Anger: cause or consequence of posttraumatic stress? A prospective study of Dutch soldiers.

PubMed

Lommen, Miriam J J; Engelhard, Iris M; van de Schoot, Rens; van den Hout, Marcel A

2014-04-01

Many studies have shown that individuals with posttraumatic stress disorder (PTSD) experience more anger over time and across situations (i.e., trait anger) than trauma-exposed individuals without PTSD. There is a lack of prospective research, however, that considers anger levels before trauma exposure. The aim of this study was to prospectively assess the relationship between trait anger and PTSD symptoms, with several known risk factors, including baseline symptoms, neuroticism, and stressor severity in the model. Participants were 249 Dutch soldiers tested approximately 2 months before and approximately 2 months and 9 months after their deployment to Afghanistan. Trait anger and PTSD symptom severity were measured at all assessments. Structural equation modeling including cross-lagged effects showed that higher trait anger before deployment predicted higher PTSD symptoms 2 months after deployment (β = .36), with stressor severity and baseline symptoms in the model, but not with neuroticism in the model. Trait anger at 2 months postdeployment did not predict PTSD symptom severity at 9 months, and PTSD symptom severity 2 months postdeployment did not predict subsequent trait anger scores. Findings suggest that trait anger may be a pretrauma vulnerability factor for PTSD symptoms, but does not add variance beyond the effect of neuroticism. Copyright © 2014 International Society for Traumatic Stress Studies.

Post-traumatic Stress Disorder Among Navy Health Care Personnel Following Combat Deployment.

PubMed

MacGregor, Andrew J; Dougherty, Amber L; Mayo, Jonathan A; Han, Peggy P; Galarneau, Michael R

2015-08-01

U.S. Navy health care personnel are exposed to an array of psychological stressors during combat deployment. This study compared rates of post-traumatic stress disorder (PTSD) among Navy health care personnel with nonhealth care personnel following single and repeated combat deployments. The study sample was identified from electronic records indicating deployment to Iraq, Kuwait, or Afghanistan, and included 3,416 heath care and 4,648 nonhealth care personnel. Health care personnel had higher PTSD rates and an increasing trend in PTSD rates across repeated deployments. After adjusting for combat exposure and other covariates, health care compared with nonhealth care personnel were more likely to be diagnosed with PTSD after one (odds ratio [OR] 2.02; 95% confidence interval [CI] 1.45-2.80), two (OR 2.27; 95% CI 1.26-4.08), and three deployments (OR 4.37; 95% CI 1.25-15.28). Exposure to wounded/dead friendly forces was associated with higher PTSD rates in health care personnel (OR 1.53; 95% CI 1.13-2.07). Health care personnel occupy a unique and essential role in current wartime operations, and are a high-risk group for PTSD. These findings suggest that further research is needed on the effects of caregiver stress, and refinements to postdeployment screening for health care personnel should be pursued. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Prevalence and predictors of posttraumatic stress symptoms in utility workers deployed to the World Trade Center following the attacks of September 11, 2001.

PubMed

Cukor, Judith; Wyka, Katarzyna; Jayasinghe, Nimali; Weathers, Frank; Giosan, Cezar; Leck, Pamela; Roberts, Jennifer; Spielman, Lisa; Crane, Michael; Difede, JoAnn

2011-03-01

Recent attention has begun to be focused on the effects of disaster recovery work on nonrescue workers. The goal of this study was to assess the prevalence and predictors of posttraumatic stress disorder (PTSD) and related symptoms in a population of utility workers deployed to the World Trade Center (WTC) site in the aftermath of 9/11. Utility workers deployed to the WTC site were screened at their place of employment between 10 and 34 months following the WTC attacks, utilizing both structured interviews and self-report measures. PTSD symptoms were assessed by the CAPS and the PCL; co-morbid disorders were also assessed. 2,960 individuals with complete CAPS and PCL data were included in the analyses. Eight percent of participants had symptoms consistent with full PTSD, 9.3% with subthreshold PTSD, 6% with MDD, 3.5% with GAD, and 2.5% with panic disorder. Although risk factors included psychiatric and trauma history, 51% of individuals with probable PTSD had neither; subjective perception of threat to one's life was the best predictor of probable PTSD. Extent of exposure predicted 89% of PTSD cases in those without a psychiatric or trauma history, but only 67% of cases among those with both. Nonrescue workers deployed to a disaster site are at risk for PTSD and depression. Extent of exposure affected the most vulnerable workers differently than the least vulnerable ones. These results suggest that the relationship among predictors of PTSD may be different for different vulnerability groups, and underscore the importance of screening, education, and prevention programs for disaster workers. © 2010 Wiley-Liss, Inc.

Comparing Web, Group and Telehealth Formats of a Military Parenting Program

DTIC Science & Technology

2015-06-01

reintegration period post-deployment. Risks include increases in stress, anxiety and depression, PTSD, and substance use and abuse . These outcomes lead...deployment. Risks include increases in stress, anxiety and depression, PTSD, and substance use and abuse . These outcomes lead to disruptions in...risk behaviors associated with youth substance use by improving parenting, child, and parent adjustment. Specific aims are 1) examine the usability

Assessing PTSD in the military: Validation of a scale distributed to Danish soldiers after deployment since 1998.

PubMed

Karstoft, Karen-Inge; Andersen, Søren B; Nielsen, Anni B S

2017-06-01

Since 1998, soldiers deployed to war zones with the Danish Defense (≈31,000) have been invited to fill out a questionnaire on post-mission reactions. This provides a unique data source for studying the psychological toll of war. Here, we validate a measure of PTSD-symptoms from the questionnaire. Soldiers from two cohorts deployed to Afghanistan with the International Security Assistance Force (ISAF) in 2009 (ISAF7, N = 334) and 2013 (ISAF15, N = 278) filled out a standard questionnaire (Psychological Reactions following International Missions, PRIM) concerning a range of post-deployment reactions including symptoms of PTSD (PRIM-PTSD). They also filled out a validated measure of PTSD-symptoms in DSM-IV, the PTSD-checklist (PCL). We tested reliability of PRIM-PTSD by estimating Cronbach's alpha, and tested validity by correlating items, clusters, and overall scale with corresponding items in the PCL. Furthermore, we conducted two confirmatory factor analytic models to test the factor structure of PRIM-PTSD, and tested measurement invariance of the selected model. Finally, we established a screening and a clinical cutoff score by application of ROC analysis. We found high internal consistency of the PRIM-PTSD (Cronbach's alpha = 0.88; both cohorts), strong item-item (0.48-0.83), item-cluster (0.43-0.72), cluster-cluster (0.71-0.82) and full-scale (0.86-0.88) correlations between PRIM-PTSD and PCL. The factor analyses showed adequate fit of a one-factor model, which was also found to display strong measurement invariance across cohorts. ROC curve analysis established cutoff scores for screening (sensitivity = 1, specificity = 0.93) and clinical use (sensitivity = 0.71, specificity = 0.98). In conclusion, we find that PRIM-PTSD is a valid measure for assessing PTSD-symptoms in Danish soldiers following deployment. © 2017 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

Potentially modifiable pre-, peri-, and postdeployment characteristics associated with deployment-related posttraumatic stress disorder among ohio army national guard soldiers.

PubMed

Goldmann, Emily; Calabrese, Joseph R; Prescott, Marta R; Tamburrino, Marijo; Liberzon, Israel; Slembarski, Renee; Shirley, Edwin; Fine, Thomas; Goto, Toyomi; Wilson, Kimberly; Ganocy, Stephen; Chan, Philip; Serrano, Mary Beth; Sizemore, James; Galea, Sandro

2012-02-01

To evaluate potentially modifiable deployment characteristics-- predeployment preparedness, unit support during deployment, and postdeployment support-that may be associated with deployment-related posttraumatic stress disorder (PTSD). We recruited a sample of 2616 Ohio Army National Guard (OHARNG) soldiers and conducted structured interviews to assess traumatic event exposure and PTSD related to the soldiers' most recent deployment, consistent with DSM-IV criteria. We assessed preparedness, unit support, and postdeployment support by using multimeasure scales adapted from the Deployment Risk and Resilience Survey. The prevalence of deployment-related PTSD was 9.6%. In adjusted logistic models, high levels of all three deployment characteristics (compared with low) were independently associated with lower odds of PTSD. When we evaluated the influence of combinations of deployment characteristics on the development of PTSD, we found that postdeployment support was an essential factor in the prevention of PTSD. Results show that factors throughout the life course of deployment-in particular, postdeployment support-may influence the development of PTSD. These results suggest that the development of suitable postdeployment support opportunities may be centrally important in mitigating the psychological consequences of war. Copyright © 2012 Elsevier Inc. All rights reserved.

Home front: post-deployment mental health and divorces.

PubMed

Negrusa, Brighita; Negrusa, Sebastian

2014-06-01

Since 2003, about 14 % of U.S. Army soldiers have reported symptoms of posttraumatic stress disorder (PTSD) following deployments. In this article, we examine how post-deployment symptoms of PTSD and of other mental health conditions are related to the probability of divorce among married active-duty U.S. Army soldiers. For this purpose, we combine Army administrative individual-level longitudinal data on soldiers' deployments, marital history, and sociodemographic characteristics with their self-reported post-deployment health information. Our estimates indicate that time spent in deployment increases the divorce risk among Army enlisted personnel and that PTSD symptoms are associated with further increases in the odds of divorce. Although officers are generally less likely to screen positive for PTSD than enlisted personnel, we find a stronger relationship between PTSD symptoms and divorces among Army officers who are PTSD-symptomatic than among enlisted personnel. We estimate a larger impact of deployments on the divorce risk among female soldiers, but we do not find a differential impact of PTSD symptoms by gender. Also, we find that most of the effect of PTSD symptoms occurs early in the career of soldiers who deploy multiple times.

Trauma Informed Guilt Reduction (TrIGR) Intervention

DTIC Science & Technology

2016-10-01

posttraumatic distress and a range of adverse outcomes, including posttraumatic stress disorder (PTSD), depression and suicidality , and alcohol...outcomes, including posttraumatic stress disorder (PTSD), depression and suicidality , and alcohol/substance use disorders. There is a pressing need for...deployment, posttraumatic, distress, PTSD, depression , functioning, psychotherapy, intervention 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF

Gender differences among veterans deployed in support of the wars in Afghanistan and Iraq.

PubMed

Street, Amy E; Gradus, Jaimie L; Giasson, Hannah L; Vogt, Dawne; Resick, Patricia A

2013-07-01

The changing scope of women's roles in combat operations has led to growing interest in women's deployment experiences and post-deployment adjustment. To quantify the gender-specific frequency of deployment stressors, including sexual and non-sexual harassment, lack of social support and combat exposure. To quantify gender-specific post-deployment mental health conditions and associations between deployment stressors and posttraumatic stress disorder (PTSD), to inform the care of Veterans returning from the current conflicts. National mail survey of OEF/OIF Veterans randomly sampled within gender, with women oversampled. The community. In total, 1,207 female and 1,137 male Veterans from a roster of all Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans. Response rate was 48.6 %. Deployment stressors (including combat and harassment stress), PTSD, depression, anxiety and alcohol use, all measured via self-report. Women were more likely to report sexual harassment (OR = 8.7, 95% CI: 6.9, 11) but less likely to report combat (OR = 0.62, 95 % CI: 0.50, 0.76). Women and men were equally likely to report symptoms consistent with probable PTSD (OR = 0.87, 95 % CI: 0.70, 1.1) and symptomatic anxiety (OR = 1.1, 9 5% CI: 0.86, 1.3). Women were more likely to report probable depression (OR = 1.3, 95 % CI: 1.1, 1.6) and less likely to report problematic alcohol use (OR = 0.59, 9 5% CI: 0.47, 0.72). With a five-point change in harassment stress, adjusted odds ratios for PTSD were 1.36 (95 % CI: 1.23, 1.52) for women and 1.38 (95 % CI: 1.19, 1.61) for men. The analogous associations between combat stress and PTSD were 1.31 (95 % CI: 1.24, 1.39) and 1.31 (95 % CI: 1.26, 1.36), respectively. Although there are important gender differences in deployment stressors-including women's increased risk of interpersonal stressors-and post-deployment adjustment, there are also significant similarities. The post-deployment adjustment of our nation's growing population of female Veterans seems comparable to that of our nation's male Veterans.

Leadership and post-traumatic stress disorder: are soldiers' perceptions of organizational justice during deployment protective?

PubMed

Elrond, Andreas F; Høgh, Annie; Andersen, Søren B

2018-01-01

Background : Soldiers' perception of leadership during military deployment has gained research attention as a potentially modifiable factor to buffer against the development of postdeployment post-traumatic stress disorder (PTSD). Within nonmilitary research, the organizational justice (OJ) framework, i.e. distributive justice, procedural justice (PJ) and interactional justice (IJ), has been found to relate to mental health outcomes. Aspects of OJ may, therefore, be protective against PTSD. Objectives : We examined the prospective relationship between aspects of OJ, namely the perceptions of PJ and IJ by subordinate soldiers without leadership obligations in relationship to immediate superiors and PTSD. Method : Participants were soldiers ( n =  245) deployed to Helmand Province in Afghanistan in 2009. Logistic regression procedures were used. The primary analysis measured PTSD cases using the Structured Clinical Interview for DSM-IV-TR Axis-I Disorder (SCID) 2½ years after homecoming. PJ/IJ was measured during deployment with a 6-item composite measure ranging from 0 to 12. Supplementary primary analyses were performed with PJ/IJ measured before and immediately after deployment. A secondary PJ/IJ analysis also tested against four postdeployment measures with the Post-Traumatic Stress Disorder Checklist Civilian (PCL-C) dichotomized at screening symptom levels. Results : Higher levels of perceived PJ/IJ for soldiers without leadership obligations during deployment had a prospective relation (OR = 0.86, 95% CI = 0.75-0.98) with PTSD on the SCID 2½ years after homecoming after adjustment for factors including predeployment PTSD symptoms, trauma and combat exposure, and state affectivity. Similar results were found by measuring PJ/IJ before (OR = 0.83, 95% CI = 0.71-0.95) but not immediately after homecoming (OR = 0.97, 95% CI = 0.85-1.11). A relationship with PTSD symptoms at the screening level at the four measurements of PCL-C was found, but only when predeployment PTSD symptoms were not controlled for. Conclusions : These results suggest that PJ/IJ exercised by superiors in relation to military deployments may protect subordinate soldiers against the development of postdeployment PTSD.

Leadership and post-traumatic stress disorder: are soldiers’ perceptions of organizational justice during deployment protective?

PubMed Central

2018-01-01

ABSTRACT Background: Soldiers’ perception of leadership during military deployment has gained research attention as a potentially modifiable factor to buffer against the development of postdeployment post-traumatic stress disorder (PTSD). Within nonmilitary research, the organizational justice (OJ) framework, i.e. distributive justice, procedural justice (PJ) and interactional justice (IJ), has been found to relate to mental health outcomes. Aspects of OJ may, therefore, be protective against PTSD. Objectives: We examined the prospective relationship between aspects of OJ, namely the perceptions of PJ and IJ by subordinate soldiers without leadership obligations in relationship to immediate superiors and PTSD. Method: Participants were soldiers (n = 245) deployed to Helmand Province in Afghanistan in 2009. Logistic regression procedures were used. The primary analysis measured PTSD cases using the Structured Clinical Interview for DSM-IV-TR Axis-I Disorder (SCID) 2½ years after homecoming. PJ/IJ was measured during deployment with a 6-item composite measure ranging from 0 to 12. Supplementary primary analyses were performed with PJ/IJ measured before and immediately after deployment. A secondary PJ/IJ analysis also tested against four postdeployment measures with the Post-Traumatic Stress Disorder Checklist Civilian (PCL-C) dichotomized at screening symptom levels. Results: Higher levels of perceived PJ/IJ for soldiers without leadership obligations during deployment had a prospective relation (OR = 0.86, 95% CI = 0.75–0.98) with PTSD on the SCID 2½ years after homecoming after adjustment for factors including predeployment PTSD symptoms, trauma and combat exposure, and state affectivity. Similar results were found by measuring PJ/IJ before (OR = 0.83, 95% CI = 0.71–0.95) but not immediately after homecoming (OR = 0.97, 95% CI = 0.85–1.11). A relationship with PTSD symptoms at the screening level at the four measurements of PCL-C was found, but only when predeployment PTSD symptoms were not controlled for. Conclusions: These results suggest that PJ/IJ exercised by superiors in relation to military deployments may protect subordinate soldiers against the development of postdeployment PTSD. PMID:29707168

SKA2 Methylation is Involved in Cortisol Stress Reactivity and Predicts the Development of Post-Traumatic Stress Disorder (PTSD) After Military Deployment

PubMed Central

Boks, Marco P; Rutten, Bart P F; Geuze, Elbert; Houtepen, Lotte C; Vermetten, Eric; Kaminsky, Zachary; Vinkers, Christiaan H

2016-01-01

Genomic variation in the SKA2 gene has recently been identified as a promising suicide biomarker. In light of its role in glucocorticoid receptor transactivation, we investigated whether SKA2 DNA methylation influences cortisol stress reactivity and is involved in the development of post-traumatic stress disorder (PTSD). Increased SKA2 methylation was significantly associated with lower cortisol stress reactivity in 85 healthy individuals exposed to the Trier Social Stress Test (B=−173.40, t=−2.324, p-value=0.023). Next, we observed that longitudinal decreases in SKA2 methylation after deployment were associated with the emergence of post-deployment PTSD symptoms in a Dutch military cohort (N=93; B=−0.054, t=−3.706, p-value=3.66 × 10−4). In contrast, exposure to traumatic stress during deployment by itself resulted in longitudinal increases in SKA2 methylation (B=0.037, t=4.173, p-value=6.98 × 10−5). Using pre-deployment SKA2 methylation levels and childhood trauma exposure, we found that the previously published suicide prediction rule significantly predicted post-deployment PTSD symptoms (AUC=0.66, 95% CI: 0.53–0.79) with an optimal sensitivity of 0.81 and specificity of 0.91. Permutation analysis using random methylation loci supported these findings. Together, these data establish the importance of SKA2 for cortisol stress responsivity and the development of PTSD and provide further evidence that SKA2 is a promising biomarker for stress-related disorders including PTSD. PMID:26361058

SKA2 Methylation is Involved in Cortisol Stress Reactivity and Predicts the Development of Post-Traumatic Stress Disorder (PTSD) After Military Deployment.

PubMed

Boks, Marco P; Rutten, Bart P F; Geuze, Elbert; Houtepen, Lotte C; Vermetten, Eric; Kaminsky, Zachary; Vinkers, Christiaan H

2016-04-01

Genomic variation in the SKA2 gene has recently been identified as a promising suicide biomarker. In light of its role in glucocorticoid receptor transactivation, we investigated whether SKA2 DNA methylation influences cortisol stress reactivity and is involved in the development of post-traumatic stress disorder (PTSD). Increased SKA2 methylation was significantly associated with lower cortisol stress reactivity in 85 healthy individuals exposed to the Trier Social Stress Test (B=-173.40, t=-2.324, p-value=0.023). Next, we observed that longitudinal decreases in SKA2 methylation after deployment were associated with the emergence of post-deployment PTSD symptoms in a Dutch military cohort (N=93; B=-0.054, t=-3.706, p-value=3.66 × 10(-4)). In contrast, exposure to traumatic stress during deployment by itself resulted in longitudinal increases in SKA2 methylation (B=0.037, t=4.173, p-value=6.98 × 10(-5)). Using pre-deployment SKA2 methylation levels and childhood trauma exposure, we found that the previously published suicide prediction rule significantly predicted post-deployment PTSD symptoms (AUC=0.66, 95% CI: 0.53-0.79) with an optimal sensitivity of 0.81 and specificity of 0.91. Permutation analysis using random methylation loci supported these findings. Together, these data establish the importance of SKA2 for cortisol stress responsivity and the development of PTSD and provide further evidence that SKA2 is a promising biomarker for stress-related disorders including PTSD.

Peace and war: trajectories of posttraumatic stress disorder symptoms before, during, and after military deployment in Afghanistan.

PubMed

Berntsen, Dorthe; Johannessen, Kim B; Thomsen, Yvonne D; Bertelsen, Mette; Hoyle, Rick H; Rubin, David C

2012-12-01

In the study reported here, we examined posttraumatic stress disorder (PTSD) symptoms in 746 Danish soldiers measured on five occasions before, during, and after deployment to Afghanistan. Using latent class growth analysis, we identified six trajectories of change in PTSD symptoms. Two resilient trajectories had low levels across all five times, and a new-onset trajectory started low and showed a marked increase of PTSD symptoms. Three temporary-benefit trajectories, not previously described in the literature, showed decreases in PTSD symptoms during (or immediately after) deployment, followed by increases after return from deployment. Predeployment emotional problems and predeployment traumas, especially childhood adversities, were predictors for inclusion in the nonresilient trajectories, whereas deployment-related stress was not. These findings challenge standard views of PTSD in two ways. First, they show that factors other than immediately preceding stressors are critical for PTSD development, with childhood adversities being central. Second, they demonstrate that the development of PTSD symptoms shows heterogeneity, which indicates the need for multiple measurements to understand PTSD and identify people in need of treatment.

Leadership, cohesion, morale, and the mental health of UK Armed Forces in Afghanistan.

PubMed

Jones, Norman; Seddon, Rachel; Fear, Nicola T; McAllister, Pete; Wessely, Simon; Greenberg, Neil

2012-01-01

UK Armed Forces (AF) personnel deployed to Afghanistan are frequently exposed to intense combat and yet little is known about the short-term mental health consequences of this exposure and the potential mitigating effects of military factors such as cohesion, morale, and leadership. To assess the possible modulating influence of cohesion, morale, and leadership on post-traumatic stress disorder (PTSD) symptoms and common mental disorders resulting from combat exposure among UK AF personnel deployed to Afghanistan, UK AF personnel, during their deployment to Afghanistan in 2010, completed a self-report survey about aspects of their current deployment, including perceived levels of cohesion, morale, leadership, combat exposure, and their mental health status. Outcomes were symptoms of common mental disorder and symptoms of PTSD. Combat exposure was associated with both PTSD symptoms and symptoms of common mental disorder. Of the 1,431 participants, 17.1% reported caseness levels of common mental disorder, and 2.7% were classified as probable PTSD cases. Greater self-reported levels of unit cohesion, morale, and perceived good leadership were all associated with lower levels of common mental disorder and PTSD. Greater levels of unit cohesion, morale, and good leadership may help to modulate the effects of combat exposure and the subsequent development of mental health problems among UK Armed Forces personnel deployed to Afghanistan. © 2012 Guilford Publications, Inc.

Evaluation of a Technology-Based Adaptive Learning and Prevention Program for Stress Response-A Randomized Controlled Trial.

PubMed

Wesemann, Ulrich; Kowalski, Jens T; Jacobsen, Thomas; Beudt, Susan; Jacobs, Herbert; Fehr, Julia; Büchler, Jana; Zimmermann, Peter L

2016-08-01

To prevent deployment-related disorders, Chaos Driven Situations Management Retrieval System (CHARLY), a computer-aided training platform with a biofeedback interface has been developed. It simulates critical situations photorealistic for certain target and occupational groups. CHARLY was evaluated as a 1.5 days predeployment training method comparing it with the routine training. The evaluation was carried out for a matched random sample of N = 67 soldiers deployed in Afghanistan (International Security Assistance Force). Data collection took place before and after the prevention program and 4 to 6 weeks after deployment, which included mental state, post-traumatic stress disorder (PTSD) symptoms, knowledge of and attitude toward PTSD, and deployment-specific stressors. CHARLY has been significantly superior to the control group in terms of psychoeducation and attitude change. As to the mental state, both groups showed a significant increase in stress after deployment with significant lower increase in CHARLY. For PTSD-specific symptoms, CHARLY achieved a significant superiority. The fact that PTSD-specific scales showed significant differences at the end of deployment substantiates the validity of a specifically preventive effect of CHARLY. The study results tentatively indicate that highly standardized, computer-based primary prevention of mental disorders in soldiers on deployment might be superior to other more personal and less standardized forms of prevention. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Military mental health: the role of daily hassles while deployed.

PubMed

Heron, Elizabeth A; Bryan, Craig J; Dougherty, Craig A; Chapman, William G

2013-12-01

This study sought to identify factors contributing to symptoms of depression and posttraumatic stress disorder (PTSD) in recently deployed combat veterans. A sample of 168 active duty military personnel completed measures of combat exposure, deployment-related daily hassles, depression symptoms, and PTSD symptoms at six time points across their deployment: predeployment and 1, 3, 6, and 12 months postdeployment. Mixed-effects linear modeling with repeated measures was used to identify factors associated with depression and PTSD severity over time. Postdeployment depression severity did not change over time, but PTSD severity decreased slightly over time after returning home. Postdeployment depression severity was predicted by past (but not recent) combat exposure, daily hassles, and concurrent PTSD symptoms. Postdeployment PTSD severity was predicted by past and recent combat exposure, concurrent depression symptoms, and male sex. Depression severity mediated the relationship between daily hassles and postdeployment PTSD severity.

Posttraumatic stress disorder post Iraq and Afghanistan: prevalence among military subgroups.

PubMed

Hines, Lindsey A; Sundin, Josefin; Rona, Roberto J; Wessely, Simon; Fear, Nicola T

2014-09-01

A large body of research has been produced in recent years investigating posttraumatic stress disorder (PTSD) among military personnel following deployment to Iraq and Afghanistan, resulting in apparent differences in PTSD prevalence. We compare prevalence estimates for current PTSD between military subgroups, providing insight into how groups may be differentially affected by deployment. Systematic literature searches using the terms PTSD, stress disorder, and acute stress, combined with terms relating to military personnel, identified 49 relevant papers. Studies with a sample size of less than 100 and studies based on data for treatment seeking or injured populations were excluded. Studies were categorized according to theatre of deployment (Iraq or Afghanistan), combat and noncombat deployed samples, sex, enlistment type (regular or reserve and [or] National Guard), and service branch (for example, army, navy, and air force). Meta-analysis was used to assess PTSD prevalence across subgroups. There was large variability in PTSD prevalence between studies, but, regardless of heterogeneity, prevalence rates of PTSD were higher among studies of Iraq-deployed personnel (12.9%; 95% CI 11.3% to 14.4%), compared with personnel deployed to Afghanistan (7.1%; 95% CI 4.6% to 9.6%), combat deployed personnel, and personnel serving in the Canadian, US, or UK army or the navy or marines (12.4%; 95% CI 10.9% to 13.4%), compared with the other services (4.9%; 95% CI 1.4% to 8.4%). Contrary to findings from within-study comparisons, we did not find a difference in PTSD prevalence for regular active-duty and reserve or National Guard personnel. Categorizing studies according to deployment location and branch of service identified differences among subgroups that provide further support for factors underlying the development of PTSD.

Posttraumatic Stress Disorder Post Iraq and Afghanistan: Prevalence Among Military Subgroups

PubMed Central

Hines, Lindsey A; Sundin, Josefin; Rona, Roberto J; FFPH; Wessely, Simon; FMedSci; Fear, Nicola T

2014-01-01

A large body of research has been produced in recent years investigating posttraumatic stress disorder (PTSD) among military personnel following deployment to Iraq and Afghanistan, resulting in apparent differences in PTSD prevalence. We compare prevalence estimates for current PTSD between military subgroups, providing insight into how groups may be differentially affected by deployment. Systematic literature searches using the terms PTSD, stress disorder, and acute stress, combined with terms relating to military personnel, identified 49 relevant papers. Studies with a sample size of less than 100 and studies based on data for treatment seeking or injured populations were excluded. Studies were categorized according to theatre of deployment (Iraq or Afghanistan), combat and noncombat deployed samples, sex, enlistment type (regular or reserve and [or] National Guard), and service branch (for example, army, navy, and air force). Meta-analysis was used to assess PTSD prevalence across subgroups. There was large variability in PTSD prevalence between studies, but, regardless of heterogeneity, prevalence rates of PTSD were higher among studies of Iraq-deployed personnel (12.9%; 95% CI 11.3% to 14.4%), compared with personnel deployed to Afghanistan (7.1%; 95% CI 4.6% to 9.6%), combat deployed personnel, and personnel serving in the Canadian, US, or UK army or the navy or marines (12.4%; 95% CI 10.9% to 13.4%), compared with the other services (4.9%; 95% CI 1.4% to 8.4%). Contrary to findings from within-study comparisons, we did not find a difference in PTSD prevalence for regular active-duty and reserve or National Guard personnel. Categorizing studies according to deployment location and branch of service identified differences among subgroups that provide further support for factors underlying the development of PTSD. PMID:25569079

Comparing Posttraumatic Stress Disorder's Symptom Structure between Deployed and Nondeployed Veterans

ERIC Educational Resources Information Center

Engdahl, Ryan M.; Elhai, Jon D.; Richardson, J. Don; Frueh, B. Christopher

2011-01-01

We tested two empirically validated 4-factor models of posttraumatic stress disorder (PTSD) symptoms using the PTSD Checklist: King, Leskin, King, and Weathers' (1998) model including reexperiencing, avoidance, emotional numbing, and hyperarousal factors, and Simms, Watson, and Doebbeling's (2002) model including reexperiencing, avoidance,…

The Predictive Validity of the PTSD Checklist in a Nonclinical Sample of Combat-Exposed National Guard Troops

ERIC Educational Resources Information Center

Arbisi, Paul A.; Kaler, Matthew E.; Kehle-Forbes, Shannon M.; Erbes, Christopher R.; Polusny, Melissa A.; Thuras, Paul

2012-01-01

After returning from an extended combat deployment to Iraq, 348 National Guard soldiers were administered the PTSD Checklist (PCL-M), and the Beck Depression Inventory II (BDI-II) followed, on average, 3 months later by structured diagnostic interviews including the Clinician-Administered PTSD Scale (CAPS) for the "Diagnostic and Statistical…

The effect of enemy combat tactics on PTSD prevalence rates: A comparison of Operation Iraqi Freedom deployment phases in a sample of male and female veterans.

PubMed

Green, Jonathan D; Bovin, Michelle J; Erb, Sarah E; Lachowicz, Mark; Gorman, Kaitlyn R; Rosen, Raymond C; Keane, Terence M; Marx, Brian P

2016-09-01

Research suggests that the nature of combat may affect later development of posttraumatic stress disorder (PTSD) in combat veterans. Studies comparing rates of PTSD across different conflicts indicate that the use of asymmetric or guerilla-style tactics by enemy fighters may result in higher rates of PTSD among U.S. military personnel than the use of symmetric tactics, which mirror tactics used by U.S. forces. Investigations of the association between enemy combat tactics and PTSD across conflicts were limited because of cohort effects and a focus on male veterans. The current study examined rates of PTSD diagnosis in a sample of male and female veterans deployed to Operation Iraqi Freedom (OIF), a conflict with 3 distinct phases marked by varying enemy tactics. Participants were 738 veterans enrolled in Project VALOR (Veterans' After-Discharge Longitudinal Registry) who deployed once to OIF. Participants completed a clinician interview as well as self-report measures. Male veterans deployed during the OIF phase marked by asymmetric tactics were more than twice as likely to be diagnosed with PTSD as those deployed during the other 2 phases, even after controlling for extent of combat exposure, demographic characteristics, and other deployment-related risk factors for PTSD. Differing rates of PTSD across the 3 OIF phases were not observed among female participants. The nature of combat (specifically, asymmetric enemy tactics) may be a risk factor for the development of PTSD among males. Factors other than enemy tactics may be more important to the development of PTSD among females. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Biomarkers for PTSD

DTIC Science & Technology

2011-07-01

Intern Med 167, 476-82 (2007). 5 P. B. Watson and B. Daniels, Follow up of post - traumatic stress disorder symptoms in Australian servicemen...for DOD and VA as objective indicators of PTSD for use in post - deployment medical screening, treatment selection, treatment outcome monitoring...mitigating the associations between war zone-related PTSD and physical health problems, including cardiovascular and metabolic disorders 6-10. In

Women at war: implications for mental health.

PubMed

Dutra, Lissa; Grubbs, Kathleen; Greene, Carolyn; Trego, Lori L; McCartin, Tamarin L; Kloezeman, Karen; Morland, Leslie

2011-01-01

Few studies have investigated the impact of deployment stressors on the mental health outcomes of women deployed to Iraq in support of Operation Iraqi Freedom. This pilot study examined exposure to combat experiences and military sexual harassment in a sample of 54 active duty women and assessed the impact of these stressors on post-deployment posttraumatic stress disorder (PTSD) symptoms and depressive symptoms. Within 3 months of returning from deployment to Iraq, participants completed (a) the Combat Experiences Scale and the Sexual Harassment Scale of the Deployment Risk and Resilience Inventory, (b) the Primary Care PTSD Screen, and (c) an abbreviated version of the Center for Epidemiological Studies-Depression scale. Approximately three quarters of the sample endorsed exposure to combat experiences, and more than half of the sample reported experiencing deployment-related sexual harassment, with nearly half of the sample endorsing both stressors. Approximately one third of the sample endorsed clinical or subclinical levels of PTSD symptoms, with 11% screening positive for PTSD and 9% to 14% of the sample endorsing depressive symptoms. Regression analyses revealed that combat experiences and sexual harassment jointly accounted for significant variance in post-deployment PTSD symptoms, whereas military sexual harassment was identified as the only unique significant predictor of these symptoms. Findings from the present study lend support to research demonstrating that military sexual trauma may be more highly associated with post-deployment PTSD symptoms than combat exposure among female service members and veterans.

Cytokine production as a putative biological mechanism underlying stress sensitization in high combat exposed soldiers.

PubMed

Smid, Geert E; van Zuiden, Mirjam; Geuze, Elbert; Kavelaars, Annemieke; Heijnen, Cobi J; Vermetten, Eric

2015-01-01

Combat stress exposed soldiers may respond to post-deployment stressful life events (SLE) with increases in symptoms of posttraumatic stress disorder (PTSD), consistent with a model of stress sensitization. Several lines of research point to sensitization as a model to describe the relations between exposure to traumatic events, subsequent SLE, and symptoms of PTSD. Based on previous findings we hypothesized that immune activation, measured as a high in vitro capacity of leukocytes to produce cytokines upon stimulation, underlies stress sensitization. We assessed mitogen-induced cytokine production at 1 month, SLE at 1 year, and PTSD symptoms from 1 month up to 2 years post-deployment in soldiers returned from deployment to Afghanistan (N=693). Exploratory structural equation modeling as well as latent growth models were applied. The data demonstrated significant three-way interaction effects of combat stress exposure, cytokine production, and post-deployment SLE on linear change in PTSD symptoms over the first 2 years following return from deployment. In soldiers reporting high combat stress exposure, both high mitogen-stimulated T-cell cytokine production and high innate cytokine production were associated with increases in PTSD symptoms in response to post-deployment SLE. In low combat stress exposed soldiers as well as those with low cytokine production, post-deployment SLE were not associated with increases in PTSD symptoms. High stimulated T-cell and innate cytokine production may contribute to stress sensitization in recently deployed, high combat stress exposed soldiers. These findings suggest that detecting and eventually normalizing immune activation may potentially complement future strategies to prevent progression of PTSD symptoms following return from deployment. Copyright © 2014 Elsevier Ltd. All rights reserved.

76 FR 35002 - Agency Information Collection Activities; Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-15

... following deployment, including PTSD, Depression, or suicidal thoughts [cir] Died or was killed Youth 1. Is..., Depression, or suicidal thoughts [cir] Died or was killed Veteran Family Status and Areas of Deployment...

Are Posttraumatic Stress Symptoms Related to Mental Health Service Use? A Prospective Study of Danish Soldiers Deployed to Afghanistan.

PubMed

Madsen, Trine; Andersen, Søren Bo; Karstoft, Karen-Inge

2016-10-01

Investigating the use of mental health services by combat veterans can help illuminate utilization and unmet needs of this population. The aims of this study were to estimate the use of mental health services and to examine how such use is associated with self-reported symptoms of posttraumatic stress disorder (PTSD) in soldiers before and after deployment to Afghanistan. Prospectively, 703 Danish soldiers who deployed from January 2009 to August 2009 were followed up with 6 assessments from predeployment to 2.5 years postdeployment in 2012. At assessments, the soldiers responded to a comprehensive questionnaire including a measure of PTSD symptoms (the PTSD Checklist-Civilian version). These self-reported data were combined with individual-level records of receiving psychotherapy from the Military Psychological Division at the Danish Defense and psychiatric treatment from the Danish registers. The prevalence of PTSD symptoms increased over time, and almost 10% of the sample reported high levels of PTSD symptoms 2.5 years postdeployment. Overall, 37% of the soldiers utilized mental health services; 6% utilized psychiatric services, and 12.4% redeemed a prescription for psychiatric medicine. Approximately one-third received psychotherapy at the Military Psychological Division. In those reporting high PTSD symptomatology, 83% utilized 1 or more types of mental health service. At predeployment and homecoming, high PTSD symptomatology was significantly (P < .01) associated with attending psychotherapy, but not with psychiatric treatment or redemption of psychiatric medicine. With time, more soldiers report high PTSD symptoms. Among Danish soldiers with high symptomatology, the utilization of mental health services was high. Most frequently, soldiers with high PTSD symptomatology received psychotherapy at the Military Psychological Division and less frequently received psychiatric treatment. © Copyright 2016 Physicians Postgraduate Press, Inc.

Consistency of Recall for Deployment-Related Traumatic Brain Injury.

PubMed

Alosco, Michael L; Aslan, Mihaela; Du, Mengtian; Ko, John; Grande, Laura; Proctor, Susan P; Concato, John; Vasterling, Jennifer J

2016-01-01

To examine the temporal consistency of self-reported deployment-related traumatic brain injury (TBI) and its association with posttraumatic stress disorder (PTSD) symptom severity. In-person interviews at US Army installations (postdeployment); phone interviews (long-term follow-up). A total of 378 US Army soldiers and veterans deployed to Iraq; 14.3% (n = 54) reported TBI with loss of consciousness during an index deployment. Participants were evaluated after returning from deployment and again 5 to 9 years later. Temporal consistency of TBI endorsement based on TBI screening interviews; PTSD Checklist, Civilian Version. The concordance of deployment-related TBI endorsement from the postdeployment to long-term follow-up assessment was moderate (κ = 0.53). Of the 54 participants reporting (predominantly mild) TBI occurring during an index deployment, 32 endorsed TBI inconsistently over time. More severe PTSD symptoms at postdeployment assessment were independently associated with discordant reporting (P = .0004); each 10-point increase in PCL scores increasing odds of discordance by 69% (odds ratio = 1.69; 95% confidence interval, 1.26-2.26). Deployment-related TBI may not be reported reliably over time, particularly among war-zone veterans with greater PTSD symptoms. Results of screening evaluations for TBI history should be viewed with caution in the context of PTSD symptom history.

Trauma Informed Guilt Reduction (TrIGR) Intervention

DTIC Science & Technology

2016-10-01

posttraumatic distress and a range of adverse outcomes, including posttraumatic stress disorder (PTSD), depression and suicidality , and alcohol/substance use...and a range of adverse outcomes, including posttraumatic stress disorder (PTSD), depression and suicidality , and alcohol/substance use disorders...and depression with medium to large effect sizes. The overall objective of this study is to examine the efficacy of TrIGR in reducing deployment

Neural activity and emotional processing following military deployment: Effects of mild traumatic brain injury and posttraumatic stress disorder.

PubMed

Zuj, Daniel V; Felmingham, Kim L; Palmer, Matthew A; Lawrence-Wood, Ellie; Van Hooff, Miranda; Lawrence, Andrew J; Bryant, Richard A; McFarlane, Alexander C

2017-11-01

Posttraumatic Stress Disorder (PTSD) and mild traumatic brain injury (mTBI) are common comorbidities during military deployment that affect emotional brain processing, yet few studies have examined the independent effects of mTBI and PTSD. The purpose of this study was to examine distinct differences in neural responses to emotional faces in mTBI and PTSD. Twenty-one soldiers reporting high PTSD symptoms were compared to 21 soldiers with low symptoms, and 16 soldiers who reported mTBI-consistent injury and symptoms were compared with 16 soldiers who did not sustain an mTBI. Participants viewed emotional face expressions while their neural activity was recorded (via event-related potentials) prior to and following deployment. The high-PTSD group displayed increased P1 and P2 amplitudes to threatening faces at post-deployment compared to the low-PTSD group. In contrast, the mTBI group displayed reduced face-specific processing (N170 amplitude) to all facial expressions compared to the no-mTBI group. Here, we identified distinctive neural patterns of emotional face processing, with attentional biases towards threatening faces in PTSD, and reduced emotional face processing in mTBI. Copyright © 2017 Elsevier Inc. All rights reserved.

5-HTTLPR genotype potentiates the effects of war zone stressors on the emergence of PTSD, depressive and anxiety symptoms in soldiers deployed to iraq.

PubMed

Telch, Michael J; Beevers, Christopher G; Rosenfield, David; Lee, Han-Joo; Reijntjes, Albert; Ferrell, Robert E; Hariri, Ahmad R

2015-06-01

Exposure to war zone stressors is common, yet only a minority of soldiers experience clinically meaningful disturbance in psychological function. Identification of biomarkers that predict vulnerability to war zone stressors is critical for developing more effective treatment and prevention strategies not only in soldiers but also in civilians who are exposed to trauma. We investigated the role of the serotonin transporter linked polymorphic region (5-HTTLPR) genotype in predicting the emergence of post-traumatic stress disorder (PTSD), depressive and anxiety symptoms as a function of war zone stressors. A prospective cohort of 133 U.S. Army soldiers with no prior history of deployment to a war zone, who were scheduled to deploy to Iraq, was recruited. Multilevel regression models were used to investigate associations between 5-HTTLPR genotype, level of war zone stressors, and reported symptoms of PTSD, depression and anxiety while deployed to Iraq. Level of war zone stressors was associated with symptoms of PTSD, depression and anxiety. Consistent with its effects on stress responsiveness, 5-HTTLPR genotype moderated the relationship between level of war zone stressors and symptoms of emotional disturbance. Specifically, soldiers carrying one or two low functioning alleles (S or LG ) reported heightened symptoms of PTSD, depression and anxiety in response to increased levels of exposure to war zone stressors, relative to soldiers homozygous for the high functioning allele (LA ). These data suggest that 5-HTTLPR genotype moderates individual sensitivity to war zone stressors and the expression of emotional disturbance including PTSD symptoms. Replication of this association along with identification of other genetic moderators of risk can inform the development of biomarkers that can predict relative resilience vs. vulnerability to stress. © 2015 World Psychiatric Association.

5-HTTLPR genotype potentiates the effects of war zone stressors on the emergence of PTSD, depressive and anxiety symptoms in soldiers deployed to iraq

PubMed Central

Telch, Michael J; Beevers, Christopher G; Rosenfield, David; Lee, Han-Joo; Reijntjes, Albert; Ferrell, Robert E; Hariri, Ahmad R

2015-01-01

Exposure to war zone stressors is common, yet only a minority of soldiers experience clinically meaningful disturbance in psychological function. Identification of biomarkers that predict vulnerability to war zone stressors is critical for developing more effective treatment and prevention strategies not only in soldiers but also in civilians who are exposed to trauma. We investigated the role of the serotonin transporter linked polymorphic region (5-HTTLPR) genotype in predicting the emergence of post-traumatic stress disorder (PTSD), depressive and anxiety symptoms as a function of war zone stressors. A prospective cohort of 133 U.S. Army soldiers with no prior history of deployment to a war zone, who were scheduled to deploy to Iraq, was recruited. Multilevel regression models were used to investigate associations between 5-HTTLPR genotype, level of war zone stressors, and reported symptoms of PTSD, depression and anxiety while deployed to Iraq. Level of war zone stressors was associated with symptoms of PTSD, depression and anxiety. Consistent with its effects on stress responsiveness, 5-HTTLPR genotype moderated the relationship between level of war zone stressors and symptoms of emotional disturbance. Specifically, soldiers carrying one or two low functioning alleles (S or LG) reported heightened symptoms of PTSD, depression and anxiety in response to increased levels of exposure to war zone stressors, relative to soldiers homozygous for the high functioning allele (LA). These data suggest that 5-HTTLPR genotype moderates individual sensitivity to war zone stressors and the expression of emotional disturbance including PTSD symptoms. Replication of this association along with identification of other genetic moderators of risk can inform the development of biomarkers that can predict relative resilience vs. vulnerability to stress. PMID:26043338

Gender differences in the risk and protective factors associated with PTSD: a prospective study of National Guard troops deployed to Iraq.

PubMed

Kline, Anna; Ciccone, Donald S; Weiner, Marc; Interian, Alejandro; St Hill, Lauren; Falca-Dodson, Maria; Black, Christopher M; Losonczy, Miklos

2013-01-01

This study examines gender differences in post-traumatic stress symptoms (PTSS) and PTSS risk/protective factors among soldiers deployed to Iraq. We pay special attention to two potentially modifiable military factors, military preparedness and unit cohesion, which may buffer the deleterious psychological effects of combat. Longitudinal data were collected on 922 New Jersey National Guard soldiers (91 women) deployed to Iraq in 2008. Anonymous surveys administered at pre- and post-deployment included the PTSD Checklist (PCL), the Unit Support Scale, and a preparedness scale adapted from the Iowa Gulf War Study. Bivariate analyses and hierarchical multiple regression were used to identify predictors of PTSS and their explanatory effects on the relationship between gender and PTSS. Women had a higher prevalence of probable post-deployment PTSD than men (18.7% vs. 8.7%; OR = 2.45; CI [1.37, 4.37]) and significantly higher post-deployment PTSS (33.73 vs. 27.37; p = .001). While there were no gender differences in combat exposure, women scored higher on pre-deployment PTSS (26.9 vs. 23.1; p ≤ .001) and lower on military preparedness (1.65 vs. 2.41; p ≤ .001) and unit cohesion (32.5 vs. 38.1; p ≤ .001). In a multivariate model, controlling for all PTSS risk/resilience factors reduced the gender difference as measured by the unstandardized Beta (B) by 45%, with 18% uniquely attributable to low cohesion and low preparedness. In the fully controlled model, gender remained a significant predictor of PTSS but the effect size was small (d = .26). Modifiable military institutional factors may account for much of the increased vulnerability of women soldiers to PTSD.

Epigenetic Patterns of PTSD: DNA Methylation in Serum of OIF/OEF Service Members

DTIC Science & Technology

2009-03-01

DNA methylation patterns in cytokines in soldiers prior to OIF or OEF deployment; serum derived DNA is being used. PTSD cases with existing serum...having an outpatient record with a primary diagnosis of PTSD, based on ICD-9 codes; an appropriate control group was identified. For each PTSD case ... cases and controls and between pre- and post-deployments of each group. We will also measure levels of these specific cytokines using an ELISA

Impaired fear inhibition learning predicts the persistence of symptoms of posttraumatic stress disorder (PTSD).

PubMed

Sijbrandij, Marit; Engelhard, Iris M; Lommen, Miriam J J; Leer, Arne; Baas, Johanna M P

2013-12-01

Recent cross-sectional studies have shown that the inability to suppress fear under safe conditions is a key problem in people with posttraumatic stress disorder (PTSD). The current longitudinal study examined whether individual differences in fear inhibition predict the persistence of PTSD symptoms. Approximately 2 months after deployment to Afghanistan, 144 trauma-exposed Dutch soldiers were administered a conditional discrimination task (AX+/BX-). In this paradigm, A, B, and X are neutral stimuli. X combined with A is paired with a shock (AX+ trials); X combined with B is not (BX- trials). Fear inhibition was measured (AB trials). Startle electromyogram responses and shock expectancy ratings were recorded. PTSD symptoms were measured at 2 months and at 9 months after deployment. Results showed that greater startle responses during AB trials in individuals who discriminated between danger (AX+) and safety (BX-) during conditioning, predicted higher PTSD symptoms at 2 months and 9 months post-deployment. The predictive effect at 9 months remained significant after controlling for critical incidents during previous deployments and PTSD symptoms at 2 months. Responses to AX+ or BX- trials, or discrimination learning (AX+ minus BX-) did not predict PTSD symptoms. It is concluded that impaired fear inhibition learning seems to be involved in the persistence of PTSD symptoms. Copyright © 2013 Elsevier Ltd. All rights reserved.

A model of suicidal behavior in war veterans with posttraumatic mood disorder.

PubMed

Sher, Leo

2009-08-01

Many wars have been fought during the history of civilization. About 30 armed conflicts are occurring now around the globe involving more than 25 countries. Many war veterans have symptoms of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) including suicidal ideation and behavior. PTSD is frequently comorbid with MDD. I have previously proposed that some or all individuals diagnosed with comorbid PTSD and MDD have a separate psychobiological condition that can be termed "posttraumatic mood disorder" (PTMD). This idea was based on the fact that a significant number of studies suggested that patients suffering from comorbid PTSD and MDD differed clinically and biologically from individuals with PTSD alone or MDD alone. Individuals with comorbid PTSD and MDD are characterized by greater severity of symptoms, increased suicidality and the higher level of impairment in social and occupational functioning compared to individuals with PTSD alone or MDD alone. Neurobiological evidence supporting the concept of PTMD includes the findings from neuroendocrine challenge, cerebrospinal fluid, neuroimaging, sleep and other studies. In this paper, I propose a model of suicidal behavior in war veterans with PTMD. The model consists of the following components: (1) genetic factors; (2) prenatal development; (3) biological and psychosocial influences from birth to mobilization/deployment; (4) mobilization/pre-deployment stress; (5) combat stress, traumatic brain injury, and physical injury; (6) post-deployment stress; (7) biological and psychosocial influences after the deployment; (8) trigger (precipitant) of a suicidal act; and (9) suicidal act. The first four components determine vulnerability to combat stress. The first seven components determine predisposition to suicidal behavior, a key element that differentiates PTMD patients who are at high risk from those at lower risk. Suicidal behavior in PTMD can be attributed to the coincidence of a trigger with a predisposition for suicidal behavior. Suicide prevention in war veterans with PTMD should focus on (1) improvement in recognition of PTMD; (2) treating symptoms of PTMD; (3) preventing a relapse when the patient is in remission; (4) treating suicidal ideation; (5) treating comorbid psychiatric conditions including alcohol and drug abuse; (6) treating medical and neurological disorders including traumatic brain injury; and (7) social support. It is extremely important to understand PTMD, to optimize assessment and treatment for people with PTMD, and to identify processes that facilitate recovery from exposure to traumatic events. Every nation, every generation, faces traumas that cause suicide. The world needs to deal with this and it is one thing that the world can come together on.

Community integration after deployment to Afghanistan: a longitudinal investigation of Danish soldiers.

PubMed

Karstoft, Karen-Inge; Armour, Cherie; Andersen, Søren B; Bertelsen, Mette; Madsen, Trine

2015-04-01

In the years following military deployment, soldiers may experience problems integrating into the community. However, little is known about the nature and prevalence of these problems and if they relate to posttraumatic symptomatology. In a prospective, longitudinal study of Danish soldiers deployed to Afghanistan in 2009 (N = 743), we assessed community reintegration difficulties 2.5 years after home coming (study sample: N = 454). Furthermore, symptoms of posttraumatic stress disorder (PTSD) were assessed before, during, and after deployment. Trajectories of PTSD symptoms from a previously published latent growth mixture modeling analysis were used to address whether community reintegration difficulties differ as a result of course and level of PTSD symptoms. Between 3.6 and 18.0% reported to have some, a lot, or extreme difficulties in reintegration domains such as interpersonal functioning, productivity, community involvement, and self-care. Mean level of reintegration difficulties differed significantly across six PTSD symptom trajectories (range 6.35-36.00); with more symptomatic trajectories experiencing greater community reintegration difficulties. Reintegration difficulties after deployment are present in less than 20% of Danish soldiers who return from Afghanistan. Difficulties are greater in individuals who follow symptomatic PTSD trajectories in the first years following deployment than in those who follow a low-stable trajectory with no or few symptoms.

Prevalence of hearing loss and tinnitus in Iraq and Afghanistan Veterans: A Chronic Effects of Neurotrauma Consortium study.

PubMed

Swan, A A; Nelson, J T; Swiger, B; Jaramillo, C A; Eapen, B C; Packer, M; Pugh, M J

2017-06-01

The purpose of this study was to describe the prevalence of hearing loss and tinnitus in a cohort of Iraq and Afghanistan Veterans (IAV) with common post-deployment conditions, including traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and other typical post-concussive conditions such as headaches and vertigo/dizziness. This retrospective observational study used data from the national Veterans Health Administration (VA) data repository from fiscal years 2001-2014. Veteran data was included if there were at least three years of VA care, with one or more years of care in 2007 or after. We identified comorbidities that may be associated with post-deployment hearing loss or tinnitus including TBI, PTSD, depression, and common post-concussive symptoms using International Classification of Diseases, 9th Revision, Clinical Modification codes. A multinomial logistic regression analysis was used to examine conditions associated with hearing loss or tinnitus. Among IAV, 570,332 were included in the final analysis. Of these, 7.78% of these were diagnosed with hearing loss alone, 6.54% with tinnitus alone, and 6.24% with both hearing loss and tinnitus. Comorbid TBI, PTSD, and depression were significantly associated with increased rates of hearing loss, tinnitus, or both conditions together. Older individuals, males, and those with TBI, PTSD, or vertigo/dizziness were significantly more likely to have hearing loss, tinnitus, or both. In order to provide more holistic post-deployment support, this myriad of conditions should be carefully considered in the planning of clinical care and beyond. Copyright © 2017 Elsevier B.V. All rights reserved.

