This study examined the warzone stressors: killing in combat, experiencing personal threats, or traumatic witnessing during deployment in relation to psychological distress, alcohol consumption and quality of life at long-term follow-up. The study was conducted in two samples of Norwegian veterans who had served in Afghanistan (Study 1, N = 4,053) or in Lebanon (Study 2, N = 10,605), respectively. Data were collected through two postdeployment mental health surveys conducted by the Norwegian Armed Forces Joint Medical Services. Using linear regressions, we investigated the impact of warzone stressors on posttraumatic stress symptoms, depression, anxiety, insomnia, alcohol use, and quality of life. In study 1 (Afghanistan veterans), killing was not a significant predictor of psychological distress, alcohol use, or quality of life, when controlling for Personal Threats and Witnessing exposure. In study 2 (Lebanon veterans) killing remained a significant predictor (p < .001) of symptoms of posttraumatic stress, depression, and anxiety, after controlling for other warzone stressors. However, killing was not a significant predictor of alcohol use or quality of life in Study 2. In summary, killing in combat may be associated with increased reports of psychological distress, but there were distinct results in the two studies. Differences in mission statements, rules of engagement, and mental states during combat could explain the diverging outcomes. The results indicate that it may be erroneous to ubiquitously regard killing in combat as a moral stressor, and highlight the importance of clear rules of engagements that accounts for the “on the ground” reality of soldiers.
Combat disclosure in intimate relationships: Mediating the impact of partner support on posttraumatic stress.