun to rouse the curiosity of researchers, who offer several possible explanations for this phenomenon. Some of the stress associated with the normal physical decline and emotional challenges of aging (for example, loss of loved ones and loss of control) can cause feelings similar to combat experiences. These types of stressors may trigger delayed stress symptoms.
In a recent article published by the American Psychological Association, Dr. Paula Schnurr of the National Center for PTSD speculated that it may not be aging, but rather retirement, that produces stress symptoms. Perhaps spending more time alone leads to more reflecting on combat experiences which, in turn, leads to the development of symptoms. In the same article, Dr. Patricia Sutker, former chief of psychology at the VA Medical Center in New Orleans, suggested that PTSD-like symptoms may have always been present in these individuals; they have just been less severe and overlooked in the past. In addition, it has been pretty well established in the research on PTSD that the amount of social support available to an individual who has experienced a traumatic event tends to counteract the development of stress symptoms. Since old age is associated with more social isolation, maybe a decrease in the quantity and quality of social contacts contributes to delayed onset of stress symptoms. These are just a few of the many possible explanations for the surfacing of PTSD symptoms in older veterans, but there is still a lot to learn about this phenomenon.
As more and more veterans of the Vietnam era approach retirement and their senior years, it is important that they be aware of the potential for delayed war-related stress symptoms and seek help when necessary. The following gives brief descriptions of commonly used therapies for PTSD and other stress reactions. This information was obtained from the American Psychological Association’s website (http://www.apa.org) and from pamphlets provided by the Association for the Advancement of Behavior Therapy.
Individual Therapy. Individual therapy occurs in the presence of one veteran client and one therapist. Several different modes are available for this one-on-one type of treatment. Many therapy programs used in the treatment of stress reactions incorporate cognitive-behavioral techniques. Cognitive-behavioral types of therapy often seek to reduce anxious feelings and improve relationships with other people in one’s life. This type of therapy focuses on examining and managing thought processes in the present, and the therapist often teaches the veteran to use relaxation techniques to deal with anxious feelings associated with the traumatic events. Cognitive-behavioral therapists work with veterans to identify what experiences in their daily environment make their symptoms worse, and they work on managing and reducing the frightening feelings associated with these symptoms.
Group Therapy. Group therapy takes place in a situation in which several persons who are experiencing problems are present during the therapy session. This type of therapy offers some benefits that are not present in individual therapy. For example, group therapy can help veterans realize that they are not the only ones suffering from the problems that they face. This can reduce feelings of alienation. This type of therapy also encourages individuals to help other people who are suffering from similar problems, which likewise can have a positive effect. Some therapy programs incorporate both individual and group therapies to maximize therapeutic gains.
Family Therapy. A common problem associated with stress reactions is disturbances within interpersonal relationships; therefore, PTSD and other stress-related problems can affect the entire family. Some therapists offer family or couples therapy to help the entire family cope with the veteran’s stress-related problems. These types of therapy may include stress-reduction and relaxation techniques that can help the whole family with the healing process. Family therapy might also address the structure of the family and the way that family members interact with each other.
Medication Consultation. Medication can often help veterans deal with some of the symptoms of PTSD and other stress reactions. Many VA Medical Centers and other health care facilities employ specialists in psychopharmacology to help veterans deal with symptoms during therapy.
Veterans who served on active duty in a combat theater may be eligible for VA readjustment counseling services or other clinical care, which often include the types of treatment described above. Eligibility is based on need and income and can be quite complex, so veterans who feel that they need services should contact their local Department of Veterans Affairs offices.
In summary, it is not uncommon for veterans, even after many years of productive and normal functioning, to begin to show signs of combat-related PTSD as they reach or approach retirement age. Awareness of this phenomenon may be helpful to Vietnam veterans, many of whom will be approaching retirement in the not-too-distant future. It is important for Vietnam veterans to understand that war related stress symptoms can arise even after many years of healthy functioning. There are effective treatments for stress related reactions – treatments that might be able to make the retirement years more satisfying and enjoyable.