Missed opportunity to screen and diagnose PTSD and depression among deploying shipboard US military personnel

PubMed Central

Hale, Braden R.; Michael, Nelson L.; Scott, Paul T.

2016-01-01

Background Depression and post-traumatic stress disorder (PTSD) are significant risks for suicide and other adverse events among US military personnel, but prevalence data among ship-assigned personnel at the onset of deployment are unknown. Aims To determine the prevalence of shipboard personnel who screen positive for PTSD and/or major depressive disorder (MDD) at the onset of deployment, and also those who reported these diagnoses made by a physician or healthcare professional in the year prior to deployment. Method Active-duty ship-assigned personnel (N = 2078) completed anonymous assessments at the beginning of deployment. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D; score of ≥22), and PTSD was assessed using the PTSD Checklist–Civilian Version (PCL-C; both score and symptom criteria were used). Results In total, 7.3% (n = 151 of 2076) screened positive for PTSD and 22% (n = 461 of 2078) for MDD at deployment onset. Only 6% and 15% of those who screened positive for PTSD or MDD, respectively, had been diagnosed by a healthcare professional in the past year. Conclusions Missed opportunities for mental healthcare among screen-positive shipboard personnel reduce the benefits associated with early identification and linkage to care. Improved methods of mental health screening that promote early recognition and referral to care may mitigate psychiatric events in theatre. Declaration of interest This work was performed as part of the official duties of the authors as military service members or employees of the US Government. Copyright and usage This work was prepared by military service members or employees of the US Government as part of their official duties. As such, copyright protection is not available for this work (Title 17, USC, §105). PMID:27713833

Relationship of PTSD Symptoms With Combat Exposure, Stress, and Inflammation in American Soldiers.

PubMed

Groer, Maureen W; Kane, Bradley; Williams, S Nicole; Duffy, Allyson

2015-05-01

Posttraumatic stress disorder (PTSD) is of great concern in veterans. PTSD usually occurs after a person is exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. Active duty soldiers deployed to war zones are at risk for PTSD. Psychoneuroimmunological theory predicts that PTSD, depression, and stress can lead to low-grade, chronic inflammation. We asked whether there were relationships between PTSD symptoms and chronic stress, depression and inflammation in active duty U.S. soldiers. We enrolled 52 active duty enlisted and reservist soldiers in a cross-sectional study while they participated in a week of military training in fall 2011. They completed a demographic questionnaire, the Center for Epidemiological Studies-Depression Scale, the Combat Exposure Scale, and the PTSD symptom Checklist-Military version (PCL-M). Blood samples were taken for analysis of cytokines and C-reactive protein (CRP). Hair samples shaved from the forearm were measured for cortisol. Of the soldiers, 11 had PCL-M scores in the moderate to severe range. Regression analysis demonstrated that depression and war zone deployment were strong predictors of PTSD symptoms. CRP and hair cortisol were correlated with each other and with depression and PTSD symptoms. These results suggest relationships among war zone deployment, depression, and PTSD. Chronic stress associated with depression, PTSD, and war zone experiences may be related to inflammation in active duty soldiers. © The Author(s) 2014.

Association of predeployment gaze bias for emotion stimuli with later symptoms of PTSD and depression in soldiers deployed in Iraq.

PubMed

Beevers, Christopher G; Lee, Han-Joo; Wells, Tony T; Ellis, Alissa J; Telch, Michael J

2011-07-01

Biased processing of emotion stimuli is thought to confer vulnerability to psychopathology, but few longitudinal studies of this link have been conducted. The authors examined the relationship between predeployment gaze bias for emotion stimuli and later symptoms of posttraumatic stress disorder (PTSD) and depression in soldiers deployed to Iraq. An eye-tracking paradigm was used to assess line of gaze in 139 soldiers while they viewed a two-by-two matrix of fearful, sad, happy, and neutral facial expressions before they were deployed to Iraq. Once they were deployed, the soldiers periodically reported on their levels of war zone stress exposure and symptoms of PTSD and depression. War zone stress exposure predicted higher scores on PTSD and depression symptom measures; however, eye gaze bias moderated this relationship. In soldiers with war zone stress exposure, shorter mean fixation time when viewing fearful faces predicted higher PTSD symptom scores, and greater total fixation time and longer mean fixation time for sad faces predicted higher depressive symptom scores. Biased processing of emotion stimuli, as measured by gaze bias, appears to confer vulnerability to symptoms of PTSD and depression in soldiers who experience war zone stress.

Postdeployment suicidal ideations and trajectories of posttraumatic stress disorder in Danish soldiers: a 3-year follow-up of the USPER study.

PubMed

Madsen, Trine; Karstoft, Karen-Inge; Bertelsen, Mette; Andersen, Søren Bo

2014-09-01

Suicidal ideation in veterans is of great concern. The objective of this study is to examine how heterogeneous posttraumatic stress disorder (PTSD) trajectories are associated with postdeployment suicidal ideation in veterans 2.5 years postdeployment to a combat zone in Afghanistan. If PTSD trajectories are associated with postdeployment suicidal ideations, then the accumulative knowledge on what characterizes veterans falling into different PTSD trajectories may provide better opportunities for early identification of suicidal high-risk veterans. In this prospective study of 743 Danish soldiers deployed to Afghanistan from February to August in 2009, we collected data at 6 time points from 6 weeks before deployment to 2.5 years after homecoming (total for this study: 456). At all assessments, the soldiers responded to a comprehensive questionnaire including measures of PTSD (measured by the PTSD Checklist, Civilian Version) and other mental and physical health variables, demographics, and social and combat-related factors. Suicidal ideation was measured by an item from the European Parasuicide Study Interview Schedule II. In a previous study based on soldiers from this cohort, we identified 6 PTSD trajectories using latent growth mixture modeling, which we have extracted and applied as independent variables in this study. Adjusted multivariable logistic regression analyses were applied to examine whether deployed soldiers with certain PTSD symptom trajectories were more likely to report suicidal ideation 2.5 years after homecoming. Two PTSD trajectories with high PTSD symptom level 2.5 years after return were significantly associated with suicidal ideation 2.5 years after homecoming. Thus, a relieved-worsening class, described by initial decreasing PTSD symptom levels followed by a steep increase in symptoms had higher risk of suicidal ideation (OR = 7.84; 95% CI, 1.68-36.6), which was also the case for a late-onset class (OR 5.2; 95% CI, 2.21-12.24) when compared to a low-stable class. Heterogeneous PTSD trajectories are associated with suicidal ideation in veterans 2.5 years after homecoming. © Copyright 2014 Physicians Postgraduate Press, Inc.

Reintegrating Troops with Mild Traumatic Brain Injury (mTBI) into their Communities: Understanding the Scope and Timeline of Post-Deployment Driving Problems

DTIC Science & Technology

2015-10-01

behaviors and anxieties among post- deployed SMs with and without traumatic brain injury (TBI), post-traumatic stress syndrome (PTSD) or TBI with...post- traumatic stress syndrome (TBI/PTSD). The goal was to compare SMs who were post-deployment to SMs who had not served in OEF/OIF/OND, however all...in situations when SM would typically drive (p=.02) with TBI/PTSD reporting this more common than TBI and 0Dx. • Move to middle of road or onto

Deployment-Related Psychiatric and Behavioral Conditions and Their Association with Functional Disability in OEF/OIF/OND Veterans

PubMed Central

Lippa, Sara M.; Fonda, Jennifer R.; Fortier, Catherine B.; Amick, Melissa A.; Kenna, Alexandra; Milberg, William P.; McGlinchey, Regina E.

2017-01-01

Understanding the factors that influence veterans’ functional outcome after deployment is critical to provide appropriately targeted care. Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) have been related to disability, but other psychiatric and behavioral conditions are not as well examined. We investigated the impact of deployment-related psychiatric and behavioral conditions on disability among 255 OEF/OIF/OND service members and veterans. Structured clinical interviews assessed TBI and the psychiatric conditions of depression, PTSD, anxiety, and substance use. Self-report questionnaires assessed disability and the behavioral conditions of sleep disturbance and pain. Over 90% of participants had a psychiatric and/or behavioral condition, with approximately half presenting with ≥ 3 conditions. Exploratory factor analysis revealed 4 clinically relevant psychiatric and behavioral factors which accounted for 76.9% of the variance: (a) depression, PTSD, and military mTBI (deployment trauma factor); (b) pain and sleep (somatic factor); (c) anxiety disorders, other than PTSD (anxiety factor); and (d) substance abuse or dependence (substance use factor). Individuals with the conditions comprising the deployment trauma factor were more likely to be substantially disabled than individuals with depression and PTSD, but no military mTBI, OR = 3.52; 95% CI [1.09, 11.37]. Depression, PTSD, and a history of military mTBI may comprise an especially harmful combination associated with high risk for substantial disability. PMID:25703936

The mental health of deployed UK maritime forces.

PubMed

Whybrow, Dean; Jones, Norman; Evans, Charlotte; Minshall, Darren; Smith, Darren; Greenberg, Neil

2016-02-01

To establish the level of psychological symptoms and the risk factors for possible decreased mental health among deployed UK maritime forces. A survey was completed by deployed Royal Navy (RN) personnel which measured the prevalence of common mental disorder (CMD), post-traumatic stress disorder (PTSD) and potential alcohol misuse. Military and operational characteristics were also measured including exposure to potentially traumatic events, problems occurring at home during the deployment, unit cohesion, leadership and morale. Associations between variables of interest were identified using binary logistic regression to generate ORs and 95% CIs adjusted for a range of potential confounding variables. In total, 41.2% (n=572/1387) of respondents reported probable CMD, 7.8% (n=109/1389) probable PTSD and 17.4% (n=242/1387) potentially harmful alcohol use. Lower morale, cohesion, leadership and problems at home were associated with CMD; lower morale, leadership, problems at home and exposure to potentially traumatic events were associated with probable PTSD; working in ships with a smaller crew size was associated with potentially harmful alcohol use. CMD and PTSD were more frequently reported in the maritime environment than during recent land-based deployments. Rates of potentially harmful alcohol use have reduced but remain higher than the wider military. Experiencing problems at home and exposure to potentially traumatic events were associated with experiencing poorer mental health; higher morale, cohesion and better leadership with fewer psychological symptoms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Pre-trauma individual differences in extinction learning predict posttraumatic stress.

PubMed

Lommen, Miriam J J; Engelhard, Iris M; Sijbrandij, Marit; van den Hout, Marcel A; Hermans, Dirk

2013-02-01

In the aftermath of a traumatic event, many people suffer from psychological distress, but only a minority develops posttraumatic stress disorder (PTSD). Pre-trauma individual differences in fear conditioning, most notably reduced extinction learning, have been proposed as playing an important role in the etiology of PTSD. However, prospective data are lacking. In this study, we prospectively tested whether reduced extinction was a predictor for later posttraumatic stress. Dutch soldiers (N = 249) were administered a conditioning task before their four-month deployment to Afghanistan to asses individual differences in extinction learning. After returning home, posttraumatic stress was measured. Results showed that reduced extinction learning before deployment predicted subsequent PTSD symptom severity, over and beyond degree of pre-deployment stress symptoms, neuroticism, and exposure to stressors on deployment. The findings suggest that reduced extinction learning may play a role in the development of PTSD. Copyright © 2012 Elsevier Ltd. All rights reserved.

A Decade of War: Prospective Trajectories of Posttraumatic Stress Disorder Symptoms Among Deployed US Military Personnel and the Influence of Combat Exposure.

PubMed

Donoho, Carrie J; Bonanno, George A; Porter, Ben; Kearney, Lauren; Powell, Teresa M

2017-12-15

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder among service members and veterans. The clinical course of PTSD varies between individuals, and patterns of symptom development have yet to be clearly delineated. Previous studies have been limited by convenience sampling, short follow-up periods, and the inability to account for combat-related trauma. To determine the trajectories of PTSD symptoms among deployed military personnel with and without combat exposure, we used data from a population-based representative sample of 8,178 US service members who participated in the Millennium Cohort Study from 2001 to 2011. Using latent growth mixture modeling, trajectories of PTSD symptoms were determined in the total sample, as well as in individuals with and without combat exposure, respectively. Overall, 4 trajectories of PTSD were characterized: resilient, pre-existing, new-onset, and moderate stable. Across all trajectories, combat-deployed service members diverged from non-combat-deployed service members, even after a single deployment. The former also generally had higher PTSD symptoms. Based on the models, nearly 90% of those without combat exposure remained resilient over the 10-year period, compared with 80% of those with combat exposure. Findings demonstrate that although the clinical course of PTSD symptoms shows heterogeneous patterns of development, combat exposure is uniformly associated with poor mental health. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Emotional reactivity to a single inhalation of 35% carbon dioxide and its association with later symptoms of posttraumatic stress disorder and anxiety in soldiers deployed to Iraq.

PubMed

Telch, Michael J; Rosenfield, David; Lee, Han-Joo; Pai, Anushka

2012-11-01

The identification of modifiable predeployment vulnerability factors that increase the risk of combat stress reactions among soldiers once deployed to a war zone offers significant potential for the prevention of posttraumatic stress disorder (PTSD) and other combat-related stress disorders. Adults with anxiety disorders display heightened emotional reactivity to a single inhalation of 35% carbon dioxide (CO(2)); however, data investigating prospective linkages between emotional reactivity to CO(2) and susceptibility to war-zone stress reactions are lacking. To investigate the association of soldiers' predeployment emotional reactivity to 35% CO(2) challenge with several indices of subsequent war-zone stress symptoms assessed monthly while deployed in Iraq. Prospective cohort study of 158 soldiers with no history of deployment to a war zone were recruited from the Texas Combat Stress Risk Study between April 2, 2007, and August 28, 2009. Multilevel regression models were used to investigate the association between emotional reactivity to 35% CO(2) challenge (assessed before deployment) and soldiers' reported symptoms of general anxiety/stress, PTSD, and depression while deployed to Iraq. Growth curves of PTSD, depression, and general anxiety/stress symptoms showed a significant curvilinear relationship during the 16-month deployment period. War-zone stressors reported in theater were associated with symptoms of general anxiety/stress, PTSD, and depression. Consistent with the prediction, soldiers' emotional reactivity to a single inhalation of 35% CO(2)-enriched air before deployment significantly potentiated the effects of war-zone stressors on the subsequent development of PTSD symptoms and general anxiety/stress symptoms but not on the development of depression, even after accounting for the effects of trait anxiety and the presence of past or current Axis I mental disorders. Soldiers' emotional reactivity to a 35% CO(2) challenge may serve as a vulnerability factor for increasing soldiers' risk for PTSD and general anxiety/stress symptoms in response to war-zone stressors.

Combat experiences, pre-deployment training, and outcome of exposure therapy for post-traumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom veterans.

PubMed

Price, Matthew; Gros, Daniel F; Strachan, Martha; Ruggiero, Kenneth J; Acierno, Ron

2013-01-01

The association between exposure to multiple potentially traumatic events (PTEs) and subsequent increased risk of post-traumatic stress disorder (PTSD) is well established. However, less is known about the relation between exposure to numerous PTEs, as is typical with military service, and treatment outcome. Furthermore, there has been little research examining military specific protective factors, such as pre-deployment preparedness, on PTSD treatment response. The current study investigated combat exposure and potential moderators of treatment outcome for exposure therapy in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with PTSD. One hundred and eleven OEF/OIF veterans diagnosed with PTSD participated in 8 weeks of exposure therapy. Results indicated that increased combat exposure was associated with a reduced rate of change in PTSD symptoms but not depression symptoms. These findings were consistent across two measures of combat exposure. There was preliminary support for the moderating effect of pre-deployment preparedness on the association between combat exposure and treatment response. Together, these findings suggest that increased combat exposure is associated with poor treatment response in veterans with PTSD; however, this can be reduced by elevated pre-deployment preparedness. Copyright © 2012 John Wiley & Sons, Ltd.

Military deployment correlates with smaller prefrontal gray matter volume and psychological symptoms in a subclinical population.

PubMed

Butler, O; Adolf, J; Gleich, T; Willmund, G; Zimmermann, P; Lindenberger, U; Gallinat, J; Kühn, S

2017-02-14

Research investigating the effects of trauma exposure on brain structure and function in adults has mainly focused on post-traumatic stress disorder (PTSD), whereas trauma-exposed individuals without a clinical diagnoses often serve as controls. However, this assumes a dichotomy between clinical and subclinical populations that may not be supported at the neural level. In the current study we investigate whether the effects of repeated or long-term stress exposure on brain structure in a subclinical sample are similar to previous PTSD neuroimaging findings. We assessed 27 combat trauma-exposed individuals by means of whole-brain voxel-based morphometry on 3 T magnetic resonance imaging scans and identified a negative association between duration of military deployment and gray matter volumes in ventromedial prefrontal cortex (vmPFC) and dorsal anterior cingulate cortex (ACC). We also found a negative relationship between deployment-related gray matter volumes and psychological symptoms, but not between military deployment and psychological symptoms. To our knowledge, this is the first whole-brain analysis showing that longer military deployment is associated with smaller regional brain volumes in combat-exposed individuals without PTSD. Notably, the observed gray matter associations resemble those previously identified in PTSD populations, and concern regions involved in emotional regulation and fear extinction. These findings question the current dichotomy between clinical and subclinical populations in PTSD neuroimaging research. Instead, neural correlates of both stress exposure and PTSD symptomatology may be more meaningfully investigated at a continuous level.

Military deployment correlates with smaller prefrontal gray matter volume and psychological symptoms in a subclinical population

PubMed Central

Butler, O; Adolf, J; Gleich, T; Willmund, G; Zimmermann, P; Lindenberger, U; Gallinat, J; Kühn, S

2017-01-01

Research investigating the effects of trauma exposure on brain structure and function in adults has mainly focused on post-traumatic stress disorder (PTSD), whereas trauma-exposed individuals without a clinical diagnoses often serve as controls. However, this assumes a dichotomy between clinical and subclinical populations that may not be supported at the neural level. In the current study we investigate whether the effects of repeated or long-term stress exposure on brain structure in a subclinical sample are similar to previous PTSD neuroimaging findings. We assessed 27 combat trauma-exposed individuals by means of whole-brain voxel-based morphometry on 3 T magnetic resonance imaging scans and identified a negative association between duration of military deployment and gray matter volumes in ventromedial prefrontal cortex (vmPFC) and dorsal anterior cingulate cortex (ACC). We also found a negative relationship between deployment-related gray matter volumes and psychological symptoms, but not between military deployment and psychological symptoms. To our knowledge, this is the first whole-brain analysis showing that longer military deployment is associated with smaller regional brain volumes in combat-exposed individuals without PTSD. Notably, the observed gray matter associations resemble those previously identified in PTSD populations, and concern regions involved in emotional regulation and fear extinction. These findings question the current dichotomy between clinical and subclinical populations in PTSD neuroimaging research. Instead, neural correlates of both stress exposure and PTSD symptomatology may be more meaningfully investigated at a continuous level. PMID:28195568

Use of the Air Force Post-Deployment Health Reassessment for the identification of depression and posttraumatic stress disorder: public health implications for suicide prevention.

PubMed

McCarthy, Michael D; Thompson, Sanna J; Knox, Kerry L

2012-03-01

Military members are required to complete the Post-Deployment Health Assessment on return from deployment and the Post-Deployment Health Reassessment (PHDRA) 90 to 180 days later, and we assessed the PDHRA's sensitivity and specificity in identifying posttraumatic stress disorder (PTSD) and depression after a military deployment among US Air Force personnel. We computed the PDHRA's sensitivity and specificity for depression and PTSD and developed a structural model to suggest possible improvements to it. For depression, sensitivity and specificity were 0.704 and 0.651, respectively; for PTSD, they were 0.774 and 0.650, respectively. Several variables produced significant direct effects on depression and trauma, suggesting that modifications could increase its sensitivity and specificity. The PDHRA was moderately effective in identifying airmen with depression and PTSD. It identified behavioral health concerns in many airmen who did not develop a diagnostic mental health condition. Its low level of specificity may result in reduced barriers to care and increased support services, key components of a public health approach to suicide prevention, for airmen experiencing subacute levels of distress after deployment, which may, in part, account for lower suicide rates among airmen after deployment.

Hair cortisol concentrations and cortisol stress reactivity predict PTSD symptom increase after trauma exposure during military deployment.

PubMed

Steudte-Schmiedgen, Susann; Stalder, Tobias; Schönfeld, Sabine; Wittchen, Hans-Ulrich; Trautmann, Sebastian; Alexander, Nina; Miller, Robert; Kirschbaum, Clemens

2015-09-01

Previous evidence on endocrine risk markers for posttraumatic stress disorder (PTSD) has been inconclusive. Here, we report results of the first prospective study to investigate whether long-term hair cortisol levels and experimentally-induced cortisol stress reactivity are predictive of the development of PTSD symptomatology in response to trauma during military deployment. Male soldiers were examined before deployment to Afghanistan and at a 12-month post-deployment follow-up using dimensional measures for psychopathological symptoms. The predictive value of baseline (i) hair cortisol concentrations (HCC, N=90) and (ii) salivary cortisol stress reactivity (measured by the Trier Social Stress Test, N=80) for the development of PTSD symptomatology after being exposed to new-onset traumatic events was analyzed. Baseline cortisol activity significantly predicted PTSD symptom change from baseline to follow-up upon trauma exposure. Specifically, our results consistently revealed that lower HCC and lower cortisol stress reactivity were predictive of a greater increase in PTSD symptomatology in soldiers who had experienced new-onset traumatic events (explaining 5% and 10.3% of variance, respectively). Longitudinal analyses revealed an increase in HCC from baseline to follow-up and a trend for a negative relationship between HCC changes and the number of new-onset traumatic events. Additional pre-deployment analyses revealed that trauma history was reflected in lower HCC (at trend level) and that HCC were negatively related to stressful load. Our data indicate that attenuated cortisol secretion is a risk marker for subsequent development of PTSD symptomatology upon trauma exposure. Future studies are needed to confirm our findings in other samples. Copyright © 2015 Elsevier Ltd. All rights reserved.

Gender, position of authority, and the risk of depression and post-traumatic stress disorder among a national sample of U.S. Reserve Component Personnel

PubMed Central

Cohen, Gregory H.; Sampson, Laura A.; Fink, David S.; Wang, Jing; Russell, Dale; Gifford, Robert; Fullerton, Carol; Ursano, Robert; Galea, Sandro

2016-01-01

BACKGROUND Recent United States military operations in Iraq and Afghanistan have seen dramatic increases in the proportion of women serving, and the breadth of their occupational roles. General population studies suggest that women, compared to men, and persons with lower, as compared to higher, social position may be at greater risk of post-traumatic stress disorder (PTSD) and depression. However, these relations remain unclear in military populations. Accordingly, we aimed to estimate the effects of (1) gender, (2) military authority (i.e., rank) and (3) the interaction of gender and military authority upon: (a) risk of most-recent-deployment-related PTSD, and (b) risk of depression since most-recent-deployment. METHODS Using a nationally representative sample of 1024 previously deployed Reserve Component personnel surveyed in 2010, we constructed multivariable logistic regression models to estimate effects of interest. RESULTS Weighted multivariable logistic regression models demonstrated no statistically significant associations between gender or authority, and either PTSD or depression. Interaction models demonstrated multiplicative statistical interaction between gender and authority for PTSD (beta= −2.37;p=0.01), and depression (beta=-1.21; p=0.057). Predicted probabilities of PTSD and depression, respectively, were lowest in male officers (0.06, 0.09), followed by male enlisted (0.07, 0.14), female enlisted (0.07, 0.15), and female officers (0.30, 0.25). CONCLUSIONS Female officers in the Reserve Component may be at greatest risk for PTSD and depression following deployment, relative to their male and enlisted counterparts, and this relation is not explained by deployment trauma exposure. Future studies may fruitfully examine whether social support, family responsibilities peri-deployment, or contradictory class status may explain these findings. PMID:26899583

Epidemiology of psychiatric disability without posttraumatic stress disorder among U.S. Army and Marine Corps personnel evaluated for disability discharge.

PubMed

Piccirillo, Amanda L; Packnett, Elizabeth R; Boivin, Michael R; Cowan, David N

2015-12-01

Psychiatric disorders are a common reason for disability discharge from the U.S. military. Research on psychiatric disorders in military personnel evaluated for disability discharge has historically focused on posttraumatic stress disorder (PTSD), yet 40% of service members evaluated for a psychiatric-related disability do not have PTSD. This study's objective was to describe characteristics and correlates of disability in Army and Marine Corps personnel diagnosed with psychiatric disorders other than PTSD. In this cross-sectional study, the chi-square and Wilcoxon-Mann-Whitney tests compared the distribution of demographic, disability and deployment characteristics between those evaluated for non-PTSD psychiatric disability (N = 9125) versus those evaluated for any other non-psychiatric condition (N = 78,072). Multivariate logistic regression examined associations between disability retirement and demographic and disability characteristics. Results show a significantly higher prevalence of disability retirement, deployment, and comorbidity among Army and Marine Corps personnel evaluated for disability discharge related to a non-PTSD psychiatric disorder. Mood disorders, anxiety disorders and dementia were the most commonly evaluated psychiatric disorders. Characteristics associated with increased odds of non-PTSD psychiatric-related disability retirement includes being in the Marine Corps (OR = 1.24), being black (OR = 1.29) or other race (OR = 1.33), having a combat-related condition (OR = 2.50), and older age. Service members evaluated for a non-PTSD psychiatric disability have similar rates of disability retirement as those evaluated for PTSD, suggesting non-PTSD psychiatric disorders cause a severe and highly compensated disability. Additional research is needed describing the epidemiology of specific non-PTSD psychiatric disorders, such as depression, in service members evaluated for disability discharge. Copyright © 2015 Elsevier Ltd. All rights reserved.

Post-deployment Mental Health in Reserve and National Guard Service Members: Deploying With or Without One's Unit and Deployment Preparedness.

PubMed

Ursano, Robert J; Wang, Jing; Fullerton, Carol S; Ramsawh, Holly; Gifford, Robert K; Russell, Dale; Cohen, Gregory H; Sampson, Laura; Galea, Sandro

2018-01-01

Given the greater prevalence of post-deployment mental health concerns among reservists, the higher likelihood of deploying without their regular unit, and potentially lower rates of deployment preparedness, we examined associations between deploying with or without one's regular unit (individual augmentee status, IAS), deployment preparedness, and mental health problems including post-traumatic stress disorder (PTSD), depression (MDD), and binge drinking in a nationally representative sample of Reserve Component (RC) Army and Marine-enlisted males (n = 705). A series of multivariate regressions examined the association of mental health with IAS and deployment preparedness, adjusting for demographics. To examine whether deployment preparedness varied by IAS, an IAS × deployment preparedness interaction was included. In an adjusted model, being an individual augmentee and low deployment preparedness were associated with any mental health problem (screening positive for PTSD, MDD, binge drinking, or any combination of the three). There was a significant IAS × deployment preparedness interaction. Mental health problems did not vary by preparedness among individual augmentees. Participants deploying with regular units with low-medium preparedness had greater risk for mental health problems (odds ratio [OR] = 3.69, 95% confidence interval [CI] = 1.78-7.62 and OR = 2.29, 95% CI = 1.12-4.71), than those with high preparedness. RC-enlisted male personnel who deployed without their regular unit were five times more likely to have a mental health problem, and were 61% more likely to report binge drinking. Additionally, those with lower levels of deployment preparedness were up to three times more likely to have a mental health problem and up to six times more likely to report PTSD. The current investigation found that both IAS and deployment preparedness were associated with negative mental health outcomes in a large representative sample of previously deployed RC-enlisted male personnel. In particular, low deployment preparedness was associated with an increased likelihood of PTSD, and deploying without one's regular unit was associated with increased rates of binge drinking. There were also significant main and interaction effects of IAS and deployment preparedness on having a mental health problem. It is possible that limiting the number of RC personnel deploying without their regular unit may help to decrease alcohol misuse among U.S. Armed Services reservists during and after future conflicts. Also, to the extent that deployment preparedness is a modifiable risk factor, future studies should examine whether increasing deployment preparedness could mitigate some of the correlates of deployment-related trauma exposure. Finally, future investigation is needed to explain why those who deploy without their regular unit, but who report high deployment preparedness, remain at elevated risk for mental health problems. It is possible that individual augmentees can benefit from a specific preparation for deployment. Those deploying without their regular unit had higher rates of mental health problems regardless of preparedness. These findings have implications for deployment preparedness training for those deploying without their regular unit. Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Posttraumatic Stress and Physical Health Functioning: Moderating Effects of Deployment and Postdeployment Social Support in OEF/OIF/OND Veterans

PubMed Central

Luciano, Matthew T.; McDevitt-Murphy, Meghan E.

2016-01-01

Research indicates that posttraumatic stress disorder (PTSD) is strongly associated with physical health difficulties, and that social support may be protective for both problems. Social support, however, is often broadly conceptualized. The present analysis explores how Veteran-specific social support (during military deployment and postdeployment) may moderate the relationship between PTSD and physical health functioning. Participants were recruited from a VA Medical Center. Self-report data was analyzed from 63 Veterans (17.46% female; 42.86% White) who had been deployed in support of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND). Data indicate that military deployment social support moderated the relationship between PTSD and pain (β = .02, p = .02) while postdeployment social support moderated the relationship between PTSD and general health perceptions (β = .03, p = .01). These findings may be used to better understand the role of support in influencing psychological and physiological processes. PMID:27660993

Prospective Assessment of Neurocognition in Future Gulf-deployed and Gulf-nondeployed Military Personnel: A Pilot Study

DTIC Science & Technology

2007-02-01

increased emotional distress but with advantaged simple reactiontime. Unit cohesion buffers the adverse effects of early life events on PTSD prior to...motor speed), and emotional (e.g., mood) behaviors thought to reflect neural integrity. Unresolved issues include whether subjective...including neurobehavioral and emotional functioning, (b) examine the impact of deployment-related stress and environmental exposures on

Relationship of service members' deployment trauma, PTSD symptoms, and experiential avoidance to postdeployment family reengagement.

PubMed

Brockman, Callie; Snyder, James; Gewirtz, Abigail; Gird, Suzanne R; Quattlebaum, Jamie; Schmidt, Nicole; Pauldine, Michael R; Elish, Katie; Schrepferman, Lynn; Hayes, Charles; Zettle, Robert; DeGarmo, David

2016-02-01

This research examined whether military service members' deployment-related trauma exposure, posttraumatic stress disorder (PTSD) symptoms, and experiential avoidance are associated with their observed levels of positive social engagement, social withdrawal, reactivity-coercion, and distress avoidance during postdeployment family interaction. Self reports of deployment related trauma, postdeployment PTSD symptoms, and experiential avoidance were collected from 184 men who were deployed to the Middle East conflicts, were partnered, and had a child between 4 and 13 years of age. Video samples of parent-child and partner problem solving and conversations about deployment issues were collected, and were rated by trained observers to assess service members' positive engagement, social withdrawal, reactivity-coercion, and distress avoidance, as well as spouse and child negative affect and behavior. Service members' experiential avoidance was reliably associated with less observed positive engagement and more observed withdrawal and distress avoidance after controlling for spouse and child negative affect and behavior during ongoing interaction. Service members' experiential avoidance also diminished significant associations between service members' PTSD symptoms and their observed behavior. The results are discussed in terms of how service members' psychological acceptance promotes family resilience and adaption to the multiple contextual challenges and role transitions associated with military deployment. Implications for parenting and marital interventions are described. (c) 2016 APA, all rights reserved).

Relationship of Service Members’ Deployment Trauma, PTSD Symptoms and Experiential Avoidance to Postdeployment Family Reengagement

PubMed Central

Brockman, Callie; Snyder, James; Gewirtz, Abigail; Gird, Suzanne R.; Quattlebaum, Jamie; Schmidt, Nicole; Pauldine, Michael R.; Elish, Katie; Schrepferman, Lynn; Hayes, Charles; Zettle, Robert; DeGarmo, David

2016-01-01

This research examined whether military service members’ deployment-related trauma exposure, PTSD symptoms and experiential avoidance are associated with their observed levels of positive social engagement, social withdrawal, reactivity-coercion, and distress avoidance during postdeployment family interaction. Self reports of deployment related trauma, postdeployment PTSD symptoms and experiential avoidance were collected from 184 men who were deployed to the Middle East conflicts, were partnered, and had a child between 4 and 13 years of age. Video samples of parent-child and partner problem solving and conversations about deployment issues were collected, and were rated by trained observers to assess service members’ positive engagement, social withdrawal, reactivity-coercion, and distress avoidance, as well as spouse and child negative affect and behavior. Service members’ experiential avoidance was reliably associated with less of observed positive engagement and more observed withdrawal and distress avoidance after controlling for spouse and child negative affect and behavior during ongoing interaction. Service members’ experiential avoidance also diminished significant associations between service members’ PTSD symptoms and their observed behavior. The results are discussed in terms of how service members’ psychological acceptance promotes family resilience and adaption to the multiple contextual challenges and role transitions associated with military deployment. Implications for parenting and marital interventions are described. PMID:26437144

Prospective longitudinal evaluation of the effect of deployment-acquired traumatic brain injury on posttraumatic stress and related disorders: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

PubMed

Stein, Murray B; Kessler, Ronald C; Heeringa, Steven G; Jain, Sonia; Campbell-Sills, Laura; Colpe, Lisa J; Fullerton, Carol S; Nock, Matthew K; Sampson, Nancy A; Schoenbaum, Michael; Sun, Xiaoying; Thomas, Michael L; Ursano, Robert J

2015-11-01

Traumatic brain injury (TBI) is increasingly recognized as a risk factor for deleterious mental health and functional outcomes. The purpose of this study was to examine the strength and specificity of the association between deployment-acquired TBI and subsequent posttraumatic stress and related disorders among U.S. Army personnel. A prospective, longitudinal survey of soldiers in three Brigade Combat Teams was conducted 1-2 months prior to an average 10-month deployment to Afghanistan (T0), upon redeployment to the United States (T1), approximately 3 months later (T2), and approximately 9 months later (T3). Outcomes of interest were 30-day prevalence postdeployment of posttraumatic stress disorder (PTSD), major depressive episode, generalized anxiety disorder, and suicidality, as well as presence and severity of postdeployment PTSD symptoms. Complete information was available for 4,645 soldiers. Approximately one in five soldiers reported exposure to mild (18.0%) or more-than-mild (1.2%) TBI(s) during the index deployment. Even after adjusting for other risk factors (e.g., predeployment mental health status, severity of deployment stress, prior TBI history), deployment-acquired TBI was associated with elevated adjusted odds of PTSD and generalized anxiety disorder at T2 and T3 and of major depressive episode at T2. Suicidality risk at T2 appeared similarly elevated, but this association did not reach statistical significance. The findings highlight the importance of surveillance efforts to identify soldiers who have sustained TBIs and are therefore at risk for an array of postdeployment adverse mental health outcomes, including but not limited to PTSD. The mechanism(s) accounting for these associations need to be elucidated to inform development of effective preventive and early intervention programs.

Predicting persistent posttraumatic stress disorder (PTSD) in UK military personnel who served in Iraq: a longitudinal study.

PubMed

Rona, Roberto J; Jones, Margaret; Sundin, Josefin; Goodwin, Laura; Hull, Lisa; Wessely, Simon; Fear, Nicola T

2012-09-01

In a longitudinal study we assessed which baseline risk factors are associated with persistent and partially remitted PTSD in comparison to fully remitted PTSD. 6427 (68%) of a randomly selected sample of UK service personnel completed the PTSD checklist (PCL) between 2004 and 2006 (Phase 1) and between 2007 and 2009 (Phase 2). 230 (3.9%) had possible PTSD at baseline. 66% of those with possible PTSD at baseline remitted (PCL score <30) or partially remitted (PCL score 30-49) by phase 2 of the study. Associations of persistent PTSD with the fully remitted group for risk factors at phase 1 adjusted for confounders were having discharged from service (OR 2.97, 95% CI 1.26-6.99), higher educational qualification (OR 2.74, 95% 1.23-6.08), feeling unsupported on return from deployment (OR 10.97, 95% CI 3.13-38.45), deployed not with parent unit (OR 5.63, 95% CI 1.45-21.85), multiple physical symptoms (OR 3.36, 95% CI 1.44-7.82), perception of poor or fair health (OR 2.84, 95% CI 1.28-6.27), older age and perception of risk to self (increasing with the number of events reported, p = 0.04). Deploying but not with a parent unit and psychological distress were associated in the partially remitted PTSD when compared to the fully remitted group. The positive and negative likelihood ratios for the factors most highly associated with persistent PTSD indicated they were of marginal value to identify those whose presumed PTSD would be persistent. Many factors contribute to the persistence of PTSD but none alone is useful for clinical prediction. Copyright © 2012 Elsevier Ltd. All rights reserved.

Women Vietnam Veterans: Do PTSD Symptoms Mediate Effects of Warzone Service on Health?

PubMed Central

Kaiser, Anica Pless; Spiro, Avron; Lee, Lewina Onyi; Stellman, Jeanne Mager

2012-01-01

We assessed the impact of warzone stress on the physical and mental health functioning and well-being of 975 female nurse veterans who had been deployed to Vietnam, and examined whether PTSD symptoms at the time of the survey mediated these relations. A questionnaire was mailed to the Women’s Vietnam Memorial Project members, approximately 25 – 30 years after their wartime service. We examined current physical and mental health functioning in relation to several measures of warzone stress and PTSD symptoms, adjusting for age, length of military service, and current physical health problems. Using regression models, we evaluated whether current PTSD symptoms mediated the effects of warzone stress on mental and physical health. Findings suggested that PTSD symptoms did mediate the relationship between warzone stress and mental, but not physical, health functioning in later life. These findings suggest that among women nurses deployed to Vietnam, the effects of warzone stress many years earlier on current functioning and well-being are both direct and indirect, mediated by PTSD symptoms. The legacy of wartime deployment remains, although muted in its expression, in military nurses nearly 30 years after their return. PMID:22984348

Etiology of depression comorbidity in combat-related PTSD: a review of the literature.

PubMed

Stander, Valerie A; Thomsen, Cynthia J; Highfill-McRoy, Robyn M

2014-03-01

Posttraumatic stress disorder is often diagnosed with other mental health problems, particularly depression. Although PTSD comorbidity has been associated with more severe and chronic symptomology, relationships among commonly co-occurring disorders are not well understood. The purpose of this study was to review the literature regarding the development of depression comorbid with combat-related PTSD among military personnel. We summarize results of commonly tested hypotheses about the etiology of PTSD and depression comorbidity, including (1) causal hypotheses, (2) common factor hypotheses, and (3) potential confounds. Evidence suggests that PTSD may be a causal risk factor for subsequent depression; however, associations are likely complex, involving bidirectional causality, common risk factors, and common vulnerabilities. The unique nature of PTSD-depression comorbidity in the context of military deployment and combat exposure is emphasized. Implications of our results for clinical practice and future research are discussed. Published by Elsevier Ltd.

The mental health of the UK Armed Forces: where facts meet fiction

PubMed Central

Hunt, Elizabeth J. F.; Wessely, Simon; Jones, Norman; Rona, Roberto J.; Greenberg, Neil

2014-01-01

A substantial amount of research has been conducted into the mental health of the UK military in recent years. This article summarises the results of the various studies and offers possible explanations for differences in findings between the UK and other allied nations. Post-traumatic stress disorder (PTSD) rates are perhaps surprisingly low amongst British forces, with prevalence rates of around 4% in personnel who have deployed, rising to 6% in combat troops, despite the high tempo of operations in recent years. The rates in personnel currently on operations are consistently lower than these. Explanations for the lower PTSD prevalence in British troops include variations in combat exposures, demographic differences, higher leader to enlisted soldier ratios, shorter operational tour lengths and differences in access to long-term health care between countries. Delayed-onset PTSD was recently found to be more common than previously supposed, accounting for nearly half of all PTSD cases; however, many of these had sub-syndromal PTSD predating the onset of the full disorder. Rates of common mental health disorders in UK troops are similar or higher to those of the general population, and overall operational deployments are not associated with an increase in mental health problems in UK regular forces. However, there does appear to be a correlation between both deployment and increased alcohol misuse and post-deployment violence in combat troops. Unlike for regular forces, there is an overall association between deployment and mental health problems in Reservists. There have been growing concerns regarding mild traumatic brain injury, though this appears to be low in British troops with an overall prevalence of 4.4% in comparison with 15% in the US military. The current strategies for detection and treatment of mental health problems in British forces are also described. The stance of the UK military is that psychological welfare of troops is primarily a chain of command responsibility, aided by medical advice when necessary, and to this end uses third location decompression, stress briefings, and Trauma Risk Management approaches. Outpatient treatment is provided by Field Mental Health Teams and military Departments of Community Mental Health, whilst inpatient care is given in specific NHS hospitals. PMID:25206948

Gender, Position of Authority, and the Risk of Depression and Posttraumatic Stress Disorder among a National Sample of U.S. Reserve Component Personnel.

PubMed

Cohen, Gregory H; Sampson, Laura A; Fink, David S; Wang, Jing; Russell, Dale; Gifford, Robert; Fullerton, Carol; Ursano, Robert; Galea, Sandro

2016-01-01

Recent U.S. military operations in Iraq and Afghanistan have seen dramatic increases in the proportion of women serving and the breadth of their occupational roles. General population studies suggest that women, compared with men, and persons with lower, as compared with higher, social position may be at greater risk of posttraumatic stress disorder (PTSD) and depression. However, these relations remain unclear in military populations. Accordingly, we aimed to estimate the effects of 1) gender, 2) military authority (i.e., rank), and 3) the interaction of gender and military authority on a) risk of most recent deployment-related PTSD and b) risk of depression since most recent deployment. Using a nationally representative sample of 1,024 previously deployed Reserve Component personnel surveyed in 2010, we constructed multivariable logistic regression models to estimate effects of interest. Weighted multivariable logistic regression models demonstrated no statistically significant associations between gender or authority, and either PTSD or depression. Interaction models demonstrated multiplicative statistical interaction between gender and authority for PTSD (beta = -2.37; p = .01), and depression (beta = -1.21; p = .057). Predicted probabilities of PTSD and depression, respectively, were lowest in male officers (0.06, 0.09), followed by male enlisted (0.07, 0.14), female enlisted (0.07, 0.15), and female officers (0.30, 0.25). Female officers in the Reserve Component may be at greatest risk for PTSD and depression after deployment, relative to their male and enlisted counterparts, and this relation is not explained by deployment trauma exposure. Future studies may fruitfully examine whether social support, family responsibilities peri-deployment, or contradictory class status may explain these findings. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Evaluating PTSD on Reproductive Outcomes: Women Deployed in Iraq and Afghanistan

DTIC Science & Technology

2009-10-01

Center attacks and its effect on pregnancy outcome . Paediatric and Perinatal Epidemiology, 2005. 19(5): p. 334-41. 6. Xiong, X., et al., Exposure ...health system. Thus, the effect of women’s military service on reproductive outcomes is a key concern. Due to the unique situation of women in the... exposure to PTSD as a consequence of deployment is one example of recent concern. A recent study found women who had deployed to Iraq/Afghanistan

Establishing a Methodology to Examine the Effects of War-Zone PTSD on the Family: The Family Foundations Study

PubMed Central

Vasterling, Jennifer J.; Taft, Casey T.; Proctor, Susan P.; MacDonald, Helen Z.; Lawrence, Amy; Kalill, Kathleen; Kaiser, Anica P.; Lee, Lewina O.; King, Daniel W.; King, Lynda A.; Fairbank, John A.

2015-01-01

Military deployment may adversely affect not only returning veterans, but their families, as well. As a result, researchers have increasingly focused on identifying risk and protective factors for successful family adaptation to war-zone deployment, re-integration of the returning veteran, and the longer-term psychosocial consequences of deployment experienced by some veterans and families. Posttraumatic stress disorder (PTSD) among returning veterans may pose particular challenges to military and military veteran families; however, questions remain regarding the impact of the course of veteran PTSD and other potential moderating factors on family adaptation to military deployment. The Family Foundations Study builds upon an established longitudinal cohort of Army soldiers (i.e., the Neurocognition Deployment Health Study) to help address remaining knowledge gaps. This report describes the conceptual framework and key gaps in knowledge that guided the study design, methodological challenges and special considerations in conducting military family research, and how these gaps, challenges, and special considerations are addressed by the study. PMID:26077194

Dual-hormone stress reactivity predicts downstream war-zone stress-evoked PTSD.

PubMed

Josephs, Robert A; Cobb, Adam R; Lancaster, Cynthia L; Lee, Han-Joo; Telch, Michael J

2017-04-01

The crucial role of the hypothalamic-pituitary-adrenal axis (HPA) in stress-related homeostasis suggests dysregulated HPA involvement in the pathogenesis of post-traumatic stress disorder (PTSD), yet most studies examining linkages between HPA axis measures and PTSD have yielded null findings. One untested explanation for this inconsistency is a failure to account for simultaneous adrenal and gonadal influence. Here we tested the singular and interactive effects of cortisol (C R ) and testosterone (T R ) reactivity as moderators of war-zone stress evoked PTSD emergence in the war-zone. U.S. soldiers (N=120) scheduled for deployment to Iraq completed pre-deployment measures of C R and T R stress reactivity to a CO 2 inhalation challenge. Once deployed, monthly assessments of exposure to traumatic war-zone stressors and PTSD symptoms were collected via a web-based assessment system. Cortisol hypo-reactivity potentiated the pathogenic impact of war-zone stressors only in soldiers for whom the CO 2 challenge did not elevate testosterone, suggesting that the dual hormone stress reactivity profile of blunted cortisol and testosterone may confer increased risk for PTSD emergence by potentiating the pathogenic effects of war-zone stressors. Findings underscore the utility of assessing both HPA and HPG stress reactivity when assessing PTSD vulnerability and may help inform efforts for enhanced soldier screening and inoculation to war-zone stressors. Copyright © 2017 Elsevier Ltd. All rights reserved.

Biomarkers for PTSD

DTIC Science & Technology

2012-07-01

post - traumatic stress disorder symptoms in Australian servicemen hospitalized in 1942-1952 Australas Psychiatry 16 (1), 18-21 (2008). 6 J.A...connected disability. Development of biomarkers of PTSD is critical for DOD and VA as objective indicators of PTSD for use in post -deployment medical...for service- connected disability5. Development of biomarkers of PTSD is critical for DOD and VA as objective indicators of PTSD for use in post

Military-related posttraumatic stress disorder and intimate relationship behaviors: a developing dyadic relationship model.

PubMed

Gerlock, April A; Grimesey, Jackie; Sayre, George

2014-07-01

The protracted conflict in Iraq and Afghanistan and an all-volunteer military has resulted in multiple war zone deployments for many service members. While quick redeployment turnaround has left little time for readjustment for either the service member or family, dealing with the long-term sequelae of combat exposure often leaves families and intimate partners ill-prepared for years after deployments. Using a modified grounded theory approach, digitally recorded couple interviews of 23 couples were purposefully selected from a larger sample of 441 couples to better understand the impact of war zone deployment on the couple. The veteran sample was recruited from a randomly selected cohort of men in treatment for posttraumatic stress disorder (PTSD). Overall, it was found when veterans experiencing deployment-related PTSD reenter or start new intimate relationships they may bring with them a unique cluster of interrelated issues which include PTSD symptoms, physical impairment, high rates of alcohol and/or drug abuse, and psychological and physical aggression. These factors contributed to a dynamic of exacerbating conflict. How these couples approached relationship qualities of mutuality, balanced locus of control and weakness tolerance across six axes of caregiving, disability, responsibility, trauma, communication, and community impacted the couple's capacity to communicate and resolve conflict. This dyadic relationship model is used to help inform implications for clinical practice. © 2013 American Association for Marriage and Family Therapy.

Post-Deployment Memorial Ceremony: A Vital Link

DTIC Science & Technology

2008-03-25

stress and possible post traumatic stress disorder ( PTSD ). Post - deployment memorial ceremonies provide the final link to...grieved in the allotted time provided at a memorial ceremony. Research into post - traumatic stress disorder ( PTSD ) indicates the cumulative effects...New York: Atheneum, 1994), 40. 38 Glenn R. Schiraldi, The Post – Traumatic Stress Disorder Sourcebook (Los Angeles: Lowell House, 2000),

Screening for Anger and Sleep Difficulties.

PubMed

Steele, Nicole M; Fogarty, Gerard J

2017-03-01

Mental health screens are designed to detect individuals at risk of psychological disorders. In the military setting of this study, these disorders were post-traumatic stress disorder (PTSD) and alcohol use. This study extends the literature on deployment-related mental health screening by including measures of sleep difficulties and anger as predictors of postdeployment PTSD and alcohol abuse. Evidence that measures of anger and sleep difficulties contribute incremental validity to the prediction of postdeployment mental health problems, including substance abuse, would be helpful in designing interventions to assist the rehabilitation of returning personnel. A test battery containing the PTSD Checklist-Civilian (PCL-C) to screen for PTSD, the Kessler 10 to screen for psychological distress, a Sleep Difficulties scale, an exposure to trauma scale, and an anger scale was administered to 212 personnel nearing completion of a deployment to the Middle East. A second battery containing the PCL-C, the Kessler 10, and a measure of alcohol consumption (Alcohol Use Disorders Identification Test [AUDIT]) was administered to the same personnel 3 to 6 months after return to Australia. Hierarchical regression analyses assessed the predictive validity of measures of psychological distress (anxiety and depression), PTSD symptomatology, sleep disturbance, and anger in relation to postdeployment measures of PTSD symptomatology and alcohol use. Time 1 measures predicted 24.4% of the variance in postdeployment PCL-C scores and 13.1% of the variance in AUDIT scores, with the Sleep Difficulties scale contributing to the prediction of the PCL-C score and the anger scale helping to predict AUDIT scores. On the basis of these findings, we recommend the inclusion of improved measures of both anger and sleep difficulties in end-of-deployment mental health screens. A less behaviorally specific and more wide-ranging anger scale is recommended for future studies that aim to evaluate the role of anger in screening batteries. Our findings suggest that the Sleep Difficulties scale used in this study would be a worthwhile addition to mental health screening because it is moderately correlated with both Time 1 and Time 2 measures of PTSD symptomatology and psychological distress. Furthermore, there is minimal stigma associated with the experience of sleep difficulties. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Mental Health Disorders, Suicide Risk, and Treatment seeking among Formerly Deployed National Guardand Reserve Service Member seen in Non VA Facilities

DTIC Science & Technology

2016-10-01

1 AWARD NUMBER: W81XWH-15-1-0506 TITLE: Mental Health Disorders, Suicide Risk, and Treatment seeking among Formerly Deployed National Guard... Suicide Risk, and Treatment seeking among Formerly Deployed National Guard and Reserve Service Member seen in Non-VA Facilities 5b. GRANT NUMBER W81XWH...and Reserve veterans. The prevalence of current PTSD was 7% (95% CI = 5.7-8.5). Preliminary analyses indicated that PTSD, depression , mental health

The impact of antecedent trauma exposure and mental health symptoms on the post-deployment mental health of Afghanistan-deployed Australian troops.

PubMed

Searle, Amelia K; Van Hooff, Miranda; Lawrence-Wood, Ellie R; Grace, Blair S; Saccone, Elizabeth J; Davy, Carol P; Lorimer, Michelle; McFarlane, Alexander C

2017-10-01

Both traumatic deployment experiences and antecedent traumas increase personnel's risk of developing PTSD and depression. However, only cross-sectional studies have assessed whether antecedent trauma moderates stress reactions to deployment experiences. This study prospectively examines whether antecedent trauma moderates the association between deployment trauma and post-deployment PTSD and depressive symptoms after accounting for antecedent mental health problems, in a large Australian Defence Force (ADF) sample. In the ADF Middle East Area of Operations Prospective Study, currently-serving military personnel deployed to Afghanistan across 2010-2012 (n = 1122) completed self-reported measures at pre-deployment and post-deployment. Within multivariable regressions, associations between deployment trauma and PTSD and depressive symptoms at post-deployment were stronger for personnel with greater antecedent trauma. However, once adjusting for antecedent mental health problems, these significant interaction effects disappeared. Instead, deployment-related trauma and antecedent mental health problems showed direct associations with post-deployment mental health problems. Antecedent trauma was also indirectly associated with post-deployment mental health problems through antecedent mental health problems. Similar associations were seen with prior combat exposure as a moderator. Antecedent and deployment trauma were reported retrospectively. Self-reports may also suffer from social desirability bias, especially at pre-deployment. Our main effects results support the pervasive and cumulative negative effect of trauma on military personnel, regardless of its source. While antecedent trauma does not amplify personnel's psychological response to deployment trauma, it is indirectly associated with increased post-deployment mental health problems. Antecedent mental health should be considered within pre-deployment prevention programs, and deployment-trauma within post-operational screening. Copyright © 2017. Published by Elsevier B.V.

