Exposure to military trauma related to post-war disease and death in Civil War veterans

An examination of military archives and medical records indicates that Civil War veterans who watched more of their comrades die or were younger when they entered the military were more likely to develop physical and mental illnesses later in life, and younger soldiers also had a higher risk of early death after the war, according to a study in the February issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

War trauma has been linked to higher rates of chronic illness and death, as well as specific conditions such as cardiovascular disease, hypertension and gastrointestinal (GI) disorders, according to background information in the article. The Civil War may have been particularly devastating, the authors report. Friends and family members often served in the same company, leaving survivors with few friends or male relatives when companies experienced significant losses, they write. Hand-to-hand combat was common, and soldiers could easily identify with enemies who were sometimes from the same state or county.

Judith Pizarro, M.A., and colleagues at the University of California, Irvine, collected data on 303 randomly selected Civil War companies from military records and pension files, which included information about soldiers' post-war physical examinations and medical problems.

Of the 15,027 soldiers analyzed, 15 percent had no mental or physical diseases and 38.8 percent had both physical and mental conditions. Those in the youngest group (aged 9 to 17 years at the time of enlistment) were 93 percent more likely than the oldest soldiers (those aged 31 years or older) to have signs of both physical and mental disorders. The younger soldiers also were more likely to show signs of cardiovascular disease alone and signs of both cardiovascular and GI conditions, and were more likely to die early. Veterans with POW experiences had an increased risk of combined mental and physical problems as well as early death. Those who were wounded had an increased risk of psychological disease but a lower risk of physical disease, perhaps because only hardy soldiers survived wounds on unsanitary Civil War battlefields, the researchers write.

As part of the analysis, soldiers were placed into quartiles depending on the percentage of their company members who were killed. Those in the second quartile were one and a half times as likely as those in first (lowest) quartile to show signs of cardiac, GI and nervous diseases. "Percentage of company killed is likely a powerful variable because it serves as a proxy for various traumatic stressors, such as witnessing death or dismemberment, handling dead bodies, traumatic loss of comrades, realizing one's own imminent death, killing others and being helpless to prevent others' deaths," the authors write.

This analysis is the first to use objective records to track post-war disease and death over soldiers' lifetimes for any war, they report. The older data gave the researchers an opportunity to follow the soldiers until all of them had died, an impossibility with more modern wars. "We found strong relations between traumatic exposure (including witnessing a larger percentage of company death), comorbid disease, mental health ailments and early death," they conclude. "Unfortunately, it is likely that the deleterious health effects seen in a war conducted more than 130 years ago are applicable to the health and well-being of soldiers fighting wars in the 21st century, as recent studies have suggested." (Arch Gen Psychiatry. 2006;63:193-200. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by a grant from the National Institutes on Aging, Bethesda, Md., as a subgrant from the Center for Population Economics at the University of Chicago and the National Bureau of Economics, Boston, Mass.

Editorial: Soldiers' Struggles Similar Throughout History This analysis of Civil War data shows that there may be fewer differences than previously thought between the Vietnam War and other conflicts, writes Roger K. Pitman, M.D., of Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass., in an accompanying editorial.

"Their central findings strikingly echo the results of research into the mental health status of Vietnam veterans, including posttraumatic stress disorder," Dr. Pitman writes.

The finding that the youngest veterans sustained the greatest damage also corroborates research from other wars. This may have neurobiological as well as psychological and social explanations, Dr. Pitman writes. "Their immature nervous systems and diminished capacity to regulate emotion give even greater reason to shudder at the thought of children and adolescents serving in combat, which apparently was common in the U.S. Civil War and still occurs in some countries today," he concludes.


(Arch Gen Psychiatry. 2006;63:127-128. Available pre-embargo to the media at www.jamamedia.org.)

To contact editorialist Roger K. Pitman, M.D., call Sue McGreevey at 617-724-2764.

Last reviewed: By John M. Grohol, Psy.D. on 30 Apr 2016
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