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Publication Briefs

Study Suggests Taking a Life in War Associated with Higher Rates of PTSD and Behavioral/Adjustment Problems in OIF Soldiers


  • Overall, 40% of the soldiers in this study reported direct killing or being responsible for killing during their deployment.
  • Taking another life in war was an independent predictor of multiple mental health symptoms. Even after controlling for combat exposure, killing was a significant predictor of PTSD symptoms, alcohol abuse, anger, and relationship problems. In addition, 22% of soldiers met threshold screening criteria for PTSD, 32% for depression, and 25% for alcohol abuse.
  • The authors suggest a comprehensive evaluation of Veterans returning from combat should include an assessment of direct and indirect killing and reactions to killing. This information could be part of a treatment plan, including specific interventions targeted at the impact of taking a life.

Military personnel involved in modern warfare are at high risk of taking another life, especially given the proximity of combatants and civilians and the chaos of urban environments, among other factors. This study examined the relationship between killing and mental health among 2,797 soldiers returning from Operation Iraqi Freedom (OIF). Data were collected by the Army as part of the routine Post-Deployment Health Reassessment screening program at one large facility between November 2005 and June 2006. As part of the self-reported measures, soldiers answered questions concerning: demographics, combat exposure, PTSD, depression, alcohol abuse, hostility/anger, relationship problems, and killing experiences - both direct (killing others) and indirect (believing others were killed as a result of soldiers' own actions).


  • This was a retrospective study of OIF soldiers conducted at one large Army installation, thus may not be generalizable to other service branches or Veterans. Rates of refusal were not available.
  • Outcome measures used in this study were self-report measures used for mental health screening and not diagnostic instruments.


  • These results are similar to recent analyses of data from the National Vietnam Veterans Readjustment Study, which reported that 47% of Vietnam Veterans reported killing, or thought they killed, during deployment. Those who reported killing had higher rates of PTSD symptoms, dissociation, functional impairment, and violent behaviors. [Maguen S, Metzler T, Litz B, et al. The impact of killing in war on mental health symptoms and related functioning. Journal of Traumatic Stress, October 2009;22(5):435-443.]

This study was supported through an HSR&D Career Development Award. Drs. Maguen, Seal, and Knight are part of HSR&D's Program to Improve Care for Veterans with Complex Comorbid Conditions.

PubMed Logo Maguen S, Lucenko B, Reger M, Gahm G, Litz B, Seal K, Knight S, and Marmar C. The Impact of Reported Direct and Indirect Killing on Mental Health Symptoms in Iraq War Veterans. Journal of Traumatic Stress February 2010;23(1):86-90.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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