Adaptive Disclosure: A Combat-Specific PTSD Treatment

DTIC Science & Technology

2015-10-01

operational stressors develop posttraumatic stress disorder ( PTSD ). Evidence-based interventions for treating PTSD , however, were not developed for military...experience deployment-related psychological health problems, such as posttraumatic stress disorder ( PTSD ; e.g., Hoge et al., 2004; see Litz & Schlenger...used to determine treatment efficacy. 15. SUBJECT TERMS Active-duty, Marine Corps, Posttraumatic stress disorder , Cognitive Therapy 16. SECURITY

PTSD and marital satisfaction in military service members: examining the simultaneous roles of childhood sexual abuse and combat exposure.

PubMed

Miller, Adam B; Schaefer, Karen E; Renshaw, Keith D; Blais, Rebecca K

2013-11-01

Childhood sexual abuse (CSA) is relatively common and is associated with a multitude of negative outcomes in adulthood, including posttraumatic stress disorder (PTSD) and lower marital satisfaction. However, CSA has been understudied in military samples. The purpose of the present study was to examine the relative contributions of CSA and combat exposure to PTSD and marital satisfaction. Two hundred eighteen National Guard/Reserve veterans who deployed overseas between 2001 and 2008 completed self-report measures of CSA, marital satisfaction, combat exposure, and PTSD symptom severity. Data were analyzed using linear regression and path analysis to evaluate a comprehensive model including all variables. CSA accounted for unique variance in PTSD symptom severity independent of combat exposure. CSA also had a negative direct association with marital satisfaction, independent of combat exposure and PTSD symptom severity. In contrast, combat exposure had only a negative indirect association with marital satisfaction via PTSD when all variables were examined simultaneously. CSA accounted for unique variance in both PTSD symptom severity and marital satisfaction in this sample of combat veterans. Clinically, results suggest that assessment and treatment of CSA is indicated for military veterans suffering from PTSD. Further, treatment of CSA may improve marital satisfaction, which may positively affect psychological functioning in the veteran. Copyright © 2013 Elsevier Ltd. All rights reserved.

Anger Problems and Posttraumatic Stress Disorder in Male and Female National Guard and Reserve Service Members

PubMed Central

Worthen, Miranda; Rathod, Sujit D.; Cohen, Gregory; Sampson, Laura; Ursano, Robert; Gifford, Robert; Fullerton, Carol; Galea, Sandro; Ahern, Jennifer

2014-01-01

Anger is a common problem among veterans and has been associated with posttraumatic stress disorder (PTSD). This study aimed to improve understanding of how anger and PTSD co-occur by examining gender differences and differences by whether the triggering traumatic event is deployment-related vs. civilian-related in current service members. A representative cohort of Reserve and National Guard service personnel (n = 1,293) were interviewed to assess for deployment- or civilian-related traumas, PTSD, and anger. The prevalence of self-reported anger problems was estimated among male (n = 1,036) and female (n = 257) service members. Log Poisson regression models with robust standard errors were used to estimate the associations of problems with anger with PTSD and PTSD symptom severity for men and women. Self-reported anger problems were common among male (53.0%) and female (51.3%) service members. Adjusted prevalence ratios (PR) showed associations between anger and PTSD connected to both civilian- and deployment-related traumas (PR were 1.77 (95% CI 1.52 – 2.05) and 1.85 (95% CI 1.62 – 2.12), respectively). PTSD symptom severity was also associated with anger. This study was cross-sectional and so a causal relationship between PTSD and anger cannot be established. Problems with anger are common among male and female current Guard and Reserve members. These findings suggest that anger treatment should be made available to current service members and that clinicians should assess anger problems irrespective of gender. Future research should examine the effectiveness of anger treatment protocols by gender. PMID:24755257

Neuropsychological Performance and Subjective Symptom Reporting in Military Service Members With a History of Multiple Concussions: Comparison With a Single Concussion, Posttraumatic Stress Disorder, and Orthopedic Trauma.

PubMed

Cooper, Douglas B; Curtiss, Glenn; Armistead-Jehle, Patrick; Belanger, Heather G; Tate, David F; Reid, Matthew; Bowles, Amy O; Velez, Carmen S; Kennedy, Jan E; Vanderploeg, Rodney D

To examine differences in objective neurocognitive performance and subjective cognitive symptoms in individuals with a history of a single concussion, multiple concussions, orthopedic injuries, and posttraumatic stress disorder (PTSD). Participants included 116 military service members who sustained a mild traumatic brain injury (mTBI) during combat deployment. Subjects were subdivided into groups based on concussion frequency: a single concussion (n = 42), 2 concussions (n = 21), and 3 or more concussions (n = 53). Eighty-one subjects sustained an orthopedic injury (n = 60) during deployment or were diagnosed with PTSD (n = 21), but had no history of mTBI. Subjects completed a battery of neuropsychological tests and self-report measures of postconcussive symptoms, PTSD symptoms, and psychopathology. No differences were found among the concussion groups on a composite neuropsychological measure. The PTSD group had the highest number of symptom complaints, with the 2-concussion and 3-plus-concussion groups being most similar to the PTSD group. The concussion groups showed a nonsignificant pattern of increasing distress with increasing number of concussions. The current findings are consistent with meta-analytic results showing no differential effect on neuropsychological functioning due to multiple concussions. Results also support the burden of adversity hypothesis suggesting increasing symptom levels with increasing psychological or physically traumatic exposures.

Deployment stressors and physical health among OEF/OIF veterans: the role of PTSD.

PubMed

Nillni, Yael I; Gradus, Jaimie L; Gutner, Cassidy A; Luciano, Matthew T; Shipherd, Jillian C; Street, Amy E

2014-11-01

There is a large body of literature documenting the relationship between traumatic stress and deleterious physical health outcomes. Although posttraumatic stress disorder (PTSD) symptoms have been proposed to explain this relationship, previous research has produced inconsistent results when moderating variables such as gender or type of traumatic stressor are considered. Within a large sample of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans, the current study examined if deployment stressors (i.e., combat stress, harassment stress) contributed unique variance to the prediction of physical health symptoms (i.e., pain, nonpain) beyond the effects of PTSD symptoms. A total of 2,332 OEF/OIF Veterans, with equal representation of women and men, completed a series of self-report measures assessing deployment stressors, PTSD symptoms, and physical health symptoms. RESULTS revealed that harassment, but not combat stress, added unique variance in the prediction of pain and nonpain symptoms after accounting for PTSD symptoms. This study extends the existing literature by demonstrating the unique influence of harassment stress on physical health outcomes. Specifically, the relationship between combat stress and physical health symptoms appears to be explained mainly by an individual's experience of PTSD symptoms, whereas the relationship between harassment stress and physical health symptoms is not fully explained by PTSD symptoms, suggesting that other variables may be involved in the pathway from harassment stress to physical health symptoms. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Virtual reality goes to war: a brief review of the future of military behavioral healthcare.

PubMed

Rizzo, Albert; Parsons, Thomas D; Lange, Belinda; Kenny, Patrick; Buckwalter, John G; Rothbaum, Barbara; Difede, JoAnn; Frazier, John; Newman, Brad; Williams, Josh; Reger, Greg

2011-06-01

Numerous reports indicate that the incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel is creating a significant healthcare challenge. These findings have served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. Virtual Reality delivered exposure therapy for PTSD has been previously used with reports of positive outcomes. This article details how virtual reality applications are being designed and implemented across various points in the military deployment cycle to prevent, identify and treat combat-related PTSD in OIF/OEF Service Members and Veterans. The summarized projects in these areas have been developed at the University of Southern California Institute for Creative Technologies, a U.S. Army University Affiliated Research Center, and this paper will detail efforts to use virtual reality to deliver exposure therapy, assess PTSD and cognitive function and provide stress resilience training prior to deployment.

Longitudinal changes of telomere length and epigenetic age related to traumatic stress and post-traumatic stress disorder.

PubMed

Boks, Marco P; van Mierlo, Hans C; Rutten, Bart P F; Radstake, Timothy R D J; De Witte, Lot; Geuze, Elbert; Horvath, Steve; Schalkwyk, Leonard C; Vinkers, Christiaan H; Broen, Jasper C A; Vermetten, Eric

2015-01-01

Several studies have reported an association between traumatic stress and telomere length suggesting that traumatic stress has an impact on ageing at the cellular level. A newly derived tool provides an additional means to investigate cellular ageing by estimating epigenetic age based on DNA methylation profiles. We therefore hypothesise that in a longitudinal study of traumatic stress both indicators of cellular ageing will show increased ageing. We expect that particularly in individuals that developed symptoms of post-traumatic stress disorder (PTSD) increases in these ageing parameters would stand out. From an existing longitudinal cohort study, ninety-six male soldiers were selected based on trauma exposure and the presence of symptoms of PTSD. All military personnel were deployed in a combat zone in Afghanistan and assessed before and 6 months after deployment. The Self-Rating Inventory for PTSD was used to measure the presence of PTSD symptoms, while exposure to combat trauma during deployment was measured with a 19-item deployment experiences checklist. These groups did not differ for age, gender, alcohol consumption, cigarette smoking, military rank, length, weight, or medication use. In DNA from whole blood telomere length was measured and DNA methylation levels were assessed using the Illumina 450K DNA methylation arrays. Epigenetic ageing was estimated using the DNAm age estimator procedure. The association of trauma with telomere length was in the expected direction but not significant (B=-10.2, p=0.52). However, contrary to our expectations, development of PTSD symptoms was associated with the reverse process, telomere lengthening (B=1.91, p=0.018). In concordance, trauma significantly accelerated epigenetic ageing (B=1.97, p=0.032) and similar to the findings in telomeres, development of PTSD symptoms was inversely associated with epigenetic ageing (B=-0.10, p=0.044). Blood cell count, medication and premorbid early life trauma exposure did not confound the results. Overall, in this longitudinal study of military personnel deployed to Afghanistan we show an acceleration of ageing by trauma. However, development of PTSD symptoms was associated with telomere lengthening and reversed epigenetic ageing. These findings warrant further study of a perhaps dysfunctional compensatory cellular ageing reversal in PTSD. Copyright © 2014 Elsevier Ltd. All rights reserved.

The role of postdeployment social factors in linking deployment experiences and current posttraumatic stress disorder symptomatology among male and female veterans.

PubMed

Smith, Brian N; Wang, Joyce M; Vaughn-Coaxum, Rachel A; Di Leone, Brooke A L; Vogt, Dawne

2017-01-01

The postdeployment social context is likely highly salient in explaining mental health symptoms following deployment. The aim of this study was to examine the role of postdeployment social factors (social support and social reintegration difficulty) in linking deployment-related experiences (warfare exposure, sexual harassment, concerns about relationship disruptions, and deployment social support) and posttraumatic stress disorder (PTSD) symptomatology in male and female veterans. A survey was administered to 998 potential participants (after accounting for undeliverable mail) who had returned from deployment to Afghanistan or Iraq. Completed surveys were received from 469 veterans, yielding a response rate of 47%. Hypotheses were examined using structural equation modeling. For male and female veterans, deployment factors predicted later PTSD symptoms through postdeployment social support and social reintegration, with lower support and higher social reintegration difficulty both associated with higher PTSD symptomatology. While the final models for women and men indicated similar risk mechanisms, some differences in pathways were observed. Sexual harassment presented more of a risk for women, whereas lower social support was a greater risk factor for men. Postdeployment social factors appear to represent potentially important targets for interventions aiming to reduce the potential impact of stressful deployment experiences.

Posttraumatic stress disorder in veterans and military personnel: epidemiology, screening, and case recognition.

PubMed

Gates, Margaret A; Holowka, Darren W; Vasterling, Jennifer J; Keane, Terence M; Marx, Brian P; Rosen, Raymond C

2012-11-01

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that affects 7-8% of the general U.S. population at some point during their lifetime; however, the prevalence is much higher among certain subgroups, including active duty military personnel and veterans. In this article, we review the empirical literature on the epidemiology and screening of PTSD in military and veteran populations, including the availability of sensitive and reliable screening tools. Although estimates vary across studies, evidence suggests that the prevalence of PTSD in deployed U.S. military personnel may be as high as 14-16%. Prior studies have identified trauma characteristics and pre- and posttrauma factors that increase risk of PTSD among veterans and military personnel. This information may help to inform prevention and screening efforts, as screening programs could be targeted to high-risk populations. Large-scale screening efforts have recently been implemented by the U.S. Departments of Defense and Veterans Affairs. Given the prevalence and potential consequences of PTSD among veterans and active duty military personnel, development and continued evaluation of effective screening methods is an important public health need.

Prospective Analysis of Risk Factors Related to Depression and Post Traumatic Stress Disorder in Deployed United States Navy Personnel

DTIC Science & Technology

2011-03-28

post traumatic stress disorder ( PTSD ) and depression (MDD) than...United States Several epidemiological studies have been conducted on the prevalence of post traumatic stress disorder ( PTSD ) and major depression in...forms contain the same 4-item screener for post - traumatic stress disorder ( PTSD ). This screener was developed by the National Center for PTSD and

Alcohol Misuse in Reserve Soldiers and their Partners: Cross-Spouse Effects of Deployment and Combat Exposure.

PubMed

Vest, Bonnie M; Heavey, Sarah Cercone; Homish, D Lynn; Homish, Gregory G

2018-04-16

Military deployment and combat are associated with worse outcomes, including alcohol misuse. Less is known about how these experiences affect soldiers' spouses. The study objective was to explore relationships between deployment, combat exposure, and alcohol misuse; especially cross-spouse effects (effect of one partner's experiences/behavior on the other partner), which has been under-examined in military samples. U.S. Army Reserve/National Guard soldiers and their partners completed a questionnaire covering physical and mental health, military service and substance use. Negative binomial regression models examined number of deployments and combat exposure individually for alcohol misuse and frequent heavy drinking (FHD). In additional models, we examined combat exposure's role on alcohol outcomes, controlling for the soldiers' number of deployments, PTSD symptoms, age, and in cross-spouse models, alcohol use and FHD. We considered individuals' deployment experiences related to their alcohol outcomes and to their spouses' alcohol outcomes. The study sample included male soldiers with current/lifetime military service (n = 248) and their female partners. Combat exposure was related to FHD (RR: 1.01, p < .05, 95% CI: 1.01, 1.01) among male soldiers while controlling for PTSD symptoms, number of deployments, and age. Female partners of male soldiers were more likely to engage in FHD (RR: 1.01, p < .05, 95% CI: 1.01, 1.01) if their spouse experienced combat. Our results demonstrate that male soldiers and their spouses are at increased risk of FHD if the soldier experienced combat. This points to the need for better screening, particularly of spouses of soldiers, whose alcohol misuse may be overlooked.

Personality Assessment Inventory profiles of veterans: Differential effects of mild traumatic brain injury and psychopathology.

PubMed

Miskey, Holly M; Shura, Robert D; Yoash-Gantz, Ruth E; Rowland, Jared A

2015-09-01

Neuropsychiatric complaints often accompany mild traumatic brain injury (mTBI), a common condition in post-deployed Veterans. Self-report, multi-scale personality inventories may elucidate the pattern of psychiatric distress in this cohort. This study investigated valid Personality Assessment Inventory (PAI) profiles in post-deployed Veterans. Measures of psychopathology and mTBI were examined in a sample of 144 post-deployed Veterans divided into groups: healthy controls (n = 40), mTBI only (n = 31), any mental health diagnosis only (MH; n = 25), comorbid mTBI and Posttraumatic Stress Disorder (mTBI/PTSD; n = 23), and comorbid mTBI, PTSD, and other psychological diagnoses (mTBI/PTSD/MDD+; n = 25). There were no significant differences between the mTBI and the control group on mean PAI subscale elevation, or number of subscale elevations above 60T or 70T. The other three groups had significantly higher overall mean scores, and more elevations above 60 and 70T compared to both controls and mTBI only. The mTBI/PTSD/MDD+ group showed the highest and most elevations. After entering demographics, PTSD, and number of other psychological diagnoses into hierarchical regressions using the entire sample, mTBI history did not predict mean PAI subscale score or number of elevations above 60T or 70T. PTSD was the only significant predictor. There were no interaction effects between mTBI and presence of PTSD, or between mTBI and total number of diagnoses. This study suggests that mTBI alone is not uniquely related to psychiatric distress in Veterans, but that PTSD accounts for self-reported symptom distress.

Anger problems and posttraumatic stress disorder in male and female National Guard and Reserve Service members.

PubMed

Worthen, Miranda; Rathod, Sujit D; Cohen, Gregory; Sampson, Laura; Ursano, Robert; Gifford, Robert; Fullerton, Carol; Galea, Sandro; Ahern, Jennifer

2014-08-01

Anger is a common problem among veterans and has been associated with posttraumatic stress disorder (PTSD). This study aimed to improve understanding of how anger and PTSD co-occur by examining gender differences and differences by whether the triggering traumatic event is deployment-related vs. civilian-related in current service members. A representative cohort of Reserve and National Guard service personnel (n = 1293) were interviewed to assess for deployment- or civilian-related traumas, PTSD, and anger. The prevalence of self-reported anger problems was estimated among male (n = 1036) and female (n = 257) service members. Log Poisson regression models with robust standard errors were used to estimate the associations of problems with anger with PTSD and PTSD symptom severity for men and women. Self-reported anger problems were common among male (53.0%) and female (51.3%) service members. Adjusted prevalence ratios (PR) showed associations between anger and PTSD connected to both civilian- and deployment-related traumas (PR were 1.77 (95% CI 1.52-2.05) and 1.85 (95% CI 1.62-2.12), respectively). PTSD symptom severity was also associated with anger. This study was cross-sectional and so a causal relationship between PTSD and anger cannot be established. Problems with anger are common among male and female current Guard and Reserve members. These findings suggest that anger treatment should be made available to current service members and that clinicians should assess anger problems irrespective of gender. Future research should examine the effectiveness of anger treatment protocols by gender. Copyright © 2014 Elsevier Ltd. All rights reserved.

Searching for non-genetic molecular and imaging PTSD risk and resilience markers: Systematic review of literature and design of the German Armed Forces PTSD biomarker study.

PubMed

Schmidt, Ulrike; Willmund, Gerd-Dieter; Holsboer, Florian; Wotjak, Carsten T; Gallinat, Jürgen; Kowalski, Jens T; Zimmermann, Peter

2015-01-01

Biomarkers allowing the identification of individuals with an above average vulnerability or resilience for posttraumatic stress disorder (PTSD) would especially serve populations at high risk for trauma exposure like firefighters, police officers and combat soldiers. Aiming to identify the most promising putative PTSD vulnerability markers, we conducted the first systematic review on potential imaging and non-genetic molecular markers for PTSD risk and resilience. Following the PRISMA guidelines, we systematically screened the PubMed database for prospective longitudinal clinical studies and twin studies reporting on pre-trauma and post-trauma PTSD risk and resilience biomarkers. Using 25 different combinations of search terms, we retrieved 8151 articles of which we finally included and evaluated 9 imaging and 27 molecular studies. In addition, we briefly illustrate the design of the ongoing prospective German Armed Forces (Bundeswehr) PTSD biomarker study (Bw-BioPTSD) which not only aims to validate these previous findings but also to identify novel and clinically applicable molecular, psychological and imaging risk, resilience and disease markers for deployment-related psychopathology in a cohort of German soldiers who served in Afghanistan. Copyright © 2014 Elsevier Ltd. All rights reserved.

Posttraumatic Stress Symptoms Among National Guard Soldiers Deployed to Iraq: Associations with Parenting Behaviors and Couple Adjustment

PubMed Central

Gewirtz, Abigail H.; Polusny, Melissa A.; DeGarmo, David S.; Khaylis, Anna; Erbes, Christopher R.

2011-01-01

Objective This article reports findings from a one-year longitudinal study examining the impact of change in PTSD symptoms following combat deployment on National Guard soldiers’ perceived parenting, and couple adjustment one year following return from Iraq. Method Participants were 468 Army National Guard fathers from a Brigade Combat Team (mean age 36 years; median deployment length 16 months; 89% European American, 5% African American, 6% Hispanic American). Participants completed an in-theater survey one month before returning home from OIF deployment (Time 1), and again, one year post-deployment (Time 2). The PTSD Checklist-Military Version (PCL-M; Weathers, Litz, Herman, Huska, & Keane, 1993) was gathered at both times, and two items assessing social support were gathered at baseline only. At Time 2, participants also completed self-report measures of parenting (Alabama Parenting Questionnaire—Short Form; Elgar, Waschbusch, Dadds, & Sigvaldason, 2007), couple adjustment (Dyadic Adjustment Scale-7; Sharpley & Rogers, 1984; Spanier, 1976), parent-child relationship quality (4 items from the Social Adjustment Scale-Self Report; Weissman & Bothwell, 1976), alcohol use (Alcohol Use Disorders Identification Test; Babor, Higgins-Biddle, Saunders, & Monteiro, 2001), and items assessing injuries sustained while deployed. Results Structural equation modeling analyses showed that increases in PTSD symptoms were associated with poorer couple adjustment and greater perceived parenting challenges at Time 2 (both at p<.001). Furthermore, PTSD symptoms predicted parenting challenges independent of their impact on couple adjustment. Conclusions Findings highlight the importance of investigating and intervening to support parenting and couple adjustment among combat-affected National Guard families. PMID:20873896

The moderating role of dysphoria in the relationship between intrusions and alcohol use.

PubMed

Contractor, Ateka A; Presseau, Candice; Capone, Christy; Reddy, Madhavi K; Shea, M Tracie

2016-04-01

Posttraumatic Stress Disorder (PTSD) is frequently comorbid with alcohol use disorders (AUD; Calabrese et al., 2011; McFall, Mackay, & Donovan, 1992). Among several explanations for this comorbidity, the most empirically supported is the self-medication theory which postulates that substances are used to medicate PTSD-related distress (Keane & Wolfe, 1990; Khantzian, 1985; Stewart, 1996). The current study examines the effects of trauma-related distress on alcohol use (total drinking days, drinks per drinking day, heavy drinking days) in a sample of 127 trauma-exposed Veterans following deployment to Iraq or Afghanistan. The dysphoria symptoms of PTSD were used as an indicator of distress, and examined as a moderator in the relationship between intrusion symptoms of PTSD and alcohol use. The proposed moderation model was tested using cross-sectional data from the first month following return from deployment, and at 6 months and at 12 months post-deployment. Results showed that dysphoria symptoms significantly moderated relations between intrusions and total drinking days and heavy drinking days at one month post-deployment; however, a significant pattern was not demonstrated at 6 months and 12 months. Further, dysphoria did not moderate the relation between intrusion symptoms and drinks per drinking day at the three time points. Theoretical and clinical implications are subsequently discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Interactive effects of stress and individual differences on alcohol use and posttraumatic stress disorder among personnel deployed to Guantanamo Bay.

PubMed

De La Rosa, Gabriel M; Delaney, Eileen M; Webb-Murphy, Jennifer A; Johnston, Scott L

2015-11-01

This study examines the role of factors such as perceived stress, neuroticism, beliefs in psychotherapy stigma, resilience, and demographics in understanding posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) among deployed military personnel. Results show that personnel who screened positive for PTSD were more likely to screen positive for AUD (versus those who did not screen positive for PTSD). Perceived stress, neuroticism, and psychotherapy stigma all have direct multivariate relationships with PTSD symptoms. Moderated regression analyses show that the positive relationship between perceived stress and PTSD symptoms is significantly stronger among those scoring high on neuroticism and psychotherapy stigma. The positive relationship between perceived stress and AUD symptoms is only significant among those scoring high on psychotherapy stigma. Given the moderating role of psychotherapy stigma in the relationship between perceived stress and PTSD symptoms and the relationship between perceived stress and AUD symptoms efforts to reduce the stigma associated with mental health care in the military should be expanded. Also, the current research adds to the literature highlighting the role of neuroticism as a key variable in understanding PTSD. Copyright © 2015. Published by Elsevier Ltd.

Stellate ganglion block used to treat symptoms associated with combat-related post-traumatic stress disorder: a case series of 166 patients.

PubMed

Mulvaney, Sean W; Lynch, James H; Hickey, Matthew J; Rahman-Rawlins, Tabassum; Schroeder, Matthew; Kane, Shawn; Lipov, Eugene

2014-10-01

Report the successful use of stellate ganglion blocks (SGBs) in 166 active duty service members with multiple combat deployments experiencing anxiety symptoms associated with post-traumatic stress disorder (PTSD). Successful treatment of PTSD symptoms with SGB has been reported previously. This is the largest published case series evaluating SGB with a minimum of 3 months follow-up. Following clinical interview including administration of the PTSD Checklist (PCL), 166 service members with symptoms of PTSD elected to receive a SGB. All patients received a SGB on the right side at the level of the sixth cervical vertebrae (C6). The PCL was administered the day before treatment to establish a baseline, repeated 1 week later, and then monthly out to 3 months. A positive response was considered to be an improvement in the PCL score by 10 or greater points. Follow-up PCL scores from 3 to 6 months were obtained and analyzed for 166 patients. In a military population with multiple combat deployments, over 70% of the patients treated had a clinically significant improvement in their PCL score which persisted beyond 3 to 6 months postprocedure. Selective blockade of the right cervical sympathetic chain at the C6 level is a safe and minimally invasive procedure that may provide durable relief from anxiety symptoms associated with PTSD. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

PREDICTORS OF POST-TRAUMATIC STRESS DISORDER IN MILITARY PERSONNEL DEPLOYED TO PEACEKEEPING MISSIONS.

PubMed

Sikharulidze, G; Oniani, T; Gugushvili, N

2016-04-01

As the empirical evidence suggests PTSD, depression and anxiety represent prevalent and severe problem in armed forces. High co morbidity of these disorders with each other further complicates clinical picture. Georgian military personnel regularly take part in different peacekeeping missions, however there is no existing data regarding associations of mental health problems in Georgian armed forces. Data was collected between 2014 and 2015, after 6 month deployment. Participants were 2810 Georgian military personnel who took part in peacekeeping missions. All participants were male, average age: M=31,2 (SD=6,3). All instruments used in the study were self-report scales. PTSD was measured by PCL-5; Depression and anxiety was measured by PHQ (Patient Health Questionnaire). Both variables - Severity of Anxiety symptoms and severity of depression symptoms independently predicted PTSD, but after being placed together in the same regression model, only depression symptom severity accounted for significant portion of variance. Due to the fact that the participants of our study (n=69) were young (M=29,68 ; SD=5,8) male personnel, our findings cannot be generalized. Also it should be considered, that for PTSD screening we used self-report questionnaires, which reduces liability of participants' answers and increases the tendency of self-biased responses. It is advisable for clinical practitioners and therapists to consider depression symptoms in patients with PTSD and screen for depression additionally, in order to exclude or include co morbidity factors in treatment course.

Chapter 8 Military Personnel With Traumatic Brain Injuries and Insomnia Have Reductions in PTSD and Improved Perceived Health Following Sleep Restoration: A Relationship Moderated by Inflammation.

PubMed

Barr, Taura; Livingston, Whitney; Guardado, Pedro; Baxter, Tristin; Mysliwiec, Vincent; Gill, Jessica

2015-01-01

Up to one-third of deployed military personnel sustain a traumatic brain injury (TBI). TBIs and the stress of deployment contribute to the vulnerability for chronic sleep disturbance, resulting in high rates of insomnia diagnoses as well as symptoms of posttraumatic stress disorder (PTSD), depression, and declines in health-related quality of life (HRQOL). Inflammation is associated with insomnia; however, the impact of sleep changes on comorbid symptoms and inflammation in this population is unknown. In this study, we examined the relationship between reported sleep changes and the provision of the standard of care, which could include one or more of the following: cognitive behavioral therapy (CBT), medications, and continuous positive airway pressure (CPAP). We compared the following: (a) the group with a decrease in the Pittsburgh Sleep Quality Index (PSQI; restorative sleep) and (b) the group with no change or increase in PSQI (no change). Independent t tests and chi-square tests were used to compare the groups on demographic and clinical characteristics, and mixed between-within subjects analysis of variance tests were used to determine the effect of group differences on changes in comorbid symptoms. Linear regression models were used to examine the role of inflammation in changes in symptoms and HRQOL. The sample included 70 recently deployed military personnel with TBI, seeking care for sleep disturbances. Thirty-seven participants reported restorative sleep and 33 reported no sleep changes or worse sleep. The two groups did not differ in demographic characteristics or clinical symptoms at baseline. The TBI+restored sleep group had significant reductions in PTSD and depression over the 3-month period, whereas the TBI+no change group had a slight increase in both PTSD and depression. The TBI+restored sleep group also had significant changes in HRQOL, including the following HRQOL subcomponents: physical functioning, role limitations in physical health, social functioning, emotional well-being, energy/fatigue, and general health perceptions. In a linear regression model using a forced entry method, the dependent variable of change in C-reactive protein (CRP) concentrations was significantly related to changes in PTSD symptoms and HRQOL in the TBI+restored sleep group, with R2=0.43, F33,3=8.31, p<.01. Military personnel with TBIs who have a reduction in insomnia symptoms following a standard-of-care treatment report less severe symptoms of depression and PTSD and improved HRQOL, which relate to decreased plasma concentrations of CRP. These findings suggest that treatment for sleep disturbances in this TBI+military population is associated with improvements in health and decreases in inflammation. The contributions of inflammation-induced changes in PTSD and depression in sleep disturbances in TBI + military personnel require further study.

Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military.

PubMed

Costanzo, Michelle E; Leaman, Suzanne; Jovanovic, Tanja; Norrholm, Seth D; Rizzo, Albert A; Taylor, Patricia; Roy, Michael J

2014-01-01

Subthreshold posttraumatic stress disorder (PTSD) has garnered recent attention because of the significant distress and functional impairment associated with the symptoms as well as the increased risk of progression to full PTSD. However, the clinical presentation of subthreshold PTSD can vary widely and therefore is not clearly defined, nor is there an evidence-based treatment approach. Thus, we aim to further the understanding of subthreshold PTSD symptoms by reporting the use of a virtual combat environment in eliciting distinctive psychophysiological responses associated with PTSD symptoms in a sample of subthreshold recently deployed US service members. Heart rate, skin conductance, electromyography (startle), respiratory rate, and blood pressure were monitored during three unique combat-related virtual reality scenarios as a novel procedure to assess subthreshold symptoms in a sample of 78 service members. The Clinician-Administered PTSD Scale was administered, and linear regression analyses were used to investigate the relationship between symptom clusters and physiological variables. Among the range of psychophysiological measures that were studied, regression analysis revealed heart rate as most strongly associated with Clinician-Administered PTSD Scale-based measures hyperarousal (R = 0.11, p = .035,) reexperiencing (R = 0.24, p = .001), and global PTSD symptoms (R = 0.17, p = .003). Our findings support the use of a virtual reality environment in eliciting physiological responses associated with subthreshold PTSD symptoms.

Psychosocial Functioning and Health-Related Quality of Life Associated with Posttraumatic Stress Disorder in Male and Female Iraq and Afghanistan War Veterans: The VALOR Registry.

PubMed

Fang, Shona C; Schnurr, Paula P; Kulish, Andrea L; Holowka, Darren W; Marx, Brian P; Keane, Terence M; Rosen, Raymond

2015-12-01

Iraq and Afghanistan war veterans suffer from high rates of posttraumatic stress disorder (PTSD). Given the growing number of women in the military, there is a critical need to understand the nature and extent of potential gender differences in PTSD-associated psychosocial functioning and health-related quality of life (HRQOL) in Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans, which has not been studied to date. We used data from a gender-balanced national patient registry of warzone-deployed OEF/OIF veterans (Project VALOR: Veterans After-Discharge Longitudinal Registry) to determine the impact of gender on PTSD-related psychosocial functioning and HRQOL in 1,530 United States Iraq and Afghanistan war veterans (50% female) with and without PTSD. Overall psychosocial functioning was assessed with the Inventory of Psychosocial Functioning (IPF) and mental and physical HRQOL with the Veterans RAND 12-item Health Survey (VR-12) Mental and Physical Component Summary scores, respectively. Stratified linear regression models estimated gender-specific associations, controlling for demographic, deployment, and postdeployment factors. Interaction models tested for significant effect moderation by gender. In gender-stratified models, PTSD was strongly associated with higher IPF scores (greater functional impairment), with similar associations by gender. PTSD was also associated with lower Mental Component Summary scores (lower mental HRQOL) in both men and women, with no evidence of effect moderation by gender. PTSD was associated with lower Physical Component Summery scores in women but not men in adjusted models; however, interactions were not significant. PTSD among warzone-deployed OEF/OIF veterans is associated with significant impairments in both overall psychosocial functioning and HRQOL, with associations that are largely similar by gender. Findings support the need for thorough and continuous assessment of functional impairment and HRQOL during treatment of PTSD for both male and female OEF/OIF veterans.

Deployment-Related Injury and Posttraumatic Stress Disorder in US Military Personnel

DTIC Science & Technology

2013-01-01

aspects of the EMED include detailed information regarding the injury incident , which is collected at or near the point of injury, as well as the...higher incidence of PTSD among survivors of terrorist attacks admitted to local emergency rooms compared with survivors of motor vehicle accidents.33...individuals on the occurrence of BI during deployment, particularly since most BI incidents are minor and may not be accurately documented in the

Posttraumatic stress disorder and risk of spontaneous preterm birth.

PubMed

Shaw, Jonathan G; Asch, Steven M; Kimerling, Rachel; Frayne, Susan M; Shaw, Kate A; Phibbs, Ciaran S

2014-12-01

To evaluate the association between antenatal posttraumatic stress disorder (PTSD) and spontaneous preterm delivery. We identified antenatal PTSD status and spontaneous preterm delivery in a retrospective cohort of 16,334 deliveries covered by the Veterans Health Administration from 2000 to 2012. We divided mothers with PTSD into those with diagnoses present the year before delivery (active PTSD) and those only with earlier diagnoses (historical PTSD). We identified spontaneous preterm birth and potential confounders including age, race, military deployment, twins, hypertension, substance use, depression, and results of military sexual trauma screening and then performed multivariate regression to estimate adjusted odds ratio (OR) of spontaneous preterm delivery as a function of PTSD status. Of 16,334 births, 3,049 (19%) were to mothers with PTSD diagnoses, of whom 1,921 (12%) had active PTSD. Spontaneous preterm delivery was higher in those with active PTSD (9.2%, n=176) than those with historical (8.0%, n=90) or no PTSD (7.4%, n=982) before adjustment (P=.02). The association between PTSD and preterm birth persisted, when adjusting for covariates, only in those with active PTSD (adjusted OR 1.35, 95% confidence interval [CI] 1.14-1.61). Analyses adjusting for comorbid psychiatric and medical diagnoses revealed the association with active PTSD to be robust. In this cohort, containing an unprecedented number of PTSD-affected pregnancies, mothers with active PTSD were significantly more likely to suffer spontaneous preterm birth with an attributable two excess preterm births per 100 deliveries (95% CI 1-4). Posttraumatic stress disorder's health effects may extend, through birth outcomes, into the next generation.

Associations of coping processes with posttraumatic stress disorder symptoms in national guard/reserve service members deployed during the OEF-OIF era.

PubMed

Rodrigues, Camila S; Renshaw, Keith D

2010-10-01

Studies have identified coping processes as one potential factor influencing PTSD in veterans. This study examined the associations between coping, combat exposure, and PTSD among 218 National Guard veterans deployed overseas since 2001. Problem-focused coping was unrelated to combat exposure and PTSD symptoms. In contrast, increased levels of emotion focused coping (EFC) were found in veterans who reported higher levels of combat exposure. Moreover, the severity of combat was a curvilinear moderator of the relation between coping process and PTSD, such that EFC was unrelated to PTSD symptom severity at low levels of combat, associated with higher symptom severity at moderate levels of combat, and associated with lower symptom severity at high levels of combat. These findings indicate that the type and severity of trauma may moderate the association of coping and psychological outcomes, and that these associations might not be linear. Published by Elsevier Ltd.

Longitudinal changes in glucocorticoid receptor exon 1F methylation and psychopathology after military deployment

PubMed Central

Schür, R R; Boks, M P; Rutten, B P F; Daskalakis, N P; de Nijs, L; van Zuiden, M; Kavelaars, A; Heijnen, C J; Joëls, M; Kahn, R S; Geuze, E; Vermetten, E; Vinkers, C H

2017-01-01

Several cross-sectional studies have demonstrated the relevance of DNA methylation of the glucocorticoid receptor exon 1F region (GR-1F) for trauma-related psychopathology. We conducted a longitudinal study to examine GR-1F methylation changes over time in relation to trauma exposure and the development of post-deployment psychopathology. GR-1F methylation (52 loci) was quantified using pyrosequencing in whole blood of 92 military men 1 month before and 6 months after a 4-month deployment period to Afghanistan. GR-1F methylation overall (mean methylation and the number of methylated loci) and functional methylation (methylation at loci associated with GR exon 1F expression) measures were examined. We first investigated the effect of exposure to potentially traumatic events during deployment on these measures. Subsequently, changes in GR-1F methylation were related to changes in mental health problems (total Symptom Checklist-90 score) and posttraumatic stress disorder (PTSD) symptoms (Self-Report Inventory for PTSD). Trauma exposure during deployment was associated with an increase in all methylation measures, but development of mental health problems 6 months after deployment was only significantly associated with an increased functional methylation. Emergence of post-deployment PTSD symptoms was not related to increased functional methylation over time. Pre-deployment methylation levels did not predict post-deployment psychopathology. To our knowledge, this is the first study to prospectively demonstrate trauma-related increases in GR-1F methylation, and it shows that only increases at specific functionally relevant sites predispose for post-deployment psychopathology. PMID:28742078

The Effects of Mild Traumatic Brain Injury, Post-Traumatic Stress Disorder, and Combined Mild Traumatic Brain Injury/Post-Traumatic Stress Disorder on Returning Veterans.

PubMed

Combs, Hannah L; Berry, David T R; Pape, Theresa; Babcock-Parziale, Judith; Smith, Bridget; Schleenbaker, Randal; Shandera-Ochsner, Anne; Harp, Jordan P; High, Walter M

2015-07-01

United States veterans of the Iraqi (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]) conflicts have frequently returned from deployment after sustaining mild traumatic brain injury (mTBI) and enduring stressful events resulting in post-traumatic stress disorder (PTSD). A large number of returning service members have been diagnosed with both a history of mTBI and current PTSD. Substantial literature exists on the neuropsychological factors associated with mTBI and PTSD occurring separately; far less research has explored the combined effects of PTSD and mTBI. The current study employed neuropsychological and psychological measures in a sample of 251 OIF/OEF veterans to determine whether participants with a history of mTBI and current PTSD (mTBI+PTSD) have poorer cognitive and psychological outcomes than participants with mTBI only (mTBI-o), PTSD only (PTSD-o), or veteran controls (VC), when groups are comparable on intelligence quotient, education, and age. The mTBI+PTSD group performed more poorly than VC, mTBI-o, and PTSD-o groups on several neuropsychological measures. Effect size comparisons suggest small deleterious effects for mTBI-o on measures of processing speed and visual attention and small effects for PTSD-o on measures of verbal memory, with moderate effects for mTBI+PTSD on the same variables. Additionally, the mTBI+PTSD group was significantly more psychologically distressed than the PTSD-o group, and PTSD-o group was more distressed than VC and mTBI-o groups. These findings suggest that veterans with mTBI+PTSD perform significantly lower on neuropsychological and psychiatric measures than veterans with mTBI-o or PTSD-o. The results also raise the possibility of mild but persisting cognitive changes following mTBI sustained during deployment.

The Effects of Mild Traumatic Brain Injury, Post-Traumatic Stress Disorder, and Combined Mild Traumatic Brain Injury/Post-Traumatic Stress Disorder on Returning Veterans

PubMed Central

Combs, Hannah L.; Berry, David T. R.; Pape, Theresa; Babcock-Parziale, Judith; Smith, Bridget; Schleenbaker, Randal; Shandera-Ochsner, Anne; Harp, Jordan P.

2015-01-01

Abstract United States veterans of the Iraqi (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]) conflicts have frequently returned from deployment after sustaining mild traumatic brain injury (mTBI) and enduring stressful events resulting in post-traumatic stress disorder (PTSD). A large number of returning service members have been diagnosed with both a history of mTBI and current PTSD. Substantial literature exists on the neuropsychological factors associated with mTBI and PTSD occurring separately; far less research has explored the combined effects of PTSD and mTBI. The current study employed neuropsychological and psychological measures in a sample of 251 OIF/OEF veterans to determine whether participants with a history of mTBI and current PTSD (mTBI+PTSD) have poorer cognitive and psychological outcomes than participants with mTBI only (mTBI-o), PTSD only (PTSD-o), or veteran controls (VC), when groups are comparable on intelligence quotient, education, and age. The mTBI+PTSD group performed more poorly than VC, mTBI-o, and PTSD-o groups on several neuropsychological measures. Effect size comparisons suggest small deleterious effects for mTBI-o on measures of processing speed and visual attention and small effects for PTSD-o on measures of verbal memory, with moderate effects for mTBI+PTSD on the same variables. Additionally, the mTBI+PTSD group was significantly more psychologically distressed than the PTSD-o group, and PTSD-o group was more distressed than VC and mTBI-o groups. These findings suggest that veterans with mTBI+PTSD perform significantly lower on neuropsychological and psychiatric measures than veterans with mTBI-o or PTSD-o. The results also raise the possibility of mild but persisting cognitive changes following mTBI sustained during deployment. PMID:25350012

Testing a Military Family Stress Model.

PubMed

Gewirtz, Abigail H; DeGarmo, David S; Zamir, Osnat

2017-03-15

The current study examines a military family stress model, evaluating associations between deployment-related stressors (i.e., deployment length/number, posttraumatic stress disorder [PTSD] symptoms) and parent, child, parenting, and dyadic adjustment among families in which a parent had previously deployed to Iraq or Afghanistan in the recent conflicts. Married families (N = 293) with at least one child between the ages of 4 and 12 were recruited from a Midwestern state. Service members were from the Reserve Component (National Guard or Reserves); fathers (N = 253) and/or mothers had deployed (N = 45) to the recent conflicts in the Middle East. Multiple-method (observations of parenting and couple interactions; questionnaires) and multiple informant measures were gathered online and in the homes of participants, from parents, children, and teachers. Findings demonstrated associations between mothers' and fathers' PTSD symptoms and a latent variable of child adjustment comprising teacher, parent, and child report. Mothers' but not fathers' PTSD symptoms were also associated with dyadic adjustment and parenting practices; parenting practices were in turn associated with child adjustment. The results are discussed in terms of their implications for military family stress research and interventions to support and strengthen parents and families after deployment. © 2017 Family Process Institute.

Innovative Service Delivery for Secondary Prevention of PTSD in At-Risk OIF-OEF Service Men and Women

DTIC Science & Technology

2010-04-01

posttraumatic stress disorder ;” “Predictors of patient satisfaction in OIF/OEF veterans receiving behavioral activation/exposure-based treatment for PTSD ...intervention to prevent the functional impairment associated with PTSD and subclinical PTSD in post -deployed OIF/OEF service men and women, and b...month follow up). Programs that reduce traumatic stress symptoms and related functional impairment will have patient, medical system, and military

Exploration of the resilience construct in posttraumatic stress disorder severity and functional correlates in military combat veterans who have served since September 11, 2001.

PubMed

Green, Kimberly T; Calhoun, Patrick S; Dennis, Michelle F; Beckham, Jean C

2010-07-01

This study evaluated the relationship between resilience and psychological functioning in military veterans deployed to a region of military conflict in support of Operation Enduring Freedom or Operation Iraqi Freedom. 497 military veterans completed a structured psychiatric interview and questionnaires measuring psychological symptoms, resiliency, and trauma exposure. The study had 2 primary aims: (1) to examine whether the association between trauma exposure and PTSD was moderated by resilience and (2) to examine whether resilience was uniquely associated with functional outcomes after accounting for PTSD. Measures included the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (for PTSD diagnosis), the Connor-Davidson Resilience Scale, and the Traumatic Life Events Questionnaire. Data were collected between June 2005 and February 2009. Evaluating the association of resilience and trauma exposure with PTSD revealed main effects for combat exposure, lifetime trauma exposure, and resilience. Additionally, there was a significant (P < .05) interaction between combat exposure and resilience such that higher levels of resilience were particularly protective among individuals with high combat exposure. After controlling for age, gender, minority status, trauma exposure, and PTSD diagnosis, resilience was uniquely associated with decreased suicidality, reduced alcohol problems, lower depressive symptom severity, and fewer current health complaints and lifetime and past-year medical problems. These results suggest that resilience is a construct that may play a unique role in the occurrence of PTSD and severity of other functional correlates among deployed veterans. Future studies in this area would benefit from a prospective design, the evaluation of other possible protective processes (e.g., social support), and specific examination of particular aspects of resilience and how resilience may be increased. (c) Copyright 2010 Physicians Postgraduate Press, Inc.

The psychological effects of improvised explosive devices (IEDs) on UK military personnel in Afghanistan.

PubMed

Jones, Norman; Thandi, Gursimran; Fear, Nicola T; Wessely, Simon; Greenberg, Neil

2014-07-01

To explore the psychological consequences of improvised explosive device (IED) exposure as IEDs have been the greatest threat to UK military personnel in Afghanistan though the mental health consequences of IED exposure are largely unknown. Deployed UK military personnel completed a survey while deployed in Afghanistan. Combat personnel and those dealing specifically with the IED threat were compared with all other deployed personnel; the relationship between IED exposure, general combat experiences, Post Traumatic Stress Disorder (PTSD) Checklist-Civilian Version (PCL-C) and General Health Questionnaire scores were evaluated. The response rate was 98% (n=2794). Half reported IED-related concerns, a third experienced exploding IEDs and a quarter gave medical aid to IED casualties. Combat and counter-IED threat personnel had higher levels of IED exposure than other deployed personnel. 18.8% of personnel who witnessed exploding IEDs scored positive for common mental disorder (General Health Questionnaire-12 scores ≥4) and 7.6% scored positive for probable PTSD symptoms (PTSD Checklist-Civilian Version scores ≥44). After adjusting for general combat exposure and other observed confounders, PTSD symptoms were associated with IED exposure whereas common mental disorder symptoms were not. IED exposure, IED-related concerns and functional impairment accumulated during deployment but functional impairment was related to factors other than IED exposure alone. In Afghanistan, a substantial proportion of personnel were exposed to exploding IEDs however, the majority of exposed personnel were psychologically healthy. Psychological effects were similar for combat personnel and those dealing specifically with the IED threat but both groups were at greater psychological risk than other deployed personnel. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Early identification of posttraumatic stress following military deployment: Application of machine learning methods to a prospective study of Danish soldiers.

PubMed

Karstoft, Karen-Inge; Statnikov, Alexander; Andersen, Søren B; Madsen, Trine; Galatzer-Levy, Isaac R

2015-09-15

Pre-deployment identification of soldiers at risk for long-term posttraumatic stress psychopathology after home coming is important to guide decisions about deployment. Early post-deployment identification can direct early interventions to those in need and thereby prevents the development of chronic psychopathology. Both hold significant public health benefits given large numbers of deployed soldiers, but has so far not been achieved. Here, we aim to assess the potential for pre- and early post-deployment prediction of resilience or posttraumatic stress development in soldiers by application of machine learning (ML) methods. ML feature selection and prediction algorithms were applied to a prospective cohort of 561 Danish soldiers deployed to Afghanistan in 2009 to identify unique risk indicators and forecast long-term posttraumatic stress responses. Robust pre- and early postdeployment risk indicators were identified, and included individual PTSD symptoms as well as total level of PTSD symptoms, previous trauma and treatment, negative emotions, and thought suppression. The predictive performance of these risk indicators combined was assessed by cross-validation. Together, these indicators forecasted long term posttraumatic stress responses with high accuracy (pre-deployment: AUC = 0.84 (95% CI = 0.81-0.87), post-deployment: AUC = 0.88 (95% CI = 0.85-0.91)). This study utilized a previously collected data set and was therefore not designed to exhaust the potential of ML methods. Further, the study relied solely on self-reported measures. Pre-deployment and early post-deployment identification of risk for long-term posttraumatic psychopathology are feasible and could greatly reduce the public health costs of war. Copyright © 2015 Elsevier B.V. All rights reserved.

The role of sexual assault on the risk of PTSD among Gulf War veterans.

PubMed

Kang, Han; Dalager, Nancy; Mahan, Clare; Ishii, Erick

2005-03-01

The 1991 Gulf War was the first major military deployment where female troops were integrated into almost every military unit, except for combat ground units. We evaluated the impact of reported sexual trauma during this deployment on the risk of post-traumatic stress disorder (PTSD) after the war. A nested case-control analysis was conducted using the data collected in a population-based health survey of 30,000 Gulf War era veterans. A total of 1381 Gulf War veterans with current PTSD were compared with 10,060 Gulf veteran controls without PTSD for self-reported in-theater experiences of sexual harassment/assault and combat exposure. The adjusted odds ratio (aOR) for PTSD associated with a report of sexual assault was 5.41 (95% confidence interval [CI], 3.19-9.17) in female veterans and 6.21 (95% CI, 2.26-17.04) in male veterans. The aOR for PTSD associated with "high" combat exposure was also statistically significant (aOR, 4.03 [95% CI, 1.97-8.23] for females; aOR, 4.45 [95% CI, 3.54-5.60] for males). Notwithstanding a possibility of recall bias of combat and sexual trauma, for both men and women, sexual trauma as well as combat exposure appear to be strong risk factors for PTSD.

Longitudinal analyses of the DNA methylome in deployed military servicemen identify susceptibility loci for post-traumatic stress disorder.

PubMed

Rutten, B P F; Vermetten, E; Vinkers, C H; Ursini, G; Daskalakis, N P; Pishva, E; de Nijs, L; Houtepen, L C; Eijssen, L; Jaffe, A E; Kenis, G; Viechtbauer, W; van den Hove, D; Schraut, K G; Lesch, K-P; Kleinman, J E; Hyde, T M; Weinberger, D R; Schalkwyk, L; Lunnon, K; Mill, J; Cohen, H; Yehuda, R; Baker, D G; Maihofer, A X; Nievergelt, C M; Geuze, E; Boks, M P M

2018-05-01

In order to determine the impact of the epigenetic response to traumatic stress on post-traumatic stress disorder (PTSD), this study examined longitudinal changes of genome-wide blood DNA methylation profiles in relation to the development of PTSD symptoms in two prospective military cohorts (one discovery and one replication data set). In the first cohort consisting of male Dutch military servicemen (n=93), the emergence of PTSD symptoms over a deployment period to a combat zone was significantly associated with alterations in DNA methylation levels at 17 genomic positions and 12 genomic regions. Evidence for mediation of the relation between combat trauma and PTSD symptoms by longitudinal changes in DNA methylation was observed at several positions and regions. Bioinformatic analyses of the reported associations identified significant enrichment in several pathways relevant for symptoms of PTSD. Targeted analyses of the significant findings from the discovery sample in an independent prospective cohort of male US marines (n=98) replicated the observed relation between decreases in DNA methylation levels and PTSD symptoms at genomic regions in ZFP57, RNF39 and HIST1H2APS2. Together, our study pinpoints three novel genomic regions where longitudinal decreases in DNA methylation across the period of exposure to combat trauma marks susceptibility for PTSD.

Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq.

PubMed

Thomas, Jeffrey L; Wilk, Joshua E; Riviere, Lyndon A; McGurk, Dennis; Castro, Carl A; Hoge, Charles W

2010-06-01

A growing body of literature has demonstrated the association of combat in Iraq and Afghanistan with postdeployment mental health problems, particularly posttraumatic stress disorder (PTSD) and depression. However, studies have shown varying prevalence rates of these disorders based on different case definitions and have not assessed functional impairment, alcohol misuse, or aggressive behavior as comorbid factors occurring with PTSD and depression. To (1) examine the prevalence rates of depression and PTSD using several case definitions including functional impairment, (2) determine the comorbidity of alcohol misuse or aggressive behaviors with depression or PTSD, and (3) compare rates between Active Component and National Guard soldiers at the 3- and 12-month time points following their deployment to Iraq. Population-based, cross-sectional study. United States Army posts and National Guard armories. A total of 18 305 US Army soldiers from 4 Active Component and 2 National Guard infantry brigade combat teams. Between 2004 and 2007, anonymous mental health surveys were collected at 3 and 12 months following deployment. Current PTSD, depression, functional impairment, alcohol misuse, and aggressive behavior. Prevalence rates for PTSD or depression with serious functional impairment ranged between 8.5% and 14.0%, with some impairment between 23.2% and 31.1%. Alcohol misuse or aggressive behavior comorbidity was present in approximately half of the cases. Rates remained stable for the Active Component soldiers but increased across all case definitions from the 3- to 12-month time point for National Guard soldiers. The prevalence rates of PTSD and depression after returning from combat ranged from 9% to 31% depending on the level of functional impairment reported. The high comorbidity with alcohol misuse and aggression highlights the need for comprehensive postdeployment screening. Persistent or increased prevalence rates at 12 months compared with 3 months postdeployment illustrate the persistent effects of war zone service and provide important data to guide postdeployment care.

