As part of Public Law 98–160, the US Congress in 1983 mandated that research on Vietnam veterans be undertaken to determine “the prevalence and incidence of post-traumatic stress disorder and other psychological problems in readjusting to civilian life.” In addition to Public Law 98–160, the US Congress passed other public laws mandating studies of the “health effects” of Vietnam service. As a consequence of these new laws, several well-designed cohort studies of Vietnam veterans were undertaken during the late 1980s (Boscarino, 2007
). These studies avoided many of the shortcomings of previous research, chiefly because of advancements in sampling and measurement that evolved from earlier research. One of these measurement advances included the availability of the Diagnostic Interview Schedule
(DIS), which for the first time permitted the gathering of DSM-III psychiatric diagnoses by means of population surveys, something previously not possible (Robins et al., 1981
). This later research confirmed that Vietnam combat veterans had higher rates of postwar adjustment difficulties, mental health disorders, medical morbidity, and higher postwar mortality than non-combat veterans or comparable non-veterans (Boscarino, 2007
). Importantly, these studies indicated that the postwar adjustment difficulties and health problems experienced by these veterans were often due to combat exposures in Vietnam, not the selection biases or measurement inadequacies that had affected earlier studies (Boscarino, 1995
Among these newer generation of studies was the National Vietnam Veterans Readjustment Study
(NVVRS). This national study, which involved a large random sample of Vietnam theater and non-theater veterans (in addition to civilian, non-veterans), was considered one of the most com- prehensive psychosocial assessment at the time it was conducted in the late 1980s. The NVVRS findings were a wake-up call for the American mental health community. Among other things, the NVVRS suggested that 15% of male Vietnam veterans were current PTSD cases (9% of female veterans) and that 31% of male veterans (27% of female veterans) had PTSD in their lifetimes (Kulka et al., 1990
). The NVVRS further confirmed that the PTSD-positive veterans often had disrupted lives in almost every domain, including in employment and in family relationships.
As significant as the psychosocial consequences of the war were for Vietnam veterans, their postwar experiences went beyond only psychosocial outcomes. For example, the “Vietnam Experience Study” (VES), another national landmark study conducted in the late 1980s, revealed that Vietnam veterans had higher rates of postwar mortality in the first 5 years after discharge, primarily due to suicides, homicides, drug overdoses, and motor vehicle accidents (Centers for Disease Control, 1987
). Furthermore, VES findings related to the postwar morbidity experienced by these veterans confirmed that Vietnam “theater” veterans as a group had higher rates of health care utilization and reported themselves to be in poorer physical health, in comparison to veterans without Vietnam service (Center for Disease Control, 1988a
; Centers for Disease Control, 1988b
). In addition, when the postwar health status of Vietnam veterans was examined by whether the veteran had PTSD, PTSD-positive veterans had substantially higher postwar rates (i.e., 50–150% higher prevalence) of many major chronic diseases, including circulatory, nervous system, digestive, musculoskeletal, and respiratory diseases, even controlling for the major risk factors for these conditions (Boscarino, 1997
Another compelling study provided additional evidence linking PTSD to adverse health outcomes was a VES study that examined the causes of death among 15,288 male US Army veterans 30 years after military service (Boscarino, 2006
). These findings indicated that postwar mortality for all-cause, cardiovascular, cancer, and external causes of death (including, motor vehicle accidents, accidental poisonings, suicides, homicides, and injuries) was associated with PTSD among Vietnam “theater” veterans. For Vietnam “era” veterans with no Vietnam service, PTSD was associated with all-cause mortality. This study suggested, among other things, that Vietnam veterans with PTSD were at about twice the risk of postwar death from multiple causes 30 years after military service than veterans without PTSD (Boscarino, 2006
What can be concluded from this research is that while combat exposure and service in Vietnam had a negative impact on the veteran’s health status, it was whether the veteran developed PTSD from these exposures that had the greatest adverse impact health status in the long-term.