World War II vets: physical backlash.

World War II combat veterans who grew up in privileged households and attended an elite university developed relatively few symptoms of post-traumatic stress disorder (PTSD), a debilitating stress reaction observed in a substantial minority of Vietnam vets, according to a 50-year study.

However, veterans from the same group who survived heavy fighting in World War II developed more chronic physical illnesses and died sooner than those who experienced little or no combat, report George E. Vaillant, a psychiatrist at Brigham and Women's Hospital in Boston, and his coworkers.

Even though the incidence of PTSD in this group is relatively low, the data "confirm that severity of trauma is the best predictor of who is likely to develop PTSD," the scientists conclude in the April American Journal of Psychiatry. Moreover, the study suggests that PTSD symptoms do not necessarily prove incapacitating.

Vaillant's group drew on physical and psychological data gathered between 1939 and 1944 from 249 male sophomores at Harvard University. Of that number, 152 served abroad for at least 1 month and completed further testing shortly after their return; six men died in World War II. These 152 veterans completed questionnaires every 2 years thereafter. A final questionnaire and a physical examination were administered in 1988 to 107 of the surviving participants.

This study has the advantage of tracking men throughout much of their lives, beginning before combat exposure. It also largely excludes several predispositions for PTSD, such as poverty, poor education, low military rank, and long-standing behavior problems. These influences have clouded the exact role of combat on Vietnam- era cases of PTSD, the researchers hold.

PTSD symptoms include recurring memories of and nightmares about combat, sleep difficulties, overreactions to sudden noises or other startling events, and a numbing of emotions.

Upon returning to civilian life in 1946, 17 of the 152 veterans- -12 of them survivors of heavy combat--reported two or more PTSD symptoms. Only 1 of the 17 suffered from full-blown PTSD, as defined in 1988; another four nearly qualified for PTSD.

Of those five veterans, two eventually killed themselves, one was murdered, one still suffered from PTSD symptoms in 1988, and one refused to participate in the follow-up.

In 1988, a total of eight veterans, including five who survived heavy combat in World War II, reported one or more PTSD symptoms. These eight had reported no marked signs of anxiety or emotional disorder as undergraduates, the investigators say. Students scoring high on a measure of psychological distress tended to cite comparable distress at age 65, regardless of combat exposure.

Still, intense fighting exacted a physical toll on World War II veterans. Thirty of 54 heavy-combat survivors--including 16 of 27 who faced heavy combat and cited one or more PTSD symptoms in 1946--developed a chronic physical illness or died by age 65. A much lower rate of disease and death occurred in the remaining vets.

Stable family backgrounds may have prepared vets in this sample to master wartime traumas, suggests John C. Nemiah, a psychiatrist at Dartmouth Medical School in Hanover, N.H., in an accompanying editorial.

Extroverted, athletic men were more likely to engage in heavy combat, Nemiah notes. These individuals may be less inclined to reflect on trauma-related emotions and more apt to suffer damaging physiological stress responses, he theorizes.