摘要：Objectives. We sought to better understand the association between early life exposure to war and trauma and older adult health status in a developing setting. Methods. We analyzed data of 405 Vietnamese men and women in 1 northern Vietnam commune who entered early adulthood during the Vietnam War and who are now entering late adulthood (i.e., ages 55 years and older in 2010). Results. The toll of war’s trauma in the aging northern Vietnamese population was perceptible in the association between exposure to war trauma and various measures of physical health, including negative self-reported health and somatic symptoms. Killing another person and being exposed to toxic substances in warfare was especially detrimental to health in older adulthood. War traumas were likely implicated more strongly as determinants of late adulthood health in men than in women. The weak association between trauma exposure and reported depressive symptoms raised questions about measuring mental health. Conclusions. Military service and war trauma were important determinants of older adult health beyond the US context, given the widespread waging of war and concentration of recent armed conflicts within developing societies. Understanding of how exposure to war influences health derives almost exclusively from research among American veterans of 20th century wars. A few notable exceptions demonstrate war’s enduring health consequences in non-Western veteran and civilian populations. 1,2 Although the health of US Vietnam War veterans has been examined extensively, 3–6 little is known about the Vietnamese who experienced war on the side of North Vietnam. Accordingly, aside from a handful of studies 7–9 that examined individual- and community-level Agent Orange exposure, “the ramifications of this war for Vietnamese society are absent from public discourse…[and] social science.” 7 (p12) Vietnam is estimated to have had 1 to 4 million casualties from 1965 to 1975, 10,11 more than 100 times that of the Americans. What, then, might be war’s lingering effects on Vietnamese survivors’ health? Using a unique data set, we examined the effects of specific wartime trauma events and their intensity on the health of veteran and nonveteran populations in older adulthood. Vietnam’s 20th century history was inextricably defined by war, 12 which encompassed all social strata—from soldiers to militia members and civilians. Draft laws made service in the Vietnam People’s Army (VPA) nearly universal for young men from the 1960s to 1980s, 13 and wartime service often entailed combat stress and lengthy, uninterrupted deployments. Alongside the VPA, many northern Vietnamese men, women, and youth served in paramilitary support and defense groups, such as the Youth Shock Brigades, in which duties often entailed combat participation. 14,15 Given high levels of mobilization and expansive US bombing, today’s elderly northern Vietnamese spent their young adulthood proximate to armed conflict, often directly supporting the war effort, engaging in armed combat, and witnessing multiple wartime traumas. Studies of American Vietnam War veterans indicate posttraumatic stress disorder (PTSD) is a central mechanism through which war trauma influences later-life health. 3,16,17 A few studies of Vietnamese refugees who resettled in western societies found psychiatric morbidity associated with high degrees of trauma exposure. 18 Questions remain regarding war’s impacts on health among war survivors in Vietnam, who often endured prolonged periods of stress, as well as injuries, hazardous work, infectious disease conditions, and other exposures prone to undermine health over the long term. 19 Vietnamese cultural beliefs, which stigmatize mental illness, make psychological complaints socially disadvantageous, and somatic complaints socially acceptable, are also implicated in war’s health-related impacts. 20 Refugees who fled Vietnam were a highly selective population whose postwar stressors, and cultural and health environments diverged widely from those who stayed in Vietnam. We examined trauma and health in a sample, who like the majority of Vietnamese, experienced war and readjustment in their home country. We hypothesized that exposure to wartime traumatic events would be a significant determinant of health status among northern Vietnamese older adults. Specifically, we hypothesized that relatively intense war trauma exposure was positively associated with poor self-reported health (SRH), somatic symptom complaints, and depressive symptoms (hypothesis 1) in Vietnamese older adults. We further anticipated that health status would be associated with exposure to particularly severe traumatic events during war. Following previous studies that identified killing in war as uniquely scarring over the life course, 21 we hypothesized that older veterans who reported mortally wounding another person would have poorer health outcomes in later adulthood (hypothesis 2). In addition, given the direct and indirect effects of exposure to toxic materials (e.g., dioxin), 22,23 we expected that older adults who reported such exposure in wartime would be more likely to exhibit poor health status as older adults (hypothesis 3).
