Pizarro Judith, Silver Roxane Cohen, Prause JoAnn
Department of Psychology and Social Behavior, University of California, Irvine, 92697-7085, USA.
Arch Gen Psychiatry. 2006 Feb;63(2):193-200. doi: 10.1001/archpsyc.63.2.193.
Hundreds of thousands of soldiers face exposure to combat during wars across the globe. The health effects of traumatic war experiences have not been adequately assessed across the lifetime of these veterans.
To identify the role of traumatic war experiences in predicting postwar nervous and physical disease and mortality using archival data from military and medical records of veterans from the Civil War.
An archival examination of military and medical records of Civil War veterans was conducted. Degree of trauma experienced (prisoner-of-war experience, percentage of company killed, being wounded, and early age at enlistment), signs of lifetime physician-diagnosed disease, and age at death were recorded.
The US Pension Board surgeons conducted standardized medical examinations of Civil War veterans over their postwar lifetimes. Military records of 17,700 Civil War veterans were matched to postwar medical records.
Signs of physician-diagnosed disease, including cardiac, gastrointestinal, and nervous disease; number of unique ailments within each disease; and mortality.
Military trauma was related to signs of disease and mortality. A greater percentage of company killed was associated with signs of postwar cardiac and gastrointestinal disease (incidence risk ratio [IRR], 1.34; P < .02), comorbid nervous and physical disease (IRR, 1.51; P < .005), and more unique ailments within each disease (IRR, 1.14; P < .005). Younger soldiers (<18 years), compared with older enlistees (>30 years), showed a higher mortality risk (hazard ratio, 1.52), signs of comorbid nervous and physical disease (IRR, 1.93), and more unique ailments within each disease (IRR, 1.32) (P < .005 for all), controlling for time lived and other covariates.
Greater exposure to death of military comrades and younger exposure to war trauma were associated with increased signs of physician-diagnosed cardiac, gastrointestinal, and nervous disease and more unique disease ailments across the life of Civil War veterans. Physiological mechanisms by which trauma might result in disease are discussed.
全球各地数十万士兵在战争期间面临战斗风险。这些退伍军人一生当中，战争创伤经历对健康的影响尚未得到充分评估。
利用美国内战退伍军人军事和医疗记录中的档案数据，确定战争创伤经历在预测战后神经和身体疾病及死亡率方面的作用。
对美国内战退伍军人的军事和医疗记录进行档案审查。记录经历的创伤程度（战俘经历、连队阵亡百分比、受伤情况以及入伍时年龄较小）、一生中医师诊断疾病的体征以及死亡年龄。
美国养老金委员会的外科医生在退伍军人战后的一生中对他们进行了标准化体检。17700名美国内战退伍军人的军事记录与战后医疗记录进行了匹配。
医师诊断疾病的体征，包括心脏、胃肠道和神经疾病；每种疾病中独特病症的数量；以及死亡率。
军事创伤与疾病体征和死亡率相关。连队阵亡比例较高与战后心脏和胃肠道疾病体征相关（发病风险比[IRR]，1.34；P < 0.02）、神经和身体合并疾病（IRR，1.51；P < 0.005）以及每种疾病中更多独特病症相关（IRR，1.14；P < 0.005）。与入伍年龄较大者（>30岁）相比，年轻士兵（<18岁）显示出更高的死亡风险（风险比，1.52）、神经和身体合并疾病体征（IRR，1.93）以及每种疾病中更多独特病症（IRR，1.32）（所有P < 0.005），对生存时间和其他协变量进行了控制。
在内战退伍军人的一生中，更多地经历战友死亡以及更早地暴露于战争创伤与医师诊断的心脏、胃肠道和神经疾病体征增加以及更多独特疾病病症相关。文中讨论了创伤可能导致疾病的生理机制。