Treatment seeking for posttraumatic stress in Israel Defense Forces veterans deployed in the Second Lebanon War (2006) and "Operation Cast Lead" in the Gaza Strip (2009): a comparative study.

PubMed

Levi, Ofir; Lubin, Gadi

2018-05-01

The goal of the study was to determine the long-term prevalence of combat-related treatment seeking and posttraumatic stress disorder (PTSD) in Israel's veterans deployed to the Second Lebanon War (2006) and "Operation Cast Lead" in the Gaza Strip (2009). The prevalence of treatment seeking and DSM-IV-TR diagnoses among Israel Defense Force (IDF) veterans was assessed using seven and five year's surveillance and records. The whereabouts and combat exposure of veterans during the war was determined based on the IDF's Operations Directorate records. Overall prevalence of treatment seeking was 1.32% and 0.38% in the Second Lebanon War and "Operation Cast Lead", respectively. The prevalence of treatment-seeking veterans from the Second Lebanon War and in "Operation Cast Lead" was significantly higher in soldiers deployed to high combat-exposure zones (2.19% and 3.1%, respectively), relative to low combat-exposure zones (0.24% and 0.06%, respectively), and relative to soldiers deployed elsewhere (0.26% and 0.02%, respectively). PTSD prevalence was similar among treatment-seeking veterans deployed in high combat-exposure zones in both combats. There is a gap of anywhere between 3% and 11% between treatment seeking by IDF veterans following war deployment and the actual prevalence of PTSD in this soldier population.

Moral injury: a mechanism for war-related psychological trauma in military family members.

PubMed

Nash, William P; Litz, Brett T

2013-12-01

Recent research has provided compelling evidence of mental health problems in military spouses and children, including post-traumatic stress disorder (PTSD), related to the war-zone deployments, combat exposures, and post-deployment mental health symptoms experienced by military service members in the family. One obstacle to further research and federal programs targeting the psychological health of military family members has been the lack of a clear, compelling, and testable model to explain how war-zone events can result in psychological trauma in military spouses and children. In this article, we propose a possible mechanism for deployment-related psychological trauma in military spouses and children based on the concept of moral injury, a model that has been developed to better understand how service members and veterans may develop PTSD and other serious mental and behavioral problems in the wake of war-zone events that inflict damage to moral belief systems rather by threatening personal life and safety. After describing means of adapting the moral injury model to family systems, we discuss the clinical implications of moral injury, and describe a model for its psychological treatment.

[Analysis of posttraumatic stress disorders in Polish soldiers who returned from stabilization mission in Iraq].

PubMed

Skotnicka, Justyna

2013-01-01

The aim of the survey was to establish whether PTSD is present among Polish soldiers returning from a one-year deployment to Iraq and an analysis of its individual symptoms. Sixty soldiers were examined, including 30 who returned from the Iraqi mission and 30 who remained in Poland. Five analysing devices were used: (IPSA), (STAI), (BDI), a PTSD questionnaire and a socio-demographical form. A significant number of soldiers experienced a traumatic event during the mission in Iraq. Although the Iraq deployment did not change the level of depression and anxiety among the two groups of soldiers, disproportions were found in the range of anger level intensity, which was significantly higher among soldiers who returned from Iraq. Stabilisation mission and the experience of a traumatic event influenced the biological and psychological functioning patterns among soldiers who returned from Iraq. The manifestations of this were emotional and physiological reactions that the soldiers experienced (nightmares, excessive sweating, increased heartbeat rate, stressful reactions in situations similar to the traumatic occurrence and intensified responses to them). However, contrary to the assumptions, it was not concluded that soldiers who returned from Iraq are suffering from PTSD.

2013-2014 Behavioral Health Risk Assessment Data Report (BH-RADR)

DTIC Science & Technology

2016-10-01

post-traumatic stress disorder (PTSD) symptoms, depression symptoms, and hazardous drinking behavior using the health assessment survey data. The...and/or Patient Health Questionnaire – 8 (PHQ-8) reported moderate to severe PTSD symptoms and/or depression symptoms and reported the symptoms made...to see an increase in PTSD and depression symptoms in the previously deployed population 2-3 , the findings suggest hazardous drinking behavior

Medical-encounter mental health diagnoses, non-fatal injury and polypharmacy indicators of risk for accident death in the US Army enlisted soldiers, 2004-2009.

PubMed

Lewandowski-Romps, Lisa; Schroeder, Heather M; Berglund, Patricia A; Colpe, Lisa J; Cox, Kenneth; Hauret, Keith; Hay, Jeffrey D; Jones, Bruce; Little, Roderick J A; Mitchell, Colter; Schoenbaum, Michael; Schulz, Paul; Stein, Murray B; Ursano, Robert J; Heeringa, Steven G

2018-06-01

Accidents are a leading cause of deaths in U.S. active duty personnel. Understanding accident deaths during wartime could facilitate future operational planning and inform risk prevention efforts. This study expands prior research, identifying health risk factors associated with U.S. Army accident deaths during the Afghanistan and Iraq war. Military records for 2004-2009 enlisted, active duty, Regular Army soldiers were analyzed using logistic regression modeling to identify mental health, injury, and polypharmacy (multiple narcotic and/or psychotropic medications) predictors of accident deaths for current, previously, and never deployed groups. Deployed soldiers with anxiety diagnoses showed higher risk for accident deaths. Over half had anxiety diagnoses prior to being deployed, suggesting anticipatory anxiety or symptom recurrence may contribute to high risk. For previously deployed soldiers, traumatic brain injury (TBI) indicated higher risk. Two-thirds of these soldiers had first TBI medical-encounter while non-deployed, but mild, combat-related TBIs may have been undetected during deployments. Post-Traumatic Stress Disorder (PTSD) predicted higher risk for never deployed soldiers, as did polypharmacy which may relate to reasons for deployment ineligibility. Health risk predictors for Army accident deaths are identified and potential practice and policy implications discussed. Further research could test for replicability and expand models to include unobserved factors or modifiable mechanisms related to high risk. PTSD predicted high risk among those never deployed, suggesting importance of identification, treatment, and prevention of non-combat traumatic events. Finally, risk predictors overlapped with those identified for suicides, suggesting effective intervention might reduce both types of deaths. Copyright © 2017 Elsevier Inc. All rights reserved.

Development and early evaluation of the Virtual Iraq/Afghanistan exposure therapy system for combat-related PTSD.

PubMed

Rizzo, Albert Skip; Difede, JoAnn; Rothbaum, Barbara O; Reger, Greg; Spitalnick, Josh; Cukor, Judith; McLay, Rob

2010-10-01

Numerous reports indicate that the growing incidence of posttraumatic stress disorder (PTSD) in returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) military personnel is creating a significant health care and economic challenge. These findings have served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. Virtual reality-delivered exposure therapy for PTSD has been previously used with reports of positive outcomes. The current paper will detail the development and early results from use of the Virtual Iraq/Afghanistan exposure therapy system. The system consists of a series of customizable virtual scenarios designed to represent relevant Middle Eastern contexts for exposure therapy, including a city and desert road convoy environment. The process for gathering user-centered design feedback from returning OEF/OIF military personnel and from a system deployed in Iraq (as was needed to iteratively evolve the system) will be discussed, along with a brief summary of results from an open clinical trial using Virtual Iraq with 20 treatment completers, which indicated that 16 no longer met PTSD checklist-military criteria for PTSD after treatment. © 2010 Association for Research in Nervous and Mental Disease.

Brain-derived neurotropic factor polymorphisms, traumatic stress, mild traumatic brain injury, and combat exposure contribute to postdeployment traumatic stress.

PubMed

Dretsch, Michael N; Williams, Kathy; Emmerich, Tanja; Crynen, Gogce; Ait-Ghezala, Ghania; Chaytow, Helena; Mathura, Venkat; Crawford, Fiona C; Iverson, Grant L

2016-01-01

In addition to experiencing traumatic events while deployed in a combat environment, there are other factors that contribute to the development of posttraumatic stress disorder (PTSD) in military service members. This study explored the contribution of genetics, childhood environment, prior trauma, psychological, cognitive, and deployment factors to the development of traumatic stress following deployment. Both pre- and postdeployment data on 231 of 458 soldiers were analyzed. Postdeployment assessments occurred within 30 days from returning stateside and included a battery of psychological health, medical history, and demographic questionnaires; neurocognitive tests; and blood serum for the D2 dopamine receptor (DRD2), apolipoprotein E (APOE), and brain-derived neurotropic factor (BDNF) genes. Soldiers who screened positive for traumatic stress at postdeployment had significantly higher scores in depression (d = 1.91), anxiety (d = 1.61), poor sleep quality (d = 0.92), postconcussion symptoms (d = 2.21), alcohol use (d = 0.63), traumatic life events (d = 0.42), and combat exposure (d = 0.91). BDNF Val66 Met genotype was significantly associated with risk for sustaining a mild traumatic brain injury (mTBI) and screening positive for traumatic stress. Predeployment traumatic stress, greater combat exposure and sustaining an mTBI while deployed, and the BDNF Met/Met genotype accounted for 22% of the variance of postdeployment PTSD scores (R (2)  = 0.22, P < 0.001). However, predeployment traumatic stress, alone, accounted for 17% of the postdeployment PTSD scores. These findings suggest predeployment traumatic stress, genetic, and environmental factors have unique contributions to the development of combat-related traumatic stress in military service members.

Indirect associations of combat exposure with post-deployment physical symptoms in U.S. soldiers: roles of post-traumatic stress disorder, depression and insomnia.

PubMed

Quartana, Phillip J; Wilk, Joshua E; Balkin, Thomas J; Hoge, Charles W

2015-05-01

To characterize the indirect associations of combat exposure with post-deployment physical symptoms through shared associations with post-traumatic stress disorder (PTSD), depression and insomnia symptoms. Surveys were administered to a sample of U.S. soldiers (N = 587) three months after a 15-month deployment to Iraq. A multiple indirect effects model was used to characterize direct and indirect associations between combat exposure and physical symptoms. Despite a zero-order correlation between combat exposure and physical symptoms, the multiple indirect effects analysis did not provide evidence of a direct association between these variables. Evidence for a significant indirect association of combat exposure and physical symptoms was observed through PTSD, depression, and insomnia symptoms. In fact, 92% of the total effect of combat exposure on physical symptoms scores was indirect. These findings were evident even after adjusting for the physical injury and relevant demographics. This is the first empirical study to suggest that PTSD, depression and insomnia collectively and independently contribute to the association between combat exposure and post-deployment physical symptoms. Limitations, future research directions, and potential policy implications are discussed. Published by Elsevier Inc.

Risk of incident mental health conditions among critical care air transport team members.

PubMed

Tvaryanas, Anthony P; Maupin, Genny M

2014-01-01

This study investigated whether Critical Care Air Transport Team (CCATT) members are at increased risk for incident post-deployment mental health conditions. We conducted a retrospective cohort study of 604 U.S. Air Force medical personnel without preexisting mental health conditions who had at least one deployment as a CCATT member during 2003-2012 as compared to a control group of 604 medical personnel, frequency matched based on job role, with at least one deployment during the same period, but without CCATT experience. Electronic health record data were used to ascertain the diagnosis of a mental health condition. The incidence of post-deployment mental health conditions was 2.1 per 1000 mo for the CCATT group versus 2.2 per 1000 mo for the control group. The six most frequent diagnoses were the same in both groups: adjustment reaction not including posttraumatic stress disorder (PTSD), anxiety, major depressive disorder, specific disorders of sleep of nonorganic origin, PTSD, and depressive disorder not elsewhere classified. Women were at marginally increased risk and nurses and technicians were at twice the risk of physicians. The distribution of the time interval from end of the most recent deployment to diagnosis of incident mental health condition was positively skewed with a median greater than 6 mo. CCATT members were at no increased risk for incident post-deployment mental health conditions as compared to non-CCATT medical service members. Nearly two-thirds of incident post-deployment mental health conditions were diagnosed outside the standard 6-mo medical surveillance period, a finding warranting further study.

Association Between Traumatic Brain Injury and Risk of Posttraumatic Stress Disorder in Active-Duty Marines

DTIC Science & Technology

2013-01-01

traumatic brain injury (TBI) is a risk factor for posttraumatic stress disorder ( PTSD ) has been difficult to determine because of the prevalence of...Qualification Test; CAPS, Clinician-Administered PTSD Scale; PTSD , posttraumatic stress disorder ; TBI, traumatic brain injury. a For the zeromodel, base...New onset and persistent symptoms of post - traumatic stress disorder self reported after deployment and combat exposures. BMJ.

Biomarkers for PTSD

DTIC Science & Technology

2010-07-01

connected disability (5). Development of biomarkers of PTSD is critical for DOD and VA as objective indicators of PTSD for use in post -deployment medical...2 C. W. Hoge, A. Terhakopian, C. A. Castro et al., Association of posttraumatic stress disorder with somatic symptoms, health care visits, and...seen at Department of Veterans Affairs facilities. Arch Intern Med 167, 476- 82 (2007). 5 P. B. Watson and B. Daniels, Follow up of post - traumatic

Associations of contextual risk and protective factors with fathers’ parenting practices in the post-deployment environment

PubMed Central

Davis, Laurel; Hanson, Sheila K.; Zamir, Osnat; Gewirtz, Abigail H.; DeGarmo, David S.

2015-01-01

Deployment separation and reunifications are salient contexts that directly impact effective family functioning and parenting for military fathers. Yet, we know very little about determinants of post-deployed father involvement and effective parenting. The present study examined hypothesized risk and protective factors of observed parenting for 282 post-deployed fathers who served in the Army National Guard/Reserves. Pre-intervention data were employed from fathers participating in the After Deployment, Adaptive Parenting Tools (ADAPT) randomized control trial. Parenting practices were obtained from direct observation of father-child interaction and included measures of problem solving, harsh discipline, positive involvement, encouragement, and monitoring. Risk factors included combat exposure, negative life events, months deployed, and PTSD symptoms. Protective factors included education, income, dyadic adjustment, and social support. Results of a structural equation model predicting an effective parenting construct indicated that months deployed, income, and father age were most related to observed parenting, explaining 16% of the variance. We are aware of no other study utilizing direct parent-child observations of father’s parenting skills following overseas deployment. Implications for practice and preventive intervention are discussed. PMID:26213794

Comorbidity of PTSD and depression in Korean War veterans: prevalence, predictors, and impairment.

PubMed

Ikin, Jillian F; Creamer, Mark C; Sim, Malcolm R; McKenzie, Dean P

2010-09-01

Rates of PTSD and depression are high in Korean War veterans. The prevalence and impact of the two disorders occurring comorbidly, however, has not been investigated. This paper aims to investigate the extent to which PTSD and depression co-occur in Australian veterans of the Korean War, the symptom severity characteristics of comorbidity, the impact on life satisfaction and quality, and the association with war-related predictors. Veterans (N=5352) completed self-report questionnaires including the Posttraumatic Stress Disorder Checklist, the Hospital Anxiety and Depression Scale, the Life Satisfaction Scale, the brief World Health Organisation Quality of Life questionnaire and the Combat Exposure Scale. Seventeen percent of veterans met criteria for comorbid PTSD and depression, 15% had PTSD without depression, and a further 6% had depression without PTSD. Compared with either disorder alone, comorbidity was associated with impaired life satisfaction, reduced quality of life, and greater symptom severity. Several war-related factors were associated with comorbidity and with PTSD alone, but not with depression alone. The reliance on self-reported measures and the necessity for retrospective assessment of some deployment-related factors renders some study data vulnerable to recall bias. Comorbid PTSD and depression, and PTSD alone, are prevalent among Korean War veterans, are both associated with war-related factors 50 years after the Korean War, and may represent a single traumatic stress construct. The results have important implications for understanding complex psychopathology following trauma. 2010 Elsevier B.V. All rights reserved.

Prevalence of, risk factors for, and consequences of posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan.

PubMed

Ramchand, Rajeev; Rudavsky, Rena; Grant, Sean; Tanielian, Terri; Jaycox, Lisa

2015-05-01

This review summarizes the epidemiology of posttraumatic stress disorder (PTSD) and related mental health problems among persons who served in the armed forces during the Iraq and Afghanistan conflicts, as reflected in the literature published between 2009 and 2014. One-hundred and sixteen research studies are reviewed, most of which are among non-treatment-seeking US service members or treatment-seeking US veterans. Evidence is provided for demographic, military, and deployment-related risk factors for PTSD, though most derive from cross-sectional studies and few control for combat exposure, which is a primary risk factor for mental health problems in this cohort. Evidence is also provided linking PTSD with outcomes in the following domains: physical health, suicide, housing and homelessness, employment and economic well-being, social well-being, and aggression, violence, and criminality. Also included is evidence about the prevalence of mental health service use in this cohort. In many instances, the current suite of studies replicates findings observed in civilian samples, but new findings emerge of relevance to both military and civilian populations, such as the link between PTSD and suicide. Future research should make effort to control for combat exposure and use longitudinal study designs; promising areas for investigation are in non-treatment-seeking samples of US veterans and the role of social support in preventing or mitigating mental health problems in this group.

RESPECT-Mil: feasibility of a systems-level collaborative care approach to depression and post-traumatic stress disorder in military primary care.

PubMed

Engel, Charles C; Oxman, Thomas; Yamamoto, Christopher; Gould, Darin; Barry, Sheila; Stewart, Patrice; Kroenke, Kurt; Williams, John W; Dietrich, Allen J

2008-10-01

U.S. military ground forces report high rates of war-related traumatic stressors, posttraumatic stress disorder (PTSD), and depression following deployment in support of recent armed conflicts in Iraq and Afghanistan. Affected service members do not receive needed mental health services in most cases, and they frequently report stigma and significant structural barriers to mental health services. Improvements in primary care may help address these issues, and evidence supports the effectiveness of a systems-level collaborative care approach. To test the feasibility of systems-level collaborative care for PTSD and depression in military primary care. We named our collaborative care model "Re-Engineering Systems of Primary Care for PTSD and Depression in the Military" (RESPECT-Mil). Key elements of RESPECT-Mil care include universal primary care screening for PTSD and depression, brief standardized primary care diagnostic assessment for those who screen positive, and use of a nurse "care facilitator" to ensure continuity of care for those with unmet depression and PTSD treatment needs. The care facilitator assists primary care providers with follow-up, symptom monitoring, and treatment adjustment and enhances the primary care interface with specialty mental health services. We report assessments of feasibility of RESPECT-Mil implementation in a busy primary care clinic supporting Army units undergoing frequent Iraq, Afghanistan, and other deployments. Thirty primary care providers (family physicians, physician assistants, and nurse practitioners) were trained in the model and in the care of depression and PTSD. The clinic screened 4,159 primary care active duty patient visits: 404 screens (9.7%) were positive for depression, PTSD, or both. Sixty-nine patients participated in collaborative care for 6 weeks or longer, and the majority of these patients experienced clinically important improvement in PTSD and depression. Even although RESPECT-Mil participation was voluntary for providers, only one refused participation. No serious adverse events were noted. Collaborative care is an evidence-based approach to improving the quality of primary care treatment of anxiety and depression. Our version of collaborative care for PTSD and depression, RESPECT-Mil, is feasible, safe, and acceptable to military primary care providers and patients, and participating patients frequently showed clinical improvements. Efforts to implement and evaluate collaborative care approaches for mental disorders in populations at high risk for psychiatric complications of military service are warranted.

Mental health consequences of overstretch in the UK Armed Forces, 2007-09: a population-based cohort study.

PubMed

Rona, Roberto J; Jones, Margaret; Keeling, Mary; Hull, Lisa; Wessely, Simon; Fear, Nicola T

2014-12-01

Concerns have been raised about the effect of tour length on the mental health of the UK armed forces. In 2007, we reported that cumulative length of deployment was associated with mental illness in military personnel. Our findings provided empirical evidence to support the UK advisory policy for tour length, known as the Harmony Guidelines. If fully implemented, these guidelines could aid prevention of mental illnesses. We aimed to reassess the association between cumulative length of deployment and number of deployments with mental illness in the UK forces. Our analysis was based on data from a representative study of the military for UK regular personnel who had completed a questionnaire between Nov 2, 2007, and Sept 24, 2009, and were deployed in the 3 years before questionnaire completion. Study outcomes were presence of possible post-traumatic stress disorder (PTSD), psychological distress, multiple physical symptoms, alcohol misuse, problems at home during and after deployment, and relationship or family problems. The key independent factors were deployment for 13 months or more, and months and number of deployments in the past 3 years. 8278 regulars responded to the questionnaire, of whom 3982 (48%) had been deployed in the 3 years before questionnaire completion. Deployment for 13 months or more decreased from 22% in March, 2005, (median March 8, 2005 [IQR Oct 10, 2004 to April 28, 2005]), to 12% in May, 2008, (May 17, 2008, [Feb 14, 2008, to Dec 5, 2008]). We noted an association between cumulative time deployed as a continuous variable and a score of 40 or more on the PTSD checklist (p=0·002), presence of psychological distress (p=0·018), and multiple physical symptoms (p=0·030; table 2). Furthermore, 13 months or more of deployment was associated with multiple physical symptoms (adjusted odds ratio [OR] 2·15, 95% CI 1·39-3·32), a PTSD checklist score of 40 or more (2·02, 1·31-3·12), and problems at home, but not a PTSD checklist score of 50 or more (1·50, 0·82-2·75), psychological distress 1·34, 0·98-1·85), or alcohol misuse (1·32, 0·97-1·80). Number of deployments was not associated with worse mental illness status or problems at home. The Harmony Guidelines can prevent mental illness in the UK Armed Forces and, since 2006, their introduction has prevented personnel from being deployed for a longer period than recommended in the guidelines. Monitoring of cumulative length of deployment might reduce mental illness in the UK military. The UK Ministry of Defence. Copyright © 2014 Elsevier Ltd. All rights reserved.

Incidence of and risk for post-traumatic stress disorder and depression in a representative sample of US Reserve and National Guard.

PubMed

Fink, David S; Cohen, Gregory H; Sampson, Laura A; Gifford, Robert K; Fullerton, Carol S; Ursano, Robert J; Galea, Sandro

2016-03-01

We aim to determine the incidence rates (IR) of first-ever post-traumatic stress disorder (PTSD) and depression in a population-based cohort of US Reserve and National Guard service members. We used data from the US Reserve and National Guard Study (n = 2003) to annually investigate incident and recurrent PTSD and depression symptoms from 2010 to 2013. We estimated the IR and recurrence rate over 4 years and according to several sociodemographic and military characteristics. From 2010 to 2013, IRs were 4.7 per 100 person-years for both PTSD and depression symptoms using the sensitive criteria, 2.9 per 100 person-years using the more specific criteria, recurrence rates for both PTSD and depression were more than 4 times as high as IRs, and IRs were higher among those with past-year civilian trauma, but not past-year deployment. The finding that civilian trauma, but not past-year military deployment, is associated with an increased risk of PTSD and depression incidence suggest that Reserve National Guard psychopathology could be driven by other, nonmilitary, traumatic experiences. Copyright © 2016 Elsevier Inc. All rights reserved.

From Darkness to Light: Posttraumatic Growth among Recently Deployed Army National Guard Soldiers

DTIC Science & Technology

2013-02-14

reminders of the trauma, emotional deadening, and physiological arousal.54 Dekel et al. outlined three possible relationships between PTG and PTSD extant...decreased. Dekel suggested this relationship demonstrated PTG and PTSD existed on opposite ends of a spectrum.55 For instance, in a study on sexual...Second, Dekel et al. postulated no relationship between trauma-related growth and posttraumatic negative symptoms.57 In other words, PTG and PTSD

Prazosin Augmentation of Outpatient Treatment of Alcohol Use Disorders in Active Duty Soldiers with and without PTSD

DTIC Science & Technology

2014-10-01

future combat deployments. It is also important to avoid sedation, weight gain, decreased libido, and other adverse effects of psychotropic drugs that...ated, and blood pressure changes did not differ between groups. Conclusions: Prazosin is effective for combat- related PTSD with trauma night- mares in...combat- related trauma nightmares, sleep quality, and global status. Prazosin was also effective for overall PTSD symptoms even after the CAPS

Approximating a DSM-5 Diagnosis of PTSD Using DSM-IV Criteria

PubMed Central

Rosellini, Anthony J.; Stein, Murray B.; Colpe, Lisa J.; Heeringa, Steven G.; Petukhova, Maria V.; Sampson, Nancy A.; Schoenbaum, Michael; Ursano, Robert J.; Kessler, Ronald C.

2015-01-01

Background Diagnostic criteria for DSM-5 posttraumatic stress disorder (PTSD) are in many ways similar to DSM-IV criteria, raising the possibility that it might be possible to closely approximate DSM-5 diagnoses using DSM-IV symptoms. If so, the resulting transformation rules could be used to pool research data based on the two criteria sets. Methods The Pre-Post Deployment Study (PPDS) of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) administered a blended 30-day DSM-IV and DSM-5 PTSD symptom assessment based on the civilian PTSD Checklist for DSM-IV (PCL-C) and the PTSD Checklist for DSM-5 (PCL-5). This assessment was completed by 9,193 soldiers from three US Army Brigade Combat Teams approximately three months after returning from Afghanistan. PCL-C items were used to operationalize conservative and broad approximations of DSM-5 PTSD diagnoses. The operating characteristics of these approximations were examined compared to diagnoses based on actual DSM-5 criteria. Results The estimated 30-day prevalence of DSM-5 PTSD based on conservative (4.3%) and broad (4.7%) approximations of DSM-5 criteria using DSM-IV symptom assessments were similar to estimates based on actual DSM-5 criteria (4.6%). Both approximations had excellent sensitivity (92.6-95.5%), specificity (99.6-99.9%), total classification accuracy (99.4-99.6%), and area under the receiver operating characteristic curve (0.96-0.98). Conclusions DSM-IV symptoms can be used to approximate DSM-5 diagnoses of PTSD among recently-deployed soldiers, making it possible to recode symptom-level data from earlier DSM-IV studies to draw inferences about DSM-5 PTSD. However, replication is needed in broader trauma-exposed samples to evaluate the external validity of this finding. PMID:25845710

Mind-Body Therapy for Military Veterans with Post-Traumatic Stress Disorder: A Systematic Review.

PubMed

Cushing, Robin E; Braun, Kathryn L

2018-02-01

About one-third of service members returning from post-9/11 deployment in Afghanistan and Iraq report combat-related mental health conditions, but many do not seek conventional treatment. Mind-body therapies have been offered as alternative approaches to decreasing post-traumatic stress disorder (PTSD), but no review of studies with veterans of post-9/11 operations was found. The objective of this study was to fill that gap. A systematic literature review was conducted following the preferred items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed MeSH terms were used to capture articles reporting on the military population (veteran and veterans) with PTSD who received a portable mind-body intervention (e.g., mindfulness, mind-body therapy, and yoga). PubMed/MEDLINE and PsycINFO were searched. Studies were included if participants were a mixed group of war veterans, as long as some post-9/11 veterans were included. In addition, participants must have had a diagnosis of PTSD or subthreshold PTSD, and the PTSD must have been attributable to combat, rather than another event, such as sexual trauma or natural disaster. Of 175 records identified, 15 met inclusion criteria. Studies reported on seated or gentle yoga that included breath work, meditation, mantra repetition, or breathing exercises. For 14 of the 15 studies, study retention was 70% or higher. Overall, studies reported significant improvements in PTSD symptoms in participants in these interventions. Although each study included post-9/11 veterans, about 85% of participants were from other conflicts, predominantly Vietnam. Although findings were positive, future studies are needed to evaluate the short- and long-term impact of mind-body therapies on larger samples of post-9/11 veterans and to address research questions related to broadening service member and veteran participation in these therapies.

Heart rate response to fear conditioning and virtual reality in subthreshold PTSD.

PubMed

Roy, Michael J; Costanzo, Michelle E; Jovanovic, Tanja; Leaman, Suzanne; Taylor, Patricia; Norrholm, Seth D; Rizzo, Albert A

2013-01-01

Posttraumatic stress disorder (PTSD) is a significant health concern for U.S. military service members (SMs) returning from Afghanistan and Iraq. Early intervention to prevent chronic disability requires greater understanding of subthreshold PTSD symptoms, which are associated with impaired physical health, mental health, and risk for delayed onset PTSD. We report a comparison of physiologic responses for recently deployed SMs with high and low subthreshold PTSD symptoms, respectively, to a fear conditioning task and novel virtual reality paradigm (Virtual Iraq). The high symptom group demonstrated elevated heart rate (HR) response during fear conditioning. Virtual reality sequences evoked significant HR responses which predicted variance of the PTSD Checklist-Military Version self-report. Our results support the value of physiologic assessment during fear conditioning and combat-related virtual reality exposure as complementary tools in detecting subthreshold PTSD symptoms in Veterans.

Postdeployment symptom changes and traumatic brain injury and/or posttraumatic stress disorder in men.

PubMed

Macera, Caroline A; Aralis, Hilary J; Macgregor, Andrew J; Rauh, Mitchell J; Galarneau, Michael R

2012-01-01

In Operation Iraqi Freedom and Operation Enduring Freedom, blast-related injuries associated with combat are frequent and can result in traumatic brain injury (TBI) symptoms that may be difficult to distinguish from psychological problems. Using data from the Post-Deployment Health Assessment and Reassessment, we identified 12,046 male U.S. Navy sailors and Marines with reported combat exposure from 2008 to 2009. Symptoms potentially associated with blast-related TBI and posttraumatic stress disorder (PTSD) that were reported immediately after deployment were compared with symptoms present several months later. Our study supports others that have found that subjects with blast-related injuries may experience the development or worsening of symptoms during the months following deployment. Additionally, our study found that those who screened positive for PTSD and TBI formed a unique group, with the presence of TBI exacerbating development of PTSD symptoms at reassessment. Providers should recognize the late development of symptoms, consider the possibility of comorbidity, and be prepared to treat multiple symptoms rather than a specific diagnostic category.

Post-deployment screening for mental disorders and tailored advice about help-seeking in the UK military: a cluster randomised controlled trial.

PubMed

Rona, Roberto J; Burdett, Howard; Khondoker, Mizanur; Chesnokov, Melanie; Green, Kevin; Pernet, David; Jones, Norman; Greenberg, Neil; Wessely, Simon; Fear, Nicola T

2017-04-08

The effectiveness of post-deployment screening for mental disorders has not been assessed in a randomised controlled trial. We aimed to assess whether post-deployment screening for post-traumatic stress disorder (PTSD), depression, anxiety, or alcohol misuse was effective. We defined screening as the presumptive identification of a previously unrecognised disorder using tests to distinguish those who probably had the disorder from those who probably did not so that those people with a probable disorder could be referred appropriately, and assessed effectiveness and consequences for help-seeking by the odds ratio at follow-up between those receiving tailored help-seeking advice and those who received general mental health advice. We did a cluster randomised controlled trial among Royal Marines and Army personnel in the UK military after deployment to Afghanistan. Platoons were randomly assigned (1:1 initially, then 2:1) by stratified block randomisation with randomly varying block sizes of two and four to the screening group, which received tailored help-seeking advice, or the control group, which received general mental health advice. Initial assessment took place 6-12 weeks after deployment; follow-up assessments were done 10-24 months later. Follow-up measures were the PTSD Checklist-Civilian Version, Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 scale, Alcohol Use Disorder Identification Test (AUDIT), and self-reported help-seeking from clinical and welfare providers comparing those receiving tailored advice and those receiving only general advice. All participants and all investigators other than the person who analysed the data were masked to allocation. The primary outcomes were PTSD, depression or generalised anxiety disorder, and alcohol misuse at follow-up. A key secondary outcome was assessment of whether post-deployment screening followed by tailored advice would modify help-seeking behaviour. Comparisons were made between screening and control groups, with primary analyses by intention to treat. This trial is registered with the ISRCTN Registry, number ISRCTN19965528. Between Oct 24, 2011, and Oct 31, 2014, 434 platoons comprising 10 190 personnel were included: 274 (6350 personnel) in the screening group and 160 (3840 personnel) in the control group. 5577 (88%) of 6350 personnel received screening and 3996 (63%) completed follow-up, whereas 3149 (82%) of 3840 received the control questionnaire and 2369 (62%) completed follow-up. 1958 (35%) of 5577 personnel in the screening group declined to see the tailored advice, but those with PTSD (83%) or anxiety or depression (84%) were more likely than non-cases (64%) to view the advice (both p<0·0001). At follow-up, there were no significant differences in prevalence between groups for PTSD (adjusted odds ratio 0·92, 95% CI 0·75-1·14), depression or anxiety (0·91, 0·71-1·16), alcohol misuse (0·88, 0·73-1·06), or seeking support for mental disorders (0·92, 0·78-1·08). Post-deployment screening for mental disorders based on tailored advice was not effective at reducing prevalence of mental health disorders nor did it increase help-seeking. Countries that have implemented post-deployment screening programmes for mental disorders should consider monitoring the outcomes of their programmes. The US Army Medical Research and Materiel Command-Military Operational Medicine Research Program (USAMRMC-MOMRP). Copyright © 2017 Elsevier Ltd. All rights reserved.

Cognitive Emotion Regulation Strategies Associated With the DSM-5 Posttraumatic Stress Disorder Criteria.

PubMed

Kaczkurkin, Antonia N; Zang, Yinyin; Gay, Natalie G; Peterson, Alan L; Yarvis, Jeffrey S; Borah, Elisa V; Dondanville, Katherine A; Hembree, Elizabeth A; Litz, Brett T; Mintz, Jim; Young-McCaughan, Stacey; Foa, Edna B

2017-08-01

Maladaptive cognitive emotion regulation strategies have been proposed to contribute to the maintenance of posttraumatic stress disorder (PTSD). Prior work has focused on the relationship between these strategies and PTSD as a whole, rather than on how they are related to each PTSD symptom cluster. The purpose of the current study was to determine whether cognitive emotion regulation strategies are predictive of certain PTSD symptom clusters under the Diagnostic and Statistical Manual of Mental Disorders 5th ed. (DSM-5; American Psychiatric Association, 2013) criteria (intrusive thoughts, avoidance, negative alterations in cognitions and mood, and hyperarousal). Participants included 365 treatment-seeking, active-duty military personnel with PTSD. The negative alterations in cognitions and mood cluster were associated with dysfunctional cognitions: greater negative cognitions about the self, negative cognitions about the world, and self-blame, as well as catastrophizing (Rc2 = .519). The negative alterations in cognitions and mood cluster did not show a strong relationship with blaming others, possibly due to the complex nature of self- and other-blame in this primarily deployment-related PTSD sample. Finally, the intrusive thoughts cluster was associated with catastrophizing (Rc2 = .211), suggesting an association between frequent intrusive memories and excessively negative interpretation of those memories. Copyright © 2017 International Society for Traumatic Stress Studies.

Compelling Evidence that Exposure Therapy for PTSD Normalizes Brain Function.

PubMed

Roy, Michael J; Costanzo, Michelle E; Blair, James R; Rizzo, Albert A

2014-01-01

Functional magnetic resonance imaging (fMRI) is helping us better understand the neurologic pathways involved in posttraumatic stress disorder (PTSD). We previously reported that military service members with PTSD after deployment to Iraq or Afghanistan demonstrated significant improvement, or normalization, in the fMRI-measured activation of the amygdala, prefrontal cortex and anterior cingulate gyrus following exposure therapy for PTSD. However, our original study design did not include repeat scans of control participants, rendering it difficult to discern how much of the observed normalization in brain activity is attributable to treatment, rather than merely a practice effect. Using the same Affective Stroop task paradigm, we now report on a larger sample of PTSD-positive combat veterans that we treated with exposure therapy, as well as a combat-exposed control group of service members who completed repeat scans at 3-4 month intervals. Findings from the treatment group are similar to our prior report. Combat controls showed no significant change on repeat scanning, indicating that the observed differences in the intervention group were in fact due to treatment. We continue to scan additional study participants, in order to determine whether virtual reality exposure therapy has a different impact on regional brain activation than other therapies for PTSD.

Health of women after wartime deployments: correlates of risk for selected medical conditions among females after initial and repeat deployments to Afghanistan and Iraq, active component, U.S. Armed Forces.

PubMed

2012-07-01

Women account for approximately 10 percent of all U.S. military deployers to Afghanistan and Iraq. This analysis estimates the percentages of female deployers (n=154,548) who were affected by selected illnesses and injuries after first through third deployments to Iraq/Afghanistan in relation to age group, service branch, military occupation, marital status, pre-deployment medical history, "dwell time" prior to 2nd and 3rd deployments, and length of deployment. Of these factors, diagnosis of a condition before deployment was by far the strongest predictor of diagnosis of the condition after deployment. Durations of dwell times before repeat deployments were not strong predictors of post-deployment diagnoses of any of the conditions considered. For several conditions (e.g., PTSD, disorders of joints, peripheral enthesopathies, infertility), the percentages of deployers diagnosed with the conditions sharply increased with deployment length. Post-deployment morbidity moderately increased with increasing numbers of deployments in the case of some conditions (e.g., PTSD, migraine, musculoskeletal disorders), but not others. The findings suggest that limiting wartime deployments to nine months may have broad beneficial effects on the post-deployment health of female service members. However, limiting the number of wartime deployments and lengthening "dwell times" before repeat deployments would likely not have strong and broad beneficial effects on the health of female veterans. Further research to mitigate the effects of heavy loads and repetitive stresses on the musculoskeletal systems of combat deployed females is indicated.

What are the effects of having an illness or injury whilst deployed on post deployment mental health? A population based record linkage study of UK Army personnel who have served in Iraq or Afghanistan

PubMed Central

2012-01-01

Background The negative impact of sustaining an injury on a military deployment on subsequent mental health is well-documented, however, the relationship between having an illness on a military operation and subsequent mental health is unknown. Methods Population based study, linking routinely collected data of attendances at emergency departments in military hospitals in Iraq and Afghanistan [Operational Emergency Department Attendance Register (OpEDAR)], with data on 3896 UK Army personnel who participated in a military health study between 2007 and 2009 and deployed to Iraq or Afghanistan between 2003 to 2009. Results In total, 13.8% (531/3896) of participants had an event recorded on OpEDAR during deployment; 2.3% (89/3884) were medically evacuated. As expected, those medically evacuated for an injury were at increased risk of post deployment probable PTSD (odds ratio 4.27, 95% confidence interval 1.80-10.12). Less expected was that being medically evacuated for an illness was also associated with a similarly increased risk of probable PTSD (4.39, 1.60-12.07) and common mental disorders (2.79, 1.41-5.51). There was no association between having an OpEDAR event and alcohol misuse. Having an injury caused by hostile action was associated with increased risk of probable PTSD compared to those with a non-hostile injury (3.88, 1.15 to 13.06). Conclusions Personnel sustaining illnesses on deployment are just as, if not more, at risk of having subsequent mental health problems as personnel who have sustained an injury. Monitoring of mental health problems should consider those with illnesses as well as physical injuries. PMID:23095133

Complex contribution of combat-related post-traumatic stress disorder to veteran suicide: facing an increasing challenge.

PubMed

Lee, Elizabeth A D

2012-04-01

The purpose of this case study is to present the complex contribution of combat-related post-traumatic stress disorder (PTSD) to suicide and international standards of treatment among veterans deployed to the Middle East. PTSD carries increased physical and psychological health risk in combat soldiers. Internationally, guidelines for PTSD promote cognitive behavior therapies, specifically exposure therapy, as first line treatment; however, implementation varies among countries. Evidence supports the benefit of exposure-based psychotherapy for combat-related PTSD. Commonly prescribed antidepressants and other psychotherapy treatments may not be as beneficial. © 2011 Wiley Periodicals, Inc.

Comprehensive Soldier Fitness (CSF) Experiment: Research Biases in the Development of the CSF

DTIC Science & Technology

2013-06-13

issues that Soldiers were having, mostly during or returning from deployments. Issues such as PTSD, depression , and suicide . Seligman helped the...argues that the domains that are being measured do not necessarily link themselves to the key stressors that cause PTSD, depression , or suicide (Eidelson...or lessen any one of the key of stressors that cause PTSD, depression , and suicidality , which was supposed to be the results of the CSF (Eidelson

The Mediating Roles of Coping, Sleep, and Anxiety Motives in Cannabis Use and Problems among Returning Veterans with PTSD and MDD

PubMed Central

Metrik, Jane; Jackson, Kristina; Bassett, Shayna S.; Zvolensky, Michael J.; Seal, Karen; Borsari, Brian

2016-01-01

Veterans with posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), the two most prevalent mental health disorders in the Iraq and Afghanistan veterans, are at increased risk for cannabis use and problems including cannabis use disorder (CUD). The present study examined the relationship of PTSD and MDD with cannabis use frequency, cannabis problems, and CUD as well as the role of three coping-oriented cannabis use motives (coping with negative affect, situational anxiety, and sleep) that might underlie this relationship. Participants were veterans (N = 301) deployed post 9/11/2001 recruited from Veterans Health Administration facility in the Northeast US based on self-reported lifetime cannabis use. There were strong unique associations between PTSD and MDD and cannabis use frequency, cannabis problems, and CUD. Mediation analyses revealed the three motives accounted, in part, for the relationship between PTSD and MDD with three outcomes in all cases but for PTSD with cannabis problems. When modeled concurrently, sleep motives, but not situational anxiety or coping with negative affect motives, significantly mediated the association between PTSD and MDD with use. Together with coping motives, sleep motives also fully mediated the effects of PTSD and MDD on CUD and in part the effect of MDD on cannabis problems. Findings indicate the important role of certain motives for better understanding the relation between PTSD and MDD with cannabis use and misuse. Future work is needed to explore the clinical utility in targeting specific cannabis use motives in the context of clinical care for mental health and CUD. PMID:27786514

Residual sleep disturbances following PTSD treatment in active duty military personnel.

PubMed

Pruiksma, Kristi E; Taylor, Daniel J; Wachen, Jennifer Schuster; Mintz, Jim; Young-McCaughan, Stacey; Peterson, Alan L; Yarvis, Jeffrey S; Borah, Elisa V; Dondanville, Katherine A; Litz, Brett T; Hembree, Elizabeth A; Resick, Patricia A

2016-11-01

Sleep disturbances, including nightmares and insomnia, are frequently reported symptoms of posttraumatic stress disorder (PTSD). Insomnia is one of the most common symptoms to persist after evidence-based PTSD treatment. The purpose of this study was to examine the prevalence of sleep disturbances in a sample of active duty military personnel before and after receiving therapy for PTSD in a clinical trial and to explore the associations of insomnia and nightmares with PTSD diagnosis after treatment. Sleep parameters were evaluated with the PTSD Checklist in 108 active duty U.S. Army soldiers who had completed at least one deployment in support of the wars in Iraq and Afghanistan and who participated in a randomized clinical trial comparing Group Cognitive Processing Therapy-Cognitive Only Version with Group Present-Centered Therapy. Insomnia was the most frequently reported symptom before and after treatment, with 92% reporting insomnia at baseline and 74%-80% reporting insomnia at follow-up. Nightmares were reported by 69% at baseline and by 49%-55% at follow-up. Among participants who no longer met criteria for PTSD following treatment, 57% continued to report insomnia, but only 13% continued to report nightmares. At baseline, 54% were taking sleep medications, but sleep medication use did not affect the overall results. Insomnia was found to be one of the most prevalent and persistent problems among service members receiving PTSD treatment. Nightmares were relatively more positively responsive to treatment. For some service members with PTSD, the addition of specific treatments targeting insomnia and/or nightmares may be indicated. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Electrocortical processing of social signals of threat in combat-related post-traumatic stress disorder.

PubMed

MacNamara, Annmarie; Post, David; Kennedy, Amy E; Rabinak, Christine A; Phan, K Luan

2013-10-01

Post-traumatic stress disorder (PTSD) is characterized by avoidance, emotional numbing, increased arousal and hypervigilance for threat following a trauma. Thirty-three veterans (19 with PTSD, 14 without PTSD) who had experienced combat trauma while on deployment in Iraq and/or Afghanistan completed an emotional faces matching task while electroencephalography was recorded. Vertex positive potentials (VPPs) elicited by happy, angry and fearful faces were smaller in veterans with versus without PTSD. In addition, veterans with PTSD exhibited smaller late positive potentials (LPPs) to angry faces and greater intrusive symptoms predicted smaller LPPs to fearful faces in the PTSD group. Veterans with PTSD were also less accurate at identifying angry faces, and accuracy decreased in the PTSD group as hyperarousal symptoms increased. These findings show reduced early processing of emotional faces, irrespective of valence, and blunted prolonged processing of social signals of threat in conjunction with impaired perception for angry faces in PTSD. Copyright © 2013 Elsevier B.V. All rights reserved.

Risk and Protective Factors for Difficulty Controlling Violent Behavior in National Guard and Reserve Service Members.

PubMed

Worthen, Miranda; Rathod, Sujit D; Cohen, Gregory; Sampson, Laura; Ursano, Robert; Gifford, Robert; Fullerton, Carol; Galea, Sandro; Ahern, Jennifer

2017-11-01

Violent behavior is an important problem for military service members and veterans. A representative cohort of U.S. Reserve and National Guard personnel ( N = 1,293) were interviewed to assess self-reported problems controlling violent behavior, deployment traumas, posttraumatic stress disorder (PTSD), alcohol abuse, and social support. Poisson regression models were used to estimate the associations of violent behavior with risk and protective factors. Problems controlling violent behavior were uncommon among male (3.3%) and female (1.7%) service members. Adjusted prevalence ratios (aPR) showed associations between violent behavior and deployment traumas (aPR = 1.67, 95% confidence interval [CI] = [1.34, 2.08]), PTSD (aPR = 9.95, 95% CI = [5.09, 19.48]), and PTSD symptom severity (aPR for each additional PTSD symptom = 1.07, 95% CI = [1.06, 1.09]). Social support was associated with lower prevalence of violent behavior (aPR = 0.62, 95% CI = [0.52, 0.76]). The association between violent behavior and alcohol abuse was not statistically significant (aPR = 1.94, 95% CI = [0.92, 4.09]). Results were consistent when the population was restricted to personnel who had deployed to a war zone. Problems controlling violent behavior were less common in this cohort than has been documented in other studies. Associations of violent behavior with risk and protective factors are consistent with prior research.

Family adjustment of deployed and non-deployed mothers in families with a parent deployed to Iraq or Afghanistan

PubMed Central

Gewirtz, Abigail H.; McMorris, Barbara J.; Hanson, Sheila; Davis, Laurel

2014-01-01

Almost nothing is known about the family and individual adjustment of military mothers who have deployed to the conflicts in Iraq or Afghanistan (Operations Iraqi and Enduring Freedom, and Operation New Dawn; OIF, OEF, OND), constituting a gap in psychologists’ knowledge about how best to help this population. We report baseline data on maternal, child, parenting, and couple adjustment for mothers in 181 families in which a parent deployed to OIF/OEF/OND. Among this sample, 34 mothers had deployed at least once, and 147 mothers had experienced the deployment of a male spouse/partner. Mothers completed self-report questionnaires assessing past year adverse life events, war experiences (for deployed mothers only), posttraumatic stress disorder (PTSD) and depression symptoms, difficulties in emotion regulation, parenting, couple adjustment, and child functioning. Mothers who had deployed reported greater distress than non-deployed mothers (higher scores on measures of PTSD and depression symptoms), and slightly more past year adverse events. A moderate number of war experiences (combat and post-battle aftermath events) were reported, consistent with previous studies of women in current and prior conflicts. However, no differences were found between the two groups on measures of couple adjustment, parenting, or child functioning. Results are discussed in terms of the dearth of knowledge about deployed mothers, and implications for psychologists serving military families. PMID:25663739

Effects of military service and deployment on clinical symptomatology: The role of trauma exposure and social support.

PubMed

Moore, Tyler M; Risbrough, Victoria B; Baker, Dewleen G; Larson, Gerald E; Glenn, Daniel E; Nievergelt, Caroline M; Maihofer, Adam; Port, Allison M; Jackson, Chad T; Ruparel, Kosha; Gur, Ruben C

2017-12-01

The Marine Resiliency Study-II examined changes in symptomatology across a deployment cycle to Afghanistan. U.S. Servicemembers (N = 1041) received clinical testing at two time points either bracketing a deployment (855) or not (186). Factor analyses were used to generate summary and change scores from Time 1 to Time 2. A between-subject design was used to examine changes across the deployment cycle with deployment (low-trauma, high-trauma, and non-deployed) and social support (low vs. high) as the grouping variables. Insomnia increased post-deployment regardless of deployment trauma (std. effect for high-trauma and low-trauma = 0.39 and 0.26, respectively). Only the high-trauma group showed increased PTSD symptoms and non-perspective-taking (std. effect = 0.40 and 0.30, respectively), while low-trauma showed decreased anxiety symptoms after deployment (std. effect = -0.17). These associations also depend on social support, with std. effects ranging from -0.22 to 0.51. When the groups were compared, the high-trauma deployed group showed significantly worse PTSD and non-perspective-taking than all other groups. Similar to studies in other military divisions, increased clinical symptoms were associated with high deployment stress in active duty Servicemembers, and social support shows promise as a moderator of said association. Copyright © 2017 Elsevier Ltd. All rights reserved.

Post-traumatic Stress Disorder and Antepartum Complications: a Novel Risk Factor for Gestational Diabetes and Preeclampsia.

PubMed

Shaw, Jonathan G; Asch, Steven M; Katon, Jodie G; Shaw, Kate A; Kimerling, Rachel; Frayne, Susan M; Phibbs, Ciaran S

2017-05-01

Prior work shows that Post-traumatic Stress Disorder (PTSD) predicts an increased risk of preterm birth, but the causal pathway(s) are uncertain. We evaluate the associations between PTSD and antepartum complications to explore how PTSD's pathophysiology impacts pregnancy. This retrospective cohort analysis of all Veterans Health Administration (VA)-covered deliveries from 2000-12 used the data of VA clinical and administration. Mothers with current PTSD were identified using the ICD-9 diagnostic codes (i.e. code present during the antepartum year), as were those with historical PTSD. Medical and administrative data were used to identify the relevant obstetric diagnoses, demographics and health, and military deployment history. We used Poisson regression with robust error variance to derive the adjusted relative risk estimates (RR) for the association of PTSD with five clinically relevant antepartum complications [gestational diabetes (GDM), preeclampsia, gestational hypertension, growth restriction, and abruption]. Secondary outcomes included proxies for obstetric complexity (repeat hospitalisation, prolonged delivery hospitalisation, and caesarean delivery). Of the 15 986 singleton deliveries, 2977 (19%) were in mothers with PTSD diagnoses (1880 (12%) current PTSD). Mothers with the complication GDM were 4.9% and those with preeclampsia were 4.6% of all births. After adjustment, a current PTSD diagnosis (reference = no PTSD) was associated with an increased risk of GDM (RR 1.4, 95% confidence interval (CI) 1.2, 1.7) and preeclampsia (RR 1.3, 95% CI 1.1, 1.6). PTSD also predicted prolonged (>4 day) delivery hospitalisation (RR 1.2, 95% CI 1.01, 1.4), and repeat hospitalisations (RR 1.4, 95% CI 1.2, 1.6), but not caesarean delivery. The observed association of PTSD with GDM and preeclampsia is consistent with our nascent understanding of PTSD as a disruptor of neuroendocrine and cardiovascular health. © 2017 John Wiley & Sons Ltd.

A Brief Exposure-Based Intervention for Service Members with PTSD

ERIC Educational Resources Information Center

Steenkamp, Maria M.; Litz, Brett T.; Gray, Matt J.; Lebowitz, Leslie; Nash, William; Conoscenti, Lauren; Amidon, Amy; Lang, Ariel

2011-01-01

The growing number of service members in need of mental health care requires that empirically based interventions be tailored to the unique demands and exigencies of this population. We discuss a 6-session intervention for combat-related PTSD designed to foster willingness to engage with and disclose difficult deployment memories through a…

Gene networks specific for innate immunity define post-traumatic stress disorder.

PubMed

Breen, M S; Maihofer, A X; Glatt, S J; Tylee, D S; Chandler, S D; Tsuang, M T; Risbrough, V B; Baker, D G; O'Connor, D T; Nievergelt, C M; Woelk, C H

2015-12-01

The molecular factors involved in the development of Post-Traumatic Stress Disorder (PTSD) remain poorly understood. Previous transcriptomic studies investigating the mechanisms of PTSD apply targeted approaches to identify individual genes under a cross-sectional framework lack a holistic view of the behaviours and properties of these genes at the system-level. Here we sought to apply an unsupervised gene-network based approach to a prospective experimental design using whole-transcriptome RNA-Seq gene expression from peripheral blood leukocytes of U.S. Marines (N=188), obtained both pre- and post-deployment to conflict zones. We identified discrete groups of co-regulated genes (i.e., co-expression modules) and tested them for association to PTSD. We identified one module at both pre- and post-deployment containing putative causal signatures for PTSD development displaying an over-expression of genes enriched for functions of innate-immune response and interferon signalling (Type-I and Type-II). Importantly, these results were replicated in a second non-overlapping independent dataset of U.S. Marines (N=96), further outlining the role of innate immune and interferon signalling genes within co-expression modules to explain at least part of the causal pathophysiology for PTSD development. A second module, consequential of trauma exposure, contained PTSD resiliency signatures and an over-expression of genes involved in hemostasis and wound responsiveness suggesting that chronic levels of stress impair proper wound healing during/after exposure to the battlefield while highlighting the role of the hemostatic system as a clinical indicator of chronic-based stress. These findings provide novel insights for early preventative measures and advanced PTSD detection, which may lead to interventions that delay or perhaps abrogate the development of PTSD.

