One of the promises this country makes to veterans of its armed forces is that we will tend to their health, both physical and mental, long after they leave the service.
A new study from Oregon State University focuses on veterans who saw combat during their service — and suggests that the commitment to supporting mental health may take challenging turns as those veterans age.
One of the authors of the new study, recently published in the journal Psychology and Aging, was Carolyn Aldwin, director of the Center for Healthy Aging Research in OSU's College of Public Health and Human Sciences. (The first author is Hyunyup Lee, who conducted the research as a doctoral student at OSU; co-authors are Soyoung Choun of OSU and Avron Spiro III of Boston University and the VA Boston Health Care System.)
The paper notes that military veterans who were exposed to combat are more likely to exhibit signs of depression and anxiety in later life than colleagues who did not see combat.
For Aldwin, who has made a career out of studying issues related to aging, the study examines themes that have been longtime interests, dating back to her stint in the 1980s as a research psychologist at what was then the Veterans Administration Aging Outpatient Clinic in Boston. (The branch of the federal government now is known as Veterans Affairs.) Even then, Aldwin said, she was interested in how the stress that goes along with combat could affect participants over the long run. "Combat is about the worst stressor I can think of other than being in a concentration camp," she told me in a phone interview last week.
And yet, she said, "there were no studies on the long-term effects of combat on aging. ... We've been doing work in this area for 30 years now. Almost nobody asks about this."
The new study aims to fill that gap.
Aldwin noted that veterans, as a group, offer an interesting population to study for experts on aging. "On the one hand," she said, "the folks who go into the military tend to age well," for this reason: "They've been selected for good health" when they started their military service.
But, as veterans themselves often will remind you, the experience of veterans who were in combat was different than the experience of others who did not come under fire. The difference between the two cohorts is one that researchers generally have not explored.
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So, using data from the Veterans Affairs Normative Aging Study, a study that began in the 1960s to investigate aging in initially healthy men, the researchers explored the relationship between combat exposure and depressive and anxiety symptoms. They found that increased rates of those mental health symptoms were found only among combat veterans; the increases were not noted in veterans who had not been exposed to combat.
The findings made sense to Aldwin: "Once they retire, a lot of people do life reviews. Then they have to make sense of their combat. And some of them really have a hard time of that."
The study focused primarily on veterans of World War II and Korea, but Aldwin said the combat experience is dramatically different from war to war. For example, she said, traumatic brain injuries have risen among veterans of conflicts after the attacks of Sept. 11, as improvised explosive devices became weapons of choice. Veterans of the Persian Gulf war may have suffered exposure to chemicals.
That calls for additional research, and so Aldwin and her colleagues are at work on a pilot study dubbed VALOR (Veterans Aging: Longitudinal studies in Oregon), which includes veterans with service in Vietnam, the Persian Gulf and the post-9/11 conflicts. The VALOR study also represents a chance to explore the impact of service on female veterans, who generally have been neglected in previous studies.
The results of the first study suggest that Veterans Affairs caregivers and others need to be particularly watchful for symptoms of mental distress among aging veterans, especially those who have seen combat.
Aldwin said support groups can be helpful as well, and some of those can be provided by veterans' organizations: "Veterans do best in some ways in reaching out to each other. ... In some ways, places like the VFW (the Veterans of Foreign Wars) are natural support groups."
But younger veterans, in particular, can be skeptical about joining such groups, and that adds to the challenge of providing help when it's needed.
"It would be really great," Aldwin said, "if we could come up with a millennial version of the VFW."
Regardless of whatever form support takes, we need to remember this: That support is part of a promise we made. It's a promise we must honor. (mm)