Mental health of U.S. combat veterans by war era: Results from the National health and Resilience in veterans study.

Combat exposure is associated with elevated risk for adverse psychiatric outcomes in military veterans. However, few studies have examined psychiatric characteristics of veterans who served in different war eras. We analyzed data from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 1257 US combat veterans including World War II or Korean War veterans (n = 61, weighted 4.9%), Vietnam War veterans (n = 767, weighted 44.5%), Gulf War veterans (n = 168, weighted 14.5%), and Iraq/Afghanistan War veterans (n = 261, weighted 36.2%). Sociodemographic, military, and mental health factors were examined. Gulf and Iraq/Afghanistan War era veterans were comprised of younger veterans and included more women and racial/ethnic minorities relative to previous era veterans. Overall, Gulf and Iraq/Afghanistan War veterans endorsed greater trauma burden, and were more likely to screen positive for lifetime and current major depressive disorder and posttraumatic stress disorder (PTSD), as well as current suicidal ideation. Among all war era groups, Iraq/Afghanistan war veterans reported the greatest lifetime trauma and combat exposure severity, and were most likely to screen positive for lifetime PTSD (weighted 29.3%), current alcohol use disorder (weighted 17.2%), and current drug use disorder (weighted 12.4%). Specifically, more than 1-in-4 Iraq/Afghanistan War veterans (weighted 26.3%) reported current suicidal thoughts. Collectively, these findings provide war-era specific characterization of the psychiatric status of US combat veterans, which may help inform era-specific assessment, monitoring, and treatment of psychiatric disorders in the combat veteran population.