The impact of reported direct and indirect killing on mental health symptoms in Iraq war veterans


  • This study was funded by a VA Health Services Research and Development Career Development Award. The authors would like to thank Jeane Bosch and Sabra Inslicht for their assistance with this manuscript. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or representing the views of the Department of the Army or the Department of Defense. Preliminary results were presented at The International Society of Traumatic Stress Studies, Chicago, November 13–15, 2008.


This study examined the mental health impact of reported direct and indirect killing among 2,797 U.S. soldiers returning from Operation Iraqi Freedom. Data were collected as part of a postdeployment screening program at a large Army medical facility. Overall, 40% of soldiers reported killing or being responsible for killing during their deployment. Even after controlling for combat exposure, killing was a significant predictor of posttraumatic disorder (PTSD) symptoms, alcohol abuse, anger, and relationship problems. Military personnel returning from modern deployments are at risk of adverse mental health conditions and related psychosocial functioning related to killing in war. Mental health assessment and treatment should address reactions to killing to optimize readjustment following deployment.