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. 2026 Jan 1;64(2S Suppl 2):S137-S148.
doi: 10.1097/MLR.0000000000002149. Epub 2025 Dec 12.

Psychiatric Conditions and Symptoms After Toxic Environmental Exposures During Military Service: An Evidence Map

Anna T Magnante  1   2   3   4   5 , Shannon M Nugent  6   7 , Kyle J Bourassa  2   8   9   10 , Nina Leflore-Lloyd  11 , Samantha J Meckes  2   11   12 , Adelaide M Gordon  12   13 , Stephen H Boyle  14 , Dazhe Chen  15 , Amir Alishahi Tabriz  16 , Stephanie Y Wells  2   11   12 , Morgan Jacobs  12   13 , Julee Snyder  13 , Liziqiu Yang  17 , Sarah Cantrell  18 , Karen M Goldstein  11   12   13   19 , Jennifer M Gierisch  12   13   20   21
Affiliations

Psychiatric Conditions and Symptoms After Toxic Environmental Exposures During Military Service: An Evidence Map

Anna T Magnante et al. Med Care. .

Abstract

Background: US service members are often exposed to a range of service-related hazards. To date, there has been limited synthesis of the existing research conducted on military environmental exposures and subsequent psychiatric conditions and symptoms.

Objective: To systematically review and characterize the main features of studies examining associations between military exposures and mental health outcomes.

Methods: We used evidence mapping methodology to systematically search MEDLINE, Embase, PsycINFO, and PTSDpubs for studies of toxic exposure during military service and psychiatric outcomes, which included psychiatric diagnoses, psychiatric symptoms, and neurocognitive functioning.

Results: We identified 49 studies; most were comprised of predominantly White, male veteran samples. Chemical exposures, including chemical munitions from the Gulf War era and Agent Orange from the Vietnam War era, were the most frequently examined military toxic exposures. Symptoms of depression, PTSD, and anxiety were the most commonly examined psychiatric outcomes. Only 9 studies assessed neurocognitive functioning. We found extensive variation in how exposures and outcomes were defined and measured. Most exposure and symptom data were based on self-reports. Overall, available evidence suggests that veterans reporting environmental toxic exposures may report relatively high levels of mental health needs.

Conclusions: We found broad evidence that toxic exposure was associated with poorer mental health outcomes, though the ability to draw stronger conclusions is limited by the quality of the current literature. Future research should focus on longitudinal studies of toxic exposure and mental health that include more broadly representative military populations, including diverse samples and more recent service cohorts.

Keywords: PACT Act; mental health; military; toxic exposures; veterans.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Literature flow.
FIGURE 2
FIGURE 2
Visualization of associations across included studies by Era of Service, Military Toxic Exposure, and Psychiatric Symptoms and Diagnoses.
FIGURE 3
FIGURE 3
Visualization of associations across included studies by Era of Service, Military Toxic Exposure, and Neurocognitive Symptoms and Diagnosis.
FIGURE 4
FIGURE 4
Size of associations across most common exposures and most common symptoms and condition.
See this image and copyright information in PMC

References

    1. Mahan CM, Page WF, Bullman TA, et al. Health effects in Army Gulf War veterans possibly exposed to chemical munitions destruction at Khamisiyah, Iraq: part I, morbidity associated with potential exposure. Mil Med. 2005;170:935–944. - PubMed
    1. Page WF, Mahan CM, Kang HK, et al. Health effects in Army Gulf War veterans possibly exposed to chemical munitions destruction at Khamisiyah, Iraq: part II. Morbidity associated with notification of potential exposure. Mil Med. 2005;170:945–951. - PubMed
    1. McDiarmid MA, Engelhardt SM, Dorsey CD, et al. Longitudinal health surveillance in a cohort of Gulf War veterans 18 years after first exposure to depleted uranium. J Toxicol Environ Health A. 2011;74:678–691. - PubMed
    1. National Academies. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. National Academies Press; 2020. - PubMed
    1. Department of Veterans Affairs. Public Health. [Website] Vietnam War Exposures. Accessed March 27, 2024. http://www.publichealth.va.gov/exposures/wars-operations/vietnam-war.asp

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