Abstract
Military veterans have high rates of posttraumatic stress disorder (PTSD) along with multi-morbid problems, including physical pain and problematic substance use. The etiology of multi-morbid problems likely involves both military experiences and culture. Qualitative research can build understanding of vulnerability for multi-morbid problems. Participants were US veterans with PTSD symptoms, pain, and problematic substance use (n = 20). Qualitative interviews focused on military experiences, multi-morbid problems, and coping. Transcripts were analyzed to develop an explanatory model of multi-morbidity. Military experiences that left veterans vulnerable to PTSD and multi-morbid problems included (1) military deployments, (2) specific discrete events, and (3) the accumulation of stressors over time. In the aftermath of these experiences, military cultural factors that increased vulnerability included (4) the significance of losing one's physical and mental fitness, (5) a tendency to ignore or minimize pain, (6) discrepancies between military and civilian culture, (7) military drinking norms, and (8) treatment stigma. Military cultural factors that decreased vulnerability included (9) camaraderie and (10) service. Military culture moderated the impact of challenging experiences to influence participants' vulnerability for PTSD and multi-morbid problems, in line with bio-cultural models of health. Clinical assessments and treatments should incorporate the range of military cultural risk and protective factors, and veterans' perceptions of how these factors influence their health.