Combat-acquired traumatic brain injury, posttraumatic stress disorder, and their relative associations with postdeployment binge drinking

PubMed Central

Adams, Rachel Sayko; Larson, Mary Jo; Corrigan, John D.; Ritter, Grant A.; Horgan, Constance M.; Bray, Robert M.; Williams, Thomas V.

2014-01-01

Objective To examine whether experiencing a traumatic brain injury (TBI) on a recent combat deployment was associated with postdeployment binge drinking, independent of posttraumatic stress disorder (PTSD). Methods Using the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel, an anonymous survey completed by 28,546 personnel, the study sample included 6,824 personnel who had a combat deployment in the past year. Path analysis was used to examine whether PTSD accounted for the total association between TBI and binge drinking. Main Measures The dependent variable, binge drinking days, was an ordinal measure capturing the number of times personnel drank 5+ drinks on one occasion (4+ for women) in the past month. TBI-level captured the severity of TBI after a combat injury event exposure: TBI-AC (altered consciousness only), TBI-LOC≤20 (loss of consciousness up to 20 minutes), and TBI-LOC>20 (loss of consciousness greater than 20 minutes). APTSD positive screen relied on the standard diagnostic cutoff of 50+ on the PCL-C. Results The final path model found that while the direct effect of TBI (0.097) on binge drinking was smaller than that of PTSD (0.156), both were significant. Almost 70% of the total effect of TBI on binge drinking was from the direct effect; only 30% represented the indirect effect through PTSD. Conclusion Further research is needed to replicate these findings and to understand the underlying mechanisms that explain the relationship between TBI and increased postdeployment drinking. PMID:25310293

Women Veterans, a Population at Risk for Fibromyalgia: The Associations Between Fibromyalgia, Symptoms, and Quality of Life.

PubMed

D'Aoust, Rita F; Rossiter, Alicia Gill; Elliott, Amanda; Ji, Ming; Lengacher, Cecile; Groer, Maureen

2017-07-01

The Institute of Federal Health Care recently published an executive summary from a round table discussion indicating that active duty and retired female military personnel are at high risk for adverse health outcomes unique to military service including complications related to post-traumatic stress disorder (PTSD), unreported sexual trauma, and musculoskeletal problems. In 2008, the Institute of Medicine began to review, evaluate, and summarize the literature on health outcomes in Gulf War-deployed and found sufficient evidence of a causal relationship with PTSD and suggestive evidence of an association with fibromyalgia (FM). This study examines the prevalence and impact of FM in women veterans and to explore the association between other comorbidities to improve risk differentiation for treatment and improve outcomes. This study is designed as a nested, cross-sectional study within a larger project funded by the U.S. Army at the University of South Florida, College of Nursing entitled "Nursing Health Initiative for Empowering Women Veterans." A sample of 76 participants completed a battery of study instruments related to physical and psychological stressors. Over half of the sample had a positive FM screening score (56.68%) although only 14.42% were deployed to the Middle East. More than 70% of participants reported harassment in life in the military and 32.9% reported sexual assault while in the military. Results of the 1-way analysis of variances find that there was a significant association of FM with the psychological symptoms of stress, depression, and PTSD. There was a significant association of FM with quality of life and sleep difficulty. The results from this pilot study suggest there is a significant relationship between FM and the psychological symptoms of depression and PTSD. Nearly two-thirds of these women screened positive for depressive symptoms and just over one-quarter of participants had symptoms indicative of PTSD. Only a small proportion of women veterans in this study were deployed (14.42%) and this suggests that a trigger or risk factor other than deployment or combat may contribute to the development of FM and mental health symptomology. To focus on the complex interrelationships between pain, fatigue, sleep, and depression, a follow-up study with a larger sample powered for more complex statistical analyses is warranted. Additional analyses in this study reveal that over half of women veterans who reported military sexual trauma (MST) while in the military, screened positive for FM. Although our analyses did not reveal there to be a significant effect between FM and MST, it should be considered as a potential risk factor for FM as MST can be a precursor for PTSD. Women veterans who present with FM should be screened for MST as sexual trauma may not be disclosed. Understanding how many women veterans are affected with FM and the relationship with PTSD, MST, stress, depression, and sleep can improve screening and treatment to improve quality of life. This will also inform decision-making about how best to design and implement interventions, programs, and policies. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Traumatic Brain Injury and PTSD Screening Efforts Evaluated Using Latent Class Analysis

DTIC Science & Technology

2014-01-01

Pastorek, & Thornton, 2009; Breslau, Reboussin, Anthony, & Storr, 2005; Naifeh, Richardson, Del Ben, & Elhai, 2010; Shevlin, Armour , Murphy, Houston...about a wide range of demographic characteristics, environmental exposures, and com- bat experiences. The Post-Deployment Health Reassessment (PDHRA...treatment, responses from the PDHRA were used. Demographic variables. Demographic variables included age, military pay grade, and branch of service. All

Mental health outcomes in US and UK military personnel returning from Iraq.

PubMed

Sundin, Josefin; Herrell, Richard K; Hoge, Charles W; Fear, Nicola T; Adler, Amy B; Greenberg, Neil; Riviere, Lyndon A; Thomas, Jeffrey L; Wessely, Simon; Bliese, Paul D

2014-03-01

Research of military personnel who deployed to the conflicts in Iraq or Afghanistan has suggested that there are differences in mental health outcomes between UK and US military personnel. To compare the prevalence of post-traumatic stress disorder (PTSD), hazardous alcohol consumption, aggressive behaviour and multiple physical symptoms in US and UK military personnel deployed to Iraq. Data were from one US (n = 1560) and one UK (n = 313) study of post-deployment military health of army personnel who had deployed to Iraq during 2007-2008. Analyses were stratified by high- and low-combat exposure. Significant differences in combat exposure and sociodemographics were observed between US and UK personnel; controlling for these variables accounted for the difference in prevalence of PTSD, but not in the total symptom level scores. Levels of hazardous alcohol consumption (low-combat exposure: odds ratio (OR) = 0.13, 95% CI 0.07-0.21; high-combat exposure: OR = 0.23, 95% CI 0.14-0.39) and aggression (low-combat exposure: OR = 0.36, 95% CI 0.19-0.68) were significantly lower in US compared with UK personnel. There was no difference in multiple physical symptoms. Differences in self-reported combat exposures explain most of the differences in reported prevalence of PTSD. Adjusting for self-reported combat exposures and sociodemographics did not explain differences in hazardous alcohol consumption or aggression.

Mental Health and Comorbidities in U.S. Military Members.

PubMed

Crum-Cianflone, Nancy F; Powell, Teresa M; LeardMann, Cynthia A; Russell, Dale W; Boyko, Edward J

2016-06-01

Using data from a prospective cohort study of U.S. service members who joined after September 11, 2001 to determine incidence rates and comorbidities of mental and behavioral disorders. Calculated age and sex adjusted incidence rates of mental and behavioral conditions determined by validated instruments and electronic medical records. Of 10,671 service members, 3,379 (32%) deployed between baseline and follow-up, of whom 49% reported combat experience. Combat deployers had highest incidence rates of post-traumatic stress disorder (PTSD) (25 cases/1,000 person-years [PY]), panic/anxiety (21/1,000 PY), and any mental disorder (34/1,000 PY). Nondeployers had substantial rates of mental conditions (11, 13, and 18 cases/1,000 PY). Among combat deployers, 12% screened positive for mental disorder, 59% binge drinking, 16% alcohol problem, 19% cigarette smoking, and 20% smokeless tobacco at follow-up. Of those with recent PTSD, 73% concurrently developed >1 incident mental or behavioral conditions. Of those screening positive for PTSD, 11% had electronic medical record diagnosis. U.S. service members joining during recent conflicts experienced high rates of mental and behavioral disorders. Highest rates were among combat deployers. Most cases were not represented in medical codes, suggesting targeted interventions are needed to address the burden of mental disorders among service members and Veterans. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Intimate Partner Aggression Perpetrated and Sustained by Male Afghanistan, Iraq, and Vietnam Veterans with and without Posttraumatic Stress Disorder

ERIC Educational Resources Information Center

Teten, Andra L.; Schumacher, Julie A.; Taft, Casey T.; Stanley, Melinda A.; Kent, Thomas A.; Bailey, Sara D.; Dunn, Nancy Jo; White, Donna L.

2010-01-01

Veterans with posttraumatic stress disorder (PTSD) consistently evidence higher rates of intimate partner aggression perpetration than veterans without PTSD, but most studies have examined rates of aggression among Vietnam veterans several years after their deployment. The primary aim of this study was to examine partner aggression among male…

Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) on Pain Intensity Levels in OEF/OIF/OND Veterans.

PubMed

Stojanovic, Milan P; Fonda, Jennifer; Fortier, Catherine Brawn; Higgins, Diana M; Rudolph, James L; Milberg, William P; McGlinchey, Regina E

2016-11-01

Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are common among US veterans of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND). We postulated that these injuries may modulate pain processing in these individuals and affect their subjective pain levels. Cross-sectional. 310 deployed service members of OEF/OIF/OND without a lifetime history of moderate or severe TBI were included in this study. All participants completed a comprehensive evaluation for Blast Exposure, mTBI, PTSD, and Pain Levels. The Boston Assessment of TBI-Lifetime Version (BAT-L) was used to assess blast exposure and potential brain injury during military service. The Clinician-Administered PTSD Scale (CAPS) characterized presence and severity of PTSD. The Visual Analog Scale (VAS) was used to assess pain intensity over the previous month before the interview, with higher scores indicative of worse pain. Statistical analysis was performed by ANOVA and results were adjusted for co-morbidities, clinical characteristics and demographic data. In comparison to control participants (veterans without mTBI or current PTSD), veterans with both current PTSD and mTBI reported the highest pain intensity levels, followed by veterans with PTSD only (P < 0.0001 and P = 0.0005, respectively). Pain levels in veterans with mTBI only were comparable to control participants. Comorbid PTSD and mTBI is associated with increased self-reported pain intensity. mTBI alone was not associated with increased pain. Published by Oxford University Press on behalf of the American Academy of Pain Medicine 2016. This work is written by US Government employees and is in the public domain in the US.

A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans.

PubMed

Ghaffarzadegan, Navid; Ebrahimvandi, Alireza; Jalali, Mohammad S

2016-01-01

Post-traumatic stress disorder (PTSD) stands out as a major mental illness; however, little is known about effective policies for mitigating the problem. The importance and complexity of PTSD raise critical questions: What are the trends in the population of PTSD patients among military personnel and veterans in the postwar era? What policies can help mitigate PTSD? To address these questions, we developed a system dynamics simulation model of the population of military personnel and veterans affected by PTSD. The model includes both military personnel and veterans in a "system of systems." This is a novel aspect of our model, since many policies implemented at the military level will potentially influence (and may have side effects on) veterans and the Department of Veterans Affairs. The model is first validated by replicating the historical data on PTSD prevalence among military personnel and veterans from 2000 to 2014 (datasets from the Department of Defense, the Institute of Medicine, the Department of Veterans Affairs, and other sources). The model is then used for health policy analysis. Our results show that, in an optimistic scenario based on the status quo of deployment to intense/combat zones, estimated PTSD prevalence among veterans will be at least 10% during the next decade. The model postulates that during wars, resiliency-related policies are the most effective for decreasing PTSD. In a postwar period, current health policy interventions (e.g., screening and treatment) have marginal effects on mitigating the problem of PTSD, that is, the current screening and treatment policies must be revolutionized to have any noticeable effect. Furthermore, the simulation results show that it takes a long time, on the order of 40 years, to mitigate the psychiatric consequences of a war. Policy and financial implications of the findings are discussed.

A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans

PubMed Central

Ghaffarzadegan, Navid; Ebrahimvandi, Alireza; Jalali, Mohammad S.

2016-01-01

Post-traumatic stress disorder (PTSD) stands out as a major mental illness; however, little is known about effective policies for mitigating the problem. The importance and complexity of PTSD raise critical questions: What are the trends in the population of PTSD patients among military personnel and veterans in the postwar era? What policies can help mitigate PTSD? To address these questions, we developed a system dynamics simulation model of the population of military personnel and veterans affected by PTSD. The model includes both military personnel and veterans in a “system of systems.” This is a novel aspect of our model, since many policies implemented at the military level will potentially influence (and may have side effects on) veterans and the Department of Veterans Affairs. The model is first validated by replicating the historical data on PTSD prevalence among military personnel and veterans from 2000 to 2014 (datasets from the Department of Defense, the Institute of Medicine, the Department of Veterans Affairs, and other sources). The model is then used for health policy analysis. Our results show that, in an optimistic scenario based on the status quo of deployment to intense/combat zones, estimated PTSD prevalence among veterans will be at least 10% during the next decade. The model postulates that during wars, resiliency-related policies are the most effective for decreasing PTSD. In a postwar period, current health policy interventions (e.g., screening and treatment) have marginal effects on mitigating the problem of PTSD, that is, the current screening and treatment policies must be revolutionized to have any noticeable effect. Furthermore, the simulation results show that it takes a long time, on the order of 40 years, to mitigate the psychiatric consequences of a war. Policy and financial implications of the findings are discussed. PMID:27716776

Family perceptions of post‐deployment healthcare needs of Iraq/Afghanistan military personnel

PubMed Central

2010-01-01

Nearly 40 000 service members returning from Iraq and Afghanistan have suffered traumatic injuries, with over 300 000 at risk for post‐traumatic stress disorder (PTSD) or other psychiatric problems. These veterans face numerous post‐deployment health concerns, sharing substantial burdens with their families. Although many rely upon community‐based health care, little is known about how these individuals present at family medicine clinics for perceived medical and psychological issues. We surveyed 347 patients during visits at six clinics, and respondents reported whether they,a family member or a close acquaintance had been deployed since 2001. Patients identified traumatic military experiences, plus any attributable health or social problems. The mean patient age was 47.5 years, with 71% women and 55% Hispanic individuals. Nearly one‐quarter reported family members serving overseas while 52% knew someone deployed. Significant events included nearby explosion (21%) or combat injury (9%), along with a variety of other incidents. Among the half of individuals perceiving significant health or social ramifications, the most prevalent consequences were PTSD, depression and alcohol abuse. Divorce or marital problems were noted by13%, while many reported employment, legal or other difficulties. This study offers insights into post‐deployment needs of military personnel and subsequent problems reported by family members. A high prevalence of traumatic combat events translated into serious health needs, plus social disruptions for veterans and their loved ones. As the long‐term problems disclosed by returning service personnel continue to ripple across community clinics and other health systems, effective treatment planning mandates coordinated attention from multiple providers and service organisations. PMID:22477935

Paternal history of mental illness associated with posttraumatic stress disorder among veterans.

PubMed

Shepherd-Banigan, Megan; Kelley, Michelle L; Katon, Jodie G; Curry, John F; Goldstein, Karen M; Brancu, Mira; Wagner, H Ryan; Fecteau, Teresa E; Van Houtven, Courtney H

2017-10-01

This study examined the association between parent and family reported history of non-PTSD mental illness (MI), PTSD specifically, and substance use problems, and participant clinical diagnosis of PTSD. Participants were drawn from the US Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) Post-Deployment Mental Health (PDMH) study (n = 3191), an ongoing multi-site cohort study of US Afghanistan and Iraq conflict era veterans. Participants who recalled a father history of PTSD had a 26-percentage point higher likelihood of meeting criteria for PTSD; while participants reporting any family history of PTSD had a 15-percentage point higher probability of endorsing symptoms consistent with PTSD. Mother history of substance use problems was associated with Veteran current PTSD, but results were sensitive to model specification. Current PTSD was not associated with family/parent history of non-PTSD mental illness, mother history of PTSD, or family/father history of substance use problems. Family history of PTSD may increase PTSD risk among veterans exposed to trauma, particularly when a father history is reported. Knowledge of family history could improve clinical decision-making for trauma-exposed individuals and allow for more effective targeting of programs and clinical services. Published by Elsevier B.V.

Prevalence of mental health symptoms in Dutch military personnel returning from deployment to Afghanistan: a 2-year longitudinal analysis.

PubMed

Reijnen, A; Rademaker, A R; Vermetten, E; Geuze, E

2015-02-01

Recent studies in troops deployed to Iraq and Afghanistan have shown that combat exposure and exposure to deployment-related stressors increase the risk for the development of mental health symptoms. The aim of this study is to assess the prevalence of mental health symptoms in a cohort of Dutch military personnel prior to and at multiple time-points after deployment. Military personnel (n=994) completed various questionnaires at 5 time-points; starting prior to deployment and following the same cohort at 1 and 6 months and 1 and 2 years after their return from Afghanistan. The prevalence of symptoms of fatigue, PTSD, hostility, depression and anxiety was found to significantly increase after deployment compared with pre-deployment rates. As opposed to depressive symptoms and fatigue, the prevalence of PTSD was found to decrease after the 6-month assessment. The prevalence of sleeping problems and hostility remained relatively stable. The prevalence of mental health symptoms in military personnel increases after deployment, however, symptoms progression over time appears to be specific for various mental health symptoms. Comprehensive screening and monitoring for a wide range of mental health symptoms at multiple time-points after deployment is essential for early detection and to provide opportunities for intervention. This project was funded by the Dutch Ministry of Defence. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

The impact of deployment to Iraq or Afghanistan on partners and wives of military personnel.

PubMed

de Burgh, H Thomas; White, Claire J; Fear, Nicola T; Iversen, Amy C

2011-04-01

Deployment has well documented psychological consequences for military personnel. To fully understand the human cost of war, the psychosocial impact of separation and homecoming of military personnel on their families must also be considered. Recent arduous conflicts in Iraq and Afghanistan make understanding the impact of war on spouses topical and pertinent. Widespread psychological morbidity and social dysfunction have been reported in spouses of military personnel who have been deployed to combat zones such as Vietnam, with difficulties most acute for spouses of military personnel with post-traumatic stress disorder (PTSD). A review of the literature published between 2001 and 2010 assessing the impact of deployments to Iraq and Afghanistan on spouses of military personnel was conducted. A total of 14 US-based studies were identified which examined psychological morbidity, help seeking, marital dysfunction and stress in spouses. Longer deployments, deployment extensions and PTSD in military personnel were found to be associated with psychological problems for the spouse. Methodological differences in the studies limit direct comparisons. Recommendations for future research are outlined. The needs of spouses of military personnel remain an important issue with implications for service provision and occupational capability of both partners.

Suicide and war: the mediating effects of negative mood, posttraumatic stress disorder symptoms, and social support among army National Guard soldiers.

PubMed

Griffith, James

2012-08-01

The mediating effects of posttraumatic stress disorder (PTSD) symptoms, negative mood, and social support on the relationship of war experiences to suicidality were examined. The research literature suggested a sequence among study scales representing these constructs, which was then tested on survey data obtained from a sample of National Guard soldiers (N=4,546). Results from structural equation modeling suggested that war experiences may precipitate a sequence of psychological consequences leading to suicidality. However, suicidality may be an enduring behavioral health condition. War experiences showed no direct effects on postdeployment suicidality, rather its effect was indirect through PTSD symptoms and negative mood. War experiences were, however, predictive of PTSD symptoms, as would be expected. PSTD symptoms showed no direct effect on postdeployment suicidality, but showed indirect effects through negative mood. Results also suggested that suicidality is relatively persistent, at least during deployment and postdeployment. The percentage of those at risk for suicide was low both during and after deployment, with little association between suicidality and time since returning from deployment. Additionally, few soldiers were initially nonsuicidal and then reported such symptoms at postdeployment. Implications of relationships of both negative mood and combat trauma to suicidality are discussed, as well as possible mediating effects of both personal dispositions and social support on relationships of war experiences to PTSD, negative mood, and suicidality. © 2012 The American Association of Suicidology.

Parent-child relationship quality and family transmission of parent posttraumatic stress disorder symptoms and child externalizing and internalizing symptoms following fathers' exposure to combat trauma.

PubMed

Snyder, James; Gewirtz, Abigail; Schrepferman, Lynn; Gird, Suzanne R; Quattlebaum, Jamie; Pauldine, Michael R; Elish, Katie; Zamir, Osnat; Hayes, Charles

2016-11-01

Transactional cascades among child internalizing and externalizing symptoms, and fathers' and mothers' posttraumatic stress disorder (PTSD) symptoms were examined in a sample of families with a male parent who had been deployed to recent military conflicts in the Middle East. The role of parents' positive engagement and coercive interaction with their child, and family members' emotion regulation were tested as processes linking cascades of parent and child symptoms. A subsample of 183 families with deployed fathers and nondeployed mothers and their 4- to 13-year-old children who participated in a randomized control trial intervention (After Deployment: Adaptive Parenting Tools) were assessed at baseline prior to intervention, and at 12 and 24 months after baseline, using parent reports of their own and their child's symptoms. Parents' observed behavior during interaction with their children was coded using a multimethod approach at each assessment point. Reciprocal cascades among fathers' and mothers' PTSD symptoms, and child internalizing and externalizing symptoms, were observed. Fathers' and mothers' positive engagement during parent-child interaction linked their PTSD symptoms and their child's internalizing symptoms. Fathers' and mothers' coercive behavior toward their child linked their PTSD symptoms and their child's externalizing symptoms. Each family member's capacity for emotion regulation was associated with his or her adjustment problems at baseline. Implications for intervention, and for research using longitudinal models and a family-systems perspective of co-occurrence and cascades of symptoms across family members are described.

Course and Predictors of Postdeployment Fatigue: A Prospective Cohort Study in the Dutch Armed Forces.

PubMed

Wiborg, Jan F; Rademaker, Arthur R; Geuze, Elbert; Twisk, Jos W R; Vermetten, Eric; Knoop, Hans

2016-08-01

The purpose of this study was to examine course and predictors of fatigue in military personnel deployed to Afghanistan. A total of 906 soldiers in the Dutch Armed Forces who participated in a 4-month mission to Afghanistan were included in this study. Assessment took place prior to and 1, 6, 12, and 24 months after deployment. Data were collected between 2005 and 2011. The fatigue severity subscale of the Checklist Individual Strength was used to indicate the level of fatigue during the previous 2 weeks. Mixed models and logistic regression analysis were used to predict course and prevalence of fatigue after deployment. Predictors of postdeployment fatigue were assessed prior to deployment. The mean level of fatigue increased significantly following deployment (B = 0.58, P = .007). In total, 274 soldiers (30.2%) were severely fatigued at least once after deployment and 130 (14.3%) soldiers had recurrent levels of severe fatigue. Only a minority of the veterans with severe fatigue could be classified as having posttraumatic stress disorder (PTSD, per DSM-IV-TR criteria) or potential medical problems. Significant predeployment predictors of less favorable courses of fatigue after deployment were higher levels of fatigue (B = 0.46, P ≤ .001), emotional abuse during childhood (B = 0.99, P ≤ .001), and harm avoidance (B = 0.27, P = .012). These predeployment factors also predicted severe fatigue after deployment. Severe fatigue is a substantial problem in Afghanistan War veterans that does not seem to resolve over time. In a majority of cases, the symptoms cannot be attributed to medical problems or PTSD, whereas predeployment differences in psychosocial factors partially explain course and prevalence of postdeployment fatigue. These findings support assumptions that a complex interplay of various factors might be responsible for the symptoms. © Copyright 2016 Physicians Postgraduate Press, Inc.

Explanations for the increase in mental health problems in UK reserve forces who have served in Iraq.

PubMed

Browne, Tess; Hull, Lisa; Horn, Oded; Jones, Margaret; Murphy, Dominic; Fear, Nicola T; Greenberg, Neil; French, Claire; Rona, Roberto J; Wessely, Simon; Hotopf, Matthew

2007-06-01

Deployment to the 2003 Iraq War was associated with ill health in reserve armed forces personnel. To investigate reasons for the excess of ill health in reservists. UK personnel who were deployed to the 2003 Iraq War completed a health survey about experiences on deployment to Iraq. Health status was measured using self-report of common mental disorders, post-traumatic stress disorder (PTSD), fatigue, physical symptoms and well-being. Reservists were older and of higher rank than the regular forces. They reported higher exposure to traumatic experiences, lower unit cohesion, more problems adjusting to homecoming and lower marital satisfaction. Most health outcomes could be explained by role, experience of traumatic events or unit cohesion in theatre. PTSD symptoms were the one exception and were paradoxically most powerfully affected by differences in problems at home rather than events in Iraq. The increased ill-health of reservists appears to be due to experiences on deployment and difficulties with homecoming.

Hearing Loss and Tinnitus in Military Personnel with Deployment-Related Mild Traumatic Brain Injury.

PubMed

Karch, Stephanie J; Capó-Aponte, José E; McIlwain, D Scott; Lo, Michael; Krishnamurti, Sridhar; Staton, Roger N; Jorgensen-Wagers, Kendra

2016-01-01

The objective of this study was to analyze differences in incidence and epidemiologic risk factors for significant threshold shift (STS) and tinnitus in deployed military personnel diagnosed with mild traumatic brain injury (mTBI) due to either a blast exposure or nonblast head injury. A retrospective longitudinal cohort study of electronic health records of 500 military personnel (456 met inclusion criteria) diagnosed with deployment-related mTBI was completed. Chi-square tests and STS incidence rates were calculated to assess differences between blast-exposed and nonblast groups; relative risks and adjusted odds ratios of developing STS or tinnitus were calculated for risk factors. Risk factors included such characteristics as mechanism of injury, age, race, military occupational specialty, concurrent diagnosis of posttraumatic stress disorder (PTSD), and nicotine use. Among blast-exposed and nonblast patients, 67% and 58%, respectively, developed STS, (P=.06); 59% and 40%, respectively, developed tinnitus (P<.001). Incidence of STS was 24% higher in the blast-exposed than nonblast group. Infantry service was associated with STS; Marine Corps service, PTSD, and zolpidem use were associated with tinnitus. Unprotected noise exposure was associated with both STS and tinnitus. This study highlights potential risk factors for STS and tinnitus among blast-exposed and nonblast mTBI patient groups.

Catecholamine responses to virtual combat: implications for post-traumatic stress and dimensions of functioning.

PubMed

Highland, Krista B; Costanzo, Michelle E; Jovanovic, Tanja; Norrholm, Seth D; Ndiongue, Rochelle B; Reinhardt, Brian J; Rothbaum, Barbara; Rizzo, Albert A; Roy, Michael J

2015-01-01

Posttraumatic stress disorder (PTSD) symptoms can result in functional impairment among service members (SMs), even in those without a clinical diagnosis. The variability in outcomes may be related to underlying catecholamine mechanisms. Individuals with PTSD tend to have elevated basal catecholamine levels, though less is known regarding catecholamine responses to trauma-related stimuli. We assessed whether catecholamine responses to a virtual combat environment impact the relationship between PTSD symptom clusters and elements of functioning. Eighty-seven clinically healthy SMs, within 2 months after deployment to Iraq or Afghanistan, completed self-report measures, viewed virtual-reality (VR) combat sequences, and had sequential blood draws. Norepinephrine responses to VR combat exposure moderated the relationship between avoidance symptoms and scales of functioning including physical functioning, physical-role functioning, and vitality. Among those with high levels of avoidance, norepinephrine change was inversely associated with functional status, whereas a positive correlation was observed for those with low levels of avoidance. Our findings represent a novel use of a virtual environment to display combat-related stimuli to returning SMs to elucidate mind-body connections inherent in their responses. The insight gained improves our understanding of post-deployment symptoms and quality of life in SMs and may facilitate enhancements in treatment. Further research is needed to validate these findings in other populations and to define the implications for treatment effectiveness.

Chronic traumatic encephalopathy in an Iraqi war veteran with posttraumatic stress disorder who committed suicide.

PubMed

Omalu, Bennet; Hammers, Jennifer L; Bailes, Julian; Hamilton, Ronald L; Kamboh, M Ilyas; Webster, Garrett; Fitzsimmons, Robert P

2011-11-01

Following his discovery of chronic traumatic encephalopathy (CTE) in football players in 2002, Dr. Bennet Omalu hypothesized that posttraumatic stress disorder (PTSD) in military veterans may belong to the CTE spectrum of diseases. The CTE surveillance at the Brain Injury Research Institute was therefore expanded to include deceased military veterans diagnosed with PTSD. The authors report the case of a 27-year-old United States Marine Corps (USMC) Iraqi war veteran, an amphibious assault vehicle crewman, who committed suicide by hanging after two deployments to Fallujah and Ramadi. He experienced combat and was exposed to mortar blasts and improvised explosive device blasts less than 50 m away. Following his second deployment he developed a progressive history of cognitive impairment, impaired memory, behavioral and mood disorders, and alcohol abuse. Neuropsychiatric assessment revealed a diagnosis of PTSD with hyperarousal (irritability and insomnia) and numbing. He committed suicide approximately 8 months after his honorable discharge from the USMC. His brain at autopsy appeared grossly unremarkable except for congestive brain swelling. There was no atrophy or remote focal traumatic brain injury such as contusional necrosis or hemorrhage. Histochemical and immunohistochemical brain tissue analysis revealed CTE changes comprising multifocal, neocortical, and subcortical neurofibrillary tangles and neuritic threads (ranging from none, to sparse, to frequent) with the skip phenomenon, accentuated in the depths of sulci and in the frontal cortex. The subcortical white matter showed mild rarefaction, sparse perivascular and neuropil infiltration by histiocytes, and mild fibrillary astrogliosis. Apolipoprotein E genotype was 3/4. The authors report this case as a sentinel case of CTE in an Iraqi war veteran diagnosed with PTSD to possibly stimulate new lines of thought and research in the possible pathoetiology and pathogenesis of PTSD in military veterans as part of the CTE spectrum of diseases, and as chronic sequelae and outcomes of repetitive traumatic brain injuries.

Parenting Stress After Deployment in Navy Active Duty Fathers.

PubMed

Yablonsky, Abigail M; Yan, Guofen; Bullock, Linda

2016-08-01

Military fathers are being deployed, and leaving their families, for greater lengths of time and more frequently than ever before. The purpose of this study was to examine the impact of recent deployment on parenting stress in U.S. Navy fathers with young children. Of the 111 participants who completed the one-time study questionnaire at a large military outpatient clinic on the Eastern seaboard, 67.6% had returned from a ship-based deployment. Regression analyses were performed, using the Parenting Stress Index as the outcome variable, deployment elements (such as time away from home in the past 5 years) as predictors, and adjusting for other factors such as post-traumatic stress disorder (PTSD) and depression. Higher perceived threat and greater warfare exposure were both associated with increased parenting stress (p < 0.05) in the unadjusted model. These associations were greatly attenuated and no longer significant after adjustment for depression. In addition, rates of positive screens for PTSD and depression (17.1%) in this sample were higher than in other recent studies. In summary, these data indicate that various deployment factors are associated with increased parenting stress in Navy fathers back from deployment within the past year; these relationships are largely explained by depressive symptoms. Clinical implications are discussed. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Perceptions of stigma and barriers to care among UK military personnel deployed to Afghanistan and Iraq.

PubMed

Osório, Carlos; Jones, Norman; Fertout, Mohammed; Greenberg, Neil

2013-09-01

Perceived stigma and organizational barriers to care (stigma/BTC) can influence the decision to seek help for military personnel when they are suffering from mental health problems. We examined the relationship between stigmatizing beliefs, perceived BTC, and probable post-traumatic stress disorder (PTSD) in 23,101 UK military personnel deployed to Afghanistan and Iraq both during and after deployment; and in a smaller group some six months later. Overall, our results suggest that stigma/BTC perceptions were significantly, and substantially higher during deployment than when personnel are returning home; however, within the smaller follow-up group, the rates climbed significantly over the first six-months post-deployment although they still remained lower than during-deployment levels. Male personnel, those who reported higher levels of PTSD symptoms and/or greater combat exposure were significantly more likely to endorse more stigma/BTC at both sampling points. Rates of stigma/BTC on deployment are substantially higher than rates measured when personnel are in less threatening environments. We suggest that the considerable efforts that military forces make to encourage effective help seeking should take account of the fluctuating levels of stigma/BTC. Commanders should be aware that encouraging help seeking may be more difficult in operational environments than when personnel have returned home.

Family support, family stress, and suicidal ideation in a combat-exposed sample of Operation Enduring Freedom/Operation Iraqi Freedom veterans.

PubMed

Gradus, Jaimie L; Smith, Brian N; Vogt, Dawne

2015-01-01

Deployment-related risk factors for suicidal ideation among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans have received a great deal of attention. Studies show that mental health symptoms mediate the association between most deployment stressors and suicidal ideation; however, family-related factors during deployment are largely unexplored. We examined posttraumatic stress disorder (PTSD) and depression symptoms as mediators of the associations between deployment family support and stress and post-deployment suicidal ideation in combat-exposed OEF/OIF veterans. National cross-sectional mail survey. 1046 veterans responded to the survey. The sample for this study was 978 veterans who experienced combat. Regression-based path analyses were conducted. Family support and stress had direct associations with suicidal ideation. When PTSD and depression symptoms were examined as mediators of these associations, results revealed significant indirect paths through these symptoms. This study contributes to the literature on suicidal ideation risk factors among OEF/OIF veterans. Deployment family support and family stress are associated with suicidal ideation; however these associations occur primarily through mental health symptomatology, consistent with findings observed for other deployment factors. This research supports ongoing efforts to treat mental health symptomatology as a means of suicide prevention.

Prevalence and characteristics of trauma and post-traumatic stress symptoms in operational members of the South African National Defence Force.

PubMed

Seedat, Soraya; le Roux, Christoff; Stein, Dan J

2003-01-01

The prevalence of traumatic event exposure and post-traumatic stress disorder (PTSD) were surveyed in a cohort of 198 full-time operational members of the South African National Defence Force stationed in their "home" unit between deployments. Approximately 90% of members reported having experienced or witnessed trauma in their lifetime (mean number of traumatic events = 4.3 +/- 3.2), whereas 51% reported having inflicted trauma. Twenty-six percent met diagnostic criteria for PTSD on self-report with approximately 29% with PTSD also meeting diagnostic criteria for depression. Few members, however, sought help. PTSD symptom severity was best predicted by trauma type (exposure to physical assault and infliction of life-threatening injury). These findings highlight the high rates of exposure to multiple, noncombat-related trauma in military personnel, the potentially high rates of PTSD, and the role of inflicted trauma as an additional risk factor for PTSD.

Accounting for intrusive thoughts in PTSD: Contributions of cognitive control and deliberate regulation strategies.

PubMed

Bomyea, Jessica; Lang, Ariel J

2016-03-01

Persistent, trauma-related intrusive thoughts are common in individuals with posttraumatic stress disorder (PTSD). Automatic aspects of cognitive functioning (including executive functioning) and maladaptive deliberate attempts at cognitive regulation have been proposed as individual difference factors that may perpetuate intrusive thoughts. The current study sought to examine the joint contribution of these two factors on intrusive thoughts in PTSD. Forty-two women with PTSD completed an executive functioning assessment followed by a thought suppression task. Intrusive thoughts (frequency and duration), as well as participants' use of specific cognitive regulation strategies (avoidance-based thought regulation strategies; TRS), were measured during the task. Hierarchical linear regression was used to examine the interaction of executive functioning and TRS on intrusive thoughts. Greater use of TRS was associated with greater intrusive thought persistence for those with low executive functioning, but not those with high executive functioning. Data was collected cross-sectionally and the laboratory thought suppression task may not correspond to naturalistic thought regulation. Results are consistent with prior literature suggesting that certain responses deployed by individuals to control intrusive thoughts may be unhelpful, but that a higher level of cognitive capacity may mitigate this effect. Implications of these findings for recent models of cognition in PTSD are discussed. Published by Elsevier B.V.

CHALLENGES FOR IMPLEMENTING A PTSD PREVENTIVE GENOMIC SEQUENCING PROGRAM IN THE U.S. MILITARY

PubMed Central

Lázaro-Muñoz, Gabriel; Juengst, Eric T.

2015-01-01

There is growing interest in using the quickly developing field of genomics to contribute to military readiness and effectiveness. Specifically, influential military advisory panels have recommended that the U.S. military apply genomics to help treat, prevent, or minimize the risk for post-traumatic stress disorder (PTSD) among service members. This article highlights some important scientific, legal, and ethical challenges regarding the development and deployment of a preventive genomic sequencing (PGS) program to predict the risk of PTSD among military service members. PMID:26401056

Latent dimensions of posttraumatic stress disorder and their relations with alcohol use disorder.

PubMed

Biehn, Tracey L; Contractor, Ateka A; Elhai, Jon D; Tamburrino, Marijo; Fine, Thomas H; Cohen, Gregory; Shirley, Edwin; Chan, Philip K; Liberzon, Israel; Calabrese, Joseph R; Galea, Sandro

2016-03-01

The objective of this study was to evaluate the relationship between factors of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) using confirmatory factor analysis (CFA) in order to further our understanding of the substantial comorbidity between these two disorders. CFA was used to examine which factors of PTSD's dysphoria model were most related to AUD in a military sample. Ohio National Guard soldiers with a history of overseas deployment participated in the survey (n = 1215). Participants completed the PTSD Checklist and a 12-item survey from the National Survey on Drug Use used to diagnosis AUD. The results of the CFA indicated that a combined model of PTSD's four factors and a single AUD factor fit the data very well. Correlations between PTSD's factors and a latent AUD factor ranged from correlation coefficients of 0.258-0.285, with PTSD's dysphoria factor demonstrating the strongest correlation. However, Wald tests of parameter constraints revealed that AUD was not more correlated with PTSD's dysphoria than other PTSD factors. All four factors of PTSD's dysphoria model demonstrate comparable correlations with AUD. The role of dysphoria to the construct of PTSD is discussed.

Etiology of Depression Comorbidity in Combat-Related PTSD: A Review of the Literature

DTIC Science & Technology

2014-01-01

release: distribution is unlimited. This research was conducted in compliance with all applicable federal regulations governing the protection of...VeteransPosttraumatic stress disorder is often diagnosed with other mental health problems, particularly depression. Although PTSD comorbidity has been...of military deployment and combat exposure is emphasized. Implications of our results for clinical practice and future research are discussed

Deployment Related Risk of Incident Mental Health Conditions Among Aeromedical Evacuation Crewmembers

DTIC Science & Technology

2015-09-01

PHA Physical Health Assessment PTSD Post-Traumatic Stress Disorder USAF United States Air Force xvi THIS PAGE INTENTIONALLY LEFT BLANK xvii...the Egyptian, Roman, and Greek empires, Soldiers have recounted stories of fellow Soldiers exhibiting physical and psychological symptoms after...again during a time of peace (American Psychological Association, 2013). The definition was broadened further to include the 12 threat of physical harm

77 FR 31689 - Proposed Information Collection (Deployment Risk and Resilience Inventory (DRRI)) Activities...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-29

... for Post Traumatic Stress Disorder (PTSD) and other health problems that Operation Enduring Freedom... (Deployment Risk and Resilience Inventory (DRRI)) Activities Under OMB Review AGENCY: Veterans Health... Reduction Act (PRA) of 1995 (44 U.S.C. 3501-3521), this notice announces that the Veterans Health...

Effects of prolonged exposure and virtual reality exposure on suicidal ideation in active duty soldiers: An examination of potential mechanisms.

PubMed

Norr, Aaron M; Smolenski, Derek J; Reger, Greg M

2018-05-12

The current study sought to investigate the effects of exposure therapy on suicidal ideation (SI), as well as potential mechanistic pathways of SI reduction among active duty military personnel. Active duty army soldiers (N = 162) were recruited from a military base in the U.S. and were enrolled in a randomized clinical trial comparing Prolonged Exposure (PE), Virtual Reality Exposure (VRE), and a wait-list control for the treatment of posttraumatic stress disorder (PTSD) stemming from deployments to Iraq or Afghanistan. PTSD diagnosis followed DSM-IV-TR criteria. Outcome measures were assessed via self-report and clinician interview. PTSD symptoms, depressive symptoms, and SI were included in an autoregressive cross-lagged panel model to examine mechanistic pathways. Analyses revealed that PE/VRE had a lower probability of post-treatment suicidal ideation (OR = 0.23, 95% CI [0.06, 0.86]) compared to the waitlist control. Mediation analyses revealed a significant indirect effect from treatment condition to post-treatment PTSD symptoms through mid-treatment SI (Estimate = -1.420, 95% CI -3.559, -0.223]). Baseline suicidal ideation did not interact with treatment condition to predict PTSD symptom change at mid-treatment (p = .231) or post-treatment (p = .672). PE/VRE successfully reduced SI, and the presence of SI at baseline did not affect PTSD symptom reduction, promoting the utility of using PE/VRE to address suicidality among individuals with PTSD. Mediation analyses suggest that reductions in SI were achieved early in treatment. Published by Elsevier Ltd.

The Effect of Post Traumatic Stress Disorder on Military Leadership: An Historical Perspective

DTIC Science & Technology

2011-05-19

Post Traumatic Stress Disorder ( PTSD ) on military leadership. For over twenty years, the United States Army has used the Be...Introduction Multiple deployment cycles to Iraq and Afghanistan combat zones and the increase in Post - Traumatic Stress Disorder ( PTSD ) have resulted...Approved for Public Release; Distribution is Unlimited The Effect of Post Traumatic Stress Disorder on Military Leadership: An

Testing and Evaluation of a Predeployment Stress Inoculation Training Program (PreSTINT)

DTIC Science & Technology

2016-07-01

PreSTINT training to reduce the risk of PTSD and other psychological distress symptoms. Multivariate analyses assessed differences between experimental...the risk of post-traumatic stress disorder (PTSD) and other post-deployment psychological distress symptoms. Participants reported their stress...Employment or Research Opportunities Jessica Kelley Morgan, MS, a doctoral student in psychology , worked as an intern on this grant. During the last 16

PTSD Symptom Increases in Iraq-Deployed Soldiers: Comparison with NonDeployed Soldiers and Associations with Baseline Symptoms, Deployment Experiences, and Postdeployment Stress

DTIC Science & Technology

2010-02-01

Findings also highlighl the impact of homefront and poSl-deploymentlife events in addition to war -zone stress exposures, and emphasize the imponance of...additional 20% of the variance; Wlr-7.0ne stTessors and perceived war -zone threat together contributed an additional 19% of the variance; and homefront ...in the types of noncombat (i.e., post battle) war -zone events experienced by the two groups. Homefront concerns experienced during deployment were

Spouses/Family Members of Service Members at Risk for PTSD or Suicide

DTIC Science & Technology

2016-09-01

time/program (like a “halfway house”) between deployment and return to family c. Establish mechanisms so that seeking help does not jeopardize job...using interview and self -report measures to (a) validate information gathered in Phase 1 and (b) examine the longitudinal associations among service...deployment, (2) difficulties associated with Army lifestyle (outside of deployment), (3) stigma of behavioral health problems, (4) personal struggles of

The Temporal Relationship Between Intrafamilial Violence, Deployment, and Serious Mental Illness in US Army Service Members

DTIC Science & Technology

2017-01-01

categorized mental health diagnoses into the following groups: PTSD, mood disorders , anxiety disorders , psychotic disorders , attention deficit ... disorders , 8 violence-related disorders , personality disorders , sleep disorders , and substance abuse disorders (Appendix D). We first conducted an...pre-deployment period. First- time diagnoses of adjustment and acute stress disorder increased from 5.5% of soldiers in pre- deployment to 8.1% in post

Deployment-Related Benefit Finding and Postdeployment Marital Satisfaction in Military Couples.

PubMed

Renshaw, Keith D; Campbell, Sarah B

2017-12-01

Extensive research has evaluated potential negative effects of military deployments on romantic relationships. Comparatively few studies have examined potential positive effects of such deployments. In stressful situations, benefit finding (BF) has been found to be linked with better functioning on both individual and interpersonal levels. This study reports on deployment-related BF in a sample of 67 male service members (SMs) who deployed at least once since 9/11/2001 and their wives. Couples completed measures of marital satisfaction at baseline (an average of 1 year postdeployment) and follow-up 4-6 months later. At follow-up, SMs also provided data on symptoms of posttraumatic stress, and both partners provided reports of deployment-related BF. Multivariate path analysis controlling for SMs' PTSD symptom severity revealed that wives' BF was positively associated with increases in SMs' relationship satisfaction. These findings suggest that wives' responses to deployment may be more influential than SMs' responses to deployment on military couples' relationships. This pattern indicates that support for spouses during deployments is essential; furthermore, such support should include an emphasis on trying to facilitate personal growth in spouses. © 2016 Family Process Institute.

Aggressive and violent behavior among military personnel deployed to Iraq and Afghanistan: prevalence and link with deployment and combat exposure.

PubMed

MacManus, Deirdre; Rona, Roberto; Dickson, Hannah; Somaini, Greta; Fear, Nicola; Wessely, Simon

2015-01-01

A systematic review and meta-analyses were conducted on studies of the prevalence of aggressive and violent behavior, as well as of violent offenses and convictions, among military personnel following deployment to Iraq and/or Afghanistan; the relationship with deployment and combat exposure; and the role that mental health problems, such as post-traumatic stress disorder (PTSD), have on the pathway between deployment and combat to violence. Seventeen studies published between January 1, 2001, and February 12, 2014, in the United States and the United Kingdom met the inclusion criteria. Despite methodological differences across studies, aggressive behavior was found to be prevalent among serving and formerly serving personnel, with pooled estimates of 10% (95% confidence interval (CI): 1, 20) for physical assault and 29% (95% CI: 25, 36) for all types of physical aggression in the last month, and worthy of further exploration. In both countries, rates were increased among combat-exposed, formerly serving personnel. The majority of studies suggested a small-to-moderate association between combat exposure and postdeployment physical aggression and violence, with a pooled estimate of the weighted odds ratio = 3.24 (95% CI: 2.75, 3.82), with several studies finding that violence increased with intensity and frequency of exposure to combat traumas. The review's findings support the mediating role of PTSD between combat and postdeployment violence and the importance of alcohol, especially if comorbid with PTSD. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Prescription Stimulants and PTSD Among U.S. Military Service Members.

PubMed

Crum-Cianflone, Nancy F; Frasco, Melissa A; Armenta, Richard F; Phillips, Christopher J; Horton, Jaime; Ryan, Margaret A K; Russell, Dale W; LeardMann, Cynthia

2015-12-01

Posttraumatic stress disorder (PTSD) is a prevalent condition among military service members and civilians who have experienced traumatic events. Stimulant use has been postulated to increase the risk of incident PTSD; however, research in this area is lacking. In this study, the association between receipt of prescription stimulants and PTSD was examined in a secondary analysis among active duty U.S. military members (n = 25,971), participating in the Millennium Cohort Study, who completed a baseline (2001-2003) and two follow-up surveys (between 2004-2008). Prescription stimulant data were obtained from the military Pharmacy Data Transaction Service. PTSD was assessed using the PTSD Checklist-Civilian Version and incident PTSD was defined as meeting the criteria at follow-up among those who did not have a history of PTSD at baseline. Overall, 1,215 (4.7%) persons developed new-onset PTSD during follow-up. Receipt of prescription stimulants were significantly associated with incident PTSD, hazard ratio = 5.09, 95% confidence interval [3.05, 8.50], after adjusting for sociodemographic factors, military characteristics, attention-deficit/hyperactivity disorder, baseline mental and physical health status, deployment experiences, and physical/sexual trauma. Findings suggested that prescription stimulants are associated with incident PTSD among military personnel; these data may inform the underlying pathogenesis of and preventive strategies for PTSD. Copyright © 2015 International Society for Traumatic Stress Studies.

Increased cognitive control and reduced emotional interference is associated with reduced PTSD symptom severity in a trauma-exposed sample: A preliminary longitudinal study.

PubMed

White, Stuart F; Costanzo, Michelle E; Thornton, Laura C; Mobley, Alita M; Blair, James R; Roy, Michael J

2018-06-12

Individuals with posttraumatic stress disorder (PTSD) show deficits in recruiting neural regions associated with cognitive control. In contrast, trauma exposed individuals (TEIs) show increased recruitment of these regions. While many individuals who experience a trauma exhibit some PTSD symptoms, relatively few develop PTSD. Despite this, no work has examined the relationship between changes in PTSD symptoms and changes in neural functioning in TEIs longitudinally. This study examined the neural correlates of changing PTSD symptom levels in TEIs. Twenty-one military service members completed the affective stroop task while undergoing fMRI within 2 months of returning from deployment and a second scan 6-12 months later. Participants with PTSD or depression at baseline were excluded. PTSD symptom improvement was associated with greater increase in response to incongruent relative to congruent negative stimuli in dorsal anterior cingulate cortex and inferior frontal gyrus/anterior insula and increased BOLD response over time to emotional relative to neutral stimuli in inferior parietal cortex. Improvement in PTSD symptoms were not associated with changes in amygdala responsiveness to emotional stimuli. In short, the current data indicate that TEIs who become more able to recruit regions implicated in cognitive control show greater reductions in PTSD symptom levels. Copyright © 2018. Published by Elsevier B.V.

PTSD in Limb Trauma and Recovery

DTIC Science & Technology

2008-10-16

field of view, much greater image fidelity and more comfortable viewing than the Emagin head-mounted display, and is well-suited to deployment in a...run on display platforms other than the eMagin Head-Mounted Display (HMD). This will include Brown University’s Cave, an eight- foot immersive VR...Samsung display provides wider field of view, much greater image fidelity and more comfortable viewing than the Emagin head-mounted display, and is

PHIT for Duty, a Personal Health Intervention Tool for Psychological Health and Traumatic Brain Injury

DTIC Science & Technology

2016-06-01

smartphone or tablet computer platforms, including both Google Android™ and Apple iOS based devices. Recruiting for the pilot study was very...framework design.. 15. SUBJECT TERMS PTSD, post-traumatic stress disorder, mobile health, self-help, iOS , Android, mindfulness, relaxation... study and subsequent randomized controlled trial (RCT) with post-deployed personnel; and (5) adapting the developed system for several popular

Effect of the 5-HTTLPR polymorphism on posttraumatic stress disorder, depression, anxiety, and quality of life among Iraq and Afghanistan veterans.

PubMed

Kimbrel, Nathan A; Morissette, Sandra B; Meyer, Eric C; Chrestman, Roberta; Jamroz, Robert; Silvia, Paul J; Beckham, Jean C; Young, Keith A

2015-01-01

Posttraumatic stress disorder (PTSD), depression, anxiety, and stress are significant problems among returning veterans and are associated with reduced quality of life. A correlational design was used to examine the impact of a polymorphism (5-HTTLPR) in the serotonin transporter promoter gene on post-deployment adjustment among returning veterans. A total of 186 returning Iraq and Afghanistan veterans were genotyped for the 5-HTTLPR polymorphism. Symptoms of PTSD, depression, general stress, and anxiety were assessed along with quality of life. After controlling for combat exposure, age, sex of the participant, and race, 5-HTTLPR had a significant multivariate effect on post-deployment adjustment, such that S' carriers reported more post-deployment adjustment problems and worse quality of life than veterans homozygous for the L' allele. This effect was larger when the analyses were restricted to veterans of European ancestry. Our findings suggest that veterans who carry the S' allele of the 5-HTTLPR polymorphism may be at increased risk for adjustment problems and reduced quality of life following deployments to war zones.

The Influence of Social Support on Dyadic Functioning and Mental Health Among Military Personnel During Postdeployment Reintegration.

PubMed

Cederbaum, Julie A; Wilcox, Sherrie L; Sullivan, Kathrine; Lucas, Carrie; Schuyler, Ashley

Although many service members successfully cope with exposure to stress and traumatic experiences, others have symptoms of depression, posttraumatic stress disorder (PTSD), and anxiety; contextual factors may account for the variability in outcomes from these experiences. This work sought to understand mechanisms through which social support influences the mental health of service members and whether dyadic functioning mediates this relationship. We collected cross-sectional data as part of a larger study conducted in 2013; 321 military personnel who had at least 1 deployment were included in these analyses. Surveys were completed online; we collected data on demographic characteristics, social support, mental health measures (depression, PTSD, and anxiety), and dyadic functioning. We performed process modeling through mediation analysis. The direct effects of social support on the mental health of military personnel were limited; however, across all types of support networks, greater social support was significantly associated with better dyadic functioning. Dyadic functioning mediated the relationships between social support and depression/PTSD only when social support came from nonmilitary friends or family; dyadic functioning mediated social support and anxiety only when support came from family. We found no indirect effects of support from military peers or military leaders. Findings here highlight the need to continue to explore ways in which social support, particularly from family and nonmilitary-connected peers, can bolster healthy intimate partner relationships and, in turn, improve the well-being of military service members who are deployed.

