Combat Exposure, Agency, Perceived Threat, Guilt, and Posttraumatic Stress Disorder among Iraq and Afghanistan War Veterans

This study assessed how various combat experiences related to post-deployment adjustment among 289 Iraq/Afghanistan veterans. The study examined the relationships among three predictor variables (combat exposure, agency, perceived threat), one mediator (guilt), and two criterion factors (posttraumatic stress disorder/PTSD, and psychological wellbeing/PWB). It distinguished agency (e.g., firing or killing) from combat exposure (e.g., being fired at or witnessing). The study sought to: a) examine whether combat exposure differs from agency as constructs of combat experiences; b) determine the contributions of three predictors to the degree of PTSD and PWB; and c) determine whether guilt mediated the relationships between the three predictors and the two criterion factors. Instruments used included the Combat Experiences Subscale, the Post-Battle Subscale, and the Perceived Threat Subscale from the Deployment Risk and Resilience Inventory (DRRI), the Atrocities Exposure Subscale, the Laufer-Parson Guilt Inventory, the PTSD Checklist (PCL – Military), the Satisfaction With Life Scale, the Self-Acceptance Subscale and the Purpose in Life Subscale developed by Ryff (1989). Factor analyses, correlational analyses, hierarchical regression analyses, and Sobel Tests were used to analyze the data. Results indicated that exposure and agency were two constructs with shared commonalties (especially those involving injuring and killing of enemy combatants). Agency-Civilian-Casualties emerged as a new variable that merits further exploration due to the increases in civilian causalities in modern warfare. Atrocity also appeared to be a distinct variable that needs further examination. About 96% of participants reported having been under fire. However, 41% reported never having fired at the enemies. About 72% reported having at least one moderate PTSD symptom, and 43% could be identified as PTSD positive. All three predictors were highly correlated with guilt, PTSD, and PWB. PTSD was found to be highly (negatively) correlated with PWB. Together, the three predictors accounted for 58% of the total variance for PTSD, and 46% for PWB. When guilt was included in the regression, the four variables accounted for 78% of the total variance for PTSD, and 64% for PWB. Guilt mediated between exposure and PTSD, agency and PTSD, and agency and PWB. Implications of these findings were discussed