- The purpose of this dissertation was to examine the effects of war stressors and psychosocial factors on negative and positive mental health outcomes among Korean Vietnam War veterans. The sample consisted of 367 male veterans who completed a self-reported survey conducted in 2017 (Mage = 72, SD = 2.66, range = 65-84). Most were married (86.89%), high school graduates or below (89.4%), and served at the Army (87.5%).
In Study 1, we examined the relative impacts of four types of war stressors (combat exposure, malevolent environments, perceived threat, and moral injury) on PTSD, depressive, and anxiety symptoms, controlling for demographics (education, income) and psychosocial factors (optimism, unit cohesion, and homecoming experience). Overall, combat exposure was significantly associated with the three types of psychological outcomes. However, its impact became non-significant when subjective war stressors (malevolent environments, perceived threat, and moral injury) were added to the models. Interestingly, malevolent environments, which may be regarded less severe but more chronic stressors, were consistently and strongly associated with higher levels of PTSD, depressive, and anxiety symptoms. Moral injury had a unique impact on PTSD and anxiety symptoms, while perceived threat was independently associated with depressive and anxiety symptoms. Among psychosocial factors, only optimism provided an independent impact on the three types of mental health outcomes in the final regression models. The results are in line with James et al. (2013) and Maguen et al. (2009), which showed stronger effects of moral injury or perceive threat over combat exposure on PTSD symptoms, but extended it by examining the unique effects of four types of war stressors on depressive or anxiety symptoms, as well as PTSD symptoms.
In Study 2, we sought to identify the classifications of veterans’ mental health, using late-onset stress symptomatology (LOSS), PTSD symptoms, and psychosocial well-being (WB). A latent profile analysis yielded five classes as the best phenotypes of mental health: 1) Low Affect (n = 45, low LOSS, low PTSD, and low WB), 2) Resilience (n = 43, middle LOSS, low PTSD, and high WB), 3) Normal (n = 134, middle LOSS, middle PTSD, and middle WB), 4) Moderate Distress (n = 109, moderate LOSS, moderate PTSD, and middle WB), and 5) Severe Distress (n = 24, high LOSS, high PTSD, and middle WB). The Resilience class showed the highest levels of optimism, desirable appraisals of military service, and social support from family, significant others, friends, and military peers. Undesirable appraisals of military service were highest in the Severe Distress class, and lowest in the Resilience and Low Affect classes. These results provide empirical evidence for the individual-level process model from Spiro, Settersten, and Aldwin (2016), which emphasized the beneficial impacts of resilience resources on negative and positive mental health outcomes.
Given that most research findings on veterans are from studies of Western veterans, the findings from this dissertation provide information about the long-term impacts of multiple types of war stressors on psychological distress and the importance of intervention focusing on resilience resources for mental health among Korean Vietnam War veterans, an Asian veteran sample. Specifically, it revealed relatively high levels of PTSD in this sample, suggesting a need of psychosocial interventions to improve the mental health in this group.