The Influence of Social Support on Dyadic Functioning and Mental Health Among Military Personnel During Postdeployment Reintegration

PubMed Central

Wilcox, Sherrie L.; Sullivan, Kathrine; Lucas, Carrie; Schuyler, Ashley

2016-01-01

Objectives: Although many service members successfully cope with exposure to stress and traumatic experiences, others have symptoms of depression, posttraumatic stress disorder (PTSD), and anxiety; contextual factors may account for the variability in outcomes from these experiences. This work sought to understand mechanisms through which social support influences the mental health of service members and whether dyadic functioning mediates this relationship. Methods: We collected cross-sectional data as part of a larger study conducted in 2013; 321 military personnel who had at least 1 deployment were included in these analyses. Surveys were completed online; we collected data on demographic characteristics, social support, mental health measures (depression, PTSD, and anxiety), and dyadic functioning. We performed process modeling through mediation analysis. Results: The direct effects of social support on the mental health of military personnel were limited; however, across all types of support networks, greater social support was significantly associated with better dyadic functioning. Dyadic functioning mediated the relationships between social support and depression/PTSD only when social support came from nonmilitary friends or family; dyadic functioning mediated social support and anxiety only when support came from family. We found no indirect effects of support from military peers or military leaders. Conclusion: Findings here highlight the need to continue to explore ways in which social support, particularly from family and nonmilitary-connected peers, can bolster healthy intimate partner relationships and, in turn, improve the well-being of military service members who are deployed. PMID:28005474

Associability-modulated loss learning is increased in posttraumatic stress disorder

PubMed Central

Brown, Vanessa M; Zhu, Lusha; Wang, John M; Frueh, B Christopher

2018-01-01

Disproportionate reactions to unexpected stimuli in the environment are a cardinal symptom of posttraumatic stress disorder (PTSD). Here, we test whether these heightened responses are associated with disruptions in distinct components of reinforcement learning. Specifically, using functional neuroimaging, a loss-learning task, and a computational model-based approach, we assessed the mechanistic hypothesis that overreactions to stimuli in PTSD arise from anomalous gating of attention during learning (i.e., associability). Behavioral choices of combat-deployed veterans with and without PTSD were fit to a reinforcement learning model, generating trial-by-trial prediction errors (signaling unexpected outcomes) and associability values (signaling attention allocation to the unexpected outcomes). Neural substrates of associability value and behavioral parameter estimates of associability updating, but not prediction error, increased with PTSD during loss learning. Moreover, the interaction of PTSD severity with neural markers of associability value predicted behavioral choices. These results indicate that increased attention-based learning may underlie aspects of PTSD and suggest potential neuromechanistic treatment targets. PMID:29313489

Predictors of Neurocognitive Syndromes in Combat Veterans

PubMed Central

Roy, Michael J; Gill, Jessica; Leaman, Suzanne; Law, Wendy; Ndiongue, Rochelle; Taylor, Patricia; Kim, Hyung-Suk; Bieler, Gayle S; Garge, Nikhil; Rapp, Paul E; Keyser, David; Nathan, Dominic; Xydakis, Michael; Pham, Dzung; Wassermann, Eric

2015-01-01

Traumatic brain injury, depression and posttraumatic stress disorder (PTSD) are neurocognitive syndromes often associated with impairment of physical and mental health, as well as functional status. These syndromes are also frequent in military service members (SMs) after combat, although their presentation is often delayed until months after their return. The objective of this prospective cohort study was the identification of independent predictors of neurocognitive syndromes upon return from deployment could facilitate early intervention to prevent disability. We completed a comprehensive baseline assessment, followed by serial evaluations at three, six, and 12 months, to assess for new-onset PTSD, depression, or postconcussive syndrome (PCS) in order to identify baseline factors most strongly associated with subsequent neurocognitive syndromes. On serial follow-up, seven participants developed at least one neurocognitive syndrome: five with PTSD, one with depression and PTSD, and one with PCS. On univariate analysis, 60 items were associated with syndrome development at p < 0.15. Decision trees and ensemble tree multivariate models yielded four common independent predictors of PTSD: right superior longitudinal fasciculus tract volume on MRI; resting state connectivity between the right amygdala and left superior temporal gyrus (BA41/42) on functional MRI; and single nucleotide polymorphisms in the genes coding for myelin basic protein as well as brain-derived neurotrophic factor. Our findings require follow-up studies with greater sample size and suggest that neuroimaging and molecular biomarkers may help distinguish those at high risk for post-deployment neurocognitive syndromes. PMID:26251769

Intensive weekend group treatment for panic disorder and its impact on co-occurring PTSD: A pilot study.

PubMed

Teng, Ellen J; Barrera, Terri L; Hiatt, Emily L; Chaison, Angelic D; Dunn, Nancy Jo; Petersen, Nancy J; Stanley, Melinda A

2015-06-01

This pilot study examines the feasibility, acceptability, and potential effectiveness of delivering an intensive weekend group treatment for panic disorder (PD) to Veterans returning from deployments to Iraq and Afghanistan with co-occurring posttraumatic stress disorder (PTSD). The treatment program lasted 6h each day and was delivered by two experienced therapists. Patients received core components of panic treatment, including psychoeducation, cognitive restructuring, and interoceptive exposure. The interoceptive exposure exercises directly targeted anxiety sensitivity, a psychological construct also implicated in the maintenance of PTSD. Eighty-nine percent of patients who expressed interest in the treatment attended a baseline evaluation, and 63% of those who were study eligible initiated treatment. Treatment retention was high, with all 10 patients who initiated treatment completing the program. Veterans reported finding the treatment and delivery format highly acceptable and reported high levels of satisfaction. Panic symptoms improved significantly following the treatment and were maintained at a 7-month follow-up, with 71.4% of the sample reporting being panic free. Co-occurring PTSD symptoms also improved along with symptoms of anxiety and depression. Preliminary findings suggest that brief and intensive group treatments for PD/PTSD are a promising method of delivering cognitive behavioral therapy that may rapidly improve symptoms. This innovative treatment delivery format also may be a cost-effective way of increasing treatment engagement through increased access to quality care. Published by Elsevier Ltd.

Evaluating PTSD on Reproductive Outcomes: Women Deployed in Iraq and Afghanistan

DTIC Science & Technology

2010-04-14

more likely to smoke, abuse alcohol and drugs , and have peer prenatal care but the study did not have sufficient power to identify pregnancy outcomes...fetal wt Yes (ect preg, spon AB, Ptcont, macro, hyperem; no (GDM, pre-ec, labor diff) Drug abuse sig more w/PTSD (p<.001); spont AB, excess...Prenatal Complications gestational diabetes hypertension preeclampsia infections drug /alcohol use hyperemesis Postpartum Complications

Self-Compassion as a Prospective Predictor of PTSD Symptom Severity Among Trauma-Exposed U.S. Iraq and Afghanistan War Veterans

PubMed Central

Hiraoka, Regina; Meyer, Eric C.; Kimbrel, Nathan A.; DeBeer, Bryann B.; Gulliver, Suzy Bird; Morissette, Sandra B.

2016-01-01

U. S. combat veterans of the Iraq and Afghanistan wars have elevated rates of posttraumatic stress disorder (PTSD) compared to the general population. Self-compassion, characterized by self-kindness, a sense of common humanity when faced with suffering, and mindful awareness of suffering, is a potentially modifiable factor implicated in the development and maintenance of PTSD. We examined the concurrent and prospective relationship between self-compassion and PTSD symptom severity after accounting for level of combat exposure and baseline PTSD severity. Participants at baseline assessment were 115 Iraq and Afghanistan war veterans exposed to 1 or more traumatic events during deployment (n = 101 at follow-up). PTSD symptoms were assessed using the Clinician Administered PTSD Scale for DSM-IV at baseline and 12 months. Self-compassion and combat exposure were assessed at baseline via self-report. Self-compassion was associated with baseline PTSD symptoms after accounting for combat exposure (β = −.59; p < .001; ΔR2 = .34; f2 = .67; large effect) and predicted 12-month PTSD symptom severity after accounting for combat exposure and baseline PTSD severity (β = −.24; p = .008; ΔR2 = .03; f2 = .08; small effect). Findings suggest that interventions that increase self-compassion may be beneficial for treating chronic PTSD symptoms among some Iraq and Afghanistan war veterans. PMID:25808565

Self-Compassion as a prospective predictor of PTSD symptom severity among trauma-exposed U.S. Iraq and Afghanistan war veterans.

PubMed

Hiraoka, Regina; Meyer, Eric C; Kimbrel, Nathan A; DeBeer, Bryann B; Gulliver, Suzy Bird; Morissette, Sandra B

2015-04-01

U.S. combat veterans of the Iraq and Afghanistan wars have elevated rates of posttraumatic stress disorder (PTSD) compared to the general population. Self-compassion, characterized by self-kindness, a sense of common humanity when faced with suffering, and mindful awareness of suffering, is a potentially modifiable factor implicated in the development and maintenance of PTSD. We examined the concurrent and prospective relationship between self-compassion and PTSD symptom severity after accounting for level of combat exposure and baseline PTSD severity in 115 Iraq and Afghanistan war veterans exposed to 1 or more traumatic events during deployment. PTSD symptoms were assessed using the Clinician Administered PTSD Scale for DSM-IV (CAPS-IV) at baseline and 12 months (n =101). Self-compassion and combat exposure were assessed at baseline via self-report. Self-compassion was associated with baseline PTSD symptoms after accounting for combat exposure (β = -.59; p < .001; ΔR(2) = .34; f(2) = .67; large effect) and predicted 12-month PTSD symptom severity after accounting for combat exposure and baseline PTSD severity (β = -.24; p = .008; ΔR(2) = .03; f(2) = .08; small effect). Findings suggest that interventions that increase self-compassion may be beneficial for treating chronic PTSD symptoms among some Iraq and Afghanistan war veterans. Copyright © 2015 Wiley Periodicals, Inc., A Wiley Company.

The Influence of Pre-Deployment Neurocognitive Functioning on Post-Deployment PTSD Symptom Outcomes Among Iraq-Deployed Army Soldiers

DTIC Science & Technology

2009-01-01

Autobiographical memory studies of non-trauma-exposed samples have dem- onstrated that decreased visual input reduces the recollection of autobiographical events...Rubin, Burt, & Fifeld, 2003), and damage to the occipital lobe impedes autobiographical memory (Greenberg & Rubin, 2003). Although speculative. it is...McNally, RJ .. Lasko. N.B .. Macklin. M.L.. & Pitman, RK. (1995). Autobiographical memory disturbance in combat-related post- traumatic stress disorder

Lower stress-reactive cortisol in female veterans associated with military status but not PTSD.

PubMed

Pierce, Meghan E; Pritchard, Laurel M

2016-09-01

Female veterans are a growing yet understudied population. Currently, 14.6% of all troops deployed to Afghanistan and Iraq are female. Military service is associated with an increased risk for trauma exposure and subsequent development of posttraumatic stress disorder (PTSD). Dysregulation of the hypothalamic-pituitary-adrenal axis is frequently associated with PTSD. Few studies have examined females diagnosed with PTSD and only one study, to our knowledge, has examined HPA-axis dysregulation in female veterans. This study examined salivary cortisol in 52 female veterans and civilians both with and without PTSD. We collected saliva samples at bedtime and awakening, as well as in response to the Trier social stress test (TSST). We found that female veterans had blunted cortisol concentrations at all time points during the TSST compared to female civilians, regardless of PTSD status. Even though all groups showed the expected diurnal decline in cortisol, the difference between awakening and bedtime samples were significant only in civilians without PTSD. The results of our study suggest that stressors specific to the military may lead to lower than normal cortisol, which may not be associated with the expressions of PTSD.

Risk for Incident Hypertension Associated With Posttraumatic Stress Disorder in Military Veterans and the Effect of Posttraumatic Stress Disorder Treatment.

PubMed

Burg, Matthew M; Brandt, Cynthia; Buta, Eugenia; Schwartz, Joseph; Bathulapalli, Harini; Dziura, James; Edmondson, Donald E; Haskell, Sally

Posttraumatic stress disorder (PTSD) increases cardiovascular disease and cardiovascular mortality risk. Neither the prospective relationship of PTSD to incident hypertension risk nor the effect of PTSD treatment on hypertension risk has been established. Data from a nationally representative sample of 194,319 veterans were drawn from the Veterans Administration (VA) roster of United States service men and women. This included veterans whose end of last deployment was from September 2001 to July 2010 and whose first VA medical visit was from October 1, 2001 to January 1, 2009. Incident hypertension was modeled as 3 events: (1) a new diagnosis of hypertension and/or (2) a new prescription for antihypertensive medication, and/or (3) a clinic blood pressure reading in the hypertensive range (≥140/90 mm Hg, systolic/diastolic). Posttraumatic stress disorder diagnosis was the main predictor. Posttraumatic stress disorder treatment was defined as (1) at least 8 individual psychotherapy sessions of 50 minutes or longer during any consecutive 6 months and/or (2) a prescription for selective serotonin reuptake inhibitor medication. Over a median 2.4-year follow-up, the incident hypertension risk independently associated with PTSD ranged from hazard ratio (HR), 1.12 (95% confidence interval [CI], 1.08-1.17; p < .0001) to HR, 1.30 (95% CI, 1.26-1.34; p < .0001). The interaction of PTSD and treatment revealed that treatment reduced the PTSD-associated hypertension risk (e.g., from HR, 1.44 [95% CI, 1.38-1.50; p < .0001] for those untreated, to HR, 1.20 [95% CI, 1.15-1.25; p < .0001] for those treated). These results indicate that reducing the long-term health impact of PTSD and the associated costs may require very early surveillance and treatment.

Parent-Child Relationship Quality and Family Transmission of Parent Posttraumatic Stress Disorder Symptoms and Child Externalizing and Internalizing Symptoms Following Fathers’ Combat-Trauma Exposure

PubMed Central

Snyder, James; Gewirtz, Abigail; Schrepferman, Lynn; Gird, Suzanne R.; Quattlebaum, Jamie; Pauldine, Michael R.; Elish, Katie; Zamir, Osnat; Hayes, Charles

2016-01-01

Transactional cascades among child internalizing and externalizing symptoms, and fathers’ and mothers’ post-traumatic stress disorder symptoms were examined in a sample of families with a male parent who had been deployed to recent military conflicts in the Middle East. The role of parents’ positive engagement and coercive interaction with their child, and family members’ emotion regulation were tested as processes linking cascades of parent and child symptoms. A subsample of 183 families with deployed fathers and non-deployed mothers and their 4 to 13 year old children who participated in a randomized control trial intervention (After Deployment: Adaptive Parenting Tools, or ADAPT) were assessed at baseline prior to intervention, and at 12 and 24 months after baseline, using parent reports of their own and their child’s symptoms. Parents’ observed behavior during interaction with their children was coded using a multi-method approach at each assessment point. Reciprocal cascades among fathers’ and mothers’ PTSD symptoms, and child internalizing and externalizing symptoms were observed. Fathers’ and mothers’ positive engagement during parent-child interaction linked their PTSD symptoms and their child’s internalizing symptoms. Fathers’ and mothers’ coercive behavior toward their child linked their PTSD symptoms and their child’s externalizing symptoms. Each family members’ capacity for emotion regulation was associated with their adjustment problems at baseline. Implications for intervention, and for research using longitudinal models and a family-systems perspective of co-occurrence and cascades of symptoms across family members are described. PMID:27739388

Posttraumatic Stress Symptoms among National Guard Soldiers Deployed to Iraq: Associations with Parenting Behaviors and Couple Adjustment

ERIC Educational Resources Information Center

Gewirtz, Abigail H.; Polusny, Melissa A.; DeGarmo, David S.; Khaylis, Anna; Erbes, Christopher R.

2010-01-01

Objective: In this article, we report findings from a 1-year longitudinal study examining the impact of change in posttraumatic stress disorder (PTSD) symptoms following combat deployment on National Guard soldiers' perceived parenting and couple adjustment 1 year following return from Iraq. Method: Participants were 468 Army National Guard…

The effect of military motion-assisted memory desensitization and reprocessing treatment on the symptoms of combat-related post traumatic stress disorder: first preliminary results.

PubMed

Vermetten, Eric; Meijer, Lydia; van der Wurff, Peter; Mert, Agali

2013-01-01

Although the symptoms of Post-Traumatic Stress Disorder (PTSD) in the general and military population seem very similar, combat-related PTSD (cr-PTSD) is typically thought to be more severe due to the repeated and prolonged exposure of traumatic events. Therapeutic adherence is reported a problem in military populations compromising treatment efficacy. Therefore, a new potential supplementary treatment is specially designed for patients with cr-PTSD. This intervention is called Military Motion Memory Desensitization and Reprocessing (3MDR). The treatment incorporates key elements of successful treatments as Virtual Reality Exposure (VRE) and Eye Movement Desensitization Reprocessing (EMDR) and adds motion to the condition. We aimed at designing a treatment procedure that preserved dual task processing principle, yet introduced new engagement by performing the desensitization during motion by to walking on a treadmill. Moreover, we aimed at exposure to real high-affect pictures of deployment setting. Subjects walk a repetitive cycle while walking and viewing high affect pictures of deployment scenes. Dual task processing was maintained by an oscillating ball. Aspects of presence are adhered to, to maximize possible positive outcome. Two veterans with chronic PTSD, received four weekly sessions of 3MDR therapy. The indicator of effectiveness was difference in CAPS (Clinical Administrated PTSD Scale)-score. The treatment was designed on the Computer Assisted Rehabilitation Environment (CAREN) facility. The 3MDR treatment did further decrease PTSD symptoms. Patients were highly satisfied about the treatment and had no attention to drop out. The results of the two cases suggest that the 3MDR treatment is a successful, more additional treatment that goes further into the patients affect where other treatment may stagnate. The presence was highly appreciated. Further research with more patients needs to be performed to obtain more reliable results.

Previous Traumatic Life Events versus Course and Effectiveness of PTSD Therapy in Veterans of Polish Military Contingents

DTIC Science & Technology

2011-04-01

complaining of a continuous emotional tension remaining for several months. Sleep problems, memories of the Iraq deployment were recurring in his dreams...tension and insomnia. When his sleep was pharmaceutically rectified, unbearable nightmares occurred. Despite this at the forum of the therapeutical...by local Death Squads. The memories included also brutal scenes of women being raped and whose children were killed. Unintentionally he devoted his

Differential Odor Sensitivity in PTSD: Implications for Treatment and Future Research

PubMed Central

Cortese, Bernadette M.; Leslie, Kimberly; Uhde, Thomas W.

2015-01-01

Background Given that odors enhance the retrieval of autobiographical memories, induce physiological arousal, and trigger trauma-related flashbacks, it is reasonable to hypothesize that odors play a significant role in the pathophysiology of posttraumatic stress disorder (PTSD). For these reasons, this preliminary study sought to examine self-reported, odor-elicited distress in PTSD. Methods Combat veterans with (N=30) and without (N=22) PTSD and healthy controls (HC: N=21), completed an olfactory questionnaire that provided information on the hedonic valence of odors as well as their ability to elicit distress or relaxation. Results Two main findings were revealed: Compared to HC, CV+PTSD, but not CV-PTSD, reported a higher prevalence of distress to a limited number of select odors that included fuel (p=.004), blood (p=.02), gunpowder (p=.03), and burning hair (p=.02). In contrast to this increased sensitivity, a blunting effect was reported by both groups of veterans compared to HC that revealed lower rates of distress and relaxation in response to negative hedonic odors (p=.03) and positive hedonic odors (p<.001), respectively. Limitations The study is limited by its use of retrospective survey methods, whereas future investigations would benefit from laboratory measures taken prior, during, and after deployment. Conclusion The present findings suggest a complex role of olfaction in the biological functions of threat detection. Several theoretical models are discussed. One possible explanation for increased sensitivity to select odors with decreased sensitivity to other odors is the co-occurrence of attentional bias toward threat odors with selective ignoring of distractor odors. Working together, these processes may optimize survival. PMID:25845746

Medical Surveillance Monthly Report (MSMR). Volume 14, Number 4, July 2007

DTIC Science & Technology

2007-07-01

they do not off er protection in the event of sexual assault. A survey of women in the Navy found a high proportion of unplanned pregnancies among...Finally, extended and/or multiple deployments can disrupt relationships with spouses, other family members, friends, and work associates (Reserves); and...PTSD Relationships between age and rates of any mental disorder and PTSD diagnoses varied between the active and Reserve components (Figure 1). For

The Protective Value of Hardiness on Military Posttraumatic Stress Symptoms

DTIC Science & Technology

2013-01-01

such as the death of service member colleagues and combat experi- ences. Extensive military experience may play a larger role in the development of...related stres - sors, such as number of deployments, combat experience, and exposure to death or serious injury of military colleagues and nonmilitary...predictor of PTSD. Although it is impor- tant to acknowledge that extensive military ser- vice may play a role in the development of PTSD, it is

Post-Traumatic Stress Symptoms and Burnout Among Medical Rescue Workers 4 Years After the Great East Japan Earthquake: A Longitudinal Study.

PubMed

Kawashima, Yuzuru; Nishi, Daisuke; Noguchi, Hiroko; Usuki, Masato; Yamashita, Akihiro; Koido, Yuichi; Okubo, Yoshiro; Matsuoka, Yutaka J

2016-12-01

This study aimed to evaluate factors associated with post-traumatic stress disorder (PTSD) symptoms and burnout 4 years after the Great East Japan Earthquake among medical rescue workers in Disaster Medical Assistance Teams (DMATs). We examined participants' background characteristics, prior health condition, rescue work experiences, and the Peritraumatic Distress Inventory (PDI) score at 1 month after the earthquake. Current psychological condition was assessed by the Impact of Event Scale-Revised and Maslach Burnout Inventory administered 4 years after the earthquake. By applying univariate and multivariate linear regression analyses, we assessed the relative value of the PDI and other baseline variables for PTSD symptoms and burnout at 4 years after the earthquake. We obtained baseline data from 254 participants during April 2 to 22, 2011. Of the 254 participants, 188 (74.0%) completed the follow-up assessment. PDI score 1 month after the earthquake was associated with symptoms of PTSD (β=0.35, P<.01) and burnout (β=0.21, P<.01). Stress before deployment was a related factor for burnout 4 years after the earthquake in these medical rescue workers (β=2.61, P<.04). It seems important for DMAT headquarters to establish a routine system for assessing the PDI of medical rescue workers after deployment and screen those workers who have high stress prior to deployment (Disaster Med Public Health Preparedness. 2016;10:848-853).

The impact of social support, unit cohesion, and trait resilience on PTSD in treatment-seeking military personnel with PTSD: The role of posttraumatic cognitions.

PubMed

Zang, Yinyin; Gallagher, Thea; McLean, Carmen P; Tannahill, Hallie S; Yarvis, Jeffrey S; Foa, Edna B

2017-03-01

The personal resources of social support, unit cohesion, and trait resilience have been found to be associated with posttraumatic stress disorder (PTSD) severity among military personnel. However, the underlying mechanisms of these relationships are unclear. We hypothesized that negative posttraumatic cognitions, which are associated with PTSD, mediate the relationships between these personal resources and PTSD. The relationship between PTSD symptom severity and a latent factor comprised of social support, unit cohesion, and trait resilience was evaluated using cross-sectional data from 366 treatment-seeking active duty military personnel with PTSD following deployments to or near Iraq or Afghanistan. Structural equation modeling (SEM) was used to test whether posttraumatic cognitions mediated this relationship. The SEM model indicated that (1) a robust latent variable named personal resources (indicated by social support, unit cohesion, and trait resilience) was negatively associated with PTSD severity; (2) personal resources were negatively associated with negative posttraumatic cognitions; (3) negative posttraumatic cognitions fully mediated the association between personal resources and PTSD severity. The final SEM mediation model showed a highly satisfactory fit [χ 2 (22) = 16.344, p = 0.798; χ 2 /df = 0.743; CFI = 1; RMSEA = 0.000]. These findings suggest that among active duty military personnel seeking treatment for PTSD, personal resources (social support, unit cohesion, and trait resilience) may mitigate PTSD severity by reducing negative posttraumatic cognitions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Principles for developing animal models of military PTSD

PubMed Central

Daskalakis, Nikolaos P.; Yehuda, Rachel

2014-01-01

The extent to which animal studies can be relevant to military posttraumatic stress disorder (PTSD) continues to be a matter of discussion. Some features of the clinical syndrome are more easily modeled than others. In the animal literature, a great deal of attention is focused on modeling the characteristics of military exposures and their impact on measurable behaviors and biological parameters. There are many issues to consider regarding the ecological validity of predator, social defeat or immobilization stress to combat-related experience. In contrast, less attention has been paid to individual variation following these exposures. Such variation is critical to understand how individual differences in the response to military trauma exposure may result to PTSD or resilience. It is important to consider potential differences in biological findings when comparing extremely exposed to non-exposed animals, versus those that result from examining individual differences. Animal models of military PTSD are also critical in advancing efforts in clinical treatment. In an ideal translational approach to study deployment related outcomes, information from humans and animals, blood and brain, should be carefully considered in tandem, possibly even computed simultaneously, to identify molecules, pathways and networks that are likely to be the key drivers of military PTSD symptoms. With the use novel biological methodologies (e.g., optogenetics) in the animal models, critical genes and pathways can be tuned up or down (rather than over-expressed or ablated completely) in discrete brain regions. Such techniques together with pre-and post-deployment human imaging will accelerate the identification of novel pharmacological and non-pharmacological intervention strategies. PMID:25206946

Sleep disorders in combat-related PTSD.

PubMed

Williams, Scott G; Collen, Jacob; Orr, Nicholas; Holley, Aaron B; Lettieri, Christopher J

2015-03-01

We sought to assess the rate of sleep complaints and sleep disorders among active duty soldiers with deployment-related PTSD and to determine whether any clinical features differentiated those with sleep disorders. Retrospective review of consecutive soldiers diagnosed with PTSD. We recorded subjective measures of sleep and polysomnographic data. We compared clinical and demographic variables including psychoactive medication use, psychiatric comorbidity, and combat-related traumatic injury with the presence of sleep disorders. One hundred thirty patients were included (91.5 % male, mean age of 35.1 ± 10.6 years, mean body mass index (BMI) 28.9 ± 4.4 Kg/m(2)). About 88.5 % had comorbid depression, with the majority (96.2 %) taking psychoactive medications (mean 3.4 ± 1.6 medications per patient). Over half of the cohort suffered combat-related traumatic physical injuries (54.6 %). The obstructive sleep apnea syndrome (OSAS) was diagnosed in 67.3 % (80 % of the cohort underwent polysomnography), with a mean apnea hypopnea index of 24.1 ± 22.8 events/hour and a mean oxygen saturation nadir of 84.2 ± 5.7 %. OSAS was significantly more common in the non-injured soldiers (72.9 vs. 38.0 %, p < 0.001). In multivariate analysis, absence of physical injury showed a trend towards predicting OSAS. Sleep complaints are common among soldiers with PTSD. We observed significantly higher rates of OSAS among those without physical injuries, raising the possibility that underlying sleep-disordered breathing is a risk factor for the development of PTSD. This potential association requires further validation.

Effect of the 5-HTTLPR polymorphism on posttraumatic stress disorder, depression, anxiety, and quality of life among Iraq and Afghanistan veterans

PubMed Central

Kimbrel, Nathan A.; Morissette, Sandra B.; Meyer, Eric C.; Chrestman, Roberta; Jamroz, Robert; Silvia, Paul J.; Beckham, Jean C.; Young, Keith A.

2015-01-01

Background Posttraumatic stress disorder (PTSD), depression, anxiety, and stress are significant problems among returning veterans and are associated with reduced quality of life. Design A correlational design was used to examine the impact of a polymorphism (5-HTTLPR) in the serotonin transporter promoter gene on post-deployment adjustment among returning veterans. Methods A total of 186 returning Iraq and Afghanistan veterans were genotyped for the 5-HTTLPR polymorphism. Symptoms of PTSD, depression, general stress, and anxiety were assessed along with quality of life. Results After controlling for combat exposure, age, sex of the participant, and race, 5-HTTLPR had a significant multivariate effect on post-deployment adjustment, such that S′ carriers reported more post-deployment adjustment problems and worse quality of life than veterans homozygous for the L′ allele. This effect was larger when the analyses were restricted to veterans of European ancestry. Conclusions Our findings suggest that veterans who carry the S′ allele of the 5-HTTLPR polymorphism may be at increased risk for adjustment problems and reduced quality of life following deployments to war zones. PMID:25314020

Co-occurring Posttraumatic Stress Disorder and Alcohol Use Disorders in Veteran Populations

PubMed Central

Carter, Ashlee C.; Capone, Christy; Short, Erica Eaton

2012-01-01

Co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorders have become increasingly prevalent in military populations. Over the past decade, PTSD has emerged as one of the most common forms of psychopathology among the 1.7 million American military personnel deployed to Iraq and Afghanistan in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND). Among veterans from all eras, symptoms of PTSD have been highly correlated with hazardous drinking, leading to greater decreases in overall health and greater difficulties readjusting to civilian life. In fact, a diagnosis of co-occurring PTSD and alcohol use disorder has proven more detrimental than a diagnosis of PTSD or alcohol use disorder alone. In order to effectively address co-occurring PTSD and alcohol use disorder, both the clinical and research communities have focused on better understanding this comorbidity, as well as increasing treatment outcomes among the veteran population. The purpose of the present article is threefold: (1) present a case study that highlights the manner in which PTSD and alcohol use disorder co-develop after trauma exposure; (2) present scientific theories on co - occurrence of PTSD and alcohol use disorder; and (3) present current treatment options for addressing this common comorbidity. PMID:23087599

Repetitive traumatic brain injury, psychological symptoms, and suicide risk in a clinical sample of deployed military personnel.

PubMed

Bryan, Craig J; Clemans, Tracy A

2013-07-01

Traumatic brain injury (TBI) is believed to be one factor contributing to rising suicide rates among military personnel and veterans. This study investigated the association of cumulative TBIs with suicide risk in a clinical sample of deployed military personnel referred for a TBI evaluation. To determine whether suicide risk is more frequent and heightened among military personnel with multiple lifetime TBIs than among those with no TBIs or a single TBI. Patients completed standardized self-report measures of depression, posttraumatic stress disorder (PTSD), and suicidal thoughts and behaviors; clinical interview; and physical examination. Group comparisons of symptom scores according to number of lifetime TBIs were made, and generalized regression analyses were used to determine the association of cumulative TBIs with suicide risk. Patients included 161 military personnel referred for evaluation and treatment of suspected head injury at a military hospital's TBI clinic in Iraq. Behavioral Health Measure depression subscale, PTSD Checklist-Military Version, concussion symptoms, and Suicide Behaviors Questionnaire-Revised. Depression, PTSD, and TBI symptom severity significantly increased with the number of TBIs. An increased incidence of lifetime suicidal thoughts or behaviors was associated with the number of TBIs (no TBIs, 0%; single TBI, 6.9%; and multiple TBIs, 21.7%; P = .009), as was suicidal ideation within the past year (0%, 3.4%, and 12.0%, respectively; P = .04). The number of TBIs was associated with greater suicide risk (β [SE] = .214 [.098]; P = .03) when the effects of depression, PTSD, and TBI symptom severity were controlled for. A significant interaction between depression and cumulative TBIs was also found (β  = .580 [.283]; P = .04). Suicide risk is higher among military personnel with more lifetime TBIs, even after controlling for clinical symptom severity. Results suggest that multiple TBIs, which are common among military personnel, may contribute to increased risk for suicide.

Postdeployment Behavioral Health Screens and Linkage to the Veterans Health Administration for Army Reserve Component Members.

PubMed

Vanneman, Megan E; Harris, Alex H S; Chen, Cheng; Adams, Rachel Sayko; Williams, Thomas V; Larson, Mary Jo

2017-08-01

Approximately three to six months after returning from deployment, military service members complete the Post-Deployment Health Reassessment (PDHRA), which includes screens for alcohol misuse, depression, and posttraumatic stress disorder (PTSD). To determine whether Army Reserve Component (RC) members (Army National Guard and Army Reserve) with positive screening scores on the PDHRA receive needed care, the investigators examined the association between positive scores and enrollment and utilization of care ("linkage") in the Veterans Health Administration (VHA), as well as rescreening scores, diagnosis, and behavioral treatment in VHA. Mixed-effects regression models were used to predict linkage to VHA within six months after RC members (N=73,164) completed the PDHRA, with alcohol misuse, depression, and PTSD screen scores as key independent variables. Regression models were stratified by gender and National Guard versus Reserve status. Among those who linked to VHA (N=25,168), screening scores and subsequent diagnosis and treatment in VHA were also examined. Army RC members with positive PTSD and depression screening scores were more likely than those with negative screens to link to VHA, and most (54%-84%) received VHA treatment once diagnosed. Positive screens for alcohol misuse were associated with linkage to VHA for men but not for women, and treatment rates for alcohol use disorders were relatively low (0%-25%) for both men and women diagnosed as having an alcohol use disorder. The finding that Army RC members with greater indications of behavioral health problems linked to VHA is encouraging. However, more outreach and treatment engagement strategies could be directed to those with alcohol use disorder, particularly women.

Good Practices of End of Deployment Debriefing in the Royal Netherlands Navy

DTIC Science & Technology

2006-04-01

Stress Disorders ( PTSD ) among the victims of accidents or traumatic events. At the international level, it was recommended that the term ‘debriefing...single session debriefing in the civilian sector does not lead to a decline in the incidence of Post Traumatic Stress Meijer, M.; de Vries, R. (2006...46 - 2 RTO-MP-HFM-134 Disorders ( PTSD ) among the victims of accidents or traumatic events. At the international level, it is even recommended

Project VALOR: Trajectories of Change in PTSD in Combat-Exposed Veterans

DTIC Science & Technology

2016-10-01

Behavioral and Cognitive Therapy 50th Annual Meeting. New York, NY. Black, S. K., Erb, S. Green, J. D., Bovin, M., Sloan, D. M., & Marx, B. (November...reactivity and regulation in PTSD; Chair: K. McHugh) at the Association for Behavioral and Cognitive Therapies 49th Annual Meeting. Chicago, IL. Black, S. K...comparison of OIF deployment phases. Poster presented at the Association for Behavioral and Cognitive Therapies 49th Annual Meeting. Chicago, IL

The Separate and Cumulative Effects of TBI and PTSD on Cognitive Function and Emotional Control

DTIC Science & Technology

2012-10-01

Swick et al., in preparation). A measure of RT variability on Go trials, the intra-individual coefficient of variation (ICV), was obtained from...deployment func- tioning relative to PTSD, depression, and other psychiatric disorders (e.g., Hoge et al., 2008; Hoge, Goldberg , & Castro, 2009). Results could... Goldberg , H.M., & Castro, C.A. (2009). Care of war veterans with mild traumatic brain injury–flawed perspectives. New England Journal of Medicine, 360

Adverse childhood experiences and risk for suicidal behavior in male Iraq and Afghanistan veterans seeking PTSD treatment.

PubMed

Carroll, Timothy D; Currier, Joseph M; McCormick, Wesley H; Drescher, Kent D

2017-09-01

Adverse childhood experiences (ACEs) are associated with increased risk for suicide and appear to occur in disproportionately high rates among men who served in the U.S. military. However, research has yet to examine a comprehensive range of ACEs among Iraq/Afghanistan veterans with combat-related posttraumatic stress disorder (PTSD) or whether these premilitary stressors may contribute to suicidal behavior in this highly vulnerable population. A sample of 217 men entering a residential program for combat-related PTSD completed measures for ACEs, combat exposure, and lifetime suicidal ideation and attempts. The majority of patients had experienced multiple types of adversity or traumas during childhood/adolescence. In particular, 83.4% endorsed at least 1 ACE category and 41.5% reported experiencing 4 or more ACEs. When accounting for effects of deployment-related stressors, we further found that accumulation of ACEs was uniquely linked with thoughts of suicide or attempts among these patients. Namely, for every 1-point increase on the ACE Questionnaire, veterans' risk of suicidal ideation and attempts increased by 23% and 24%, respectively. This brief report provides initial evidence that veterans seeking treatment for combat-related PTSD often have extensive histories of premilitary stressors that may increase suicide risk beyond probable deployment-related traumas. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Support mechanisms and vulnerabilities in relation to PTSD in veterans of the Gulf War, Iraq War, and Afghanistan deployments: a systematic review.

PubMed

Wright, Breanna K; Kelsall, Helen L; Sim, Malcolm R; Clarke, David M; Creamer, Mark C

2013-06-01

Pretrauma factors of psychiatric history and neuroticism have been important in highlighting vulnerability to posttraumatic stress disorder (PTSD), whereas posttrauma support mechanisms have been associated with positive health and well-being outcomes, particularly in veterans. The relationship between these factors and PTSD has not been the subject of a systematic review in veterans. An online search was conducted, supplemented by reference list and author searches. Two investigators systematically and independently examined eligible studies. From an initial search result of 2,864, 17 met inclusion criteria. A meta-analysis of unit cohesion involving 6 studies found that low unit cohesion was associated with PTSD, standardised mean difference of -1.62, 95% confidence interval (CI) [-2.80, -0.45]. A meta-analysis of social support involving 7 studies found that low social support was associated with PTSD, standardised mean difference of - 12.40, 95% CI [-3.42, -1.38]. Three of 5 studies found a significant relationship between low-family support and PTSD; insufficient data precluded a meta-analysis. Regarding pretrauma vulnerability, 2 studies on psychiatric history and 1 on neuroticism found positive relationships with PTSD. Posttrauma factors of low support were associated with higher reporting of PTSD. Cross-sectional methodology may be inadequate to capture complex relationships between support and PTSD; more longitudinal research is required. Copyright © 2013 International Society for Traumatic Stress Studies.

Longitudinal Measurement Invariance of Posttraumatic Stress Disorder in Deployed Marines.

PubMed

Contractor, Ateka A; Bolton, Elisa; Gallagher, Matthew W; Rhodes, Charla; Nash, William P; Litz, Brett

2017-06-01

The meaningful interpretation of longitudinal study findings requires temporal stability of the constructs assessed (i.e., measurement invariance). We sought to examine measurement invariance of the construct of posttraumatic stress disorder (PTSD) as based on the Diagnostic and Statistical Manual of Mental Disorders indexed by the PTSD Checklist (PCL) and the Clinician-Administered PTSD Scale (CAPS) in a sample of 834 Marines with significant combat experience. PTSD was assessed 1-month predeployment (T0), and again at 1-month (T1), 5-months (T2), and 8-months postdeployment (T3). We tested configural (pattern of item/parcel loadings), metric (item/parcel loadings on latent factors), and scalar (item/parcel-level severity) invariance and explored sources of measurement instability (partial invariance testing). The T0 best-fitting emotional numbing model factor structure informed the conceptualization of PTSD's latent factors and parcel formations. We found (1) scalar noninvariance for the construct of PTSD as measured by the PCL and the CAPS, and for PTSD symptom clusters as assessed by the CAPS; and (2) metric noninvariance for PTSD symptom clusters as measured by the PCL. Exploratory analyses revealed factor-loading and intercept differences from pre- to postdeployment for avoidance symptoms, numbing symptoms (mainly psychogenic amnesia and foreshortened future), and the item assessing startle, each of which reduced construct stability. Implications of these findings for longitudinal studies of PTSD are discussed. Copyright © 2017 International Society for Traumatic Stress Studies.

Gender Differences in Machine Learning Models of Trauma and Suicidal Ideation in Veterans of the Iraq and Afghanistan Wars.

PubMed

Gradus, Jaimie L; King, Matthew W; Galatzer-Levy, Isaac; Street, Amy E

2017-08-01

Suicide rates among recent veterans have led to interest in risk identification. Evidence of gender-and trauma-specific predictors of suicidal ideation necessitates the use of advanced computational methods capable of elucidating these important and complex associations. In this study, we used machine learning to examine gender-specific associations between predeployment and military factors, traumatic deployment experiences, and psychopathology and suicidal ideation (SI) in a national sample of veterans deployed during the Iraq and Afghanistan conflicts (n = 2,244). Classification, regression tree analyses, and random forests were used to identify associations with SI and determine their classification accuracy. Findings converged on several associations for men that included depression, posttraumatic stress disorder (PTSD), and somatic complaints. Sexual harassment during deployment emerged as a key factor that interacted with PTSD and depression and demonstrated a stronger association with SI among women. Classification accuracy for SI presence or absence was good based on the receiver operating characteristic area under the curve, men = .91, women = .92. The risk for SI was classifiable with good accuracy, with associations that varied by gender. The use of machine learning analyses allowed for the discovery of rich, nuanced results that should be replicated in other samples and may eventually be a basis for the development of gender-specific actuarial tools to assess SI risk among veterans. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Utility of the T2 Mood Tracker mobile application among army warrior transition unit service members.

PubMed

Bush, Nigel E; Ouellette, Gary; Kinn, Julie

2014-12-01

Many military personnel returning from deployment experience increases in psychological symptoms, including post-traumatic stress disorder (PTSD), depression, and mood changes. Patient health diaries are commonly used for self-reporting over time away from the clinic. "T2 Mood Tracker" is an application ("app") for smartphones and other mobile devices that enables users to rate their moods, to self-monitor across time, and to report their emotional experiences to health providers. We designed T2 Mood Tracker to track symptoms associated with deployment-related behavioral health issues, including PTSD, Head Injury, Stress, Depression, Anxiety, and General Well-Being. We field-tested T2 Mood Tracker with a small sample of redeployed soldiers under treatment for behavioral health issues at a Warrior Transition Unit. Participants used the app an average of 10 different days over the 2- to 3-week test period. Consensus was that T2 Mood Tracker was easy to use, useful and beneficial. The majority said they would use the app in the future, would recommend it to other service members, and would use the app to share their mood information with a provider. Warrior Transition Unit providers were enthusiastic about the potential of T2 Mood Tracker as a tool for use with their patients. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Sleep disorders in US military personnel: a high rate of comorbid insomnia and obstructive sleep apnea.

PubMed

Mysliwiec, Vincent; Gill, Jessica; Lee, Hyunhwa; Baxter, Tristin; Pierce, Roslyn; Barr, Taura L; Krakow, Barry; Roth, Bernard J

2013-08-01

Sleep disturbances are among the most common symptoms of military personnel who return from deployment. The objective of our study was to determine the presence of sleep disorders in US military personnel referred for evaluation of sleep disturbances after deployment and examine associations between sleep disorders and service-related diagnoses of depression, mild traumatic brain injury, pain, and posttraumatic stress disorder (PTSD). This was a cross-sectional study of military personnel with sleep disturbances who returned from combat within 18 months of deployment. Sleep disorders were assessed by clinical evaluation and polysomnogram with validated instruments to diagnose service-related illnesses. Of 110 military personnel included in our analysis, 97.3% were men (mean age, 33.6 ± 8.0 years; mean BMI, 30.0 ± 4.3 kg/m2), and 70.9% returned from combat within 12 months. Nearly one-half (47.3%) met diagnostic criteria for two or more service-related diagnoses. Sleep disorders were diagnosed in 88.2% of subjects; 11.8% had a normal sleep evaluation and served as control subjects. Overall, 62.7% met diagnostic criteria for obstructive sleep apnea (OSA) and 63.6% for insomnia. The exclusive diagnoses of insomnia and OSA were present in 25.5% and 24.5% of subjects, respectively; 38.2% had comorbid insomnia and OSA. Military personnel with comorbid insomnia and OSA were significantly more likely to meet criteria for depression (P < .01) and PTSD (P < .01) compared with control subjects and those with OSA only. Comorbid insomnia and OSA is a frequent diagnosis in military personnel referred for evaluation of sleep disturbances after deployment. This diagnosis, which is difficult to treat, may explain the refractory nature of many service-related diagnoses.

Chronic Hypopituitarism Associated with Increased Postconcussive Symptoms Is Prevalent after Blast-Induced Mild Traumatic Brain Injury

PubMed Central

Undurti, Arundhati; Colasurdo, Elizabeth A.; Sikkema, Carl L.; Schultz, Jaclyn S.; Peskind, Elaine R.; Pagulayan, Kathleen F.; Wilkinson, Charles W.

2018-01-01

The most frequent injury sustained by US service members deployed to Iraq or Afghanistan is mild traumatic brain injuries (mTBI), or concussion, by far most often caused by blast waves from improvised explosive devices or other explosive ordnance. TBI from all causes gives rise to chronic neuroendocrine disorders with an estimated prevalence of 25–50%. The current study expands upon our earlier finding that chronic pituitary gland dysfunction occurs with a similarly high frequency after blast-related concussions. We measured circulating hormone levels and accessed demographic and testing data from two groups of male veterans with hazardous duty experience in Iraq or Afghanistan. Veterans in the mTBI group had experienced one or more blast-related concussion. Members of the deployment control (DC) group encountered similar deployment conditions but had no history of blast-related mTBI. 12 of 39 (31%) of the mTBI participants and 3 of 20 (15%) veterans in the DC group screened positive for one or more neuroendocrine disorders. Positive screens for growth hormone deficiency occurred most often. Analysis of responses on self-report questionnaires revealed main effects of both mTBI and hypopituitarism on postconcussive and posttraumatic stress disorder (PTSD) symptoms. Symptoms associated with pituitary dysfunction overlap considerably with those of PTSD. They include cognitive deficiencies, mood and anxiety disorders, sleep problems, diminished quality of life, deleterious changes in metabolism and body composition, and increased cardiovascular mortality. When such symptoms are due to hypopituitarism, they may be alleviated by hormone replacement. These findings suggest consideration of routine post-deployment neuroendocrine screening of service members and veterans who have experienced blast-related mTBI and are reporting postconcussive symptoms. PMID:29515515

Sleep Disorders in US Military Personnel

PubMed Central

Gill, Jessica; Lee, Hyunhwa; Baxter, Tristin; Pierce, Roslyn; Barr, Taura L.; Krakow, Barry; Roth, Bernard J.

2013-01-01

Background: Sleep disturbances are among the most common symptoms of military personnel who return from deployment. The objective of our study was to determine the presence of sleep disorders in US military personnel referred for evaluation of sleep disturbances after deployment and examine associations between sleep disorders and service-related diagnoses of depression, mild traumatic brain injury, pain, and posttraumatic stress disorder (PTSD). Methods: This was a cross-sectional study of military personnel with sleep disturbances who returned from combat within 18 months of deployment. Sleep disorders were assessed by clinical evaluation and polysomnogram with validated instruments to diagnose service-related illnesses. Results: Of 110 military personnel included in our analysis, 97.3% were men (mean age, 33.6 ± 8.0 years; mean BMI, 30.0 ± 4.3 kg/m2), and 70.9% returned from combat within 12 months. Nearly one-half (47.3%) met diagnostic criteria for two or more service-related diagnoses. Sleep disorders were diagnosed in 88.2% of subjects; 11.8% had a normal sleep evaluation and served as control subjects. Overall, 62.7% met diagnostic criteria for obstructive sleep apnea (OSA) and 63.6% for insomnia. The exclusive diagnoses of insomnia and OSA were present in 25.5% and 24.5% of subjects, respectively; 38.2% had comorbid insomnia and OSA. Military personnel with comorbid insomnia and OSA were significantly more likely to meet criteria for depression (P < .01) and PTSD (P < .01) compared with control subjects and those with OSA only. Conclusions: Comorbid insomnia and OSA is a frequent diagnosis in military personnel referred for evaluation of sleep disturbances after deployment. This diagnosis, which is difficult to treat, may explain the refractory nature of many service-related diagnoses. PMID:23681455

Treatment of active duty military with PTSD in primary care: A follow-up report.

PubMed

Cigrang, Jeffrey A; Rauch, Sheila A M; Mintz, Jim; Brundige, Antoinette; Avila, Laura L; Bryan, Craig J; Goodie, Jeffrey L; Peterson, Alan L

2015-12-01

First-line trauma-focused therapies offered in specialty mental health clinics do not reach many veterans and active duty service members with posttraumatic stress disorder (PTSD). Primary care is an ideal environment to expand access to mental health care. Several promising clinical case series reports of brief PTSD therapies adapted for primary care have shown positive results, but the long-term effectiveness with military members is unknown. The purpose of this study was to determine the long-term outcome of an open trial of a brief cognitive-behavioral primary care-delivered protocol developed specifically for deployment-related PTSD in a sample of 24 active duty military (15 men, 9 women). Measures of PTSD symptom severity showed statistically and clinically significant reductions from baseline to posttreatment that were maintained at the 6-month and 1-year follow-up assessments. Similar reductions were maintained in depressive symptoms and ratings of global mental health functioning. Copyright © 2015 Elsevier Ltd. All rights reserved.

Exploring the post-deployment reintegration experiences of veterans with PTSD and their significant others.

PubMed

Freytes, I Magaly; LeLaurin, Jennifer H; Zickmund, Susan L; Resende, Rosana D; Uphold, Constance R

2017-01-01

Veterans with family support have better functional recovery and reintegration outcomes. However, families' ability to support the veteran with PTSD's rehabilitation and reintegration oftentimes is hindered by interpersonal challenges. We report findings of a qualitative study that examined OEF/OIF veterans with PTSD/TBI and their significant others' (SOs') perceptions of family functioning. We conducted 24 in-depth interviews with 12 veteran/SO dyads using an adapted version of the Family Assessment Device Structured Interview. Descriptive qualitative analytic methods were used to analyze the data. Data show that the impact of deployment and the resulting changes in the individuals and the family dynamics lingered years after the veterans returned home and had a lasting influence on veterans' and SOs' perceptions of family functioning. Most couples acknowledged growth in their relationships several years postdeployment. However, many continued to struggle with disruptions generated by deployment. Four themes emerged from the data: individual changes, coping strategies, relationship changes, and a "new normal." Postdeployment family functioning was influenced by a dynamic interplay of individual and relationship factors and the development of coping strategies and a new normal. This study contributes to the understanding of the prolonged postdeployment family reintegration experiences of veterans and their SOs. Findings underscore the importance of continuing to advance the current knowledge base about the long-term impact of deployment on veterans and their families, especially factors that contribute to positive postdeployment family functioning. Additional empirical studies are needed to provide more in-depth understanding of the long-term postdeployment reintegration experiences of veterans and their families. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Unit cohesion, traumatic exposure and mental health of military personnel.

PubMed

Kanesarajah, J; Waller, M; Zheng, W Y; Dobson, A J

2016-06-01

The benefit of military unit cohesion to morale and psychological resilience is well established. But it remains unclear whether unit cohesion modifies the association between deployment-related traumatic exposure and mental health problems. To examine the association between unit cohesion, traumatic exposure and poor mental health [symptoms of post-traumatic stress disorder (PTSD), psychological distress and alcohol dependency] and assess whether the relationship between traumatic exposure and poor mental health differs by level of unit cohesion. A self-reported cross-sectional survey of Australian military personnel deployed to Iraq or Afghanistan between 2001 and 2009. Among 11411 participants, those with low levels of unit cohesion had higher odds of PTSD symptoms [aOR (95% CI): 2.54 (1.88, 3.42)], very high psychological distress [aOR (95% CI): 4.28 (3.04, 6.02)] and a high level of alcohol problems [aOR (95% CI): 1.71 (1.32, 2.22)] compared with those reporting high unit cohesion on deployment. Higher exposure to traumatic events on deployment was associated with greater risk of PTSD symptoms, very high levels of psychological distress and high levels of alcohol problems in this cohort. However, there was no evidence of a statistically significant interaction between unit cohesion and traumatic exposures in influencing poor mental health. Our findings suggest that both unit cohesion and traumatic exposure are independently associated with poor mental health. Efforts to improve military unit cohesion may help to improve the mental health resilience of military personnel, regardless of their level of traumatic exposure. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Association between baseline psychological attributes and mental health outcomes after soldiers returned from deployment.

PubMed

Shen, Yu-Chu; Arkes, Jeremy; Lester, Paul B

2017-10-05

Psychological health is vital for effective employees, especially in stressful occupations like military and public safety sectors. Yet, until recently little empirical work has made the link between requisite psychological resources and important mental health outcomes across time in those sectors. In this study we explore the association between 14 baseline psychological health attributes (such as adaptability, coping ability, optimism) and mental health outcomes following exposure to combat deployment. Retrospective analysis of all U.S. Army soldiers who enlisted between 2009 and 2012 and took the Global Assessment Tools (GAT) before their first deployment (n = 63,186). We analyze whether a soldier screened positive for depression and posttraumatic stress disorder (PTSD) after returning from deployment using logistic regressions. Our key independent variables are 14 psychological attributes based on GAT, and we control for relevant demographic and service characteristics. In addition, we generate a composite risk score for each soldier based on the predicted probabilities from the above multivariate model using just baseline psychological attributes and demographic information. Comparing those who scored in the bottom 5 percentile of each attribute to those in the top 95 percentile, the odds ratio of post-deployment depression symptoms ranges from 1.21 (95% CI 1.06, 1.40) for organizational trust to 1.73 (CI 1.52, 1.97) for baseline depression. The odds ratio of positive screening of PTSD symptoms ranges from 1.22 for family support (CI 1.08, 1.38) to 1.51 for baseline depression (CI 1.32, 1.73). The risk profile analysis shows that 31% of those who screened positive for depression and 27% of those who screened positive for PTSD were concentrated among the top 5% high risk population. A set of validated, self-reported questions administered early in a soldier's career can predict future mental health problems, and can be used to improve workforce fit and provide significant financial benefits to organizations that do so.