PTSD AMONG VIETNAM VETERANS:
RECENT RESEARCH FINDINGS
(Editor's Note: This article was written by Dan and Lynda King of the National Center for PTSD, Boston)
The American Psychiatric Association has designated Post-traumatic Stress Disorder(PTSD) as a condition observed in persons who have been exposed to an extreme stressor or highly stressful situation that evokes feelings of "intense fear, helplessness, or horror." The diagnosis of PTSD can apply not only to war veterans, but also to those exposed to other traumatic events such as victims of natural disasters, rape victims, or those who have suffered from a catastrophic injury or illness. Although we have been aware of the symptoms of PTSD for over a century, it has only been since 1980 that the American Psychiatric Association has officially recognized it as a consequence of being exposed to a traumatic event.
The symptoms of PTSD include constantly being bothered by intrusive memories of the traumatic event in the form of nightmares, flashbacks, and the like; a tendency to withdraw and stay away from other people, or to be numb and have no feelings; and to be easily aroused, angered, or to have a "short fuse." In addition, people suffering from PTSD often are depressed and tend to abuse drugs and alcohol.
In the mid-1980s, the Congress commissioned a national study to determine the rates of PTSD in the Vietnam veteran population. That study, called the National Vietnam Veterans Readjustment Study (NVVRS) involved face-to-face interviews with Vietnam theater veterans, Vietnam era veterans, and non-veterans. The interviews lasted over four hours, on average, and much information was gathered. Regarding the primary question--what is the rate of PTSD among Vietnam veterans?--The NVVRS found the rate of PTSD for male Vietnam veterans as a whole to be 15.2%, and for female Vietnam veterans to be 8.9%. For those male veterans exposed to heavy combat, the rate was higher, about 30%.
It is noteworthy that, although the incidence of PTSD in the Vietnam veteran population is high, not all veterans are suffering from it. Even among the heavy combat-exposed veterans, the rate was found to be 30%, not 90% or 100%. So one might ask: Why are some veterans suffering while others are not? Or, what are the factors that are most likely to result in a veteran getting PTSD? Conversely, are there factors that might tend to shield the veteran from PTSD?
In 1992, we began a program of research using the data collected by the NVVRS researchers and attempted to find some answers to these questions. We recently completed our series of research studies and have some ideas about what factors seem to be most potent. We studied both male and female veterans, but here we will restrict our comments to our findings about male veterans, which are highlighted in the accompanying.
As you might expect, the most important contributor to PTSD is the level of exposure to traumatic events in the war zone itself, what we call combat exposure. This is not a surprising finding, but what was particularly interesting was that the effect of combat on PTSD for the veteran was channeled through his perceptions of the experience. That is, any combat event that a veteran might have experienced in Vietnam, such a being in an ambush or a firefight, tended to influence PTSD indirectly, through his interpretation of what happened. In addition, the level of combat exposure influenced the veteran's sense that the overall environment of Vietnam was threatening, uncomfortable, or malevolent. We found the veteran's perception of the "malevolent environment" of Vietnam also to be a contributor to PTSD symptoms. So it appears that combat exposure, as expected, is implicated--the more combat, the more PTSD--but its influence is indirect.
We considered the possible role of prewar risk or vulnerabilities that might, in addition to his Vietnam experience, contribute to the veteran's PTSD symptoms. A very important element was the age of the veteran when he went to Vietnam. As we all know, younger men were more likely to be of lower rank, and thus prone to directly experience the heavier combat. This indirect link of the veteran's age through combat may not be particularly revealing, but we also documented a direct link between the veteran’s age at entry to Vietnam and his reported PTSD symptoms. This finding is suggestive of a maturation-based explanation: The younger the veteran was when he served in Vietnam, the less he was capable of "working through" his experience and the more PTSD symptoms he felt when he returned.
