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14 Biobehavioral Resilience to Stress

feel down,” were separated from service in less than 4 years, compared with
just 30% of those who responded “false” to the same question. When train-
ees were asked to respond to the statement, “I have seriously thought about
taking my life more than once,” attrition rates were 48% and 30% for those
who answered “true” and “false,” respectively.
Certainly, mental illness has known relevance to suicide and PTSD.
Although relatively few young people with psychiatric disorders commit sui-
cide, 90% of those who commit suicide have suffered at least one psychiatric

disorder (see Gould et al., 2003). Similarly, previous psychiatric history is
a predictor of PTSD in military populations (weighted average r = 0.14;
Brewin et al., 2000).

Childhood Physical or Sexual Abuse
Numerous studies have demonstrated a relationship between childhood
abuse and subsequent attrition from the military (Booth-Kewley et al., 2002;

Carbone, Cigrang, Todd & Fiedler, 1999; Caulfield, 2000; Cigrang, Carbone,
Todd & Fiedler, 1998; Crawford & Fiedler, 1992; Knapik et al., 2004; Merrill,

Stander, Thomsen, Crouch & Milner, 2004; Smikle, Fiedler, Sorem, Spencer
& Satin, 1996; Staal, Cigrang & Fiedler, 2000). For example, in a prospective
study of 5491 U.S. Navy recruits (Merrill et al., 2004), 55% reported having
been exposed or directly victimized by family violence, physical abuse, or
sexual abuse. Merrill et al. found that attrition rates were signifi cantly higher
for these recruits. Rates of attrition for male and female recruits who had
experienced all three types of abuse were 3.0 and 1.4 times greater than attri-
tion rates for recruits who had not been exposed to family violence or abuse,
respectively.
Although statistical relationships reported in the literature are gener-
ally small in magnitude, it appears that a history of child abuse may also
relate to a range of psychiatric symptoms later in life. Child abuse has been
linked to somatization (physical complaints without known physical basis),
depression, anxiety, and hostility (Rosen & Martin, 1996). Longitudinal
community studies have found that self-reports of childhood physical and
sexual abuse are associated with an increased risk of suicidal behavior in
adolescence (Fergusson, Horwood & Lynskey, 1996; Silverman, Reinherz
& Giaconia, 1996). A review of the literature on PTSD (Brewin et al., 2000)

identified one study that reported a correlative relationship (r = 0.25)
between child abuse and PTSD in military populations. Two additional
studies of military populations also point to a possible relationship between
childhood abuse and the subsequent development of PTSD-related symp-

toms (Merrill, 2001; Merrill, Thomsen, Sinclair, Gold & Milner, 2001). Th at

is, some individuals who enter the military already suffer from undiagnosed
PTSD symptoms that may be exacerbated by exposure to combat-related
stress.

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