What happens when childhood trauma and combat trauma collide in a soldier's
psyche? The mental health fallout can be exponential, a new study
The study was headed by Capt. Oscar Cabrera, deputy commander of the U.S.
Army Medical Research Unit-Europe. Results were published in the August
American Journal of Preventive Medicine.
Past research has shown a dose-response relationship between childhood
adversity and a plethora of negative outcomes in adulthood for both physical
and mental health. Studies have also shown a strong link between combat and
depression and between combat and posttraumatic stress disorder (PTSD),
Cabrera and his colleagues noted. So they decided to study the extent to which
depression and PTSD in soldiers might be linked to childhood adversity and to
They evaluated some 2,400 soldiers three months after returning from Iraq
for adverse childhood experiences. The unfavorable childhood experiences
included exposure to a mentally ill person in the home, exposure to an
alcoholic adult in the home, sexual abuse, physical abuse, psychological
abuse, and violence directed against one's mother. Over half the soldiers
reported at least one adverse childhood experience, and over one-fourth
reported two or more.
The researchers used the Patient Health Questionnaire and the
Post-Traumatic Stress Disorder Checklist to evaluate the soldiers for
depression and PTSD. They found that 8 percent of the soldiers met criteria
for depression, and about 25 percent did so for PTSD.
The researchers then evaluated whether the degree of childhood adversity
the soldiers had experienced could significantly predict the presence of
depression or PTSD. They found that the likelihood of screening positive for
depression or PTSD was in fact significantly higher for soldiers reporting
exposure to two or more categories of childhood adversity.
They also found that combat exposure could significantly predict depression
or PTSD in the soldiers studied.
When the researchers looked at the interaction among childhood adversity,
combat, and the two psychiatric disorders, they found that exposure to
childhood adversity appeared to be not just a significant predictor of
depression and PTSD in these soldiers, but was even "a significant
predictor of depression and posttraumatic stress symptoms above and beyond the
role of combat exposure."
These results have practical implications for the treatment of soldiers
returning from war, the researchers believe. For example, evaluation of
childhood trauma in soldiers might be worthwhile "as this factor may
contribute to the intractability of symptoms and/or the length of
The study was funded by the U.S. Army Medical Research and Materiel
"Childhood Adversity and Combat as Predictors of Depression
and Post-Traumatic Stress in Deployed Troops" is posted at<www.ajpm-online.net>
under "Free access articles." ▪