February 3, 2025 – Two major new studies from the Columbia University Mailman School of Public Health reveal that veterans of the Vietnam War continue to face significant psychological and physical health challenges decades after their combat experience. The research, one of the longest observational studies of Vietnam veterans to date, finds that PTSD and combat exposure are strongly linked to cardiovascular disease and chronic illnesses, as well as ongoing psychological distress, with effects persisting up to 50 years after their service.
Published in the Journal of Occupational and Environmental Medicine (JOEM), the studies are the result of a unique, 35-year-long investigation into the health and well-being of now aging Vietnam War veterans. (See Impact of Persistent Combat-Related PTSD on Heart Disease and Chronic Disease Comorbidity in Aging Vietnam Veterans and Persistence and Patterns of Combat-Related PTSD, Medical, and Social Dysfunction in Male Military Veterans 50 Years After Deployment to Vietnam.) A subgroup of 729 still living veterans deployed to Vietnam, drawn from a broader sample of 12,400 men who served in the U.S. Armed Forces during the Vietnam War, were surveyed over three data collection periods (1984, 1998, and 2020). The study shows that both combat exposure and PTSD are key predictors of long-term physical and mental health outcomes.
"Combat exposure and PTSD were strong predictors of heart disease and other chronic illnesses in veterans, especially those who faced the most intense combat," said Jeanne Stellman, PhD, co-author and Professor Emerita of Health Policy and Management at Columbia Mailman School. "This research reinforces how the trauma of war continues to affect veterans long after the war ends."
The study's findings are especially concerning regarding veterans' cardiovascular health: 28% of participants reported being diagnosed with heart disease, with those who experienced higher levels of combat exposure being twice as likely to report heart disease compared to those with less exposure. PTSD was also strongly associated with increased rates of chronic conditions such as arthritis (46.5%), sleep apnea (33%), and gastroesophageal reflux disease (GERD) (23.5%).
"These findings are significant not only for veterans but for public health as a whole," said Steven Stellman, PhD, co-author and Professor Emeritus of Epidemiology at Columbia Mailman. "The ongoing health risks, particularly cardiovascular disease, highlight the need for long-term care strategies that account for both the psychological and physical burdens of PTSD."
Sub-threshold PTSD
A form of PTSD where veterans' symptoms fall below the threshold for a formal diagnosis—was also identified as a significant contributor to health issues. Veterans with sub-threshold PTSD were found to have worse physical and mental health outcomes than those who never experienced PTSD. Despite the clear evidence of distress, veterans with sub-threshold PTSD are often ineligible for Veterans Affairs (VA) services, highlighting a critical gap in the current healthcare system.
"Veterans with sub-threshold PTSD suffer significant health burdens that are often overlooked," said Steven Stellman, emphasizing the need for updated VA policies to include these veterans in care and treatment programs.
The study tracking the psychosocial aspects of combat exposure identified four distinct patterns of PTSD over 35 years. In 2020, 9% of veterans still had PTSD, with 15.5% of those who had been exposed to heavy combat. Additionally, 25% had sub-threshold PTSD, while 10% had PTSD in the past but no longer exhibited symptoms. More than half (56%) of the participants never experienced PTSD. Those with PTSD or sub-threshold PTSD reported significantly worse life satisfaction, higher levels of anxiety and depression, and poorer overall health.
"Veterans who had fewer community social supports upon their return from Vietnam were more likely to develop PTSD," noted Jeanne Stellman. This finding underscores the importance of early, ongoing social and mental health support for veterans as they reintegrate into civilian life.
The study also links PTSD to social and familial challenges. Veterans with PTSD or sub-threshold PTSD had higher rates of divorce and separation, especially those who had been exposed to more intense combat. These long-term mental health effects contribute to the complex, multifaceted challenges faced by aging veterans.
With an average age of 72, this cohort of veterans is at a critical stage in life, and their ongoing health problems necessitate continued attention from both healthcare providers and policymakers. The researchers call for a more comprehensive approach to veteran care, one that considers the full spectrum of PTSD symptoms, including sub-threshold cases, and addresses both the psychological and physical toll of combat.
"The relationship between PTSD and chronic illness, particularly cardiovascular disease, continues to evolve, and it is essential to continue assessing and treating the long-term effects of these conditions," said Jeanne Stellman. "This study provides crucial insights into the lasting legacy of the Vietnam War on those who served and underscores the urgent need for improved care and policies to address their ongoing health needs."
The study was funded by The Foundation for Worker, Veteran and Environmental Health (VA241-17-Q-0337), The American Legion, The American Cancer Society, National Academy of Sciences (NASVA-5124- 98-001), and Department of Veterans Affairs.
Other co-authors of the study include Anica Pless Kaiser, Brian N. Smith, and Avron Spiro from the National Center for PTSD and Boston University School of Medicine.
The authors report no conflicts of interest.
Columbia University Mailman School of Public Health
