Findings from the National Vietnam Veterans' Readjustment
Study
Jennifer L. Price, Ph.D.
Introduction
The National Vietnam Veterans' Readjustment Study (NVVRS) was
conducted in response to a congressional mandate in 1983 for an
investigation of posttraumatic stress disorder (PTSD) and other
postwar psychological problems among Vietnam veterans (Kulka et
al., 1990a, Kulka et al., 1990b). The purpose of the NVVRS was to
obtain accurate prevalence rates of postwar psychological
problems in order to serve the needs of the nation's veterans.
The NVVRS used a multimethod assessment approach (e.g.,
self-report, clinical interview) to study representative national
samples of Vietnam veterans and their peers. Participants were
grouped according to their involvement in the Vietnam war,
including Vietnam theater veterans (i.e., men and women who
served on active duty in Vietnam, Laos, or Cambodia), Vietnam era
veterans (i.e., men and women who served on active duty during
the Vietnam era but not in the Vietnam theater), and nonveterans
or civilian counterparts (i.e., men and women who did not serve
in the military during the Vietnam era).
What were the major findings of the NVVRS?
The most important overall conclusion of the NVVRS was that
across over 100 life-adjustment indices, the majority of Vietnam
veterans appeared to have successfully readjusted to postwar
life, and the majority were at the time of the study experiencing
few symptoms of psychological disorders. However, the NVVRS also
revealed that a substantial minority of Vietnam theater veterans
were suffering from a variety of psychological problems and
experiencing a wide range of life-adjustment problems (e.g.,
marital problems, work difficulties). Unfortunately, only a small
number of these veterans actually sought treatment from mental
health providers.
What is the prevalence of posttraumatic stress disorder?
PTSD was assessed using a multimethod approach, including
three primary indicators: the Mississippi Combat-Related PTSD
Scale, the Minnesota Multiphasic Personality Inventory-PTSD
Scale, and the Structured Clinical Interview for DSM-III-R PTSD
module. Seven secondary indicators were also used. According to
the results gathered using these assessment tools, an estimated
15.2% of male and 8.5% of female Vietnam theater veterans met
criteria for current PTSD (Schlenger et al., 1992; see Table 1).
Those with high levels of war-zone exposure had significantly
higher rates, with 35.8% of men and 17.5% of women meeting
criteria for current PTSD. Rates of PTSD were consistently higher
for Vietnam theater veterans than for Vietnam era veterans and
civilians. The NVVRS estimated prevalence of lifetime PTSD among
Vietnam theater veterans was even higher, with similar rates
between male and female veterans (see Table 1). As opposed to
full PTSD, Weiss et al. (1992) found that a substantial number of
Vietnam veterans had current partial PTSD, with even higher
prevalence rates for lifetime partial PTSD (see Table 1).
Overall, the NVVRS found that at the time of the study
approximately 830,000 male and female Vietnam theater veterans
(26%) had symptoms and related functional impairment associated
with PTSD.
Table 1
Rates of PTSD and Partial PTSD for Vietnam Theater
Veterans
PTSD
Partial PTSD
Current
Lifetime
Current
Lifetime
Male
15.2
30.9
11.1
22.5
Female
8.5
26.9
7.8
21.2
In a reanalysis of the NVVRS data, along with analysis of the
data from the Matsunaga Vietnam Veterans Project, Schnurr,
Lunney, Sengupta, and Waelde (2003) found that, contrary to the
initial analysis of the NVVRS data, a large majority of Vietnam
veterans struggled with chronic PTSD symptoms, with four out of
five reporting recent symptoms when interviewed 20-25 years after
Vietnam.
What other psychological disorders are common among Vietnam
veterans?
Vietnam veterans also struggle with a number of psychological
disorders other than PTSD. The most commonly reported disorders
vary slightly between male and female veterans. However,
depression, anxiety, and alcohol problems are typically the most
prevalent across groups (see Table 2).
Table 2
Most-Prevalent Disorders Among Vietnam Theater
Veterans
Almost all of these disorders were more common among Vietnam
theater veterans than among their civilian counterparts, but
initial investigation revealed few differences between Vietnam
theater veterans and Vietnam era veterans. Jordan et al. (1991)
found that Vietnam theater veterans with high levels of war-zone
exposure were significantly more likely than those with low
exposure to develop the psychological disorders listed above.
What other problems did Vietnam veterans report?
In addition to the psychological disorders listed above, a
substantial minority of Vietnam theater veterans also reported
readjustment problems such as occupational instability, marital
conflicts, and family problems. Moreover, veterans with PTSD were
more likely to report marital, parental, and other family
adjustment problems (including violence) than veterans without
PTSD (Jordan et al., 1992). Veterans who experienced the highest
level of war exposure also reported the highest frequency of
physical health problems. Veterans with a current diagnosis of
PTSD or a lifetime diagnosis of substance abuse tended to report
poorer physical health as well.
