Although previous studies have identified behavioral health risks associated with combat exposure, it is unclear which types of combat events are associated with these risks, particularly regarding contrasts among the risks associated with life‐threatening experiences, killing combatants, and exposure to unjust war events, such as killing a noncombatant or being unable to help civilian women and children. In the present study, we examined surveys from 402 soldiers following deployment (i.e., baseline) and again 13 months later (i.e., Year 1). Regression analyses were conducted across a range of behavioral health (e.g., posttraumatic stress disorder, depression, suicide ideation, anxiety, somatic, insomnia, aggression) and benefit‐finding measures, each controlling for two combat event categories while assessing the predictive utility of a third. The results suggested that life‐threatening events were associated with poor behavioral health at baseline, relative risk (RR) = 10.00, but not at Year 1, RR = 2.67. At both baseline and Year 1, killing enemy combatants was not associated with behavioral health, RRs = 1.67–3.33, but was positively associated with benefit‐finding, RRs = 26.67–40.00. Exposure to unjust war events was associated with a transdiagnostic pattern of behavioral health symptoms at baseline, RR = 40.00, and Year 1, RR = 23.33. Overall, the results suggest unjust war event exposure is particularly injurious, above and beyond exposure to other combat‐related events. Future research can build on these findings to develop clearer descriptions of the combat events that might place service members at risk for moral injury and inform the development of assessment and treatment options.

中文翻译：

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区分生命威胁、杀害敌方战斗人员和不公正战争事件对美国军人的影响

尽管之前的研究已经确定了与战斗暴露相关的行为健康风险，但尚不清楚哪些类型的战斗事件与这些风险相关，特别是与危及生命的经历、杀害战斗人员和暴露于不公正战争事件相关的风险之间的对比，例如杀害非战斗人员或无法帮助平民妇女和儿童。在本研究中，我们检查了 402 名士兵在部署后（即基线）和 13 个月后（即第一年）的调查。对一系列行为健康（例如，创伤后应激障碍、抑郁、自杀意念、焦虑、躯体、失眠、攻击性）和利益发现措施进行回归分析，每个措施控制两个战斗事件类别，同时评估一个事件的预测效用。第三。结果表明，危及生命的事件与基线时的不良行为健康相关，相对风险 ( RR ) = 10.00，但在第 1 年则不然，RR = 2.67。在基线和第一年，杀死敌方战斗人员与行为健康无关，RR s = 1.67-3.33，但与利益发现呈正相关，RR s = 26.67-40.00。暴露于不公正的战争事件与基线时行为健康症状的跨诊断模式相关，RR = 40.00，第一年，RR = 23.33。总体而言，结果表明，暴露不公正的战争事件尤其有害，其危害性远远超过暴露于其他战斗相关事件。未来的研究可以基于这些发现，对可能使军人面临精神伤害风险的战斗事件进行更清晰的描述，并为评估和治疗方案的制定提供信息。