Another risk factor for PTSD was the veteran's history of exposure to traumatic events prior to entering the military. By trauma history, we mean being in a serious auto accident, being a victim of assault, being in a house fire, and other similar kinds of experiences. Prewar trauma history operated in a very interesting way to produce PTSD symptoms. Those men who were in heavy combat and had a history of prewar exposure to traumatic events reported higher levels of PTSD symptoms while those in heavy combat without a prior trauma history reported fewer symptoms. This difference in reported PTSD symptoms did not occur for veterans who were exposed to low levels of combat. So, there seems to be a kind of "piling on" effect--a prewar trauma history plus exposure to heavy combat can lead to more PTSD symptoms.
Characteristics of the veteran's family of origin also indirectly contributed to PTSD. We found that the more troubled the veteran's family was, the younger he was when he entered Vietnam. Also, the veteran's family of origin characteristics were associated with his having problems with educational and legal authority. In turn, the veteran's educational and legal problems before entering the military were related to his exposure to prewar traumatic events(the more problems, the more events), his age at entry to Vietnam(the more problems, the younger), and his exposure to combat while in Vietnam (the more problems, the more combat). So, although family of origin characteristics were not directly related to PTSD, they did seem to predict other factors that were, in turn, either directly implicated (for example, age at entry into Vietnam) or indirectly implicated (for example, premilitary educational and legal problems).
What about after Vietnam? Were there any elements in the postwar environment or in the veteran's postwar state of mind that might be associated with PTSD symptoms? To answer these questions, we considered three factors: the amount of support available to the veteran from his family and friends, his hardiness or general positive outlook on life, and his exposure to stressful events after returning home. As you might expect, support from family and friends as well as hardiness had a very strong effect on the veteran's PTSD symptoms in that the more support he received, and the more positive his outlook, the less severe were his PTSD symptoms. Likewise, exposure to postwar stressful events, such as being the victim of an assault, or the loss of a child or loved one, was associated with PTSD symptoms. This latter relationship is being borne out in the increasing number of World War II vets who are reporting to Veterans Administration facilities with PTSD-like symptoms from their war experiences. One reason for this happening might be that the veterans are now experiencing the loss of spouses and other family members, and the loss seems to trigger long-suppressed war memories.
In our research, we noted that postwar stressors (such as the loss of a family member) seem to weaken or deplete the veteran's available community and personal resources. Also, factors marking a troubled family life for the veteran before going into the military negatively influenced his hardiness or positive outlook. Furthermore, veterans who reported that they had a troubled home life before going into the military indicated they did not have much support from their families and community when they came home.
In summary, we offer three general conclusions about PTSD in Vietnam veterans. First, it appears that PTSD symptoms are a consequence of successive exposures to stressful life events. This conclusion comes from our observations of a "piling on" of prewar trauma history with combat exposure, coupled with our finding concerning the importance of postwar stressful events in contributing to PTSD.
Second, there are certain factors that can help to reduce the likelihood that a veteran will suffer from PTSD. These include his age at entry to the war zone (older veterans are less likely to get it); his general outlook on life (the more positive, the fewer symptoms);and support from family and friends (the more the better).
Third, it seems that exposure to stressful life events, be they wartime combat exposure or, family problems, premilitary traumas (being in a house fire) or postmilitary stressful events (loss of a spouse), also deplete or reduce a veteran's resources (social support or hardiness), which, in turn, can increase the occurrence of PTSD symptoms.
So the answer to the questions posed earlier is not clear. At best, it is very complex. Furthermore, as always, with research, there are some problems with the way in which we went about trying to answer the questions. Probably the biggest problem was that the veterans who participated in the NVVRS in 1986, when most of the interviews took place, were asked to remember events that happened in the 1960s or early 70s, when the war was going on, or in the 1950s, when they were children. In addition to just not remembering what happened in the past, there was also the possibility that their state of mind at the time of the interview colored their memories of past events.
This is the link to follow to the National Center for PTSD.