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Our evidence map underscores psychological and neurocognitive symptoms and diagnoses associated with military toxic exposures, as well as key gaps in the literature. Most research has focused on chemical (chemical munitions, herbicides), with less information on Camp Lejeune contaminated water, radiation, and heavy metals. Future studies should integrate diverse data sources and focus on more representative samples (women, racially diverse groups, post-9/11 Veterans), to enhance understanding of toxic exposure impacts on modern military populations.
U.S. service members have faced various toxic exposures (biological and chemical agents, airborne hazards, radioactive materials). Yet prevalence of psychiatric conditions among exposed Veterans is poorly understood. The PACT Act broadens VA health care for Veterans with presumed toxic exposure-related conditions, likely increasing Veterans' access to care. Understanding necessary resources for mental health services is crucial for future healthcare planning. This map will help VHA teams provide informed care, develop national screening, and treatment guidelines.
We identified 49 primary studies exploring psychiatric or neurocognitive outcomes associated with military toxic exposures. Depression and PTSD were the most reported psychiatric outcomes, primarily linked to Gulf War chemical munitions and Vietnam Era Agent Orange. Few studies reported other important psychiatric outcomes, such as suicidality and substance misuse. Neurocognitive functioning was less frequently assessed. Large associations were found between PTSD and chemical exposures, burn pits, and mixed exposure types, with moderate to strong links between Agent Orange and psychotic disorders. We observed more consistent associations between anxiety and herbicides and pesticides relative to other kinds of toxic military exposures. Camp Lejeune contaminated water, radiation, and heavy metals are understudied military toxic exposures. Most studies were comprised of majority White and majority male participants. Study samples that are more representative of the modern active-duty and Veteran populations are essential (eg, women, racially diverse participants, and Veterans deployed post-9/11).
Occurrence of Psychiatric Conditions or Symptoms after Military Service-related Environmental and Chemical Toxic Exposures: An Evidence Map - Management Brief
Magnante AT, Nugent SM, Bourassa KJ, et al. Psychiatric Conditions and Symptoms After Toxic Environmental Exposures During Military Service: An Evidence Map. Medical Care. 2026; 64(2S). DOI: https://doi.org/10.1097/MLR.0000000000002149.
