greater levels of hardiness had less postdeployment depression. Studies of deployed Gulf War veterans have found that hardiness was protective against the adverse effects of combat stress and stressful life events and that the level of hardiness was a significant predictor of health outcomes (Bartone 1999). Those with greater hardiness reported fewer physical symptoms than those with lower hardiness regardless of the intensity of the combat exposure or the reported level of stressful life events. For military personnel with long exposure to war-zone stressors, hardiness and perceived social support may gradually diminish, and the diminution can result in deterioration of physical health (Taft et al. 1999).
The types of physiologic changes seen in animals after exposure to uncontrollable stressors have also been observed in humans (see Chapter 4 for a discussion of the animal studies). In a prospective study of 348 Gulf War veterans (all military reservists), Benotsch et al. (2000) measured sense of control with the 45-item Dispositional Resilience Scale 14 months after the conflict (time 1) and 13 months after that (time 2). Veterans’ perceptions of their personal resources, particularly the hardiness components of control and (to a lesser degree) commitment, and problem-focused coping decreased significantly between time 1 and time 2. Conversely, coping with stress through avoidance increased significantly between the two times. Storzbach et al. (2000) found that veterans with unexplained illness reported feeling less control over stressful events that they had recently experienced than did veterans without such illness.
Coping strategies are also associated with ability to respond to stressors. In a study of Vietnam combat veterans, positive coping strategies were found to protect against the development of PTSD symptoms (Wolfe et al. 1993c). When assessed 15 years after their deployment, veterans who used negative coping strategies—such as mental escapism, externalization, and behavioral avoidance—had poorer psychological functioning and more PTSD symptoms than veterans who used nonavoidant coping styles, regardless of the level of combat exposure in each group. Vaillant (1977) found that avoidant behavior was also a major predictor of a downward trajectory in life in a civilian population. It has been shown in other stressful circumstances that ineffective coping strategies, especially avoidant or passive coping as opposed to active problem-solving strategies, predict adverse mental-health outcomes(Arata et al. 2000; Gibbs 1989; North 1995; North et al. 1994, 2001).
In addition to a positive coping style, a perception that some benefit derives from military experience is associated with reduced potential for adverse health effects after combat exposure. Lee et al. (1995), in a 50-year prospective study of World War II combat veterans, found premorbid characteristics to be significantly associated with postcombat psychopathology. Aldwin et al. (1994) conducted a study of 1287 male veterans 44-91 years old, 40% of whom had been engaged in combat. The majority of veterans responded with positive comments about their military service (for example, a sense of mastery, enhanced self-esteem, and effective coping), and there was a linear relationship between perceived benefits and combat exposure. Similar results were seen by Jennings et al. (2006), who found that veterans in the Normative Aging Study (mean age, 74 years) with moderate combat exposure had higher levels of wisdom later in life than veterans with no or high combat exposure; wisdom was assessed with the Adult Self-Transcendence Inventory. Wisdom also correlated positively with perception of benefits of military experience and with positive coping strategies. The studies suggest that a favorable appraisal of one’s combat experience or personal attributes associated with it may mitigate long-term adverse health consequences, such as PTSD.