The External, Internal, and Social Environments of Combat Veterans

Abstract

This study examines whether elevated rates of externalizing behaviors following deployment could be explained by combat exposure and internalizing symptoms of Post Traumatic Stress Disorder (PTSD), as well as the health of the social environment. This study will specifically look at external behaviors such as angry outbursts, drug use, alcohol use, smoking, relationship difficulty, and work/school problems as well as internal PTSD symptoms, guilt and moral injury. Unit leadership, organizational support, and stigma/barriers to care will be studied in order to gauge the health of the social environment for veterans following their deployment. In one study, a military unit was assessed after four months following a fifteen-month deployment to Iraq, using a sample size of 1, 397 soldiers, and 589 soldiers were assessed again five months later. The results concluded that both social environment and internalizing symptoms were significantly associated with levels of externalizing behaviors at four months and nine months post‐deployment, but combat exposure alone significantly predicted change in externalizing behaviors over the follow‐up period (Wright, 2012). Data was collected through self-report measures: Combat Exposure Survey (CES), PTSD symptoms (Mississippi Trauma Survey), Guilt/Moral injury survey and externalized behavioral problems. The goal of this study is to understand the strength of the internal symptoms of guilt and moral injury as strong predictors of expressed destructive external behaviors to PTSD symptomology. Our study will outline the need for future research on the multicultural competency of mental health providers of military culture and post deployed veterans.