After the war in Nicaragua: a psychosocial study of war wounded ex-combatants.

Despite 150 wars in the Third World since 1945, there have been virtually no psychosocial studies of war wounded ex-combatants. This community study of 72 such men, on average 4.9 years post-injury, had both quantitative (General Health Questionnaire [GHQ] and clinical interview) and qualitative (personal narrative) components. Most men were coping adaptively. However their overall GHQ scores were significantly higher than an ex-combatant control group, suggesting relative psychological vulnerability (P = 0.001). 13 (18 per cent) had post-traumatic stress disorder (PTSD) though in only three was this clinically significant, two of whom were aggressive alcoholics. Social dysfunction was a better indicator of the minority who needed psychological help than a diagnosis of PTSD. The one in three with a severe physical disability were not at greater risk than the rest of the group. Personal narratives illuminated the ways subjects had registered and responded to their war experiences. Identification with the social ideals being defended by the war effort had been psychologically bolstering. Ten severely disabled ex-Contra guerrillas, who had fought on the other side, were also interviewed. The availability of appropriate training/work, and thus the economic fortunes of the whole society, are likely to be major determinants of long-term psychosocial outcomes. Six illustrative personal histories are appended.