Combat and operational risk factors for post-traumatic stress disorder symptom criteria among United States air force remotely piloted aircraft “Drone” warfighters

•6.15% of participants met PTSD symptom criteria as outlined in DSM-5.•RPA operators 31–35 and 36–40 ha d greater odds of meeting symptom criteria.•Operators working 51+ hours also had greater odds of meeting symptom criteria.•Number of events in which bystanders were killed was a significant predictor.•Sense of shared responsibility for death of a bystander was also a predictor. The prevalence and expression of post-traumatic stress disorder (PTSD) symptoms among United States Air Force remotely piloted aircraft (RPA; commonly referred to as “drones”) warfighters exposed to battlefield trauma via remote, electronic warfare is relevant and critical to the effective delivery of mental health care for this population. RPA warfighters (n = 715) with real-time exposure to at least one traumatic event participated in an online survey. Measures included the PTSD Checklist for DSM-5 (PCL-5) and survey of exposure to traumatic events during the course of operational combat missions. A total of 6.15% met PTSD symptom criteria; those in the age ranges of 31–35 and 36–40 and those working 51 or more hours per week had greater odds of meeting symptom criteria. For combat-related events, the number of events in which RPA warfighters witnessed civilian bystanders being killed by enemy forces or felt shared responsibility for the injury or death of bystanders were also significant predictors, regardless of whether the risk was anticipated or unanticipated. The results of this study suggest that specific types of exposure and participation in missions with specific outcomes, albeit via electronic, remote means, are associated with an increased risk for meeting PTSD symptom criteria.