摘要：Objectives . This study determined the percentage of adverse outcomes in US men attributable to combat exposure. Methods . Standardized psychiatric interviews (modified Diagnostic Interview Schedule and Composite International Diagnostic Interview assessments) were administered to a representative national sample of 2583 men aged 18 to 54 in the National Comorbidity Survey part II subsample. Results . Adjusted attributable fraction estimates indicated that the following were significantly attributable to combat exposure: 27.8% of 12-month posttraumatic stress disorder, 7.4% of 12-month major depressive disorder, 8% of 12-month substance abuse disorder, 11.7% of 12-month job loss, 8.9% of current unemployment, 7.8% of current divorce or separation, and 21% of current spouse or partner abuse. Conclusions . Combat exposure results in substantial morbidity lasting decades and accounts for significant and multifarious forms of dysfunction at the national level. Horrific combat experiences were among the defining phenomena of the 20th century. Although exposure to combat is a well-known risk factor for posttraumatic stress disorder (PTSD), 1– 6 PTSD research has focused on individual costs rather than on the societal costs (e.g., national burden of illness) associated with exposure to combat. To date, the proportion of cases of PTSD among US males that is attributable to combat exposure remains undetermined. Although research has demonstrated high rates of psychiatric comorbidity among people with combatrelated PTSD, 1, 4, 6– 8 little is known about the proportion of other forms of psychiatric morbidity, such as substance abuse and major depressive disorders, attributable to combat exposure. Combat-related PTSD has also been linked to occupational morbidity 9, 10 and interpersonal violence in relationships with female partners. 11, 12 The population attributable fractions of these adverse outcomes that are associated with combat exposure have never, to our knowledge, been estimated. The aim of this study was to determine the population attributable fractions of a variety of pathologic outcomes among US males aged 18 to 54 years.
