The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods

Abstract

In 1988, the National Vietnam Veterans Readjustment Study (NVVRS) of a representative sample of 1200 veterans estimated that 30.9% had developed posttraumatic stress disorder (PTSD) during their lifetimes and that 15.2% were currently suffering from PTSD. The study also found a strong dose-response relationship: As retrospective reports of combat exposure increased, PTSD occurrence increased. Skeptics have argued that these results are inflated by recall bias and other flaws. We used military records to construct a new exposure measure and to cross-check exposure reports in diagnoses of 260 NVVRS veterans. We found little evidence of falsification, an even stronger dose-response relationship, and psychological costs that were lower than previously estimated but still substantial. According to our fully adjusted PTSD rates, 18.7% of the veterans had developed war-related PTSD during their lifetimes and 9.1% were currently suffering from PTSD 11 to 12 years after the war; current PTSD was typically associated with moderate impairment.

Fig. 1

Self-reports of war-zone stress exposure correlated well with records-based MHM war-zone stress exposure. A high percentage of veterans categorized as low exposure on the basis of records-based MHM evidence had self-reported low exposure. Veterans who self-reported high exposure were the large majority of the MHM very high exposure category. Full sample n = 1189, excluding 11 veterans with missing data on self-reported war-zone exposure. Low and moderate self-reports of exposure were grouped together as ‘‘Low self-reported war-zone stress’’ [(2), Appendix C].

Fig. 2

The percentages of veterans who had suffered from war-related PTSD during their lifetime (Onset of PTSD) and the percentages of those who still suffered from PTSD at the time of the study (Current PTSD) increase with increases in MHM probable severity of exposure to war-zone stressors. Subsample n = 253, omitting four veterans with prewar onset, two missing onset information, and one missing sampling weight.