Veterans Affairs (VA) has had it’s fair share of scandals — including 2014’s scandal about massive wait times in its healthcare system. A new policy now allows U.S. veterans to seek care outside of traditional VA hospitals in an attempt to reduce the wait time — still a month or more — for veterans seeking treatment. New research explores the long-term consequences of combat experience for veterans’ health and finds that worsening physical and mental health outcomes later in life are not directly related to combat experience (i.e., a physical injury suffered during combat or PTSD that directly results from combat). Instead, poor health can result from a variety of social and psychological processes in veterans’ lives after returning home.

Jason Schnittker used data from the 2010 National Survey of Veterans to understand how combat experience relates to poor health. Respondents reported their physical health (whether they needed help with basic activities) and mental health (whether they had been treated for a psychiatric disorder in the past six months). Schnittker restricts the analysis to veterans who served during the draft era (prior to 1974) and excludes veterans with service-related disabilities. Feeling unprepared for the transition back to civilian life, social relationships, and smoking behavior explain a significant portion of the relationship between combat experience and poor health.

Veterans who had combat experience (service in combat or a war zone) and had contact with  dead and wounded reported worse health than those who only reported combat experience. Further, those with combat experience reported worse health than those who only served during years of active combat operations.  

Psychiatric disorders explain part of the relationship between exposure to the dead or wounded and poor health outcomes. Not all health effects are the result of trauma, though — feeling unprepared for the transition back to civilian life, social relationships, and smoking behavior also explain a significant portion of the relationship between combat experience and poor health.

This research demonstrates that veteran’s health outcomes — especially physical health — involve a variety of psychological and social processes. For example, veterans whose experiences in civilian life diverge significantly from their experiences as a service member may find it difficult to reconcile their military service with their new roles and identities in civilian life. Schnittker believes this research can also help inform transitions out of other “total institutions,” like prisons, or even out of significant social roles. Understanding the unique experiences of veterans will be even more important as veterans begin seeking care outside of veteran-specific hospitals.