This mixed-methods study examined how U.S. combat veterans experience the deaths of comrades who have died in combat or by suicide and explored factors that predict their level of grief over those deaths. Recruitment of participants for semi-structured interviews was done through purposive snowball sampling, which enables researchers to create a participant network by receiving referrals from existing participants. Recruitment of participants for completion of a web-based survey was also done through snowball sampling, as well as veterans’ social media sites and non-profit organizations serving veterans’ health needs. In addition, veteran services offices on college and university campuses in several states disseminated the survey link, as did key informants, individuals who are not necessarily part of the study population but who are familiar with the population professionally or personally. All participants who were interviewed were also asked to complete the survey.
Iraq and Afghanistan veterans who lost comrades to both combat and suicide (N=28) were interviewed. Veterans who lost a comrade in combat or to suicide completed the survey (N=186), which included measures of grief, combat exposure, unit cohesion, anger, posttraumatic stress symptoms (PTSS), and social support.
Text analyses of the interview transcripts revealed seven themes: 1) Suicide death as unexpected can make acceptance of death harder; 2) Combat death as expected can ease acceptance of death; 3) Combat death as heroic can make acceptance of death easier; 4) Brotherhood forged in combat intensifies the emotional response, even if the deceased was not a friend; 5) Guilt over inability to prevent a comrade’s death makes acceptance harder; 6) Attribution of blame for a death creates anger; and 7) Detachment from the civilian world may make it more difficult to cope with comrades’ deaths.
Multiple regression analyses of survey data indicated: 1) Suicide deaths predict a higher level of non-acceptance; 2) The mode of death moderates the association between unit cohesion and grief; 3) Combat exposure, anger, closeness to the deceased, and gender predict the level of grief; 4) Combat exposure is an equally strong predictor of grief and PTSS.
This study’s focus on veteran’s grief further delineates war’s toll. The mixed-methods design allowed the study to tell a complex story about a complicated and previously unexplored consequence of war. These findings have important public health implications because these outcomes impact not only veterans, but their families and communities as well.
