Involvement in Abusive Violence Among Vietnam Veterans: Direct and Indirect Associations With Substance Use Problems and Suicidality

Circumstances of modern wars have placed service members at risk for harming noncombatants and engaging in other possible morally injurious acts. Studying a sample of 1,203 combat veterans from the National Vietnam Veterans Readjustment Study (NVVRS), this investigation used structural equation modeling (SEM) to test (1) whether experiences of abusive violence are positively directly linked with drug or alcohol problems and suicidality when accounting for traditional combat stressors, and (2) to what extent experiences of abusive violence have positive indirect effects on these postdeployment outcomes via posttraumatic stress disorder (PTSD) and war-related guilt. Overall, 40% of the sample had witnessed or were directly involved in acts of abusive violence while deployed in Vietnam. When controlling for the effects of traditional combat stressors, SEM results revealed that exposure to acts of abusive violence in Vietnam was linked indirectly with substance abuse via PTSD symptoms and both directly and indirectly with suicidality via PTSD symptoms. There was also a significant link between atrocity exposure and war-related guilt in the model, but veterans' remorse about behavior in Vietnam failed to uniquely predict study outcomes beyond the symptomatology of PTSD. These findings highlight the effects of disproportionate warzone violence on postdeployment mental health, while also suggesting the need for broader conceptual models of combat trauma.