Goldberg J, Eisen S A, True W R, Henderson W G
Hines VA Cooperative Studies Program Coordinating Center, IL.
Ann Epidemiol. 1992 Nov;2(6):841-53. doi: 10.1016/1047-2797(92)90078-5.
This article examines the methodologic difficulties encountered in studies of the long-term effects of the Vietnam War on the psychological and physical health of veterans. Alternate study designs and exposure and outcome measurements are examined in relation to psychological (post-traumatic stress disorder and alcohol use or abuse) and physical (mortality and birth defects in children) health outcomes. All major epidemiologic studies of post-traumatic stress disorder and alcohol use or abuse utilize cross-sectional research designs. Mortality and birth defect studies use cohort, case-control, or proportionate mortality strategies. Exposure is measured using either definitive dichotomous indicators of service in Southeast Asia or more complex indicators of the Vietnam experience (i.e., combat, herbicide exposure, atrocities, abusive violence) that are of suspect validity. In studies of psychological health, outcomes are based exclusively on self-reported symptoms, while investigations of mortality and birth defects use death certificates and hospital records. Epidemiologic research on the effects of the Vietnam conflict has been hampered by problems in research design and the inherent difficulties of measuring wartime exposures and long-term health outcomes.
本文探讨了在研究越南战争对退伍军人心理和身体健康的长期影响时所遇到的方法学难题。针对心理（创伤后应激障碍以及酒精使用或滥用）和身体（死亡率以及儿童出生缺陷）健康结果，研究了替代研究设计以及暴露和结果测量方法。关于创伤后应激障碍以及酒精使用或滥用的所有主要流行病学研究均采用横断面研究设计。死亡率和出生缺陷研究则使用队列研究、病例对照研究或比例死亡率策略。暴露情况的测量要么采用在东南亚服役的确切二分指标，要么采用对越南经历（即战斗、接触除草剂、暴行、虐待性暴力）更为复杂的指标，但这些指标的有效性存疑。在心理健康研究中，结果完全基于自我报告的症状，而在死亡率和出生缺陷调查中，则使用死亡证明和医院记录。越南冲突影响的流行病学研究一直受到研究设计问题以及测量战时暴露和长期健康结果所固有的困难的阻碍。
