title: Wartime stressors and mental health symptoms as predictors of late-life mortality in World War II survivors.
abstract: BACKGROUND
  Pathways through which wartime stress leads to excess mortality have not been examined so far. The current study examines wartime stress in relation to late-life mortality among 1448 World War II survivors, and potential mediating effects of mental health symptoms that were assessed in 1992.
  
  
  METHODS
  In 1992, a community survey was held. In 2002, vital status was checked.
  
  
  RESULTS
  The highest hazard rates of mortality were found among military veterans and war survivors who had been seriously wounded. Posttraumatic stress disorder, suicidal thoughts, and, particularly, depression were associated with a higher hazard rate. Depression, anxiety, and somatic complaints appeared to act as mediators between the wartime stressor 'permanent disability or illness' and survival time.
  
  
  CONCLUSIONS
  The results may not be generalizable to all World War II survivors since the sample was restricted to those who survived until 1992. In addition, there was a considerable level of non-response, and the study used self-report data on wartime exposure and psychological symptoms.
  
  
  CONCLUSIONS
  Exposure to wartime stress as well as mental health symptoms in the long-term aftermath of war and violence are significant predictors of late-life mortality. Wounded survivors and those with a permanent disability or illness are particularly vulnerable.
authors.affiliation: Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands. i.bramsen@tiscali.nl
authors.forename: Inge
authors.initials: I
authors.lastname: Bramsen
authors.forename: Dorly J H
authors.initials: DJ
authors.lastname: Deeg
authors.forename: Eleonore
authors.initials: E
authors.lastname: van der Ploeg
authors.forename: Sonja
authors.initials: S
authors.lastname: Fransman
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000437:Alcoholism / Q000401:mortality / Q000523:psychology; D001008:Anxiety Disorders / Q000401:mortality / Q000523:psychology; D003130:Combat Disorders / Q000401:mortality* / Q000523:psychology; D003866:Depressive Disorder / Q000401:mortality / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008136:Longevity; D008297:Male; D009104:Multiple Trauma / Q000401:mortality / Q000523:psychology; D009426:Netherlands; D016016:Proportional Hazards Models; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000401:mortality* / Q000523:psychology; D016019:Survival Analysis; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D047789:World War II