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The Next Time You See a Vietnam Veteran Tell Them, “Welcome Home”
By Emily Winter

Thoughts From a VA Clinician
Every day, I have Vietnam veterans in tears in my office because they feel as though their families believe they have nothing left to offer. They have realized, over the years, the gravity of their actions during wartime, and they may carry horrific guilt over to the not-so-simple fact that they survived. They know their minds are failing, but their bodies are not, or they know their minds are still sharp, but their bodies are failing. Every day I see veterans in my office who are in wheelchairs or are missing limbs, in tears because their injuries and deployments do not exist on an official level because the paperwork was lost. They are in tears because they know that the professionals who try to help them may develop secondary PTSD due to the stories they told in an attempt to heal.

Historical Context
During the Vietnam War, the military operations were complex and lacked clear front lines, presenting challenges to veterans' mental and physical well-being. Societal attitudes toward the conflict, the reception of military personnel upon their return from deployment, and the benefits of serving all contributed to the broader sociocultural influences on veterans’ mental health.1 Between 1964 and 1975, the US Armed Forces recruited roughly eight million individuals, many of whom were deployed to Vietnam, resulting in the deaths of approximately 56,000 soldiers and injury to at least 300,000. Soldiers were also exposed to Agent Orange, an herbicide containing dioxin that caused various illnesses and physical impairments. Additionally, upon returning to civilian life, many veterans were subjected to physical and verbal attacks by individuals who opposed the war, adding to their already difficult experiences.2

An Aging Population
Research has highlighted the potential long-term effects of combat trauma, which can lead to the resurgence of PTSD symptoms later in life. Vietnam veterans are entering later adulthood and, on average, are in their mid-70s to early 80s and may find it challenging to inhibit unwanted memories, resulting in increased psychological distress. It’s concerning that older individuals may have a more challenging time suppressing negative memories than do young adults, and elderly veterans may perceive that they are experiencing a loss of control due to ineffective defense mechanisms like compartmentalization and repression. This can result in distressing symptoms as negative memories of their combat-related experiences become more difficult to suppress.

Mental Health Outcomes
The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) study revealed a significant correlation between PTSD and other mental health disorders, such as depression and substance misuse. Among Vietnam veterans with PTSD, a staggering 37% also met the criteria for major depressive disorder, while 31% of those with subthreshold PTSD experienced severe depression. In contrast, only 1% of Vietnam veterans without PTSD had severe depression. Both male and female Vietnam veterans with significant trauma exposure during combat had mortality rates almost twice those with lower exposure levels. Approximately 11% of male and 7% of female veterans were diagnosed with PTSD based on DSM-5 criteria, indicating roughly 283,000 male and 400 female veterans experienced PTSD due to their service in Vietnam. Furthermore, roughly 3% of veterans showed subthreshold symptoms of PTSD, which equates to approximately 84,000 men and 200 women.

In Summary
By better understanding the mental health needs of Vietnam veterans as they age, we can develop more effective treatment options for this vulnerable population, ultimately providing the care needed to lead fulfilling and healthy lives. In the meantime, find a veteran, shake their hand, offer a hug, say “thank you,” buy them a coffee or a meal, and listen to their stories (most know which stories to tell and which parts to leave out). Do something, anything, to let them know you see them and see their sacrifice. Most important, the next time you see a Vietnam veteran, tell them, “Welcome home.”

— Emily Winter is employed as a LCSW by the VA, VISN 1, Togus Medical Center and is an adjunct professor in the Master of Social Work program at University of Massachusetts Global. The views expressed are those of the author and are independent of the VA and UMass Global.