Associations Among Combat Exposure, Adverse Childhood Experiences, Moral Injury, and Posttraumatic Growth in a Large Cohort of Post-9/11 Veterans

Objective: Post-9/11 veterans experienced more deployments, combat exposure, and disability than earlier military cohorts. Those in the military are also more likely to have experienced adverse childhood experiences. Despite these traumatic exposures, a substantial number of veterans report experiencing personal growth, development, and maturity from their military service. Method: This longitudinal survey study (n = 5,245) examined the degree to which posttraumatic growth (PTG) was present among post-9/11 veterans. Several components of PTG were examined, including relating to others, seeing new possibilities, personal strength, spiritual growth, and appreciation for life. Results: Respondents rated their degree of personal growth and new appreciation of life most highly, while spiritual growth and appreciation of others were the least highly rated. Female veterans reported greater PTG. Veterans who experienced traumatic events (i.e., combat exposure, adverse childhood experiences), screened positive for posttraumatic stress disorder, and moral injury reported greater PTG than those who had not experienced those events or screened positive for posttraumatic stress disorder. Veterans reporting higher levels of social support and personal resilience were less likely to experience PTG. Veterans with other protective factors were more likely to experience PTG. Conclusions: Post-9/11 veterans report PTG in the face of various traumatic exposures.