LAUSR

Objective To identify sociodemographic and military characteristics of combat-exposed and non-combat-exposed veterans in the United States and to compare rates of mental and physical health conditions in these populations. Methods Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a contemporary, nationally representative survey of 1,480 US veterans conducted September-October 2013. Poststratification weights were applied to analyses to permit generalizability of results to the US veteran population. Outcomes measured included lifetime and current psychiatric disorders and physical health conditions. Results A total 38% of US veterans reported being exposed to combat. Compared to noncombat veterans, combat veterans were younger, had greater household income, and served a greater number of years in the military; were more likely to be male, to have served in the Marine Corps, and to use the Veterans Affairs Healthcare System as their main source of health care; and reported a greater number of lifetime potentially traumatic events. After adjustment for these sociodemographic and military differences, combat veterans were more than 3 times as likely as noncombat veterans to screen positive for lifetime posttraumatic stress disorder (PTSD) and more than twice as likely for current PTSD and had 82% greater odds of screening positive for current generalized anxiety disorder. After additionally controlling for lifetime diagnoses of PTSD and depression, alcohol or drug use disorder, and nicotine dependence, combat veterans had 68% greater odds of having attempted suicide and 85% and 38% greater odds of being diagnosed with a stroke and chronic pain, respectively. Younger combat veterans were more likely than older combat veterans to screen positive for lifetime (30.6% vs 10.1%) and current PTSD (19.2% vs 4.9%) and suicidal ideation (18.6% vs 6.9%) and to have been diagnosed with migraine headaches (12.8% vs 2.1%), while older combat veterans were more likely than younger combat veterans to report having been diagnosed with heart disease (19.2% vs 2.6%) and heart attack (13.9% vs 2.5%). Conclusions Compared to noncombat veterans in the United States, combat veterans have elevated rates of PTSD, suicide attempt, stroke, and chronic pain independent of other sociodemographic, military, and mental health factors. Younger combat veterans have elevated rates of PTSD, suicidal ideation, and migraine headaches, while older combat veterans have elevated rates of heart disease and heart attack. These results characterize the population-based burden of mental and physical health conditions in combat veterans. They further underscore the importance of age- and condition-sensitive screening, monitoring, and treatment efforts in this population.