Assessing the effects of combat exposure, PTSD, and psychological factors on health-related quality of life among Vietnam veterans

Introduction: Previous research has examined relationships between combat exposure and post-traumatic stress disorder. Less is known about associations between PTSD and long term health consequences of PTSD and other psychological factors on health-related quality of life (HRQOL).

Methods: We carried out secondary data analyses using 2248 Vietnam Veterans from the Vietnam Experience Study. The sample included veterans who entered the U.S. Army between January, 1956 and December 1971 and were assessed at follow-up in 1982. Personality characteristics were measured using the Minnesota Multiphasic Personality Inventory (MMPI), PTSD was assessed using the Diagnostic Interview Schedule (DIS) and HRQOL was assessed with general self-rated health (GSRH; fair or poor health). We used multivariate logistic regression to quantify the effects of combat exposure, PTSD, and personality on GSRH, after adjustment for sociodemographic factors.

Results: Combat exposure, PTSD, and each of the MMPI clinical scales were significantly associated with GSRH. The largest effects were for the MMPI clinical scales HS, HY, and D, the “neurotic triad” (all p<0.001). Lifetime PTSD, 30-day PTSD, and PTSD in remission were also independently associated with GSRH (OR=2.0, [95% CI 1.6-2.6], OR=3.0, [95% CI 2.0-4.6] and OR=1.8, [95% CI 1.4- 2.3], respectively). All MMPI clinical scales were also significantly associated with all PTSD measures.

Conclusions: We provide important new information regarding long term health consequences of exposure to war traumas on global health, suggesting that public health officials and clinicians should consider assessing a broader range of psychological outcomes when assessing the impact of combat exposure on Veterans health.