Childhood experiences and exposure to combat linked to poorer mental health

Adverse childhood experiences (ACEs) are early life adversities that include exposure to abuse, neglect, and living in toxic environments. Exposure to ACEs is associated with physical and mental health, as well as developmental and behavioral problems. Individuals in the military are more likely to be exposed to ACEs compared to their civilian peers.

“The mental health of veterans who have experienced ACEs may be at particular risk because they were often exposed to other types adversity during their military career,” said Keith Aronson, associate director of the Clearinghouse for Military Family Readiness at Penn State. “Those in the military engage in combat directly, but they also are exposed to the aftermath of combat, including witnessing death and destruction.”

A recent study of approximately 9,000 new post-9/11 veterans conducted by researchers at the Clearinghouse and Veterans Affairs examined how exposure to various stressors was related to their current mental health. The study published on July 2 in Psychological Trauma.

Nearly 60% of female and 39% of male veterans reported exposure to at least one ACE. Sexual abuse was reported by 22% of female and 6% of male veterans. Female veterans were twice as likely as males to have experienced multiple ACEs. Emotional abuse, family history of mental illness, neglect, and physical abuse were common ACEs for male and female veterans. However, females experienced each type of ACE at a significantly higher rate than male veterans.

Exposure to ACEs and current mental health

Female veterans exposed to one or two ACEs did not differ from those with no exposure to ACEs with respect to PTSD symptoms. On the other hand, male veterans exposed to one of two ACEs were over 30% more likely to report PTSD symptoms. Female and male veterans exposed to three ACEs were twice as likely to report PTSD symptoms, while veterans exposed to four or more ACEs were three times more likely to experience these symptoms.

“Female and male veterans exposed to one or two ACEs did not have increased symptoms of depression, but those exposed to three or more ACEs were more than twice as likely to report depression compared with those with no exposures,” continued Aronson. “A similar picture emerged for anxiety symptoms, although males exposed to one or two ACEs were 36% more likely to have symptoms of anxiety.”

Exposure to fewer than four ACEs did not increase the odds of having probable alcohol misuse problems for male or female veterans. Over half of female veterans with four or more ACEs were more likely to have probable alcohol misuse than those exposed to none. For males, ACEs were not associated with alcohol misuse problems.

Exposure to combat and the aftermath of combat and current mental health

“Generally speaking, veterans who reported experiencing combat were more than two times more likely to report symptoms of PTSD, with females who witnessed the aftermath of combat at 86% and males more than two times more likely to report symptoms of PTSD,” added Daniel Perkins, professor in the College of Agricultural Sciences and principal scientist at the Clearinghouse.

Female veterans who experienced combat were two times more likely to report symptoms of depression compared to peers without combat exposure, while males who experienced combat were at no higher risk for depression. However, males who witnessed the aftermath of combat were 60% more likely to have symptoms of depression compared to those with no aftermath exposure.

Female veterans who experienced combat were 67% more likely to report symptoms of anxiety. Male veterans who experienced combat or its aftermath were 37% and 45% more likely to have anxiety symptoms compared to those with no combat exposure, respectively.

Neither combat or its aftermath were associated with probable alcohol misuse for female veterans. However, male veterans with combat exposure were 37% more likely to have alcohol misuse compared with veterans without combat exposure.

“The results of the study suggest that male veterans exposed to one to two ACEs are more vulnerable to mental health symptoms than women similarly exposed,” said Aronson. “For women, the experience of combat appears to make them somewhat more vulnerable to mental health challenges compared to men.”

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