Killing in Iraq combat linked with PTSD, alcohol abuse, other problems

By Steve Tokar

Among soldiers who served in Iraq, the act of taking a life in combat was a significant predictor of post-traumatic stress disorder, alcohol abuse, hostility and anger, and relationship problems, according to a study led by a psychologist at the San Francisco VA Medical Center (SFVAMC).

“This is a reminder that, in war, the emotional and psychological burden of killing is profound,” says Shira Maguen, PhD, who is also an assistant clinical professor of psychiatry at the University of California, San Francisco. “We need to recognize and address this burden in order to better help our men and women who have served in the military readjust to life after combat.”

In the study of 2,797 US Army soldiers, which appears in the online Early View section of the Journal of Traumatic Stress, 40 percent reported killing or being responsible for killing in combat. Those soldiers were at higher risk for psychological and emotional problems than those who did not report killing, even after the study authors controlled for combat exposure and combat injury.

“This tells us that the act of taking a life, apart from every other experience of war, has a potentially negative impact on mental health,” says Maguen.

The study authors recommend that a comprehensive evaluation of veterans returning from combat should include an assessment of killing and reactions to killing, the results of which could then be incorporated into readjustment treatment plans.

“We need to do this with utmost sensitivity,” Maguen cautions, “and within the context of a sound therapeutic relationship in a safe environment such as a VA facility.” She notes that “there is a lot of shame, stigma, and misunderstanding around this issue that can cause veterans to be reluctant to speak about it at all.”

The study authors caution that the study has several limitations: it is retrospective, based on self-reporting, and conducted with soldiers at one large military installation and thus not necessarily generalizable to other solders, military branches, or veterans of other wars.

Co-authors of the study are Barbara A. Lucenko, PhD, of Madigan Army Medical Center, Tacoma, WA; Mark A. Reger, PhD, and Gregory A. Gahm, PhD, of the National Center for Telehealth and Technology, Tacoma, WA; Brett T. Litz, PhD, of VA Boston Health Care System and Boston University; Karen H. Seal, MD, MPH, and Sara J. Knight, PhD, of SFVAMC and UCSF; and Charles R. Marmar, MD, of SFVAMC and UCSF at the time of the study.

The study was supported by funds from the Department of Veterans Affairs.

SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.