History Shows Depression, Mental Illness, More Likely in Younger Soldiers
> 2/7/2006 1:23:05 PM

The most recent issue of the Archives of General Psychiatry contains a piece that brings history into the study of medicine, and psychiatry specifically, in an interesting way. Researchers from the University of California Irvine have used medical records from over 15,000 Civil War soldiers to analyze the effects of battle on lifetime prevalence of psychological and physical problems.

Researcher Judith Pizarro noted that "Civil War data represent a rare opportunity to look at medical records of war veterans over the life course, from a very young age until death." Amazingly, during the Civil War, the Union army included enlistees as young as 9-years-old and as old as 71. Upon enlistment each soldier was given a physical the marked his age. As Pizarro continues, "Not only are the data complete – meaning all the veterans are deceased – but the information is remarkably reliable because veterans’ ailments were diagnosed by government physicians before being included in their official medical records."

The conclusions reached by the Irvine team highlight some important trends. "We demonstrate substantial long-term health effects of traumatic war experiences among Civil War soldiers. While war trauma was moderately associated with developing signs of GI, cardiac, or nervous disease alone, it was strongly associated with developing signs of nervous and physical disease in combination."

In particular, greater percentage of company killed, a measure of intimacy with violence, was strongly associated with a "signs of postwar cardiac and gastrointestinal disease, comorbid nervous and physical disease and more unique ailments within each disease." Researchers also found that age of enlistment was strongly correlated with health problems throughout lifespan. "Veterans who were younger at enlistment had a 93% increased risk of developing signs of comorbid physical and nervous disease and experienced a 32% increased incidence of unique disease ailments. Young veterans (<18 years at enlistment) were at increased risk of early death if they witnessed more death during the war. In all analyses, we controlled for age at death, ensuring that these results were not simply because of the fact that younger men lived longer and, thus, had more opportunity to develop disease. "

Lead researcher Roxane Cohen Silver points out that although the data being examined was mined from what seems like ancient history, war is war. "Unfortunately, it's likely that the deleterious health effects seen in a war conducted more than 130 years ago are applicable to the health and well-being of soldiers fighting in the 21st century," she said.

One intriguing side note to the team's research is that there was a fair amount of linguistic analysis that needed to happen to translate 19th century diagnoses into 21st century diseases and disorders. "Soldier's heart" was a term that covered the emotional and physical ailments affecting vets, but could have included several different diagnoses.

The team explains their medical detective work in the methods section of their paper. "A veteran was classified as having signs of cardiovascular, GI, or nervous disease if he was ever diagnosed as having 1 or more ailments from the upcoming categories in his postwar lifetime. Signs of physical or nervous disease, alone or in combination, diagnosed during any examination over the recruit's postwar lifetime were coded into one 6-level categorical variable: no disease, cardiac disease only, GI disease only, cardiac and GI disease, nervous disease only, and nervous disease with cardiac and/or GI disease... Nervous disease ailments included paranoia, psychosis, hallucinations, illusions, insomnia, confusion, hysteria, memory problems, delusions, and violent behavior." Obviously, post traumatic stress disorder and many other diagnoses would likely have been noted to a varying degree depending on symptoms and on the examining doctor. Even still, the catch-all category within the study indicates that the conclusions of the researchers still hold merit.

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