Virtual reality exposure versus prolonged exposure for PTSD: Which treatment for whom?

PubMed

Norr, Aaron M; Smolenski, Derek J; Katz, Andrea C; Rizzo, Albert A; Rothbaum, Barbara O; Difede, JoAnn; Koenen-Woods, Patricia; Reger, Mark A; Reger, Greg M

2018-06-01

The majority of studies comparing active psychological treatments for posttraumatic stress disorder (PTSD) do not find significant differences at posttreatment. This was the case in a recent trial examining prolonged exposure (PE) and virtual reality exposure (VRE) among active-duty soldiers with combat-related PTSD. Matching individual patients to specific treatments provides a potential avenue to improve significantly the public health impact of effective treatments for PTSD. A composite moderator approach was used to identify profiles of patients who would see superior PTSD symptom reduction in VRE or PE to inform future treatment matching. Active duty U.S. army soldiers (N = 108) were enrolled in a randomized clinical trial comparing VRE and PE in the treatment of PTSD stemming from deployments to Iraq or Afghanistan. Eighteen baseline variables were examined to identify treatment response heterogeneity in two patient groups: those with a superior response to PE and those with a superior response to VRE. The final composite moderator comprised four of 18 baseline variables. Results revealed that patients who were predicted to see greater PTSD symptom reduction in VRE were likely to be younger, not taking antidepressant medication, had greater PTSD hyperarousal symptoms, and were more likely to have greater than minimal suicide risk. Results suggest that treatment matching based on patient profiles could meaningfully improve treatment efficacy for combat-related PTSD. Future research can build on these results to improve our understanding of how to improve treatment matching for PTSD. © 2018 Wiley Periodicals, Inc.

Understanding how deployment experiences change over time: Comparison of female and male OEF/OIF and Gulf War veterans.

PubMed

Fox, Annie B; Walker, Brian E; Smith, Brian N; King, Daniel W; King, Lynda A; Vogt, Dawne

2016-03-01

Despite increased attention to the evolving nature of war, the unique challenges of contemporary deployment, and women's changing role in warfare, few studies have examined differences in deployment stressors across eras of service or evaluated how gender differences in deployment experiences have changed over time. Using data collected from two national survey studies, we examined war cohort and gender differences in veterans' reports of both mission-related and interpersonal stressors during deployment. Although Operation Enduring Freedom and Operation Iraqi Freedom veterans reported more combat experiences and greater preparedness for deployment compared to Gulf War veterans, Gulf War veterans reported higher levels of other mission-related stressors, including difficult living and working environment, perceived threat, and potential exposure to nuclear, biological, and chemical weapons. Gender differences also emerged, with men reporting greater exposure to mission-related stressors and women reporting higher levels of interpersonal stressors. However, the size and nature of gender differences did not differ significantly when comparing veterans of the two eras. By understanding how risk factors for PTSD differ based on war era and gender, veterans' experiences can be better contextualized. (c) 2016 APA, all rights reserved).

The Impact of Military Deployment and Reintegration on Children and Parenting: A Systematic Review

PubMed Central

Creech, Suzannah K.; Hadley, Wendy; Borsari, Brian

2015-01-01

Hundreds of thousands of children have had at least 1 parent deploy as part of military operations in Iraq (Operation Iraqi Freedom; OIF; Operation New Dawn; OND) and Afghanistan (Operation Enduring Freedom; OEF). However, there is little knowledge of the impact of deployment on the relationship of parents and their children. This systematic review examines findings from 3 areas of relevant research: the impact of deployment separation on parenting, and children's emotional, behavioral, and health outcomes; the impact of parental mental health symptoms during and after reintegration; and current treatment approaches in veteran and military families. Several trends emerged. First, across all age groups, deployment of a parent may be related to increased emotional and behavioral difficulties for children, including higher rates of health-care visits for psychological problems during deployment. Second, symptoms of PTSD and depression may be related to increased symptomatology in children and problems with parenting during and well after reintegration. Third, although several treatments have been developed to address the needs of military families, most are untested or in the early stages of implementation and evaluation. This body of research suggests several promising avenues for future research. PMID:25844014

Time-course of PTSD symptoms in the Australian Defence Force: a retrospective cohort study.

PubMed

Waller, M; Charlson, F J; Ireland, R E E; Whiteford, H A; Dobson, A J

2016-08-01

Understanding the time-course of post-traumatic stress disorder (PTSD), and the underlying events, may help to identify those most at risk, and anticipate the number of individuals likely to be diagnosed after exposure to traumatic events. Data from two health surveys were combined to create a cohort of 1119 Australian military personnel who deployed to the Middle East between 2000 and 2009. Changes in PTSD Checklist Civilian Version (PCL-C) scores and the reporting of stressful events between the two self-reported surveys were assessed. Logistic regression was used to examine the association between the number of stressful events reported and PTSD symptoms, and assess whether those who reported new stressful events between the two surveys, were also more likely to report older events. We also assessed, using linear regression, whether higher scores on the Kessler Psychological Distress Scale or the Alcohol Use Disorder Identification Test were associated with subsequent increases in the PCL-C in those who had experienced a stressful event, but who initially had few PTSD symptoms. Overall, the mean PCL-C scores in the two surveys were similar, and 78% of responders stayed in the same PCL-C category. Only a small percentage moved from having few symptoms of PTSD (PCL-C < 30) in Survey 1 to meeting the criteria for PTSD (PCL-C ≥ 50) at Survey 2 (1% of all responders, 16% of those with PCL-C ≥ 50 at Survey 2). Personnel who reported more stressful lifetime events were more likely to score higher on the PCL-C. Only 51% reported the same stressful event on both surveys. People who reported events occurring between the two surveys were more likely to record events from before the first survey which they had not previously mentioned (OR 1.48, 95% CI (1.17, 1.88), p < 0.001), than those who did not. In people who initially had few PTSD symptoms, a higher level of psychological distress, was significantly associated with higher PCL-C scores a few years later. The reporting of stressful events varied over time indicating that while the impact of some stressors endure, others may increase or decline in importance. When screening for PTSD, it is important to consider both traumatic experiences on deployment and other stressful life events, as well as other mental health problems among military personnel, even if individuals do not exhibit symptoms of PTSD on an initial assessment.

Effectiveness of an Anger Intervention for Military Members with PTSD: A Clinical Case Series.

PubMed

Cash, Richard; Varker, Tracey; McHugh, Tony; Metcalf, Olivia; Howard, Alexandra; Lloyd, Delyth; Costello, Jacqueline; Said, David; Forbes, David

2018-03-23

Problematic anger is a significant clinical issue in military personnel, and is further complicated by comorbid post-traumatic stress disorder (PTSD). Despite increasing numbers of military personnel returning from deployment with anger and aggression difficulties, the treatment of problematic anger has received scant attention. There are currently no interventions that directly target problematic anger in the context of military-related PTSD. The aim of this case series is to examine the effectiveness of an intervention specifically developed for treating problematic anger in current serving military personnel with comorbid PTSD. Eight Australian Defence Force Army personnel with problematic anger and comorbid PTSD received a manualized 12-session cognitive behaviorally based anger intervention, delivered one-to-one by Australian Defence Force mental health clinicians. Standardized measures of anger, PTSD, depression, and anxiety were administered pre- and post-treatment. The initial mean severity scores for anger indicated a high degree of pre-treatment problematic anger. Anger scores reduced significantly from pre to post-treatment (d = 1.56), with 88% of participants exhibiting meaningful reduction in anger scores. PTSD symptoms also reduced significantly (d= 0.96), with 63% of participants experiencing a clinically meaningful reduction in PTSD scores. All of those who took part in the therapy completed all therapy sessions. This brief report provides preliminary evidence that an intervention for problematic anger not only significantly reduces anger levels in military personnel, but can also significantly reduce PTSD symptoms. Given that anger can interfere with PTSD treatment outcomes, prioritizing anger treatment may improve the effectiveness of PTSD interventions.

The long-term burden of military deployment on the health care system.

PubMed

Eekhout, Iris; Geuze, Elbert; Vermetten, Eric

2016-08-01

Health care providers need to be aware that stress complaints that result from deployment can emerge even after many years. This has important implications for health care policies. The main aim of this study is to investigate the relation between the development of posttraumatic stress and other mental health complaints and the burden on (mental) health care after a deployment. For this study we used data from a large prospective cohort study on stress-factors related to deployment in 1007 Dutch soldiers, who were deployed to Afghanistan. Participants were assessed at six follow up times up until five years after deployment. In a Generalized Estimated Equations model we estimated the relation between mental health complaints and the utilization of psychological treatment and a general practitioner, respectively. Moreover, we studied the relation between mental health complaints and health care costs using bootstrap techniques. The results showed that higher scores for PTSD, depression and fatigue relate to increased use of a psychologist. And lower PTSD scores and higher depression, anxiety and somatization scores relate to increased odds to visit a GP. Furthermore, mental health complaints relate to higher costs. In conclusion, monitoring soldiers is important in order to be informed on the current demand for (mental) health care to satisfy the health care need of veterans. Early treatment, which is enabled by lowering barriers to care, relates to positive results and therefore, lower health care costs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Adaptive Disclosure: A Combat Specific PTSD Treatment

DTIC Science & Technology

2017-03-31

to determine whether AD is as least as effective as CPT, cognitive only version (CPT-C), in terms of its impact on deployment-related psychological ...be used to determine treatment efficacy. 15. SUBJECT TERMS Active-duty, Marine Corps, Posttraumatic stress disorder, Cognitive Therapy 16...the early stages of the wars suggest that 10-18% of combat troops experience deployment-related psychological health problems, such as posttraumatic

The Effects of Combat Exposure on the Military Divorce Rate

DTIC Science & Technology

2012-03-01

veterans of OIF and OEF. The study focused on mental health, specifically the conditions of post -traumatic stress disorder (PTSD), major depressive ...personnel. The thesis uses demographic data from the Defense Manpower Data Center (DMDC) coupled with responses from the post - deployment health...data from the Defense Manpower Data Center (DMDC) coupled with responses from the post -deployment health assessment (PDHA). The sample contains

Risk factors for Post Traumatic Stress Disorder amongst United Kingdom Armed Forces personnel

PubMed Central

Iversen, Amy C; Fear, Nicola T; Ehlers, Anke; Hughes, Jamie Hacker; Hull, Lisa; Earnshaw, Mark; Greenberg, Neil; Rona, Roberto; Wessely, Simon; Hotopf, Matthew

2013-01-01

Background Understanding the factors which increase the risk of PTSD for military personnel is important. This study aims to investigate the relative contribution of pre-deployment, peri-deployment, and post deployment variables to the prevalence of post traumatic stress symptoms in UK Armed Forces personnel who have been deployed in Iraq since 2003. Method Data are drawn from stage 1 of a retrospective cohort study comparing a random sample of UK military personnel deployed to the 2003 Iraq War with a control group who were not deployed to the initial phase of war fighting (response rate 61%). The analyses are limited to 4762 regular service individuals who responded and who deployed to Iraq since 2003. Results Post traumatic stress symptoms were associated with lower rank, being unmarried, low educational attainment and a history of childhood adversity. Exposure to potentially traumatising events was associated with post traumatic stress symptoms. Appraisals of the experience as involving threat to life or that work in theatre was above an individual’s trade and experience were strongly associated with post traumatic stress symptoms Low morale, poor social support within the unit and non-receipt of a homecoming brief were associated with greater risk of post traumatic stress symptoms. Conclusions These results support that there are modifiable occupational factors which may influence an individual’s risk of PTSD. Personal appraisal of threat to life during the trauma emerged as the strongest predictor of symptoms, and therefore interventions focused on reinstating a sense of control are an important focus for treatment. PMID:18226287

Do Sleep Problems Mediate the Relationship between Traumatic Brain Injury and Development of Mental Health Symptoms after Deployment?

PubMed Central

Macera, Caroline A.; Aralis, Hilary J.; Rauh, Mitchell J.; MacGregor, Andrew J.

2013-01-01

Study Objectives: Military members screening positive for blast-related traumatic brain injury (TBI) may subsequently screen positive for posttraumatic stress disorder (PTSD) or depression. The role of sleep as a mediating factor in the development of mental health symptoms was explored. Design: Prospective study with symptoms evaluated at two time points. Setting: Postdeployment service in Iraq, Afghanistan, or Kuwait during 2008 and 2009. Participants: There were 29,640 US Navy and Marine Corps men (29,019 who did not screen positive for PTSD at baseline, 27,702 who did not screen positive for depression at baseline, and 27,320 who did not screen positive at baseline for either condition). Measurements and Results: After controlling for sleep problems, the adjusted odds of receiving a positive PTSD screening at follow-up decreased from 1.61 (95% confidence interval [CI] 1.21–2.14) to 1.32 (95% CI 0.99–1.77) for a subject screening positive for TBI relative to a subject screening negative, suggesting that sleep problems mediated 26% of TBI's effect on development of PTSD. Likewise, after controlling for sleep problems, the adjusted odds of receiving a positive depression screening decreased from 1.41 (95% CI 1.11–1.80) to 1.15 (95% CI 0.90–1.47), suggesting that sleep problems mediated 41% of TBI's effect on development of depression. Results were similar for those with either PTSD or depression (37% mediated). Conclusions: These results suggest that sleep problems mediate the effect of a positive TBI screening on the development of mental health disorders, and sleep problems may be an early indicator of risk for PTSD or depression. Citation: Macera CA; Aralis HJ; Rauh MJ; MacGregor AJ. Do sleep problems mediate the relationship between traumatic brain injury and development of mental health symptoms after deployment? SLEEP 2013;36(1):83–90. PMID:23288974

Multiple physical symptoms in a military population: a cross-sectional study

PubMed Central

2013-01-01

Background Medically unexplained symptoms have been reported among both civilians and military personnel exposed to combat. A large number of military personnel deployed to the Gulf War in 1991 reported non-specific symptoms. These symptoms did not constitute a clearly defined syndrome. Post-traumatic stress disorder (PTSD) and to a lesser degree exposure to combat are associated with physical symptoms. Methods This is a cross-sectional study of representative samples of Sri Lanka Navy Special Forces and regular forces deployed in combat areas continuously during a 1-year period. Multiple physical symptoms were elicited using a checklist of 53 symptoms. Cases were defined as individuals with ten or more symptoms. Symptoms of common mental disorder were identified using the General Health Questionnaire 12 (GHQ-12). PTSD was diagnosed using the 17-item National Centre for PTSD checklist civilian version. Results Prevalence of multiple physical symptoms was 10.4% (95% CI 8.11–12.75). Prevalence was significantly less in the Special Forces (5.79%) than in the regular forces (13.35%). The mean number of symptoms reported by those who met the criteria for PTSD was 12.19 (SD 10.58), GHQ caseness 7.87 (SD 7.57) and those without these conditions 2.84 (SD 3.63). After adjusting for socio-demographic and service variables, ‘thought I might be killed’ , ‘coming under small arms fire’ , and ‘coming under mortar, missile and artillery fire’ remained significant. Multiple physical symptoms were associated with functional impairment and poor perceived general health. Conclusions Prevalence of multiple physical symptoms was significantly lower in the Special Forces despite high exposure to potentially traumatic events. More multiple physical symptoms were reported by personnel with PTSD and common mental disorders. Multiple physical symptoms were associated with functional impairment. PMID:23866109

The Effects of GWOT and Deployment Intensity on the Propensity to Develop Post-Traumatic Stress Disorder (PTSD) among Navy Personnel

DTIC Science & Technology

2008-03-01

In addition to anxiety and depression, symptoms included headaches , anorexia . . . tremors, insomnia, nightmares and palpitation which were...the traumatic event • Hyper awareness (i.e. feel constantly on guard or alert for danger, which may cause trouble sleeping) • Symptoms last longer...of war. It thus becomes much safer to simply say nothing and avoid the feelings . b. World War II Having forgotten the lessons from World War I

Post-traumatic stress disorder in U.S. soldiers with post-traumatic headache.

PubMed

Rosenthal, Jacqueline F; Erickson, Jay C

2013-01-01

To determine the impact of post-traumatic stress disorder (PTSD) on headache characteristics and headache prognosis in U.S. soldiers with post-traumatic headache. PTSD and post-concussive headache are common conditions among U.S. Army personnel returning from deployment. The impact of comorbid PTSD on the characteristics and outcomes of post-traumatic headache has not been determined in U.S. Army soldiers. A retrospective cohort study was conducted among 270 consecutive U.S. Army soldiers diagnosed with post-traumatic headache at a single Army neurology clinic. All subjects were screened for PTSD at baseline using the PTSD symptom checklist. Headache frequency and characteristics were determined for post-traumatic headache subjects with and without PTSD at baseline. Headache measures were reassessed 3 months after the baseline visit, and were compared between groups with and without PTSD. Of 270 soldiers with post-traumatic headache, 105 (39%) met screening criteria for PTSD. There was no significant difference between subjects with PTSD and those without PTSD with regard to headache frequency (17.2 vs 15.7 headache days per month; P = .15) or chronic daily headache (58.1% vs 52.1%; P = .34). Comorbid PTSD was associated with higher headache-related disability as measured by the Migraine Disability Assessment Score. Three months after the baseline neurology clinic visit, the number of subjects with at least 50% reduction in headache frequency was similar among post-traumatic headache cases with and without PTSD (25.9% vs 26.8%). PTSD is prevalent among U.S. Army soldiers with post-traumatic headache. Comorbid PTSD is not associated with more frequent headaches or chronic daily headache in soldiers evaluated at a military neurology clinic for chronic post-traumatic headache. Comorbid PTSD does not adversely affect short-term headache outcomes, although prospective controlled trials are needed to better assess this relationship. © 2013 American Headache Society.

Behavioral and neural correlates of disrupted orienting attention in posttraumatic stress disorder.

PubMed

Russman Block, Stefanie; King, Anthony P; Sripada, Rebecca K; Weissman, Daniel H; Welsh, Robert; Liberzon, Israel

2017-04-01

Prior work has revealed that posttraumatic stress disorder (PTSD) is associated with altered (a) attentional performance and (b) resting-state functional connectivity (rsFC) in brain networks linked to attention. Here, we sought to characterize and link these behavioral and brain-based alterations in the context of Posner and Peterson's tripartite model of attention. Male military veterans with PTSD (N = 49; all deployed to Iraq or Afghanistan) and healthy age-and-gender-matched community controls (N = 26) completed the Attention Network Task. A subset of these individuals (36 PTSD and 21 controls) also underwent functional magnetic resonance imaging (fMRI) to assess rsFC. The behavioral measures revealed that the PTSD group was impaired at disengaging spatial attention, relative to the control group. FMRI measures further revealed that, relative to the control group, the PTSD group exhibited greater rsFC between the salience network and (a) the default mode network, (b) the dorsal attention network, and (c) the ventral attention network. Moreover, problems with disengaging spatial attention increased the rsFC between the networks above in the control group, but not in the PTSD group. The present findings link PTSD to both altered orienting of spatial attention and altered relationships between spatial orienting and functional connectivity involving the salience network. Interventions that target orienting and disengaging spatial attention may be a new avenue for PTSD research.

PTSD in active combat soldiers: to treat or not to treat.

PubMed

Wangelin, Bethany C; Tuerk, Peter W

2014-01-01

In this paper, we consider ethical issues related to the treatment of posttraumatic stress disorder (PTSD) in combat zones, via exposure therapy. Exposure-oriented interventions are the most well-researched behavioral treatments for PTSD, and rigorous studies across contexts, populations, and research groups provide robust evidence that exposure therapy for PTSD is effective and can be widely disseminated. Clinical procedures for Prolonged Exposure therapy, a manualized exposure-oriented protocol for PTSD, are reviewed, and we illustrate the potential benefits, as well as the potential difficulties, associated with providing this treatment in combat zones. Several ethical considerations are identified: (1) Assuming successful treatment, is it ethical to send individuals with a known risk of developing PTSD back into combat? (2) If treatment is unsuccessful in theater (perhaps due to the confounding factor of ongoing danger), could that impact treatment effectiveness for soldiers who attempt therapy again post-deployment? (3) If the military finds combat-zone treatment effective and useful in maintaining an efficient work force, will treatment become mandatory for those diagnosed with PTSD? (4) What unintended consequences might be associated with large-scale dissemination of exposure therapy in or near combat, outside of mental health care infrastructures? (5) How would genetic variations known to be associated with PTSD risk influence decisions regarding who receives treatment or returns to combat? We conclude with a review of the personal and societal costs associated with not providing evidence-based PTSD treatments wherever possible. © 2014 American Society of Law, Medicine & Ethics, Inc.

Deployment, PTSD Symptoms, and Co-morbid Mental Health Conditions in the Active Force and Reserve Components

DTIC Science & Technology

2010-10-01

use, risk taking and impulsive behavior, job satisfaction , deployment, religion/spirituality, and alcohol and tobacco use. The eligible pop- ulation...48.0 374 (7.3) ≥ College graduate 22.1 99 (2.1) 27.2 143 (4.3) Marital Status Married /LAM 58.9 459 (5.1) 57.5 352 (7.6) Unmarried 41.1 437...were married (54.0%). Just over half (56.4%) reported deployment one or more times in the previous 12 months and had a mean PCL-C score of 25.9 (SD

Serum concentrations of TNF-α and its soluble receptors during psychotherapy in German soldiers suffering from combat-related PTSD.

PubMed

Himmerich, Hubertus; Willmund, Gerd D; Zimmermann, Peter; Wolf, Jörg-Egbert; Bühler, Antje H; Kirkby, Kenneth C; Dalton, Bethan; Holdt, Lesca M; Teupser, Daniel; Wesemann, Ulrich

2016-09-01

Changes in serum concentrations of tumor necrosis factor-α (TNF-α) and its soluble receptors (sTNF-R) p55 and p75 have been shown to be associated with various psychiatric treatments. Before and after treatment, serum levels of TNF-α, sTNF-R p55 and sTNF-R p75 were measured in 38 German soldiers who had been deployed abroad and suffered from combat-related post-traumatic stress disorder (PTSD). Patients were randomized either to inpatient psychotherapy (N=21) including eye movement desensitization and reprocessing (EMDR) or to outpatient clinical management (N=17). Symptoms of PTSD were measured using the Post-traumatic Stress Diagnostic Scale (PDS). The PDS score significantly decreased across time in both groups. Serum concentrations of TNF-α increased, while sTNF-R p55 and sTNF-R p75 levels decreased significantly. After the treatment period, we could not detect any significant difference regarding TNF-α, sTNF-R p55 or sTNF-R p75 levels between the inpatient psychotherapy group and the outpatient clinical management control group. This relatively small clinical study suggests that specific inpatient psychotherapy but also non-specific supportive outpatient treatment for PTSD are associated with changes in the TNF-α system. This may represent an immunological effects or side effects of psychotherapy.

STRIVE: Stress Resilience In Virtual Environments: a pre-deployment VR system for training emotional coping skills and assessing chronic and acute stress responses.

PubMed

Rizzo, Albert; Buckwalter, J Galen; John, Bruce; Newman, Brad; Parsons, Thomas; Kenny, Patrick; Williams, Josh

2012-01-01

The incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel is creating a significant healthcare challenge. This has served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. One emerging form of treatment for combat-related PTSD that has shown promise involves the delivery of exposure therapy using immersive Virtual Reality (VR). Initial outcomes from open clinical trials have been positive and fully randomized controlled trials are currently in progress to further validate this approach. Based on our research group's initial positive outcomes using VR to emotionally engage and successfully treat persons undergoing exposure therapy for PTSD, we have begun development in a similar VR-based approach to deliver stress resilience training with military service members prior to their initial deployment. The Stress Resilience In Virtual Environments (STRIVE) project aims to create a set of combat simulations (derived from our existing Virtual Iraq/Afghanistan exposure therapy system) that are part of a multi-episode narrative experience. Users can be immersed within challenging combat contexts and interact with virtual characters within these episodes as part of an experiential learning approach for training a range of psychoeducational and cognitive-behavioral emotional coping strategies believed to enhance stress resilience. The STRIVE project aims to present this approach to service members prior to deployment as part of a program designed to better prepare military personnel for the types of emotional challenges that are inherent in the combat environment. During these virtual training experiences users are monitored physiologically as part of a larger investigation into the biomarkers of the stress response. One such construct, Allostatic Load, is being directly investigated via physiological and neuro-hormonal analysis from specimen collections taken immediately before and after engagement in the STRIVE virtual experience.

Partners’ Attributions for Service Members’ Symptoms of Combat-Related Posttraumatic Stress Disorder

PubMed Central

Renshaw, Keith D.; Allen, Elizabeth S.; Carter, Sarah P.; Markman, Howard J.; Stanley, Scott M.

2014-01-01

The association of service members’ combat-related PTSD with partners’ distress is weaker when spouses/partners believe that service members experienced more traumatic events during deployment. Also, when simultaneously examining partners’ perceptions of all PTSD symptoms, perceptions of re-experiencing symptoms (the symptoms most obviously connected to traumatic events) are significantly, negatively related to distress in partners. These findings are consistent with the notion that partners may be less distressed if they make external, rather than internal, attributions for service members’ symptoms. The present study explicitly tests this possibility. Civilian wives of active duty service members completed measures regarding their own marital satisfaction, their perceptions of service members’ combat exposure during deployments, their perceptions of service members’ symptoms of PTSD, and their attributions for those symptoms. External attributions were significantly, positively associated with perceptions of combat exposure (rp = .31) and re-experiencing symptoms (β = .33) and significantly, negatively associated with perceptions of numbing/withdrawal symptoms (rp = −.22). In contrast, internal attributions were significantly, negatively associated with perceptions of re-experiencing symptoms (β = −.18) and significantly, positively associated with perceptions of numbing/withdrawal symptoms (β = .46). Internal attributions significantly moderated the negative association of PTSD symptoms with marital satisfaction, such that the association strengthened as internal attributions increased. These findings are the first explicit support for an attributional understanding of distress in partners of combat veterans. Interventions that alter partners’ attributions may improve marital functioning. PMID:24491194

A methodology for assessing deployment trauma and its consequences in OEF/OIF/OND veterans: The TRACTS longitudinal prospective cohort study

PubMed Central

McGlinchey, Regina E.; Milberg, William P.; Fonda, Jennifer R.; Fortier, Catherine Brawn

2017-01-01

Many US veterans of Afghanistan and Iraq have multiple physical and psychiatric problems. A major focus of research has been on determining the effects of mild Traumatic Brain Injury (mTBI), but mTBI is rarely diagnosed in the absence of co-occurring conditions such as blast exposure, post-traumatic stress disorder (PTSD), depression, substance abuse, etc. These potentially interactive psychological and physical conditions produce complex patterns of cognitive, psychological, and physical symptoms that impede civilian reintegration and complicate efficient and effective treatment planning. The Translational Research Center for TBI and Stress Disorders (TRACTS) has developed a multidisciplinary approach to the assessment of deployment trauma and its consequences in veterans of these wars. The prospective TRACTS longitudinal cohort study conducts state-of-the-art assessments in the domains of biomedical function, lifetime head trauma, psychological function encompassing deployment experience and lifetime exposure to traumatic events, neuropsychological function, and structural and functional neuroimaging. The TRACTS longitudinal cohort study is the first of its kind to comprehensively evaluate lifetime incidence of TBI and PTSD in these veterans, in addition to those incurred during military deployment. The protocol has begun to reveal information that will help improve understanding of the complex pathophysiology associated with co-occurring mTBI and related stress disorders. PMID:28211592

Postdeployment Behavioral Health Screens and Linkage to the Veterans Health Administration for Army Reserve Component Members

PubMed Central

Vanneman, Megan E.; Harris, Alex H. S.; Chen, Cheng; Adams, Rachel Sayko; Williams, Thomas V.; Larson, Mary Jo

2017-01-01

Objective Approximately three to six months after returning from deployment, military service members complete the Post-Deployment Health Reassessment (PDHRA), which includes screens for alcohol misuse, depression, and post-traumatic stress disorder (PTSD). To determine whether Army Reserve Component (RC) members (Army National Guard and Army Reserve) with positive screening scores on the PDHRA receive needed care, the investigators examined the association between positive scores and enrollment and utilization of care (“linkage”) in the Veterans Health Administration (VHA), as well as rescreening scores, diagnosis, and behavioral treatment in VHA. Methods Mixed-effects regression models were used to predict linkage to VHA within six months after RC members (N=73,164) completed the PDHRA, with alcohol misuse, depression, and PTSD screen scores as key independent variables. Regression models were stratified by gender and National Guard versus Reserve status. Among those who linked to VHA (N=25,168), screening scores and subsequent diagnosis and treatment in VHA were also examined. Results Army RC members with positive PTSD and depression screening scores were more likely than those with negative screens to link to VHA, and most (54%–84%) received VHA treatment once diagnosed. Positive screens for alcohol misuse were associated with linkage to VHA for men but not for women, and treatment rates for alcohol use disorders were relatively low (0%–25%) for both men and women diagnosed as having an alcohol use disorder. Conclusions The finding that Army RC members with greater indications of behavioral health problems linked to VHA is encouraging. However, more outreach and treatment engagement strategies could be directed to those with alcohol use disorder, particularly women. PMID:28412888

Effects of therapeutic horseback riding on post-traumatic stress disorder in military veterans.

PubMed

Johnson, Rebecca A; Albright, David L; Marzolf, James R; Bibbo, Jessica L; Yaglom, Hayley D; Crowder, Sandra M; Carlisle, Gretchen K; Willard, Amy; Russell, Cynthia L; Grindler, Karen; Osterlind, Steven; Wassman, Marita; Harms, Nathan

2018-01-19

Large numbers of post-deployment U.S. veterans are diagnosed with post-traumatic stress disorder (PTSD) and/or traumatic brain injury (TBI), leading to an urgent need for effective interventions to reduce symptoms and increase veterans' coping. PTSD includes anxiety, flashbacks, and emotional numbing. The symptoms increase health care costs for stress-related illnesses and can make veterans' civilian life difficult. We used a randomized wait-list controlled design with repeated measures of U.S. military veterans to address our specific aim to test the efficacy of a 6-week therapeutic horseback riding (THR) program for decreasing PTSD symptoms and increasing coping self-efficacy, emotion regulation, social and emotional loneliness. Fifty-seven participants were recruited and 29 enrolled in the randomized trial. They were randomly assigned to either the horse riding group (n = 15) or a wait-list control group (n = 14). The wait-list control group experienced a 6-week waiting period, while the horse riding group began THR. The wait-list control group began riding after 6 weeks of participating in the control group. Demographic and health history information was obtained from all the participants. PTSD symptoms were measured using the standardized PTSD Checklist-Military Version (PCL-M). The PCL-M as well as other instruments including, The Coping Self Efficacy Scale (CSES), The Difficulties in Emotion Regulation Scale (DERS) and The Social and Emotional Loneliness Scale for Adults-short version (SELSA) were used to access different aspects of individual well-being and the PTSD symptoms. Participants had a statistically significant decrease in PTSD scores after 3 weeks of THR (P ≤ 0.01) as well as a statistically and clinically significant decrease after 6 weeks of THR (P ≤ 0.01). Logistic regression showed that participants had a 66.7% likelihood of having lower PTSD scores at 3 weeks and 87.5% likelihood at 6 weeks. Under the generalized linear model(GLM), our ANOVA findings for the coping self-efficacy, emotion regulation, and social and emotional loneliness did not reach statistical significance. The results for coping self-efficacy and emotion regulation trended in the predicted direction. Results for emotional loneliness were opposite the predicted direction. Logistic regression provided validation that outcome effects were caused by riding longer. The findings suggest that THR may be a clinically effective intervention for alleviating PTSD symptoms in military veterans.

Posttraumatic stress disorder and traumatic brain injury in current military populations: a critical analysis.

PubMed

Wall, Pamela L Herbig

2012-01-01

The use of unconventional weaponry combined with decreased mortality rates and servicemembers being exposed to intense ground combat during multiple deployments has increased the risk of servicemembers living with the consequences of traumatic brain injuries (TBI) and combat operational stress. The purpose of this article is to perform a critical analysis of the literature to identify current rates of comorbid posttraumatic stress disorder (PTSD) and TBI in military and veteran populations who have served in Iraq or Afghanistan and their combined effects on persistent postconcussive symptoms. A search of the literature with military and veteran populations published after 2001 in Pubmed, OVID/Medline, Cochran Database, Embase, Scopus, CINAHL, and PsychInfo was conducted using keywords. Twenty studies met inclusion criteria. The literature search yielded mixed results for rates of PTSD, TBI, and comorbid conditions. There is some evidence that comorbid PTSD and TBI result in greater reports of postconcussive symptomology than either condition alone. Limitations include lack of consistency of measurements, sampling biases, and lack of experimental design, and these warrant further exploration. Future research is needed to decrease variability in study findings and elucidate relationships between these disorders and their effects on persistent postconcussive symptomology.

Genome-wide Association Studies of Posttraumatic Stress Disorder in 2 Cohorts of US Army Soldiers.

PubMed

Stein, Murray B; Chen, Chia-Yen; Ursano, Robert J; Cai, Tianxi; Gelernter, Joel; Heeringa, Steven G; Jain, Sonia; Jensen, Kevin P; Maihofer, Adam X; Mitchell, Colter; Nievergelt, Caroline M; Nock, Matthew K; Neale, Benjamin M; Polimanti, Renato; Ripke, Stephan; Sun, Xiaoying; Thomas, Michael L; Wang, Qian; Ware, Erin B; Borja, Susan; Kessler, Ronald C; Smoller, Jordan W

2016-07-01

Posttraumatic stress disorder (PTSD) is a prevalent, serious public health concern, particularly in the military. The identification of genetic risk factors for PTSD may provide important insights into the biological foundation of vulnerability and comorbidity. To discover genetic loci associated with the lifetime risk for PTSD in 2 cohorts from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Two coordinated genome-wide association studies of mental health in the US military contributed participants. The New Soldier Study (NSS) included 3167 unique participants with PTSD and 4607 trauma-exposed control individuals; the Pre/Post Deployment Study (PPDS) included 947 unique participants with PTSD and 4969 trauma-exposed controls. The NSS data were collected from February 1, 2011, to November 30, 2012; the PDDS data, from January 9 to April 30, 2012. The primary analysis compared lifetime DSM-IV PTSD cases with trauma-exposed controls without lifetime PTSD. Data were analyzed from March 18 to December 27, 2015. Association analyses for PTSD used logistic regression models within each of 3 ancestral groups (European, African, and Latino American) by study, followed by meta-analysis. Heritability and genetic correlation and pleiotropy with other psychiatric and immune-related disorders were estimated. The NSS population was 80.7% male (6277 of 7774 participants; mean [SD] age, 20.9 [3.3] years); the PPDS population, 94.4% male (5583 of 5916 participants; mean [SD] age, 26.5 [6.0] years). A genome-wide significant locus was found in ANKRD55 on chromosome 5 (rs159572; odds ratio [OR], 1.62; 95% CI, 1.37-1.92; P = 2.34 × 10-8) and persisted after adjustment for cumulative trauma exposure (adjusted OR, 1.64; 95% CI, 1.39-1.95; P = 1.18 × 10-8) in the African American samples from the NSS. A genome-wide significant locus was also found in or near ZNF626 on chromosome 19 (rs11085374; OR, 0.77; 95% CI, 0.70-0.85; P = 4.59 × 10-8) in the European American samples from the NSS. Similar results were not found for either single-nucleotide polymorphism in the corresponding ancestry group from the PPDS sample, in other ancestral groups, or in transancestral meta-analyses. Single-nucleotide polymorphism-based heritability was nonsignificant, and no significant genetic correlations were observed between PTSD and 6 mental disorders or 9 immune-related disorders. Significant evidence of pleiotropy was observed between PTSD and rheumatoid arthritis and, to a lesser extent, psoriasis. In the largest genome-wide association study of PTSD to date, involving a US military sample, limited evidence of association for specific loci was found. Further efforts are needed to replicate the genome-wide significant association with ANKRD55-associated in prior research with several autoimmune and inflammatory disorders-and to clarify the nature of the genetic overlap observed between PTSD and rheumatoid arthritis and psoriasis.

Associations of military sexual trauma, combat exposure, and number of deployments with physical and mental health indicators in Iraq and Afghanistan veterans.

PubMed

Godfrey, Kathryn M; Mostoufi, Sheeva; Rodgers, Carie; Backhaus, Autumn; Floto, Elizabeth; Pittman, James; Afari, Niloofar

2015-11-01

Trauma exposure (TE) and numerous deployments have been associated with negative health outcomes in veterans, many of whom have military sexual trauma (MST) and combat exposure (CE). The aims of this study were to examine the relationships between physical and mental health symptoms with MST and CE and number of deployments. Iraq and Afghanistan veterans at the Veterans Affairs San Diego Healthcare System completed self-report measures for MST, CE, number of deployments, posttraumatic stress disorder (PTSD) symptoms, depression symptoms, alcohol use, somatic symptoms, health functioning, and body mass index (BMI). Regression analyses examined main and interaction effects of CE and MST and the linear and quadratic trends of number of deployments. The sample (N = 1,294) had a mean age of 31 and was 85% male. The MST by CE interaction on BMI was significant (p = .005), such that MST was associated with lower BMI in veterans with CE and with higher BMI in veterans without CE. MST and CE were associated with higher somatic, PTSD, and depression symptoms and with lower mental health functioning (ps < .001 to .002). CE was associated with lower physical health functioning and higher alcohol use (ps < .001 to .025). Number of deployments was linearly related to higher BMI (p = .004) and had a quadratic association with alcohol use (p = .008). Findings highlight the relationship between TE and poor health outcomes and the need to further study the mechanisms of TE on physical and mental health. (c) 2015 APA, all rights reserved).

Serum concentrations of TNF-α, sTNF-R p55 and p75 and post-traumatic stress in German soldiers.

PubMed

Himmerich, Hubertus; Willmund, Gerd D; Zimmermann, Peter; Wolf, Jörg-Egbert; Bühler, Antje H; Holdt, Lesca M; Teupser, Daniel; Kirkby, Kenneth C; Wesemann, Ulrich

2015-09-01

Growing evidence suggests involvement of the tumor necrosis factor (TNF)-α system in the pathophysiology of psychiatric disorders. Research into post-traumatic stress disorder (PTSD) has investigated serum levels of TNF-α, but not to date its soluble receptors sTNF-R p55 and sTNF-R p75. We examined serum levels of TNF-α, sTNF-R p55 and sTNF-R p75 in 135 male German soldiers 70 of whom had been deployed abroad and 65 in Germany only. Post-traumatic stress symptoms were measured using the Post-traumatic Stress Diagnostic Scale (PDS) and the Trier Inventory for the Assessment of Chronic Stress (TICS). Correlational analysis controlling for multiple testing, showed no significant Spearman rank correlations between PDS or TICS scores and serum levels of TNF-α, sTNF-R p55 or sTNF-R p75, either in the full sample or in the group of soldiers who had been deployed abroad. ANCOVAs showed no significant differences between soldiers with or without a PDS-derived diagnosis of PTSD, or between soldiers with or without deployment abroad, after controlling for age, smoking and body mass index (BMI). These results suggest that the TNF-α system, as reflected by TNF-α, sTNF-R p55 and sTNF-R p75 serum levels, does not play a major role in the pathophysiology and development of PTSD symptoms as measured by the PDS and the TICS. However, several methodological and contextual issues have to be considered.

PTSD Trajectory, Comorbidity, and Utilization of Mental Health Services Among Reserves

DTIC Science & Technology

2010-07-01

Looking for work or unemployed 6 Retired 7 A homemaker 8 A student 9 On maternity or paternity leave 10 On illness or sick leave 11 On disability... benefits to participants. If this work is successful in identifying features of deployment that are associated with better long-term mental health...direct benefits to participants. If this work is successful in identifying features of deployment that are associated with better long-term mental

Risk Propensity and Health Risk Behaviors in U.S. Army Soldiers with and without Psychological Disturbances across the Deployment Cycle

DTIC Science & Technology

2012-02-09

screening instruments, participants were categorized with respect to PTSD and probable TBI. Results suggest that Soldiers engage in more alcohol use and...a longitudinal study will provide stronger evidence to our understanding of the relationships between deployment and adverse health outcomes...and alcohol use, and cost-benefit analysis tasks. The results of this study showed that cognitive regulation was predictive of rational decision

The Effects of Prior Combat Experience on the Expression of Somatic and Affective Symptoms in Deploying Soldiers

DTIC Science & Technology

2006-01-01

Journal of Psychosomatic ResThe effects of prior combat experience on the expression of somatic and affective symptoms in deploying soldiers William...rates of somatic complaints compared with combat-naive soldiers. Methods: Self-reports of posttraumatic stress disorder (PTSD) and affective and somatic ...identical for the experienced and inexperienced groups, scores on the Affective and Somatic scales differed as a function of prior combat history. Previous

Traumatic events, other operational stressors and physical and mental health reported by Australian Defence Force personnel following peacekeeping and war-like deployments

PubMed Central

2012-01-01

Background The association between stressful events on warlike deployments and subsequent mental health problems has been established. Less is known about the effects of stressful events on peacekeeping deployments. Methods Two cross sectional studies of the Australian Defence Force were used to contrast the prevalence of exposures reported by a group deployed on a peacekeeping operation (Bougainville, n = 1704) and those reported by a group deployed on operations which included warlike and non-warlike exposures (East Timor, n = 1333). A principal components analysis was used to identify groupings of non-traumatic exposures on deployment. Multiple regression models were used to assess the association between self-reported objective and subjective exposures, stressors on deployment and subsequent physical and mental health outcomes. Results The principal components analysis produced four groups of non-traumatic stressors which were consistent between the peacekeeping and more warlike deployments. These were labelled ‘separation’, ‘different culture’, ‘other people’ and ‘work frustration’. Higher levels of traumatic and non-traumatic exposures were reported by veterans of East Timor compared to Bougainville. Higher levels of subjective traumatic exposures were associated with increased rates of PTSD in East Timor veterans and more physical and psychological health symptoms in both deployed groups. In Bougainville and East Timor veterans some non-traumatic deployment stressors were also associated with worse health outcomes. Conclusion Strategies to best prepare, identify and treat those exposed to traumatic events and other stressors on deployment should be considered for Defence personnel deployed on both warlike and peacekeeping operations. PMID:22830494

Traumatic events, other operational stressors and physical and mental health reported by Australian Defence Force personnel following peacekeeping and war-like deployments.

PubMed

Waller, Michael; Treloar, Susan A; Sim, Malcolm R; McFarlane, Alexander C; McGuire, Annabel C L; Bleier, Jonathan; Dobson, Annette J

2012-07-26

The association between stressful events on warlike deployments and subsequent mental health problems has been established. Less is known about the effects of stressful events on peacekeeping deployments. Two cross sectional studies of the Australian Defence Force were used to contrast the prevalence of exposures reported by a group deployed on a peacekeeping operation (Bougainville, n = 1704) and those reported by a group deployed on operations which included warlike and non-warlike exposures (East Timor, n = 1333). A principal components analysis was used to identify groupings of non-traumatic exposures on deployment. Multiple regression models were used to assess the association between self-reported objective and subjective exposures, stressors on deployment and subsequent physical and mental health outcomes. The principal components analysis produced four groups of non-traumatic stressors which were consistent between the peacekeeping and more warlike deployments. These were labelled 'separation', 'different culture', 'other people' and 'work frustration'. Higher levels of traumatic and non-traumatic exposures were reported by veterans of East Timor compared to Bougainville. Higher levels of subjective traumatic exposures were associated with increased rates of PTSD in East Timor veterans and more physical and psychological health symptoms in both deployed groups. In Bougainville and East Timor veterans some non-traumatic deployment stressors were also associated with worse health outcomes. Strategies to best prepare, identify and treat those exposed to traumatic events and other stressors on deployment should be considered for Defence personnel deployed on both warlike and peacekeeping operations.

Anger intensification with combat-related PTSD and depression comorbidity.

PubMed

Gonzalez, Oscar I; Novaco, Raymond W; Reger, Mark A; Gahm, Gregory A

2016-01-01

Anger is becoming more widely recognized for its involvement in the psychological adjustment problems of current war veterans. Recent research with combat veterans has found anger to be related to psychological distress, psychosocial functioning, and harm risk variables. Using behavioral health data for 2,077 treatment-seeking soldiers who had been deployed to Iraq and Afghanistan, this study examined whether anger disposition was intensified for those who met screen-threshold criteria for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Anger was assessed with a 7-item screening measure previously validated with the study population. The study tested the hypothesis that anger would be highest when "PTSD & MDD" were conjoined, compared with "PTSD only," "MDD only," and "no PTSD, no MDD." PTSD and depression were assessed with well-established screening instruments. A self-rated "wanting to harm others" variable was also incorporated. Age, gender, race, military component, military grade, and military unit social support served as covariates. Hierarchical multiple regression was used to test the hypothesis, which was confirmed. Anger was intensified in the PTSD & MDD condition, in which it was significantly higher than in the other 3 conditions. Convergent support was obtained for "wanting to harm others" as an exploratory index. Given the high prevalence and co-occurrence of PTSD and MDD among veterans, the results have research and clinical practice relevance for systematic inclusion of anger assessment postdeployment from risk-assessment and screening standpoints. (c) 2016 APA, all rights reserved).

Type D personality and the development of PTSD symptoms: a prospective study.

PubMed

Rademaker, Arthur R; van Zuiden, Mirjam; Vermetten, Eric; Geuze, Elbert

2011-05-01

Psychological trauma and prolonged stress may cause mental disorders such as posttraumatic stress disorder (PTSD). Pretrauma personality is an important determinant of posttraumatic adjustment. Specifically, trait neuroticism has been identified as a risk factor for PTSD. Additionally, the combination of high negative affectivity or neuroticism with marked social inhibition or introversion, also called Type D personality (Denollet, 2000), may compose a risk factor for PTSD. There is no research available that examined pretrauma Type D personality in relation to PTSD. The present study examined the predictive validity of the Type D personality construct in a sample of Dutch soldiers. Data were collected prior to and 6 months after military deployment to Afghanistan. Separate multiple regression analyses were performed to examine the predictive validity of Type D personality. First, Type D personality was defined as the interaction between negative affect and social inhibition (Na × Si). In a second analysis, Type D was defined following cutoff criteria recommended by Denollet (2000). Results showed that negative affectivity was a significant predictor of PTSD symptoms. Social inhibition and the interaction Na × Si did not add to the amount of explained variance in postdeployment PTSD scores over the effects of childhood abuse, negative affectivity, and prior psychological symptoms. A second analysis showed that Type D personality (dichotomous) did not add to the amount of explained variance in postdeployment PTSD scores over the effects of childhood abuse, and prior psychological symptoms. Therefore, Type D personality appears to be of limited value to explain development of combat-related PTSD symptoms.

Professional Stress and Burnout in U.S. Military Medical Personnel Deployed to Afghanistan.

PubMed

Adler, Amy B; Adrian, Amanda L; Hemphill, Marla; Scaro, Nicole H; Sipos, Maurice L; Thomas, Jeffrey L

2017-03-01

Studies of medical staff members have consistently documented high levels of burnout compared to those in other professions. Although there are studies of burnout in military medical staff, there are gaps in understanding the experience of medical staff while they are deployed and few occupationally-related factors associated with decreased burnout have been identified in this population. To assess work-related variables accounting for burnout over and above rank, post-traumatic stress disorder (PTSD) symptoms, and professional stressors in the deployed environment. U.S. military medical staff members were surveyed in Afghanistan. The survey assessed burnout (emotional exhaustion and depersonalization), PTSD symptoms, perception of professional stressors, self-care behaviors, taking care of team members (team care), general leadership, and health-promoting leadership. Participants provided informed consent under a protocol approved by the institutional review board at Walter Reed Army Institute of Research, and coordinated through the Washington Headquarters Service and the Joint Casualty Care Research Team located in Afghanistan. A total of 344 individuals provided their consent (83.3%) and completed the survey. Correlations found significant positive relationships between perception of professional stressors and levels of burnout. Significant negative correlations were found between burnout and self-care, team care, general leadership, and health-promoting leadership. Regression analyses found self-care and team care accounted for less burnout even after controlling for rank, PTSD symptoms, and professional stressors. Health-promoting leadership accounted for less burnout even after controlling for these same covariates and general leadership as well. Although a cross-sectional survey, results provide three specific directions for reducing burnout in deployed medical staff. By emphasizing self-care, team care, and health-promoting leadership, policy makers, researchers, and leaders can address factors that influence burnout in this, and other occupational contexts. In addition, the constructs of team care and leadership offer novel contributions to the study of burnout in medical personnel. Reprint & Copyright © of 2017 Association Military Surgeons of the U.S.

Psychotrauma and effective treatment of post-traumatic stress disorder in soldiers and peacekeepers

PubMed Central

Vitzthum, Karin; Mache, Stefanie; Joachim, Ricarda; Quarcoo, David; Groneberg, David A

2009-01-01

Psychotrauma occurs as a result to a traumatic event, which may involve witnessing someone's actual death or personally experiencing serious physical injury, assault, rape and sexual abuse, being held as a hostage, or a threat to physical or psychological integrity. Post-traumatic stress disorder (PTSD) is an anxiety disorder and was defined in the past as railway spine, traumatic war neurosis, stress syndrome, shell shock, battle fatigue, combat fatigue, or post-traumatic stress syndrome (PTSS). If untreated, post-traumatic stress disorder can impair relationships of those affected and strain their families and society. Deployed soldiers are especially at a high risk to be affected by PTSD but often receive inadequate treatment. Reviews to date have focused only on a single type of treatment or groups of soldiers from only one country. The aim of the current review was to evaluate characteristics of therapeutic methods used internationally to treat male soldiers' PTSD after peacekeeping operations in South Eastern Europe and the Gulf wars. This systematic literature review returned results pertaining to the symptoms, diagnosis, timing and effectiveness of treatment. Sample groups and controls were relatively small and, therefore, the results lack generalizability. Further research is needed to understand the influence and unique psychological requirements of each specific military operation on the internationally deployed soldiers. PMID:19643016

Identifying latent profiles of posttraumatic stress and major depression symptoms in Canadian veterans: Exploring differences across profiles in health related functioning.

PubMed

Armour, Cherie; Contractor, Ateka; Elhai, Jon D; Stringer, Maurice; Lyle, Gary; Forbes, David; Richardson, J Don

2015-07-30

Posttraumatic stress disorder (PTSD) has been consistently reported as being highly comorbid with major depressive disorder (MDD) and as being associated with health related functional impairment (HRF). We used archival data from 283 previously war-zone deployed Canadian veterans. Latent profile analysis (LPA) was used to uncover patterns of PTSD and MDD comorbidity as measured via the PTSD Checklist-Military version (PCL-M) and the Patient Health Questionnaire-9 (PHQ-9). Individual membership of latent classes was used in a series of one-way ANOVAs to ascertain group differences related to HRF as measured via the Short-Form-36 Health Survey (SF-36). LPA resulted in three discrete patterns of PTSD and MDD comorbidity which were characterized by high symptoms of PTSD and MDD, moderate symptoms, and low symptoms. All ANOVAs comparing class membership on the SF-36 subscales were statistically significant demonstrating group differences across levels of HRF. The group with the highest symptoms reported the worst HRF followed by the medium and low symptom groups. These findings are clinically relevant as they demonstrate the need for continual assessment and targeted treatment of co-occurring PTSD and MDD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

An analysis of post-traumatic stress symptoms in United States Air Force drone operators.

PubMed

Chappelle, Wayne; Goodman, Tanya; Reardon, Laura; Thompson, William

2014-06-01

Remotely piloted aircraft (RPA), commonly referred to as "drones," have emerged over the past decade as an innovative warfighting tool. Given there is a paucity of empirical research assessing drone operators, the purpose of this study was to assess for the prevalence of PTSD symptoms among this cohort. Of the 1084 United States Air Force (USAF) drone operators that participated, a total of 4.3% endorsed a pattern of symptoms of moderate to extreme level of severity meeting criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders-4th edition. The incidence of PTSD among USAF drone operators in this study was lower than rates of PTSD (10-18%) among military personnel returning from deployment but higher than incidence rates (less than 1%) of USAF drone operators reported in electronic medical records. Although low PTSD rates may be promising, limitations to this study are discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Psychiatric disorder in veterans of the Persian Gulf War of 1991. Systematic review.

PubMed

Stimpson, Nicola J; Thomas, Hollie V; Weightman, Alison L; Dunstan, Frank; Lewis, Glyn

2003-05-01

Veterans of the Persian Gulf War of 1991 have reported symptoms attributed to their military service. To review all studies comparing the prevalence of psychiatric disorders in Gulf War veterans and in a comparison group of service personnel not deployed to the Gulf War. Studies of military personnel deployed to the Gulf published between 1990 and 2001 were identified from electronic databases. Reference lists and websites were searched and key researchers were contacted for information. A total of 2296 abstracts and 409 complete articles were reviewed and data were extracted independently by two members of the research team. The prevalence of psychiatric disorder in 20 studies of Gulf War veterans was compared with the prevalence in the comparison group. Prevalence of post-traumatic stress disorder (PTSD) and common mental disorder were higher in the Gulf War veterans. Heterogeneity between studies was significant, but all reported this increased prevalence. Veterans of the Persian Gulf War reported an increased prevalence of PTSD and common mental disorder compared with other active service personnel not deployed to the Gulf. These findings are attributable to the increase in psychologically traumatic events in wartime.

