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Home > Public Resources > Trauma Blog > 2022 - April > VA study helps us understand Vietnam Theater Veterans’ mental health

VA study helps us understand Vietnam Theater Veterans’ mental health

Yasmin Cypel

April 5, 2022

Since returning from the war, many Vietnam War veterans have faced hardships, including lack of social support (Boscarino et al., 2018), stigma (Desai et al., 2016), and social and financial difficulties (Boscarino et al., 2018). These struggles, paired with the traumas of war, could have affected their mental health for many years after the war.

Since the 1980’s, major epidemiological studies have been conducted to understand the mental health effects Vietnam War service.  Results from earlier large-scale studies that primarily investigated veterans’ mental health status, like the 1984-1988 National Vietnam Veterans Readjustment Survey and its 2012-2013 follow-up study, the National Vietnam Veterans Longitudinal Study, have shown that the war has had negative effects on veterans’ mental health (Kulka et al., 1990; Marmar et al., 2015; Schlenger et al., 2015; Schlenger et al., 2016).  

Through VA’s 2016-2017 Vietnam Era Health Retrospective Observational Study (VE-HEROeS), the first nationwide survey of Vietnam War veterans’ physical and mental health  in over 30 years was conducted. Our objective was to find out if Vietnam War veterans, particularly those veterans who served in theater and who are now all generally in or approaching their 70’s, have psychological issues today that were evident after their return from the Vietnam War (Kulka et al., 1990).  VE-HEROeS allowed us to learn more about the current health of a rapidly aging population of veterans, supporting the need for continued study of their mental health, and continued surveillance of their health care needs.

For this analysis, we compared veterans’ mental health by level of Vietnam theater service, i.e., we contrasted the mental health of veterans who served in the Vietnam theater (i.e., service in Vietnam, Cambodia, Laos) to the mental health of veterans who served elsewhere (e.g., U.S., Europe) during the Vietnam war and to sex and age-matched U.S. non-veterans who had no military service.  

We also looked at relationships among race/ethnicity, level of Vietnam theater service, and mental health status in Vietnam War veterans because various pre- and postwar factors may have placed minority veterans, namely those who served in theater, at greater current risk of mental health issues than White veterans (Dohrenwend et al., 2008; Escobar et al., 1983; Ruef et al., 2000).  Last, we studied how other veteran sociodemographic, physical health, and military service characteristics, and lifetime trauma may have contributed to their current mental health status.

We mailed survey questionnaires to over 40,000 Vietnam theater and non-theater veterans. In contrast, while nearly 7,000 surveys were sent to U.S. non-veterans. Using established survey research administration methods, these procedures resulted in a 45% response rate for veterans (6,735 theater veterans and 12,131 non-theater veterans responded) and a 67% response rate for non-veterans (4,530 responded).  Data were self-reported.

We looked at four mental health outcomes that included overall mental health functioning (i.e., mental health-related quality of life), probable posttraumatic stress disorder (PTSD), psychological distress, and depression. We examined the prevalence of these outcomes and through regression analyses obtained insights into the associations between military service during the war and each of these mental health outcomes after adjusting for sociodemographic and other health characteristics.   

What we found

  • Mental health problems persisted among Vietnam theater veterans even many decades after the end of the Vietnam War.
  • PTSD, depression, psychological distress, and poor mental health functioning were more prevalent for Vietnam theater veterans than non-theater veterans and non-veterans. 
  • Poor mental health was generally more evident for minority theater veterans than for White theater veterans, particularly for Hispanics.
Our study confirms that the war continues to negatively affect Vietnam War veterans’ mental health, particularly for those who served in the Vietnam theater, and as they are approaching or are in their eighth decade of life. Thus, the continued surveillance of their mental health status and health care needs is of critical importance.  

Reference Article 

Cypel, Y., Schnurr, P. P., Schneiderman, A. I., Culpepper, W. J., Akhtar, F. Z., Morley, S. W., ... & Davey, V. J. (2022). The mental health of Vietnam theater veterans—the lasting effects of the war: 2016–2017 Vietnam Era Health Retrospective Observational StudyJournal of Traumatic Stress.

