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I haven't noticed any long term consequences among the people I work with who have killed people (sometimes many, many people).
Everyone I know does get a little 'tweaked' but I think that is more from the stress of combat than from the act of killing. Typically after a big fight guys have a little trouble sleeping, etc. for a few days. However, after an 'easy' fight that is mostly one sided there are no problems, despite our guys killing people.
I think this is due to a couple of reasons:
1: There is no perceived moral ambiguity....We are shooting people who are shooting at us.
2: We are prepared for the eventuality that we will have to shoot people and thus it isn't a 'surprise' where you have to make a decision that is far outside your psychological norm.
3: We are not coddled by an institution that 'expects' you to be messed up following a killing and treats you accordingly. Instead of sympathy our guys get a slap on the back...Then life goes on.
I attended a fantastic lecture by Dr. Dave Grossman (wrote On Killing and On Combat) who is probably the foremost psychologist regarding the psychological effects of warfare and one of his primary points was the power of social conditioning and it's impact on how you behave following shooting someone or getting shot. Basically when you are told from an early age that killing is a horrible thing to be avoided at all costs and will be psychologically shattering, and then you are put in a culture where you are treated that way following a shooting....you are far more likely to have problems than someone limmersed in a culture that treats it as a social norm and simple necessity.
A good example (in reverse) is the behavior of people who get shot. In many, many documented cases in the United States (according to Grossman) people act like they are in the movies when they get shot (i.e. flying backwards, dropping to the floor, etc.) even when shot with small caliber rounds in non-incapacitating places. Contrariwise, in many parts of the world where people are not exposed to the 'hollywood conditioning' they keep fighting until they are physically incapacitated. There isn't enough energy in a bullet to throw you to the ground. At best it will cause you to drop to the ground. To overcome this assaulters get a lot of specialized training and run a lot of scenarios intended to get them over that psychological barrier so they can keep fighting even while wounded....and it works.
To sum up, I think the psychological impact of killing is more PTSD from the actual life-threatening situation which required it than the act of killing. I think a lot of the 'problems' are societal and I think they can be overcome by thinking through what you will or won't do when confronted by lethal-force scenarios until you are comfortable with the possibility that you have have to take someones life in order to protect your own.
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"Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy, its inherent virtue is the equal sharing of misery." - Winston Churchill
"All men dream: but not equally. Those who dream by night in the dusty recesses of their minds wake in the day to find that it was vanity: but the dreamers of the day are dangerous men, for they may act out their dream with open eyes, to make it possible." Seven Pillars of Wisdom, T.E. Lawrence
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