title: Physical and mental health costs of traumatic war experiences among Civil War veterans.
abstract: BACKGROUND
  Hundreds of thousands of soldiers face exposure to combat during wars across the globe. The health effects of traumatic war experiences have not been adequately assessed across the lifetime of these veterans.
  
  
  OBJECTIVE
  To identify the role of traumatic war experiences in predicting postwar nervous and physical disease and mortality using archival data from military and medical records of veterans from the Civil War.
  
  
  METHODS
  An archival examination of military and medical records of Civil War veterans was conducted. Degree of trauma experienced (prisoner-of-war experience, percentage of company killed, being wounded, and early age at enlistment), signs of lifetime physician-diagnosed disease, and age at death were recorded.
  
  
  METHODS
  The US Pension Board surgeons conducted standardized medical examinations of Civil War veterans over their postwar lifetimes. Military records of 17,700 Civil War veterans were matched to postwar medical records.
  
  
  METHODS
  Signs of physician-diagnosed disease, including cardiac, gastrointestinal, and nervous disease; number of unique ailments within each disease; and mortality.
  
  
  RESULTS
  Military trauma was related to signs of disease and mortality. A greater percentage of company killed was associated with signs of postwar cardiac and gastrointestinal disease (incidence risk ratio [IRR], 1.34; P < .02), comorbid nervous and physical disease (IRR, 1.51; P < .005), and more unique ailments within each disease (IRR, 1.14; P < .005). Younger soldiers (<18 years), compared with older enlistees (>30 years), showed a higher mortality risk (hazard ratio, 1.52), signs of comorbid nervous and physical disease (IRR, 1.93), and more unique ailments within each disease (IRR, 1.32) (P < .005 for all), controlling for time lived and other covariates.
  
  
  CONCLUSIONS
  Greater exposure to death of military comrades and younger exposure to war trauma were associated with increased signs of physician-diagnosed cardiac, gastrointestinal, and nervous disease and more unique disease ailments across the life of Civil War veterans. Physiological mechanisms by which trauma might result in disease are discussed.
authors.affiliation: Department of Psychology and Social Behavior, University of California, Irvine, 92697-7085, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Pizarro
authors.forename: Roxane Cohen
authors.initials: RC
authors.lastname: Silver
authors.forename: JoAnn
authors.initials: J
authors.lastname: Prause
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D047831:American Civil War; D001109:Archives / Q000266:history*; D016022:Case-Control Studies; D002648:Child; D003130:Combat Disorders; D017281:Cost of Illness; D006304:Health Status; D049672:History, 19th Century; D006801:Humans; D008016:Life Change Events; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D009017:Morbidity; D009026:Mortality; D011329:Prisoners / Q000266:history; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000266:history* / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology / Q000266:history* / Q000401:mortality