As Americans pay tribute to all veterans who have served in the U.S. Armed Forces Monday, new research suggests that how comrades died can affect levels of grief among soldiers who served in Afghanistan and Iraq.
"Our goal was to better understand how combat veterans experience the deaths of their military comrades in battle or by suicide, and what factors predict the nature and level of their grief," said study senior author Roxane Cohen Silver. She is a professor of psychological science, public health and medicine at the University of California, Irvine.
More than 5,400 U.S. military personnel have died in combat since the wars in Afghanistan and Iraq began in 2001 and 2003, respectively, according to the latest casualty report from the U.S. Department of Defense.
And a 2017 Iraq and Afghanistan Veterans of America survey found that 58% of respondents said they knew a veteran who had died by suicide, and 65% knew a veteran who had attempted suicide.
The study included hundreds of veterans of the two wars and discovered that a number of factors influence grief over the loss of comrades.
Suicide death is unexpected and can make acceptance of the loss more difficult, the findings showed, while combat death was described as expected and heroic, and can help make it easier to accept the loss.
Bonds forged in combat intensify emotional responses. Guilt over being unable to prevent a comrade's death -- whether in battle or by suicide -- makes acceptance harder, according to the report. Attribution of blame for a comrade's death causes anger, and detachment from the civilian world may make it more difficult to cope with a comrade's death.
More combat exposure, greater closeness with the comrade who died and increased anger were the main predictors of intense grief. The investigators also found that combat exposure is as strong a risk factor for grief as it is for post-traumatic stress disorder (PTSD).
"While there has been abundant research quantifying war's psychological impact, much of it has focused on PTSD, depression, and substance or alcohol abuse associated with combat exposure," said study lead author Pauline Lubens. She is a policy analyst at the Institute for Veteran Policy at Swords to Plowshares, in San Francisco. "There has been limited focus on grief among veterans," she noted.
"The more we can delineate the distinct toll of suicide and combat loss among the current generation of veterans, the better we can minimize the public health impact of the most recent U.S. wars," Lubens said in a university news release.
"Veterans' postwar health outcomes undoubtedly cascade to their immediate and extended families, as well as their broader communities. Insight into the toll of these losses may inform interventions that enable families to recognize the consequences of grief and to acknowledge it as a postwar malady distinct from PTSD," Lubens said.
The study was published online recently in the journal Social Science & Medicine.
The U.S. Department of Veterans Affairs offers mental health resources.