World War II had consequences for continental Europeans. Living in a war-torn country increased the likelihood of a number of physical and mental problems later in life, according to a paper by economists. 

 World War II was one of the transformative events of the 20th century, causing the death of 3 percent of the world's population, up to 39 million of those in Europe, half of them civilians. Six years of ground battles and bombing resulted in widespread destruction of homes and physical capital. Discrimination and persecution were widespread, with the Holocaust as the most horrific example. Many people were forced to give up or abandon their property and periods of hunger became common, even in relatively prosperous Western Europe. Families were separated for long periods of time, and many children lost their fathers and witnessed the horrors of battle. 

Experiencing the war was associated with a greater chance of suffering from diabetes, depression and heart disease as older adults, according to the analysis. Because so many men died during the conflict, the war also lowered the probability that women would marry and left many children to grow up without fathers -- a key factor in lower levels of education among those who lived through the war. 

The results come from a detailed information from older people surveyed across 12 European nations about their experiences during the war, as well as their economic status and health later in life.

"While an event of the magnitude of World War II affected all social classes across Europe, our evidence suggests that the more-severe effects over the past decades were on the middle class, with the lower class right behind them in terms of the size of the impact," said James P. Smith, one of the study's authors and Distinguished Chair in Labor Markets and Demographic Studies at the RAND Corporation, a nonprofit research organization. Other authors of the study are Iris Kesternich, Bettina Siflinger and Joachim K. Winter of the University of Munich.

While much attention has been given to studying the battles of war, less effort is devoted to how a conflict of this magnitude affects civilians decades after a conflict. The study, conducted by scholars in the United States and Germany, examines how war can influence the lives of survivors decades after the fighting ends.

"Given the scale of World War II and the ways it fundamentally changed the world, the existing economic literature about its long-term impact is remarkably thin," Winter said. "Studies of this type are important to help society better understand the many long-term consequences of military conflict."

The new study investigates the long-term effects of the war on health, education, economic attainment and marriage among people who live in continental Western Europe. Researchers analyzed information collected from the European Survey of Health, Aging, and Retirement in Europe (SHARE), which was conducted in 2008. The survey provides information from a representative sample of 20,000 people aged 50 and older from 13 countries -- Austria, Belgium, Czech Republic, Denmark, France, Germany, Greece, Italy, Netherlands, Poland, Sweden and Switzerland.

Researchers examined salient war-related facts, exposure to periods of hunger, persecution and loss of property such as a home. Experiences were contrasted between respondents who experienced the war or not, and between regions within countries where fighting was centered and those where there was little military activity.

The study found that living in a war-torn country during World War II was consistently associated with having poorer health later in life. Those respondents who experienced war were 3 percentage points more likely to have diabetes as adults and 5.8 percentage points more likely to have depression. In addition, people exposed to the war had lower education levels as adults, took more years to acquire that education, were less likely to marry, and were less satisfied with their lives as older adults.

Researchers say future economic growth was not a primary reason for long-term war effects.

"What appears to be essential in the long term in terms of economic growth was not whether countries were on the winning or losing side of the war, but whether they were able eventually to transit to democracy and open-market economies," Smith said.

People were more likely to report health problems and lower wealth in their older ages if they were from families in the middle or lower economic classes during the war, with the association strongest among those who belonged to the middle class.

While respondents from regions with heavy combat action were showing adverse long-term effects, those were not much stronger than for respondents who experienced war, but who did not directly experience heavy combat action in their region.

Instead, poor mental and physical health later in life appears to be linked to lower education, changing gender ratios caused by high rates of deaths among men, wartime hunger and long-term stress leading to adult depression and lower marriage rates. The one notable exception is depression, which is significantly higher for those respondents who lived in regions with heavy combat action.

"War has many noticeable consequences, but it also takes a toll on the health and well-being of survivors over the course of their lives," Kesternich said.

"It is important that we seek out this sort of information from the survivors of battle so we can better understand this long-term suffering," added Siflinger.

"Looking only at the costs of war during a war or immediately afterwards significantly understates the complete costs of war," Smith concluded.