The Combat Stress Process: Evidence from the American Soldier Study in World War II

Most research on combat exposure and mental health focuses on outcomes most soldiers do not experience, such as posttraumatic stress disorder and suicide. We focus instead on psychological distress using data from World War II. We find that more than 60 percent of Pacific Theater combat soldiers had very high psychological distress, which likely would have disqualified them for military service for psychiatric reasons in 1944. Their symptoms were normally distributed, like those of psychiatric patients. In our stress process model, structural location in military organizations led to psychological distress through exposure to combat and stressors linked to the combat mission. These stressors undermined some psychosocial resources and mobilized others. We conclude that psychological distress in wartime may be a primary cause of postwar problems in the lives of veterans. We recommend that research on soldiers’ mental health make psychological distress a sustained focus of inquiry.