University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Occupational Preventive Medicine


Dr. Nancy Reid, PA-C, DHSc, MHA, DFAAPA


Purpose: The purpose of this article is to report on a 10-year follow-up systematic review of the literature on injury-related mortality among war-exposed military veterans.

Methods: A patient group, intervention/exposure, comparison, and outcome (PICO) via PubMed Search Strategy was conducted with search terms “veterans,” “exposed to combat OR war,” “injury,” and “mortality,” respectively, to PICO PubMed Search Strategy for peer-reviewed articles. After reviewing the initial review from the late 2008 to 2019 timeframe of studies comparing injury-related mortality of war-exposed veterans as compared to those who did not serve in conflict deployment zones, a second review was performed.

Results: Evidence-based research identified n=49 unique records. The n=49 peer-reviewed first-step articles were screened, which resulted in n=21 unique records during the second step search. The best n=3 articles were selected after exclusion of n=18 with low relevance, ambiguous data, and studies with children of combat war-exposed veterans. The n=3 articles were further screened to identify other referenced key articles that were germane and fulfilled most or all inclusion criteria for the systematic review of post-deployment injury-related mortality on combat war-exposed veterans.

Conclusion: In summary, this 10-year follow-up systematic review of three relevant articles identified all-cause (cancer, heart disease, etc.) mortality with PTSD and PTSD subtypes etiologies were associated with significant mortality and risk increased among veterans exposed to war or combat. Previous seminal systematic reviews of post-deployment injury-related mortality among military personnel deployed to conflict zones have identified several hypotheses. The hypotheses derived from the literature included PTSD, coping behaviors (substance abuse), ill-defined diseases and symptoms, lower survivability die to comorbidities, altered perceptions of risk, risk-takers. As compared to this 10-year follow-up systematic review, several hypotheses interacted with previous seminal original research. Unquestionably, this review suggests a future direction for more public health practice and research, which is required to develop relevant interventions for identified etiologies or risk factors among veterans with increased mortality after exposure to war or combat.


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