PTSD Symptom Severity Mediates the Impact of War Zone Stress Exposure on Postdeployment Physical Health: The Fort Devens Gulf War Veterans Cohort

Clinical Impact Statement In a longitudinal study following 2,929 U.S. Army personnel who were deployed in the 1990-1991 Gulf War, PTSD was demonstrated to be a mediating link between warzone stress exposure and the onset of physical health symptoms and conditions, as well as to lower health functioning in the years following Gulf War deployment. This study is one of a growing number of investigations to examine the long-term effects of war zone stress exposure using longitudinal data. Study findings demonstrate that if war zone-related PTSD remains untreated, it could continue to negatively affect health over the years and decades following deployment. Objective: Exposure to traumatic events is associated with increased risk for negative physical health outcomes, but more work is needed to advance understanding of the mechanisms underlying this relationship. As military deployments frequently involve trauma exposure, this issue has clear implications for veteran populations. This longitudinal study examined the role of mental health symptomatology (i.e., PTSD, depression, and anxiety) in the association between war zone stress and postdeployment physical health in Gulf War veterans. Method: Data were collected in three waves over 7 years from a sample of 2,929 (92% male) Army personnel who were deployed to the 1990-1991 Gulf War. Structural equation modeling (SEM) was used to examine the associations linking war zone stress exposure reported at deployment return with subsequent physical health 6 to 7 years later, including the postdeployment onset of health symptoms and conditions and health functioning. The roles of PTSD, depression, and anxiety symptom severity as potential risk mechanisms linking stress exposure with later health outcomes were examined. Results: Self-reported higher stress exposure was linked with greater severity of PTSD, depression, and anxiety symptoms. SEM analyses revealed that PTSD symptom severity was the only significant mediator of stress exposure on subsequent physical health. Conclusion: Findings support the unique and significant role of PTSD in the development of physical health problems in the wake of war zone stress for Gulf War veterans. These results suggest that targeted PTSD interventions could reduce or prevent future physical health problems that can result from trauma exposure and mental health sequelae linked to military service.