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Over the past 20 years, U.S. military conflicts in Iraq and Afghanistan have been marked by high rates of combat and wartime killings. Research on Vietnam‐era service members suggests that the type of killing (i.e., killing a combatant vs. noncombatant) is an important predictor of later mental health problems, including posttraumatic stress disorder (PTSD). The present study aimed to update these findings by exploring the impact of type of killing on PTSD symptoms using a sample of postdeployment active duty U.S. Army personnel (N = 875). Using multiple regression analysis, we found that the act of killing a noncombatant was significantly associated with PTSD symptoms, B = 7.50, p <.001, whereas killing a combatant was not, B = ‐0.85, p =.360. This remained significant after controlling for demographic variables, depressive symptoms, and general combat experiences. These findings support the need for thoughtful postdeployment screenings and targeted clinical interventions. [ABSTRACT FROM AUTHOR]

Objectives. We characterized trends in mental health services utilization and stigma over the course of the Afghanistan and Iraq wars among active-component US soldiers. Methods. We evaluated trends in mental health services utilization and stigma using US Army data from the Health-Related Behavior (HRB) surveys from 2002, 2005, and 2008 (n = 12 835) and the Land Combat Study (LCS) surveys administered to soldiers annually from 2003 to 2009 and again in 2011 (n = 22 627). Results. HRB and LCS data suggested increased mental health services utilization and decreased stigma in US soldiers between 2002 and 2011. These trends were evident in soldiers with and without posttraumatic stress disorder (PTSD), major depressive disorder (MDD), or PTSD and MDD. Despite the improving trends, more than half of soldiers with mental health problems did not report seeking care. Conclusions. Mental health services utilization increased and stigma decreased over the course of the wars in Iraq and Afghanistan. Although promising, these findings indicate that a significant proportion of US soldiers meeting criteria for PTSD or MDD do not utilize mental health services, and stigma remains a pervasive problem requiring further attention. [ABSTRACT FROM AUTHOR]

Abstract: Background: Soldiers face a great number of traumatic combat exposures while deployed, which research has shown to contribute to the development of alcohol misuse. In addition to this known risk factor, we hypothesize that adverse childhood experiences (ACEs) also contribute to the likelihood that soldiers will engage in these behaviors, even after adjusting for deployment-related factors (mental health problems and combat exposure). Methods: Soldiers were surveyed anonymously approximately 3months upon return from Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF) from 2003 to 2006. Six brigade combat teams were included in the analyses (n=7849). Participants were asked about ACEs, mental health symptoms, alcohol misuse, risky behaviors related to alcohol misuse, and combat exposure. Results: Of the 7849 soldiers in the sample, 31.5% screened positive for alcohol misuse and of those almost half also screened positive for risky behaviors related to alcohol misuse (43.3%). Having an alcoholic in the household and experiencing sexual abuse were significantly associated with screening positive for alcohol misuse and alcohol misuse with risky behaviors. Experiencing sexual abuse was a strongly associated ACE item, with an almost 2-fold increase in risk of both outcomes even after adjusting for mental health problems and combat exposure. Conclusions: Findings suggest that ACEs are a substantial risk factor for alcohol misuse with and without risky behaviors among soldiers returning from deployments and should be considered when directing prevention efforts. [Copyright &y& Elsevier]