ArticlePsychological medicine2026
Combat injury, pain, and mental health outcomes in US Army service members.
Article in Psychological medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe impact of combat injury on the development of chronic pain and mental health concerns in combat-exposed populations is unknown. This study examined associations of combat injury and injury-related pain with pain-related factors and mental health outcomes, and potential mediation of the relation between combat injury and mental health outcomes by pain-related factors.
methodsPain interference, pain catastrophizing, pain intensity, post-traumatic stress disorder (PTSD), and major depressive episode (MDE) were assessed in (1) a probability sample of US Army soldiers and veterans cross-sectionally and (2) US Army soldiers before and 1, 3, and 9 months after deployment to Afghanistan. Associations among these variables were modeled using logistic regression and multiple mediation analyses.
resultsAmong 5003 service members with cross-sectional data, combat injury-related pain was associated with increased odds of clinically significant pain intensity (OR=2.69), pain interference (OR=3.69), MDE (OR=2.17), and PTSD (OR=3.96) relative to pain from other injuries and conditions. Among 4645 service members assessed pre- and post-deployment, combat injury was associated with increased odds of new-onset pain interference (OR=2.78), pain catastrophizing (OR=2.75), PTSD (OR=4.06), and MDE (OR=2.56) 3 months post-deployment, and PTSD (OR=2.86) and MDE (OR=1.74) 9 months post-deployment. Pain-related factors mediated the relations of combat injury with post-deployment PTSD and MDE.
conclusionsCombat injury is associated with greater odds of pain interference, pain catastrophizing, PTSD, and MDE compared to other sources of pain in a cohort of US service members. Efforts to address pain-related factors following combat injury may mitigate the risk of subsequent chronic pain and mental health disorders.
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