Longitudinal mental health outcomes of combat-injured service members

Lauren E. Walker, Jessica Watrous, Eduard Poltavskiy, Jeffrey T. Howard, Jud C. Janak, Warren B.P. Pettey, Lee Ann Zarzabal, Alan Sim, Adi Gundlapalli, Ian J. Stewart*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background: The relationship between traumatic injury and subsequent mental health diagnoses is not well understood and may have significant implications for patient screening and clinical intervention. We sought to determine the adjusted association between traumatic injury and the subsequent development of post-traumatic stress disorder (PTSD), depression, and anxiety. Methods: Using Department of Defense and Veterans Affairs datasets between February 2002 and June 2016, we conducted a retrospective cohort study of 7,787 combat-injured United States service members matched 1:1 to combat-deployed, uninjured service members. The primary exposure was combat injury versus no combat injury. Outcomes were diagnoses of PTSD, depression, and anxiety, defined by International Classification of Diseases 9th and 10th Revision Clinical Modification codes. Results: Compared to noninjured service members, injured service members had higher observed incidence rates per 100 person-years for PTSD (17.1 vs. 5.8), depression (10.4 vs. 5.7), and anxiety (9.1 vs. 4.9). After adjustment, combat-injured patients were at increased risk of development of PTSD (HR 2.92, 95%CI 2.68–3.17), depression (HR 1.47, 95%CI 1.36–1.58), and anxiety (HR 1.34, 95%CI 1.24–1.45). Conclusions: Traumatic injury is associated with subsequent development of PTSD, depression, and anxiety. These findings highlight the importance of increased screening, prevention, and intervention in patients with exposure to physical trauma.

Original languageEnglish
Article numbere02088
JournalBrain and Behavior
Issue number5
StatePublished - May 2021
Externally publishedYes


  • anxiety
  • depression
  • injury
  • military health
  • post-traumatic stress disorder
  • risk factors
  • veterans


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