The Psychological Costs Of War: Military Combat And Mental Health.pdf

Military Combat and Mental Health

While descriptive evidence suggests that deployment in the Global War on Terrorism is associated with adverse mental health, the causal effect of combat is not well established. Using data drawn from the National Longitudinal Study of Adolescent Health, we exploit exogenous variation in deployment assignment and find that soldiers deployed to combat zones where they engage in frequent enemy firefight or witness allied or civilian deaths are at substantially increased risk for suicidal ideation, psychological counseling, and post-traumatic stress disorder (PTSD). Our estimates imply lower-bound health care costs of $1.5 to $2.7 billion for combat-induced PTSD.

The mental health impairments experienced by U.S. soldiers deployed in the Global War on Terrorism have received a great deal of attention by both policymakers and the American news media. Military service has been linked to greater take-up of disability benefits among some veterans, as well as higher rates of crime and violence. Recent studies have found that PTSD is a growing problem for U.S. soldiers deployed in Operation Iraqi Freedom and Operation Enduring Freedom.

Much of this work has been descriptive in nature, and those studies that have used regression strategies have been hampered by data limitations that fail to adequately address the endogeneity of military service or to disentangle the effects of deployment length from exposure to violent combat events. The Centers for Disease Control and Prevention estimates that veterans comprise nearly 20 percent of the more than 30,000 suicides each year.

Using data drawn from the National Longitudinal Study of Adolescent Health, we examine the relationship between military combat and young adults' mental health while carefully addressing the role of individual-level unobserved heterogeneity by controlling for mental health prior to deployment as well as exploiting plausibly exogenous variation in deployment assignment and exposure to violent combat events. We find that active-duty U.S. soldiers serving in combat zones are at greater risk of PTSD and are more likely to receive psychological or emotional counseling than their active-duty counterparts serving outside the United States in non-combat zones.

Our preferred estimates suggest that combat-induced PTSD in the GWOT imposes two-year costs of $1.5 to $2.7 billion on the U.S. health care system. We find that the psychological costs of combat are largest for soldiers exposed to violent combat events such as frequent enemy firefight. Soldiers who kill someone (or believe they have killed someone), are injured in combat, or witness the death or wounding of a civilian or coalition member are at substantially increased risk of suicidal ideation, depressive symptomatology, and PTSD.

1. The mental health impairments experienced by U.S. soldiers deployed in the Global War on Terrorism have received a great deal of attention by both policymakers and the American news media.
2. Military service has been linked to greater take-up of disability benefits among some veterans, as well as higher rates of crime and violence.
3. Recent studies have found that PTSD is a growing problem for U.S. soldiers deployed in Operation Iraqi Freedom and Operation Enduring Freedom.
4. Much of this work has been descriptive in nature, and those studies that have used regression strategies have been hampered by data limitations that fail to adequately address the endogeneity of military service or to disentangle the effects of deployment length from exposure to violent combat events.
5. The Centers for Disease Control and Prevention estimates that veterans comprise nearly 20 percent of the more than 30,000 suicides each year.
6. Using data drawn from the National Longitudinal Study of Adolescent Health, we examine the relationship between military combat and young adults' mental health while carefully addressing the role of individual-level unobserved heterogeneity by controlling for mental health prior to deployment as well as exploiting plausibly exogenous variation in deployment assignment and exposure to violent combat events.
7. We find that active-duty U.S. soldiers serving in combat zones are at greater risk of PTSD and are more likely to receive psychological or emotional counseling than their active-duty counterparts serving outside the United States in non-combat zones.
8. Our preferred estimates suggest that combat-induced PTSD in the GWOT imposes two-year costs of $1.5 to $2.7 billion on the U.S. health care system.
9. We find that the psychological costs of combat are largest for soldiers exposed to violent combat events such as frequent enemy firefight.
10. Soldiers who kill someone (or believe they have killed someone), are injured in combat, or witness the death or wounding of a civilian or coalition member are at substantially increased risk of suicidal ideation, depressive symptomatology, and PTSD.