What are the risk factors for Vietnam veterans?
As indicated above, the NVVRS data revealed that higher levels
of war-zone exposure tended to contribute to a higher degree of
symptoms. Results showed that veterans with one psychological or
readjustment problem tended to have multiple difficulties. In
addition, race/ethnicity appeared to be an important risk factor,
as African-American and Hispanic Vietnam veterans tended to
report more mental health and life adjustment problems. For PTSD
in particular, Hispanic male veterans had the highest prevalence
rate. However, Ruef, Litz, and Schlenger (2000) found that when
the data were reanalyzed, several variables influenced this
relationship. This suggests that ethnicity may not have been the
primary differentiating factor.
A number of other researchers have also reanalyzed the data
from the NVVRS in order to further identify prewar and war-zone
stressor risk factors as well as postwar resilience and recovery
factors. The following summaries provide important information
about some of the most prominent findings.
King, King, Gudanowski, and Vreven (1995) examined war-zone
variables and their relationships to PTSD symptoms. Exposure to
the malevolent environment was strongly associated with PTSD
symptom severity. Other war-zone stressors such as perceived
threat and atrocities/abusive violence were also linked directly
to PTSD severity.
King, King, Foy, and Gudanowski (1996) found that prewar risk
factors differed for women and men. For women, instability within
the family of origin had the largest influence on PTSD; an early
trauma history had a direct link as well. For men, family
instability, childhood antisocial behavior, and a younger age at
entry to the war predicted total PTSD; an early trauma history
was also directly associated with PTSD. An early trauma history
interacted with the war-zone stressor level to increase PTSD
symptoms for male veterans exposed to high levels of combat.
King, King, Fairbank, Keane, and Adams (1998) examined postwar
factors and found that social support, hardiness, and additional
negative life events following Vietnam affected men's and women's
resilience and recovery. Social support played the largest role
as a protective factor against development of PTSD.
King, King, Foy, Keane, and Fairbank (1999) combined prewar,
during war, and postwar variables to determine which are most
important. For women, PTSD was directly affected by (1) the
prewar risk factor of an early trauma history; (2) the war-zone
stressors of atrocities, abusive violence, and perceived threat;
and (3) the postwar resilience-recovery variables of additional
stressful life events, hardiness, and functional social support.
For men, PTSD was directly affected by these same variables plus
the prewar risk factor of age at entry to the war, the malevolent
environment war-zone stressor, and the postwar
resilience-recovery variable of structural social support.
Schnurr, Lunney, and Sengupta (2004) also conducted a
reanalysis using a sample from the NVVRS and a sample from the
Hawaiian Vietnam Veterans Project, which was modeled on the
NVVRS. This reanalysis focused on determining which variables
predict the initial development of PTSD and which variables
predict the maintenance of PTSD symptoms over the longer term
(see Table 3).
Table 3
Risk Factors Associated with PTSD in Vietnam
Veterans
Risk Factors
for PTSD Development
Risk Factors
for PTSD Maintenance
Premilitary Factors
Hispanic ethnicity Family instability Severe punishment during childhood Childhood antisocial behavior Depression
Serious injury during Vietnam War-zone exposure Peritraumatic dissociation*
Postmilitary Factors
Recent stressful life events Post-Vietnam trauma Depression
Recent stressful life events
*Peritraumatic dissociation is
immediate dissociation at the time of the traumatic
event.
Schnurr, Lunney, and Sengupta (2004) also found evidence for
several variables acting as protective factors against the
development and maintenance of PTSD (see Table 4).
Table 4
Protective Factors Associated with PTSD in Vietnam
Veterans
Protective
Factors for PTSD Development
Protective Factors for PTSD
Maintenance
Premilitary Factors
Japanese-American ethnicity High school degree or college education Older age at entry to war Higher socioeconomic status More positive paternal relationship
Native Hawaiian or Japanese-American ethnicity College education
Military Factors
None
None
Postmilitary Factors
Social support at homecoming Current social support
Current social support
Conclusions
The NVVRS sample is arguably the most representative group of
Vietnam veterans to be studied to date. Thus, the results are
critically important in understanding the effect of the Vietnam
War on veterans. Such an understanding is important in developing
and applying mental health treatments to those who continue to
suffer from PTSD or other psychological/readjustment problems.
Using the NVVRS data, recent researchers have confirmed that
premilitary, during military, and postmilitary variables all have
strong influences on who develops PTSD, and these variables
likely also influence who maintains PTSD. An important message
for veterans already exposed to combat violence is that social
support plays a critical role in reducing PTSD symptoms and
increasing one's level of functioning.
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