Objective: Adverse childhood experiences (ACEs) are early life experiences of abuse and neglect, and observed violence, among others. For military veterans, both ACEs and combat exposure are associated with mental health problems. Method: This study examines the relationship between ACEs and combat exposure on the current mental health in a large sample of recent post-9/11 U.S. veterans. Results: Fifty-nine percent of female and 39% of male veterans reported exposure to 1 ACE, whereas 44% of female and 25% of male veterans were exposed to multiple ACEs. Female veterans were more likely to experience 4 or more ACEs. ACEs were more consistently associated with mental health problems for male veterans than their female peers. For female veterans, exposure to 1 or 2 ACEs did not increase the odds of having any mental health condition, whereas for males, this level of exposure was associated with probable PTSD and anxiety. Combat patrol events were associated with an increase in the likelihood of having a probable mental health problem, with 2 exceptions-combat patrol events were not associated with depression in male veterans and not associated with alcohol misuse in female veterans. Combat was not associated with alcohol misuse. Experiencing a corollary of combat (e.g., accidents, moral injury) was inconsistently associated with the odds of having a probable mental health problem. Conclusions: This study confirms prior studies demonstrating a relationship between ACEs and combat on subsequent mental health problems. Importantly, 2 different types of combat exposure had differential effects on mental health problems.
Clinical Impact StatementExposure to combat and to adverse childhood experiences (ACEs), such as abuse and neglect, are both associated with poorer mental health among veterans. Thus, it is critical that clinicians working with veterans take care in gathering background information on these experiences and formulate treatment plans that account for both types of traumatic exposures. There are a number of evidencebased treatments to address both childhood and combat trauma, and these should be used to treat veterans whenever possible.
Moral injury (MI) may occur in the context of committing transgressions (i.e., self‐directed MI reactions), witnessing transgressions, or being the victims of others’ transgressions (i.e., other‐directed MI reactions) that violate an individual's moral principles. Veterans with MI may experience impaired social well‐being (SWB). Studies on MI and veterans’ SWB have focused almost exclusively on social support and used cross‐sectional data. The present study used growth curve analyses to examine the associations between self‐ and other‐directed MI reactions and veterans’ levels of social support, social functioning, social activities, and social satisfaction over the first 18 to 21 months of their transition to civilian life (N = 9,566). The results demonstrated declines in all SWB outcomes, with self‐ and other‐directed MI reactions having differential effects. Higher versus lower levels of other‐directed MI reactions were related to lower baseline scores on all SWB outcomes, βs = −.06 to −.20, and steeper declines over time in social functioning, β = −.09, and social satisfaction, β = −.10. Higher versus lower levels of self‐directed MI reactions were related to lower baseline levels of social functioning, β = −.07, but higher baseline levels of social activity, β = .04. Higher versus lower levels of self‐directed MI reactions were related to a steeper decline in social activity over time, β = −.10. These findings present a more nuanced picture than that depicted by current MI theoretical frameworks and support further research to uncover moderators of the associations between self‐ and other‐directed MI reactions and SWB outcomes.
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