Discussion Questions

  1. How do the findings found for veterans of the Vietnam War compare to results observed for veterans of other, more recent conflicts? What parallels are there?
  2. What limitations exist with this research study/analysis?
  3. How does this study contribute to our understanding of minority veterans?

About the Author

Yasmin Cypel, PhD, MS is a researcher in the Department of Veterans Affairs Epidemiology Program, Health Outcomes of Military Exposures (HOME) (12POP5).  Her research on veterans has focused mainly on the health of men and women veterans of the Vietnam War.

References Cited

Boscarino, J. A., Adams, R. E., Urosevich, T. G., Hoffman, S. N., Kirchner, H. L., Boscarino, J. J., Withey, C.
A., Dugan, R. J., & Figley, C. R. (2018). Mental health impact of homecoming experience among
1730 formerly deployed veterans from the Vietnam War to current conflicts: Results from the
Veterans’ Health Study. Journal of Nervous and Mental Disease, 206(10), 757-764.
https://doi.org/10.1097/NMD.0000000000000879

Desai, M. U., Pavlo, A. J., Davidson, L., Harpaz-Rotem, I., & Rosenheck, R. (2016). “I want to come home”:
Vietnam-era veterans’ presenting for mental health care, roughly 40 years after Vietnam.
Psychiatric Quarterly, 87, 229-239. https://10.1007/s11126-015-9382-2

Dohrenwend, B. P., Turner, J. B., Turse, N. A., Lewis-Fernandez, R., & Yager, T. J. (2008). War-related 
post-traumatic stress disorder in Black, Hispanic, and majority White Vietnam veterans: The roles of 
exposure and vulnerability. Journal of Traumatic Stress21(2), 133–141. 
https://doi.org/10.1002/jts.20327
 
Escobar, J. I., Randolph, E. T., Puente, G., Spiwak, F., Asamen, J. K., Hill, M., & Hough, R. L. (1983). Post-
traumatic stress disorder in Hispanic Vietnam veterans. Clinical phenomenology and sociocultural 
characteristics. Journal of Nervous and Mental Disease171(10), 585–596. 
https://doi.org/10.1097/00005053-198310000-00001
 
Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., & Weiss, D. S. 
(1990). Trauma and the Vietnam War generation. Report of findings from the National Vietnam Veterans 
Readjustment Study. Brunner/Mazel, Inc.
 
Marmar, C. R., Schlenger, W., Henn-Haase, C., Qian, M., Purchia, E., Li, M., Corry, N., Williams, C. S., Ho, 
C.- L., Horesh, D., Karstoft, K.- I., Shalev, A., & Kulka, R. A. (2015). Course of posttraumatic stress disorder 
40 years after the Vietnam War: Findings from the National Vietnam Veterans Longitudinal Study. JAMA
Psychiatry72(9), 875–881. https://doi.org/10.1001/jamapsychiatry.2015.0803
 
Ruef, A. M., Litz, B. T., & Schlenger, W. E. (2000). Hispanic ethnicity and risk for combat-related 
posttraumatic stress disorder. Cultural Diversity & Ethnic Minority Psychology6(3), 235–251. 
https://doi.org/10.1037/1099-9809.6.3.235
 
Schlenger, W. E., Corry, N. H., Kulka, R. A., Williams, C. S., Henn-Haase, C., & Marmar, C. R. (2015). 
Design and methods of the National Vietnam Veterans Longitudinal Study. International Journal of
Methods in Psychiatric Research24(3), 186–203. https://doi.org/10.1002/mpr.1469
 
Schlenger, W. E., Mulvaney-Day, N., Williams, C. S., Kulka, R. A., Corry, N. H., Mauch, D., Nagler, C. F., Ho, 
C.- L., & Marmar, C. R. (2016). PTSD and use of outpatient general medical services among veterans of 
the Vietnam War. Psychiatric Services, 67, 543-550. https://doi.org/ 10.1176/appi.ps.201400576
 

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