title: Moral transgression during the Vietnam War: a path analysis of the psychological impact of veterans' involvement in wartime atrocities.
abstract: OBJECTIVE
  Involvement in wartime combat often conveys a number of deleterious outcomes, including posttraumatic stress disorder (PTSD), depression, hostility, aggression, and suicidal ideation. Less studied is the effect of engagement in wartime atrocities, including witnessing and perpetrating abusive violence.
  
  
  METHODS
  This study employed path analysis to examine the direct effects of involvement in wartime atrocities on hostility, aggression, depression, and suicidal ideation independent of combat exposure, as well as the indirect effects via guilt and PTSD symptom severity among 603 help-seeking male Vietnam War veterans.
  
  
  RESULTS
  Involvement in wartime atrocities was predictive of increased guilt, PTSD severity, hostility, aggression, depressive symptoms, and suicidal ideation after controlling for overall combat exposure. Combat-related guilt played a minor role in mediating the effect of atrocity involvement on depression and suicidal ideation. PTSD severity had a larger mediational effect. However, it still accounted for less than half of the total effect of involvement in wartime atrocities on hostility, aggression, and suicidal ideation.
  
  
  CONCLUSIONS
  These findings highlight the heightened risk conveyed by involvement in wartime atrocities and suggest that the psychological sequelae experienced following atrocity involvement may extend well beyond guilt and PTSD.
authors: a Durham Veterans Affairs Medical Center , Durham , NC , USA.|b Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.
authors: Paul A
authors: PA
authors: Dennis
authors: a Durham Veterans Affairs Medical Center , Durham , NC , USA.|b Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.
authors: Nora M
authors: NM
authors: Dennis
authors: a Durham Veterans Affairs Medical Center , Durham , NC , USA.|b Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.
authors: Elizabeth E
authors: EE
authors: Van Voorhees
authors: a Durham Veterans Affairs Medical Center , Durham , NC , USA.|b Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.|c Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center , Durham , NC , USA.|d Veterans Affairs Center for Health Services Research in Primary Care , Durham , NC , USA.
authors: Patrick S
authors: PS
authors: Calhoun
authors: a Durham Veterans Affairs Medical Center , Durham , NC , USA.|b Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.
authors: Michelle F
authors: MF
authors: Dennis
authors: a Durham Veterans Affairs Medical Center , Durham , NC , USA.|b Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.|c Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center , Durham , NC , USA.
authors: Jean C
authors: JC
authors: Beckham
mesh_terms: D003130:Combat Disorders / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009014:Morals; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data*; D047829:Vietnam Conflict; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Abusive violence; depression; guilt; moral injury; posttraumatic stress disorder; suicidal ideation