Reintegrating Troops with Mild Traumatic Brain Injury (mTBI) into Their Communities: Understanding the Scope and Timeline of Post-Deployment Driving Problems

DTIC Science & Technology

2012-08-01

features/ptsd.asp http://www .ndtv .com/article/ world /back-from- war -fear-and-danger-fill-driver-s- seat-165831 • Refereed Research Posters: o Goldman SB...OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for...NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1 . REPORT DATE (DD-MM-YYYY) 2. REPORT TYPE 3. DATES COVERED (From - To) 4. TITLE AND SUBTITLE 5a

Association of trauma exposure with psychiatric morbidity in military veterans who have served since September 11, 2001

PubMed Central

Dedert, Eric A.; Green, Kimberly T.; Calhoun, Patrick S.; Yoash-Gantz, Ruth; Taber, Katherine H.; Mumford, Marinell Miller; Tupler, Larry A.; Morey, Rajendra A.; Marx, Christine E.; Weiner, Richard D.; Beckham, Jean C.

2009-01-01

Objective This study examined the association of lifetime traumatic stress with psychiatric diagnostic status and symptom severity in veterans serving in the US military after 9/11/01. Method Data from 356 US military veterans were analyzed. Measures included a standardized clinical interview measure of psychiatric disorders, and paper-and-pencil assessments of trauma history, demo-graphic variables, intellectual functioning, posttraumatic stress disorder (PTSD) symptoms, depression, alcohol misuse, and global distress. Results Ninety-four percent of respondents reported at least one traumatic stressor meeting DSM-IV criterion A for PTSD (i.e., life threatening event to which the person responded with fear, helplessness or horror), with a mean of four criterion A traumas. Seventy-one percent reported serving in a war-zone, with 50% reporting occurrence of an event meeting criterion A. The rate of current psychiatric disorder in this sample was: 30% PTSD, 20% major depressive disorder, 6% substance abuse or dependence and 10% for the presence of other Axis I psychiatric disorders. After accounting for demographic covariates and combat exposure, childhood physical assault and accident/disasters were most consistently associated with increased likelihood of PTSD. However, PTSD with no comorbid major depressive disorder or substance use disorder was predicted only by combat exposure and adult physical assault. Medical/unexpected-death trauma and adult physical assault were most consistently associated with more severe symptomatology. Conclusions Particular categories of trauma were differentially associated with the risk of psychiatric diagnosis and current symptom severity. These findings underscore the importance of conducting thorough assessment of multiple trauma exposures when evaluating recently post-deployed veterans. PMID:19232639

75 FR 39843 - Stressor Determinations for Posttraumatic Stress Disorder

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-13

... Posttraumatic Stress Disorder AGENCY: Department of Veterans Affairs. ACTION: Final rule. SUMMARY: The... posttraumatic stress disorder (PTSD) by liberalizing in some cases the evidentiary standard for establishing the... Psychosocial Effects of Deployment- Related Stress, 319 (2008) (IOM Report), which states: The epidemiologic...

Examination of the dynamic interplay between posttraumatic stress symptoms and alcohol misuse among combat-exposed Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) Veterans.

PubMed

Langdon, Kirsten J; Fox, Annie B; King, Lynda A; King, Daniel W; Eisen, Susan; Vogt, Dawne

2016-05-15

Although alcohol misuse co-occurs with PTSD symptoms at a strikingly high rate (i.e., nearly 52% of men and 28% of women with PTSD also meet diagnostic criteria for an Alcohol Use Disorder), the functional associations between these symptom types remain unclear. The current study sought to clarify the nature of posttraumatic stress-alcohol misuse relations by employing a prospective longitudinal methodology-the latent difference score approach-to examine dynamic change in posttraumatic stress symptoms and alcohol misuse among 478 combat-exposed Veterans completing a longitudinal survey of post-deployment mental and physical health. This study builds on the existing literature, as most prior research has been limited to cross-sectional studies and has not explored prospective relations between specific PTSD symptom clusters and alcohol misuse. Consistent with the self-medication model, results indicated that PTSD symptoms demonstrate a prospective and proximal association with alcohol misuse during the assessment period; however, alcohol misuse did not appear to be a unique contributor to overall PTSD symptom exacerbation over time. Examination of individual PTSD symptom clusters revealed that more severe symptoms of intrusion and numbing, but not avoidance and hyperarousal, predicted greater alcohol misuse at subsequent time intervals. The constructs examined within this investigation relied on self-report data; diagnostic criteria for PTSD and/or Alcohol Use Disorders were not assessed. Future work may benefit from replicating these findings in clinical populations formally diagnosed with PTSD via clinician-administered structured interviews. Findings underscore the importance of addressing PTSD symptoms in the context of alcohol treatment to facilitate improved drinking outcomes. Copyright © 2016 Elsevier B.V. All rights reserved.

Examination of the Dynamic Interplay between Posttraumatic Stress Symptoms and Alcohol Misuse among Combat-Exposed Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) Veterans

PubMed Central

Langdon, Kirsten J.; Fox, Annie B.; King, Lynda A.; King, Daniel W.; Eisen, Susan; Vogt, Dawne

2016-01-01

Background Although alcohol misuse co-occurs with PTSD symptoms at a strikingly high rate (i.e., nearly 52% of men and 28% of women with PTSD also meet diagnostic criteria for an Alcohol Use Disorder; Kessler et al., 1995), the functional associations between these symptom types remain unclear. Methods The current study sought to clarify the nature of posttraumatic stress-alcohol misuse relations by employing a prospective longitudinal methodology - the latent difference score approach - to examine dynamic change in posttraumatic stress symptoms and alcohol misuse among 478 combat-exposed Veterans completing a longitudinal survey of post-deployment mental and physical health. This study builds on the existing literature, as most prior research has been limited to cross-sectional studies and has not explored prospective relations between specific PTSD symptom clusters and alcohol misuse. Results Consistent with the self-medication model, results indicated that PTSD symptoms demonstrate a prospective and proximal association with alcohol misuse during the assessment period; however, alcohol misuse did not appear to be a unique contributor to overall PTSD symptom exacerbation over time. Examination of individual PTSD symptom clusters revealed that more severe symptoms of intrusion and numbing, but not avoidance and hyperarousal, predicted greater alcohol misuse at subsequent time intervals. Limitations The constructs examined within this investigation relied on self-report data; diagnostic criteria for PTSD and/or Alcohol Use Disorders were not assessed. Future work may benefit from replicating these findings in clinical populations formally diagnosed with PTSD via clinician-administered structured interviews. Conclusions Findings underscore the importance of addressing PTSD symptoms in the context of alcohol treatment to facilitate improved drinking outcomes. PMID:26938966

The Effects of Alcohol Problems, PTSD, and Combat Exposure on Nonphysical and Physical Aggression Among Iraq and Afghanistan War Veterans

PubMed Central

Stappenbeck, Cynthia A.; Hellmuth, Julianne C.; Simpson, Tracy; Jakupcak, Matthew

2014-01-01

Aggression among combat veterans is of great concern. Although some studies have found an association between combat exposure and aggressive behavior following deployment, others conclude that aggression is more strongly associated with symptoms of posttraumatic stress disorder (PTSD), and that alcohol misuse may influence this association. Many of these studies have assessed aggression as a single construct, whereas the current study explored both nonphysical aggression only and physical aggression in a sample of Iraq and Afghanistan war veterans (N = 337; 91% male). We found that alcohol problems interacted with PTSD symptom severity to predict nonphysical aggression only. At low levels of PTSD symptoms, veterans with alcohol problems were more likely to perpetrate nonphysical aggression only, as compared with no aggression, than veterans without an alcohol problem. There was no difference in the likelihood of nonphysical aggression only between those with and without alcohol problems at high levels of PTSD symptoms. The likelihood of nonphysical aggression only, as compared with no aggression, was also greater among younger veterans. Greater combat exposure and PTSD symptom severity were associated with an increased likelihood of perpetrating physical aggression, as compared with no aggression. Ethnic minority status and younger age were also associated with physical aggression, as compared with no aggression. Findings suggest that a more detailed assessment of veterans’ aggressive behavior, as well as their alcohol problems and PTSD symptoms, by researchers and clinicians is needed in order to determine how best to intervene. PMID:25225593

A Decade of War: Prospective Trajectories of Posttraumatic Stress Disorder Symptoms Among Deployed US Military Personnel and the Influence of Combat Exposure (Publisher’s Version)

DTIC Science & Technology

2017-09-27

physical health (5) of service mem- bers. In addition, previous research indicates that exposure to combat may increase the likelihood of negative health ... physical , and behavioral health , studies have shown few negative effects of deployment with respect to posttraumatic stress disorder (PTSD) (10...American Journal of Epidemiology Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2017. This

Association of Predeployment Gaze Bias for Emotion Stimuli With Later Symptoms of PTSD and Depression in Soldiers Deployed in Iraq

DTIC Science & Technology

2011-01-01

Res Ther 1997; 35:297–303 13. Rinck M, Becker ES: Spider fearful individuals attend to threat, then quickly avoid it: evidence from eye movements. J Ab ...Slymen DJ, Sallis JF, Kritz- Silverstein D: New onset and persistent symptoms of post- traumatic stress disorder self reported after deployment and...26. Bliese PD, Wright KM, Adler AB , Cabrera O, Castro CA, Hoge CW: Validating the Primary Care Posttraumatic Stress Disorder Screen and the

Perceptions of Individual and Family Functioning Among Deployed Female National Guard Members.

PubMed

Kelly, Patricia J; Cheng, An-Lin; Berkel, LaVerne A; Nilsson, Johanna

2016-08-01

Females currently make up 15% of U.S. military service members. Minimal attention has been paid to families of female National Guard members who have been deployed and their subsequent reintegration challenges. This cross-sectional Internet-based survey of female members of four National Guard units compared those who were and were not deployed. Instruments, guided by the variables of the Family Resilience Model, measured individual, family, and deployment-related factors. Bivariate analysis and ordinal logistic regression were done to assess differences between the groups. Of the 239 National Guard members surveyed, deployed women (n = 164) had significantly higher levels of posttraumatic stress disorder (PTSD; p < .001) and lower coping skills (p = .003) than non-deployed women (n = 75). Perceptions of overall family functioning were higher among deployed when compared with never deployed women. Results indicate community interventions that focus on strengthening coping skills of female Guard members would be useful for this population. © The Author(s) 2016.

Mediation and Moderation of the Relationship Between Combat Experiences and Post-Traumatic Stress Symptoms in Active Duty Military Personnel.

PubMed

Steele, Marshall; Germain, Anne; Campbell, Justin S

2017-05-01

Post-traumatic stress disorder (PTSD) is a major health concern among the U.S. military population, affecting up to 12% to 24% of veterans returning from Iraq and Afghanistan. Sleep disturbances, neuroticism, and childhood trauma have all been associated with the development of PTSD in military populations, especially in relation to combat experiences. The effects of disrupted sleep and post-traumatic stress can affect the physical well-being of soldier and sailors in the field and impact them for years after deployment. This study aimed to evaluate the relationship between self-reported measures of combat experiences, PTSD symptoms, sleep, neuroticism, and childhood adversity in an active duty military population. 972 U.S. Navy Sailors serving in Afghanistan were given anonymous surveys that assess scales of combat stressors, PTSD symptoms, sleep problems, neuroticism, adverse child experiences (ACEs), and other covariates. Sleep disturbances were hypothesized as moderators, having an indirect effect on the relationship between combat experiences and PTSD symptoms. Neuroticism scores and ACEs were proposed as moderators of the combat-PTSD symptom relationship. Mediation and moderation models were developed and tested using logistic regressions. Increased number of combat experiences was found to be a significant predictor of PTSD, even when adjusting for all covariates (p < 0.05). Consistent with partial mediation, nightmares had an indirect effect on the relationship between combat experiences and PTSD symptoms in the final model (path coefficient = 0.233, 95% confidence interval = 0.036, 0.483). Neuroticism was an independent predictor of PTSD symptoms (p < 0.001), but the interaction of combat and neuroticism did not predict symptoms of PTSD. ACEs did not have a significant impact in the model as either an independent predictor or a moderating factor. These results indicate that the presence of nightmares may partially explain how traumatic combat experiences lead to the development of PTSD. The study also reaffirms neuroticism as risk factor for developing PTSD symptoms. These findings highlight the importance of sleep hygiene and operational stress models in combat situations and may help stress control professionals address risk factors associated with PTSD symptoms. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Acute Assessment of Traumatic Brain Injury and Post-Traumatic Stress After Exposure to a Deployment-Related Explosive Blast.

PubMed

Baker, Monty T; Moring, John C; Hale, Willie J; Mintz, Jim; Young-McCaughan, Stacey; Bryant, Richard A; Broshek, Donna K; Barth, Jeffrey T; Villarreal, Robert; Lancaster, Cynthia L; Malach, Steffany L; Lara-Ruiz, Jose M; Isler, William; Peterson, Alan L

2018-05-18

Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are two of the signature injuries in military service members who have been exposed to explosive blasts during deployments to Iraq and Afghanistan. Acute stress disorder (ASD), which occurs within 2-30 d after trauma exposure, is a more immediate psychological reaction predictive of the later development of PTSD. Most previous studies have evaluated service members after their return from deployment, which is often months or years after the initial blast exposure. The current study is the first large study to collect psychological and neuropsychological data from active duty service members within a few days after blast exposure. Recruitment for blast-injured TBI patients occurred at the Air Force Theater Hospital, 332nd Air Expeditionary Wing, Joint Base Balad, Iraq. Patients were referred from across the combat theater and evaluated as part of routine clinical assessment of psychiatric and neuropsychological symptoms after exposure to an explosive blast. Four measures of neuropsychological functioning were used: the Military Acute Concussion Evaluation (MACE); the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); the Headminder Cognitive Stability Index (CSI); and the Automated Neuropsychological Assessment Metrics, Version 4.0 (ANAM4). Three measures of combat exposure and psychological functioning were used: the Combat Experiences Scale (CES); the PTSD Checklist-Military Version (PCL-M); and the Acute Stress Disorder Scale (ASDS). Assessments were completed by a deployed clinical psychologist, clinical social worker, or mental health technician. A total of 894 patients were evaluated. Data from 93 patients were removed from the data set for analysis because they experienced a head injury due to an event that was not an explosive blast (n = 84) or they were only assessed for psychiatric symptoms (n = 9). This resulted in a total of 801 blast-exposed patients for data analysis. Because data were collected in-theater for the initial purpose of clinical evaluation, sample size varied widely between measures, from 565 patients who completed the MACE to 154 who completed the CES. Bivariate correlations revealed that the majority of psychological measures were significantly correlated with each other (ps ≤ 0.01), neuropsychological measures were correlated with each other (ps ≤ 0.05), and psychological and neuropsychological measures were also correlated with each other (ps ≤ 0.05). This paper provides one of the first descriptions of psychological and neuropsychological functioning (and their inter-correlation) within days after blast exposure in a large sample of military personnel. Furthermore, this report describes the methodology used to gather data for the acute assessment of TBI, PTSD, and ASD after exposure to an explosive blast in the combat theater. Future analyses will examine the common and unique symptoms of TBI and PTSD, which will be instrumental in developing new assessment approaches and intervention strategies.

Postdeployment threat-related attention bias interacts with combat exposure to account for PTSD and anxiety symptoms in soldiers.

PubMed

Sipos, Maurice L; Bar-Haim, Yair; Abend, Rany; Adler, Amy B; Bliese, Paul D

2014-02-01

Recent studies suggest that assessment of threat-related attention bias may be useful in identifying soldiers at risk for clinical symptoms. The present study assessed the degree to which soldiers experienced combat events and showed attentional threat avoidance affected their reported levels of post-traumatic stress disorder (PTSD) and anxiety symptoms. Four months after a combat deployment to Iraq, 63 US soldiers completed a survey assessing combat exposures and clinical symptoms as well as a dot-probe task assessing threat-related attention bias. Significant three-way interactions regressing threat reaction times (RTs), neutral RTs, and combat exposure on PTSD and anxiety symptoms were observed. Specifically, soldiers with high levels of combat exposure, who were more likely to demonstrate attentional bias away from threat, were also more symptomatic. These results demonstrate the potential of threat-related attention bias as a behavioral marker of PTSD and anxiety symptoms in a high-risk military occupational context. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Selective prevention of combat-related post-traumatic stress disorder using attention bias modification training: a randomized controlled trial.

PubMed

Wald, I; Fruchter, E; Ginat, K; Stolin, E; Dagan, D; Bliese, P D; Quartana, P J; Sipos, M L; Pine, D S; Bar-Haim, Y

2016-09-01

Efficacy of pre-trauma prevention for post-traumatic stress disorder (PTSD) has not yet been established in a randomized controlled trial. Attention bias modification training (ABMT), a computerized intervention, is thought to mitigate stress-related symptoms by targeting disruptions in threat monitoring. We examined the efficacy of ABMT delivered before combat in mitigating risk for PTSD following combat. We conducted a double-blind, four-arm randomized controlled trial of 719 infantry soldiers to compare the efficacy of eight sessions of ABMT (n = 179), four sessions of ABMT (n = 184), four sessions of attention control training (ACT; n = 180), or no-training control (n = 176). Outcome symptoms were measured at baseline, 6-month follow-up, 10 days following combat exposure, and 4 months following combat. Primary outcome was PTSD prevalence 4 months post-combat determined in a clinical interview using the Clinician-Administered PTSD Scale. Secondary outcomes were self-reported PTSD and depression symptoms, collected at all four assessments. PTSD prevalence 4 months post-combat was 7.8% in the no-training control group, 6.7% with eight-session ABMT, 2.6% with four-session ABMT, and 5% with ACT. Four sessions of ABMT reduced risk for PTSD relative to the no-training condition (odds ratio 3.13, 95% confidence interval 1.01-9.22, p < 0.05, number needed to treat = 19.2). No other between-group differences were found. The results were consistent across a variety of analytic techniques and data imputation approaches. Four sessions of ABMT, delivered prior to combat deployment, mitigated PTSD risk following combat exposure. Given its low cost and high scalability potential, and observed number needed to treat, research into larger-scale applications is warranted. The ClinicalTrials.gov identifier is NCT01723215.

Longitudinal interactions of pain and posttraumatic stress disorder symptoms in U.S. Military service members following blast exposure.

PubMed

Stratton, Kelcey J; Clark, Shaunna L; Hawn, Sage E; Amstadter, Ananda B; Cifu, David X; Walker, William C

2014-10-01

Military personnel returning from conflicts in Iraq and Afghanistan often endorse pain and posttraumatic stress disorder (PTSD) symptoms, either separately or concurrently. Associations between pain and PTSD symptoms may be further complicated by blast exposure from explosive munitions. Although many studies have reported on the prevalence and disability associated with polytraumatic injuries following combat, less is known about symptom maintenance over time. Accordingly, this study examined longitudinal interactive models of co-occurring pain and PTSD symptoms in a sample of 209 military personnel (mean age = 27.4 years, standard deviation = 7.6) who experienced combat-related blast exposure. Autoregressive cross-lagged analysis examined longitudinal associations between self-reported pain and PTSD symptoms over a 1-year period. The best-fitting covariate model indicated that pain and PTSD were significantly associated with one another across all assessment periods, χ² (3) = 3.66, P = .30, Tucker-Lewis index = .98, comparative fit index = 1.00, root mean squared error of approximation = .03. PTSD symptoms had a particularly strong influence on subsequent pain symptoms. The relationship between pain and PTSD symptoms is related to older age, race, and traumatic brain injury characteristics. Results further the understanding of complex injuries among military personnel and highlight the need for comprehensive assessment and rehabilitation efforts addressing the interdependence of pain and co-occurring mental health conditions. This longitudinal study demonstrates that pain and PTSD symptoms strongly influence one another and interact across time. These findings have the potential to inform the integrative assessment and treatment of military personnel with polytrauma injuries and who are at risk for persistent deployment-related disorders. Published by Elsevier Inc.

Moving effective treatment for posttraumatic stress disorder to primary care: A randomized controlled trial with active duty military.

PubMed

Cigrang, Jeffrey A; Rauch, Sheila A; Mintz, Jim; Brundige, Antoinette R; Mitchell, Jennifer A; Najera, Elizabeth; Litz, Brett T; Young-McCaughan, Stacey; Roache, John D; Hembree, Elizabeth A; Goodie, Jeffrey L; Sonnek, Scott M; Peterson, Alan L

2017-12-01

Many military service members with PTSD do not receive evidence-based specialty behavioral health treatment because of perceived barriers and stigma. Behavioral health providers in primary care can deliver brief, effective treatments expanding access and reducing barriers and stigma. The purpose of this randomized clinical trial was to determine if a brief cognitive-behavior therapy delivered in primary care using the Primary Care Behavioral Health model would be effective at reducing PTSD and co-occurring symptoms. A total of 67 service members (50 men, 17 women) were randomized to receive a brief, trauma-focused intervention developed for the primary care setting called Prolonged Exposure for Primary Care (PE-PC) or a delayed treatment minimal contact control condition. Inclusion criteria were significant PTSD symptoms following military deployment, medication stability, and interest in receiving treatment for PTSD symptoms in primary care. Exclusion criteria were moderate or greater risk of suicide, severe brain injury, or alcohol/substance use at a level that required immediate treatment. Assessments were completed at baseline, posttreatment/postminimal contact control, and at 8-week and 6-month posttreatment follow-up points. Primary measures were the PTSD Symptom Scale-Interview and the PTSD Checklist-Stressor-Specific. PE-PC resulted in larger reduction in PTSD severity and general distress than the minimal contact control. Delayed treatment evidenced medium to large effects comparable to the immediate intervention group. Treatment benefits persisted through the 6-month follow-up of the study. PE-PC delivered in integrated primary care is effective for the treatment of PTSD and co-occurring symptoms and may help reduce barriers and stigma found in specialty care settings. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Fatigue - but not mTBI history, PTSD, or sleep quality - directly contributes to reduced prospective memory performance in Iraq and Afghanistan era Veterans.

PubMed

Rau, Holly K; Hendrickson, Rebecca; Roggenkamp, Hannah C; Peterson, Sarah; Parmenter, Brett; Cook, David G; Peskind, Elaine; Pagulayan, Kathleen F

2017-10-13

Memory problems that affect daily functioning are a frequent complaint among Veterans reporting a history of repetitive mild traumatic brain injury (mTBI), especially in cohorts with comorbid PTSD. Here, we test the degree to which subjective sleep impairment and daytime fatigue account for the association of PTSD and self-reported mTBI history with prospective memory. 82 Veterans with and without personal history of repeated blast-related mTBI during deployment were administered the Clinician Administered PTSD Scale (CAPS), Memory for Intentions Test (MIST), Patient Health Questionnaire-9 (PHQ-9), Neurobehavioral Symptom Inventory (NSI), and the Pittsburgh Sleep Quality Index (PSQI). Relationships between self-reported mTBI, PTSD, self-reported poor sleep and daytime fatigue, and MIST performance were modeled using partial least squares structural equation modeling (PLS-SEM). Reported daytime fatigue was strongly associated with poorer prospective memory performance. Poor subjective sleep quality was strongly and positively associated with reported daytime fatigue, but had no significant direct effect on prospective memory performance. PTSD diagnosis and self-reported mTBI history were only associated with prospective memory via their impact on subjective sleep quality and daytime fatigue. Results suggest that daytime fatigue may be a mediating factor by which both mTBI and PTSD can interfere with prospective memory. Additional attention should be given to complaints of daytime fatigue, independent of subjective sleep quality, in the clinical care of those with a self-reported history of mTBI, and/or PTSD. Further research into whether interventions that decrease daytime fatigue lead to improvement in prospective memory and subjective cognitive functioning is warranted.

The prevalence of post-traumatic stress disorder (PTSD) in US combat soldiers: a head-to-head comparison of DSM-5 versus DSM-IV-TR symptom criteria with the PTSD checklist.

PubMed

Hoge, Charles W; Riviere, Lyndon A; Wilk, Joshua E; Herrell, Richard K; Weathers, Frank W

2014-09-01

The definition of post-traumatic stress disorder (PTSD) underwent substantial changes in the 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). How this will affect estimates of prevalence, whether clinical utility has been improved, and how many individuals who meet symptom criteria according to the previous definition will not meet new criteria is unknown. Updated screening instruments, including the PTSD checklist (PCL), have not been compared with previously validated methods through head-to-head comparisons. We compared the new 20-item PCL, mapped to DSM-5 (PCL-5), with the original validated 17-item specific stressor version (PCL-S) in 1822 US infantry soldiers, including 946 soldiers who had been deployed to Iraq or Afghanistan. Surveys were administered in November, 2013. Soldiers alternately received either of two surveys that were identical except for the order of the two PCL versions (911 per group). Standardised scales measured major depression, generalised anxiety, alcohol misuse, and functional impairment. In analysis of all soldiers, 224 (13%) screened positive for PTSD by DSM-IV-TR criteria and 216 (12%) screened positive by DSM-5 criteria (κ 0·67). In soldiers exposed to combat, 177 (19%) screened positive by DSM-IV-TR and 165 (18%) screened positive by DSM-5 criteria (0·66). However, of 221 soldiers with complete data who met DSM-IV-TR criteria, 67 (30%) did not meet DSM-5 criteria, and 59 additional soldiers met only DSM-5 criteria. PCL-5 scores from 15-38 performed similarly to PCL-S scores of 30-50; a PCL-5 score of 38 gave optimum agreement with a PCL-S of 50. The two definitions showed nearly identical association with other psychiatric disorders and functional impairment. Our findings showed the PCL-5 to be equivalent to the validated PCL-S. However, the new PTSD symptom criteria do not seem to have greater clinical utility, and a high percentage of soldiers who met criteria by one definition did not meet the other criteria. Clinicians need to consider how to manage discordant outcomes, particularly for service members and veterans with PTSD who no longer meet criteria under DSM-5. US Army Military Operational Medicine Research Program (MOMRP), Fort Detrick, MD. Copyright © 2014 Elsevier Ltd. All rights reserved.

Threat-Related Attention Bias Variability and Posttraumatic Stress.

PubMed

Naim, Reut; Abend, Rany; Wald, Ilan; Eldar, Sharon; Levi, Ofir; Fruchter, Eyal; Ginat, Karen; Halpern, Pinchas; Sipos, Maurice L; Adler, Amy B; Bliese, Paul D; Quartana, Phillip J; Pine, Daniel S; Bar-Haim, Yair

2015-12-01

Threat monitoring facilitates survival by allowing one to efficiently and accurately detect potential threats. Traumatic events can disrupt healthy threat monitoring, inducing biased and unstable threat-related attention deployment. Recent research suggests that greater attention bias variability, that is, attention fluctuations alternating toward and away from threat, occurs in participants with PTSD relative to healthy comparison subjects who were either exposed or not exposed to traumatic events. The current study extends findings on attention bias variability in PTSD. Previous measurement of attention bias variability was refined by employing a moving average technique. Analyses were conducted across seven independent data sets; in each, data on attention bias variability were collected by using variants of the dot-probe task. Trauma-related and anxiety symptoms were evaluated across samples by using structured psychiatric interviews and widely used self-report questionnaires, as specified for each sample. Analyses revealed consistent evidence of greater attention bias variability in patients with PTSD following various types of traumatic events than in healthy participants, participants with social anxiety disorder, and participants with acute stress disorder. Moreover, threat-related, and not positive, attention bias variability was correlated with PTSD severity. These findings carry possibilities for using attention bias variability as a specific cognitive marker of PTSD and for tailoring protocols for attention bias modification for this disorder.

Treatment of PTSD-Related Anger in Troops Returning From Hazardous Deployments

DTIC Science & Technology

2006-03-01

autogenics , a new relaxation exercise Session 6: The main goals of this session are to conduct cognitive restructuring and complete inoculation...Session 5 Reading G. If time permits, teach autogenics , a new relaxation exercise. ☺ Note to therapist: The patient will have begun to share our

Prevalence, Correlates, and Predictors of Insomnia in the US Army prior to Deployment.

PubMed

Taylor, Daniel J; Pruiksma, Kristi E; Hale, Willie J; Kelly, Kevin; Maurer, Douglas; Peterson, Alan L; Mintz, Jim; Litz, Brett T; Williamson, Douglas E

2016-10-01

To determine the prevalence, correlates, and predictors of insomnia in US Army personnel prior to deployment. Cross-sectional cohort design assessing insomnia and other psychosocial variables in active duty service members (n = 4,101), at Fort Hood, Texas, prior to military deployment. Insomnia was defined as an Insomnia Severity Index ≥ 15. The prevalence of insomnia was 19.9%. Enlisted personnel were five times more likely to report insomnia than officers (odds ratio [OR] = 5.17). Insomnia was higher among American Indian/Alaskan Natives than other groups (ORs = 1.86-2.85). Those in the Insomnia Group were older, had longer military careers, and reported more marriages, children, and military deployments ( d s = 0.13-0.34) than the No Insomnia group. The Insomnia Group reported more severe mental health symptoms, more recent stressful life events, greater childhood abuse, and lower levels of trait resilience, social support, and unit cohesion (Cohen d s = 0.27-1.29). After controlling for covariates, the Insomnia Group was more likely to have a history of head injuries and clinically significant posttraumatic stress disorder (PTSD), anxiety, depression, alcohol use problems, back pain, extremity pain, headaches, and fatigue (ORs = 1.40-3.30). A simultaneous logistic regression found that greater PTSD, depression, fatigue, stressful life events, headaches, anxiety, alcohol use problems, extremity pain, history of head injury, childhood physical neglect, back pain, number of times married, and lower leader support/unit cohesion and tangible social support were statistically significant predictors of insomnia status. Insomnia occurs in about one of five service members prior to a military deployment and is associated with a wide array of psychosocial stressors and mental and physical health problems. © 2016 Associated Professional Sleep Societies, LLC.

Ohio Army National Guard Mental Health Initiative: Risk and Resilience Factors for Combat-Related Posttraumatic Psychopathology and Post Combat Adjustment

DTIC Science & Technology

2013-10-01

never married , divorced/separated/widowed, married ), race (White, Black, other), annual income (≤ $60,000 vs . > $60,000), ed- ucation (high school...to a combat setting (Elhai, et al. 2012), while protection is associated with post-deployment support, being married and being female (Orr, et al...never deployed (53.0% vs . 39.5%, p = 0.005) and PTSD (8.3% vs . 1.9%, p = 0.005)  Women more often had a history of mood disorders as compared to

ALTERED DEFAULT MODE NETWORK (DMN) RESTING STATE FUNCTIONAL CONNECTIVITY FOLLOWING A MINDFULNESS-BASED EXPOSURE THERAPY FOR POSTTRAUMATIC STRESS DISORDER (PTSD) IN COMBAT VETERANS OF AFGHANISTAN AND IRAQ.

PubMed

King, Anthony P; Block, Stefanie R; Sripada, Rebecca K; Rauch, Sheila; Giardino, Nicholas; Favorite, Todd; Angstadt, Michael; Kessler, Daniel; Welsh, Robert; Liberzon, Israel

2016-04-01

Recent studies suggest that mindfulness may be an effective component for posttraumatic stress disorder (PTSD) treatment. Mindfulness involves practice in volitional shifting of attention from "mind wandering" to present-moment attention to sensations, and cultivating acceptance. We examined potential neural correlates of mindfulness training using a novel group therapy (mindfulness-based exposure therapy (MBET)) in combat veterans with PTSD deployed to Afghanistan (OEF) and/or Iraq (OIF). Twenty-three male OEF/OIF combat veterans with PTSD were treated with a mindfulness-based intervention (N = 14) or an active control group therapy (present-centered group therapy (PCGT), N = 9). Pre-post therapy functional magnetic resonance imaging (fMRI, 3 T) examined resting-state functional connectivity (rsFC) in default mode network (DMN) using posterior cingulate cortex (PCC) and ventral medial prefrontal cortex (vmPFC) seeds, and salience network (SN) with anatomical amygdala seeds. PTSD symptoms were assessed at pre- and posttherapy with Clinician Administered PTSD Scale (CAPS). Patients treated with MBET had reduced PTSD symptoms (effect size d = 0.92) but effect was not significantly different from PCGT (d = 0.46). Increased DMN rsFC (PCC seed) with dorsolateral dorsolateral prefrontal cortex (DLPFC) regions and dorsal anterior cingulate cortex (ACC) regions associated with executive control was seen following MBET. A group × time interaction found MBET showed increased connectivity with DLPFC and dorsal ACC following therapy; PCC-DLPFC connectivity was correlated with improvement in PTSD avoidant and hyperarousal symptoms. Increased connectivity between DMN and executive control regions following mindfulness training could underlie increased capacity for volitional shifting of attention. The increased PCC-DLPFC rsFC following MBET was related to PTSD symptom improvement, pointing to a potential therapeutic mechanism of mindfulness-based therapies. © 2016 Wiley Periodicals, Inc.

Sleep Disturbances in OEF/OIF/OND Veterans: Associations with PTSD, Personality, and Coping

PubMed Central

Lind, Mackenzie J.; Brown, Emily; Farrell-Carnahan, Leah; Brown, Ruth C.; Hawn, Sage; Berenz, Erin; McDonald, Scott; Pickett, Treven; Danielson, Carla Kmett; Thomas, Suzanne; Amstadter, Ananda B.

2017-01-01

Study Objectives: Sleep disturbances are well documented in relation to trauma exposure and posttraumatic stress disorder (PTSD), but correlates of such disturbances remain understudied in veteran populations. We conducted a preliminary study of sleep disturbances in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans (n = 133; mean [standard deviation] age = 29.8 [4.7] y). Methods: Veterans were assigned to one of three groups based on responses to the Clinician Administered PTSD Scale: control (no trauma-exposure [TE] or PTSD), TE, and PTSD. Sleep disturbance was assessed using the Pittsburgh Sleep Quality Index (PSQI). Measures of resilience, trauma load, personality, coping, alcohol use, and mild traumatic brain injury were also assessed via self-report. Results: The PTSD group had significantly more disturbed sleep (PSQI global score mean = 8.94, standard deviation = 3.12) than control (mean = 5.27, standard deviation = 3.23) and TE (mean = 5.34, standard deviation = 3.17) groups, but there were no differences between TE and control. The same pattern emerged across most PSQI subscales. Results of linear regression analyses indicated that current smoking, Army (versus other military branches), neuroticism, and using substances to cope were all significant correlates of higher sleep disturbance, whereas post-deployment social support was associated with less sleep disturbance. However, when combined together into a model with PTSD status, only neuroticism and substance use coping remained significant as predictors of more disturbed sleep. Conclusions: These initial findings suggest that TE itself may not be an independent risk factor for disturbed sleep in veterans, and that neurotic personality and a tendency to cope by using substances may partially explain sleep disturbance, above and beyond a diagnosis of PTSD. Citation: Lind MJ, Brown E, Farrell-Carnahan L, Brown RC, Hawn S, Berenz E, McDonald S, Pickett T, Danielson CK, Thomas S, Amstadter AB. Sleep disturbances in OEF/OIF/OND veterans: associations with PTSD, personality and coping. J Clin Sleep Med 2017;13(2):291–299. PMID:27998375

Deployment-Related Insomnia in Military Personnel and Veterans

PubMed Central

Bramoweth, Adam D.

2013-01-01

Insomnia is a prevalent disorder that greatly impacts military personnel, especially those deployed in support of combat efforts. Deployment-related stressors like combat exposure, mild traumatic brain injury (mTBI) irregular sleep-wake schedules, and adjustment to the return home all contribute to insomnia. However, insomnia can also exacerbate the deployment experience and is a risk factor for traumatic stress reactions such as PTSD, depression, and suicide. Military personnel with mTBI are significantly impacted by insomnia; the majority experience sleep disruption and this can impede recovery and rehabilitation. As more service members return home from deployment, treatment is vital to reduce the impact of insomnia. Preliminary outcome data, showing positive results for reduction of sleep disruption, has been found with treatments such as combined cognitive behavioral treatment of insomnia (CBTI) and imagery rehearsal therapy (IRT), preference-based interventions, as well as efforts to broadly disseminate CBTI. The recent literature on the impact and treatment of deployment-related insomnia is reviewed. PMID:24005883

Prevalence, Correlates, and Predictors of Insomnia in the US Army prior to Deployment

PubMed Central

Taylor, Daniel J.; Pruiksma, Kristi E.; Hale, Willie J.; Kelly, Kevin; Maurer, Douglas; Peterson, Alan L.; Mintz, Jim; Litz, Brett T.; Williamson, Douglas E.

2016-01-01

Study Objectives: To determine the prevalence, correlates, and predictors of insomnia in US Army personnel prior to deployment. Methods: Cross-sectional cohort design assessing insomnia and other psychosocial variables in active duty service members (n = 4,101), at Fort Hood, Texas, prior to military deployment. Insomnia was defined as an Insomnia Severity Index ≥ 15. Results: The prevalence of insomnia was 19.9%. Enlisted personnel were five times more likely to report insomnia than officers (odds ratio [OR] = 5.17). Insomnia was higher among American Indian/Alaskan Natives than other groups (ORs = 1.86–2.85). Those in the Insomnia Group were older, had longer military careers, and reported more marriages, children, and military deployments (ds = 0.13–0.34) than the No Insomnia group. The Insomnia Group reported more severe mental health symptoms, more recent stressful life events, greater childhood abuse, and lower levels of trait resilience, social support, and unit cohesion (Cohen ds = 0.27–1.29). After controlling for covariates, the Insomnia Group was more likely to have a history of head injuries and clinically significant posttraumatic stress disorder (PTSD), anxiety, depression, alcohol use problems, back pain, extremity pain, headaches, and fatigue (ORs = 1.40–3.30). A simultaneous logistic regression found that greater PTSD, depression, fatigue, stressful life events, headaches, anxiety, alcohol use problems, extremity pain, history of head injury, childhood physical neglect, back pain, number of times married, and lower leader support/unit cohesion and tangible social support were statistically significant predictors of insomnia status. Conclusions: Insomnia occurs in about one of five service members prior to a military deployment and is associated with a wide array of psychosocial stressors and mental and physical health problems. Citation: Taylor DJ, Pruiksma KE, Hale WJ, Kelly K, Maurer D, Peterson AL, Mintz J, Litz BT, Williamson DE, STRONG STAR Consortium. Prevalence, correlates, and predictors of insomnia in the US Army prior to deployment. SLEEP 2016;39(10):1795–1806. PMID:27450687

Problems Related to Alcohol, Other Drugs, and Violence among Military Students. Prevention Update

ERIC Educational Resources Information Center

Higher Education Center for Alcohol, Drug Abuse, and Violence Prevention, 2011

2011-01-01

According to a Research Update from the National Institute on Drug Abuse, ongoing operations in Iraq and Afghanistan "continue to strain military personnel, returning veterans, and their families. Some have experienced long and multiple deployments, combat exposure, and physical injuries, as well as post-traumatic stress disorder (PTSD) and…

Psychiatric Diagnoses and Punishment for Misconduct: The Effects of PTSD in Combat-deployed Marines

DTIC Science & Technology

2010-10-25

between cohorts of veterans with and without mental illness discharged from inpatient units. Psychiatr Serv 2008, 59:178-83. 25. Koenen KC, Lyons MJ ...1991. 44. Edwards JE, Newell CE: Navy pattern-of-misconduct discharges: A study of potential racial effects (NPRDC-TR-94-11). San Diego, CA: Navy

77 FR 3454 - Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-24

... Members Post-Operational Deployment, Dr. Richard R. Bannick 9:30-9:45 a.m. Break 9:45-10:45 a.m. OSD... 10 a.m.-12 p.m. Panel on Evidence-Based Treatment Modalities for PTSD (Program 12:00-1 p.m. Lunch 1...

Chronic daily headache in U.S. soldiers after concussion.

PubMed

Theeler, Brett J; Flynn, Frederick G; Erickson, Jay C

2012-05-01

To determine the prevalence and characteristics of, and factors associated with, chronic daily headache (CDH) in U.S. soldiers after a deployment-related concussion. A cross-sectional, questionnaire-based study was conducted with a cohort of 978 U.S. soldiers who screened positive for a deployment-related concussion upon returning from Iraq or Afghanistan. All soldiers underwent a clinical evaluation at the Madigan Traumatic Brain Injury Program that included a history, physical examination, 13-item self-administered headache questionnaire, and a battery of cognitive and psychological assessments. Soldiers with CDH, defined as headaches occurring on 15 or more days per month for the previous 3 months, were compared to soldiers with episodic headaches occurring less than 15 days per month. One hundred ninety-six of 978 soldiers (20%) with a history of deployment-related concussion met criteria for CDH and 761 (78%) had episodic headache. Soldiers with CDH had a median of 27 headache days per month, and 46/196 (23%) reported headaches occurring every day. One hundred seven out of 196 (55%) soldiers with CDH had onset of headaches within 1 week of head trauma and thereby met the time criterion for posttraumatic headache (PTHA) compared to 253/761 (33%) soldiers with episodic headache. Ninety-seven out of 196 (49%) soldiers with CDH used abortive medications to treat headache on 15 or more days per month for the previous 3 months. One hundred thirty out of 196 (66%) soldiers with CDH had headaches meeting criteria for migraine compared to 49% of soldiers with episodic headache. The number of concussions, blast exposures, and concussions with loss of consciousness was not significantly different between soldiers with and without CDH. Cognitive performance was also similar for soldiers with and without CDH. Soldiers with CDH had significantly higher average scores on the posttraumatic stress disorder (PTSD) checklist compared to soldiers with episodic headaches. Forty-one percent of soldiers with CDH screened positive for PTSD compared to only 18% of soldiers with episodic headache. The prevalence of CDH in returning U.S. soldiers after a deployment-related concussion is 20%, or 4- to 5-fold higher than that seen in the general U.S. population. CDH following a concussion usually resembles chronic migraine and is associated with onset of headaches within the first week after concussion. The mechanism and number of concussions are not specifically associated with CDH as compared to episodic headache. In contrast, PTSD symptoms are strongly associated with CDH, suggesting that traumatic stress may be an important mediator of headache chronification. These findings justify future studies examining strategies to prevent and treat CDH in military service members following a concussive injury. © 2012 American Headache Society.

Using Multidimensional Grief Theory to Explore Effects of Deployment, Reintegration, and Death on Military Youth and Families

PubMed Central

Kaplow, Julie B.; Layne, Christopher M.; Saltzman, William R.; Cozza, Stephen J.; Pynoos, Robert S.

2015-01-01

To date, the U.S. military has made major strides in acknowledging and therapeutically addressing trauma and Posttraumatic Stress Disorder (PTSD) in service members and their families. However, given the nature of warfare and high rates of losses sustained by both military members (e.g., deaths of fellow unit members) and military families (e.g., loss of a young parent who served in the military), as well as the ongoing threat of loss that military families face during deployment, we propose that a similar focus on grief is also needed to properly understand and address many of the challenges encountered by bereaved service members, spouses, and children. In this article, we describe a newly developed theory of grief (Multidimensional Grief Theory) and apply it to the task of exploring major features of military-related experiences during the phases of deployment, reintegration, and the aftermath of combat death—especially as they impact children. We also describe implications for designing preventive interventions during each phase and conclude with recommended avenues for future research. Primary aims are to illustrate: (1) the indispensable role of theory in guiding efforts to describe, explain, predict, prevent, and treat maladaptive grief in military service members, children, and families; (2) the relevance of multidimensional grief theory for addressing both losses due to physical death as well as losses brought about by extended physical separations to which military children and families are exposed during and after deployment; and (3) a focus on military-related grief as a much-needed complement to an already-established focus on military-related PTSD. PMID:23760905

Using multidimensional grief theory to explore the effects of deployment, reintegration, and death on military youth and families.

PubMed

Kaplow, Julie B; Layne, Christopher M; Saltzman, William R; Cozza, Stephen J; Pynoos, Robert S

2013-09-01

To date, the US military has made major strides in acknowledging and therapeutically addressing trauma and post-traumatic stress disorder (PTSD) in service members and their families. However, given the nature of warfare and high rates of losses sustained by both military members (e.g., deaths of fellow unit members) and military families (e.g., loss of a young parent who served in the military), as well as the ongoing threat of loss that military families face during deployment, we propose that a similar focus on grief is also needed to properly understand and address many of the challenges encountered by bereaved service members, spouses, and children. In this article, we describe a newly developed theory of grief (multidimensional grief theory) and apply it to the task of exploring major features of military-related experiences during the phases of deployment, reintegration, and the aftermath of combat death--especially as they impact children. We also describe implications for designing preventive interventions during each phase and conclude with recommended avenues for future research. Primary aims are to illustrate: (1) the indispensable role of theory in guiding efforts to describe, explain, predict, prevent, and treat maladaptive grief in military service members, children, and families; (2) the relevance of multidimensional grief theory for addressing both losses due to physical death as well as losses brought about by extended physical separations to which military children and families are exposed during and after deployment; and (3) a focus on military-related grief as a much-needed complement to an already-established focus on military-related PTSD.

What pre-deployment and early post-deployment factors predict health function after combat deployment?: a prospective longitudinal study of Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) soldiers

PubMed Central

2013-01-01

Background Physical and mental function are strong indicators of disability and mortality. OEF/OIF Veterans returning from deployment have been found to have poorer function than soldiers who have not deployed; however the reasons for this are unknown. Methods A prospective cohort of 790 soldiers was assessed both pre- and immediately after deployment to determine predictors of physical and mental function after war. Results On average, OEF/OIF Veterans showed significant declines in both physical (t=6.65, p<.0001) and mental function (t=7.11, p<.0001). After controlling for pre-deployment function, poorer physical function after deployment was associated with older age, more physical symptoms, blunted systolic blood pressure reactivity and being injured. After controlling for pre-deployment function, poorer mental function after deployment was associated with younger age, lower social desirability, lower social support, greater physical symptoms and greater PTSD symptoms. Conclusions Combat deployment was associated with an immediate decline in both mental and physical function. The relationship of combat deployment to function is complex and influenced by demographic, psychosocial, physiological and experiential factors. Social support and physical symptoms emerged as potentially modifiable factors. PMID:23631419

Genomic predictors of combat stress vulnerability and resilience in U.S. Marines: A genome-wide association study across multiple ancestries implicates PRTFDC1 as a potential PTSD gene.

PubMed

Nievergelt, Caroline M; Maihofer, Adam X; Mustapic, Maja; Yurgil, Kate A; Schork, Nicholas J; Miller, Mark W; Logue, Mark W; Geyer, Mark A; Risbrough, Victoria B; O'Connor, Daniel T; Baker, Dewleen G

2015-01-01

Research on the etiology of post-traumatic stress disorder (PTSD) has rapidly matured, moving from candidate gene studies to interrogation of the entire human genome in genome-wide association studies (GWAS). Here we present the results of a GWAS performed on samples from combat-exposed U.S. Marines and Sailors from the Marine Resiliency Study (MRS) scheduled for deployment to Iraq and/or Afghanistan. The MRS is a large, prospective study with longitudinal follow-up designed to identify risk and resiliency factors for combat-induced stress-related symptoms. Previously implicated PTSD risk loci from the literature and polygenic risk scores across psychiatric disorders were also evaluated in the MRS cohort. Participants (N=3494) were assessed using the Clinician-Administered PTSD Scale and diagnosed using the DSM-IV diagnostic criterion. Subjects with partial and/or full PTSD diagnosis were called cases, all other subjects were designated controls, and study-wide maximum CAPS scores were used for longitudinal assessments. Genomic DNA was genotyped on the Illumina HumanOmniExpressExome array. Individual genetic ancestry was determined by supervised cluster analysis for subjects of European, African, Hispanic/Native American, and other descent. To test for association of SNPs with PTSD, logistic regressions were performed within each ancestry group and results were combined in meta-analyses. Measures of childhood and adult trauma were included to test for gene-by-environment (GxE) interactions. Polygenic risk scores from the Psychiatric Genomic Consortium were used for major depressive disorder (MDD), bipolar disorder (BPD), and schizophrenia (SCZ). The array produced >800K directly genotyped and >21M imputed markers in 3494 unrelated, trauma-exposed males, of which 940 were diagnosed with partial or full PTSD. The GWAS meta-analysis identified the phosphoribosyl transferase domain containing 1 gene (PRTFDC1) as a genome-wide significant PTSD locus (rs6482463; OR=1.47, SE=0.06, p=2.04×10(-9)), with a similar effect across ancestry groups. Association of PRTFDC1 with PTSD in an independent military cohort showed some evidence for replication. Loci with suggestive evidence of association (n=25 genes, p<5×10(-6)) further implicated genes related to immune response and the ubiquitin system, but these findings remain to be replicated in larger GWASs. A replication analysis of 25 putative PTSD genes from the literature found nominally significant SNPs for the majority of these genes, but associations did not remain significant after correction for multiple comparison. A cross-disorder analysis of polygenic risk scores from GWASs of BPD, MDD, and SCZ found that PTSD diagnosis was associated with risk sores of BPD, but not with MDD or SCZ. This first multi-ethnic/racial GWAS of PTSD highlights the potential to increase power through meta-analyses across ancestry groups. We found evidence for PRTFDC1 as a potential novel PTSD gene, a finding that awaits further replication. Our findings indicate that the genetic architecture of PTSD may be determined by many SNPs with small effects, and overlap with other neuropsychiatric disorders, consistent with current findings from large GWAS of other psychiatric disorders. Copyright © 2014. Published by Elsevier Ltd.

The relationship between body mass index and mental health among Iraq and Afghanistan veterans.

PubMed

Maguen, Shira; Madden, Erin; Cohen, Beth; Bertenthal, Daniel; Neylan, Thomas; Talbot, Lisa; Grunfeld, Carl; Seal, Karen

2013-07-01

Obesity is a growing public health concern and is becoming an epidemic among veterans in the post-deployment period. To explore the relationship between body mass index (BMI) and posttraumatic stress disorder (PTSD) in a large cohort of Iraq and Afghanistan veterans, and to evaluate trajectories of change in BMI over 3 years. Retrospective, longitudinal cohort analysis of veterans' health records A total of 496,722 veterans (59,790 female and 436,932 male veterans) whose height and weight were recorded at the Department of Veterans Affairs (VA) healthcare system at least once after the end of their last deployment and whose first post-deployment outpatient encounter at the VA was at least 1 year prior to the end of the study period (December 31, 2011). BMI, mental health diagnoses. Seventy-five percent of Iraq and Afghanistan veterans were either overweight or obese at baseline. Four trajectories were observed: "stable overweight" represented the largest class; followed by "stable obese;" "overweight/obese gaining;" and "obese losing." During the 3-year ascertainment period, those with PTSD and depression in particular were at the greatest risk of being either obese without weight loss or overweight or obese and continuing to gain weight. Adjustment for demographics and antipsychotic medication attenuated the relationship between BMI and certain mental health diagnoses. Although BMI trajectories were similar in men and women, some gender differences were observed. For example, the risk of being in the persistently obese class in men was highest for those with PTSD, whereas for women, the risk was highest among those with depression. The growing number of overweight or obese returning veterans is a concerning problem for clinicians who work with these patients. Successful intervention to reduce the prevalence of obesity will require integrated efforts from primary care and mental health to treat underlying mental health causes and assist with engagement in weight loss programs.

Role of morality in the experience of guilt and shame within the armed forces.

PubMed

Nazarov, A; Jetly, R; McNeely, H; Kiang, M; Lanius, R; McKinnon, M C

2015-07-01

Despite advances in our understanding of mental health issues among military forces, a large proportion of military personnel continue to exhibit deployment-related psychological issues. Recent work has identified symptoms of guilt and shame related to moral injury as contributing significantly to combat-related mental health issues. This systematic scoping review explores the association between morality and symptoms of guilt and shame within military forces. A search of the literature pertaining to guilt, shame and morality within military samples was conducted. Nineteen articles were selected for review. There is strong evidence linking exposure to and the perceived perpetration of moral transgressions with experiences of guilt and shame. Critically, symptoms of guilt and shame were related to adverse mental health outcomes, particularly the onset of post-traumatic stress disorder (PTSD). No studies have explored moral judgment in conjunction with assessments of guilt or moral injury. These findings have important implications for the prevention and treatment of PTSD-related symptoms in military samples. By measuring moral judgment prior to deployment, it may be possible to predict the likelihood of incurring moral injuries and the development of associated symptoms. Early intervention programmes aimed at ameliorating guilt and shame are required to prevent the long-term development of deployment-related psychological distress. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Characterizing effects of mild traumatic brain injury and posttraumatic stress disorder on balance impairments in blast-exposed servicemembers and Veterans using computerized posturography.

PubMed

Wares, Joanna R; Hoke, Kathy W; Walker, William; Franke, Laura Manning; Cifu, David X; Carne, William; Ford-Smith, Cheryl

2015-01-01

The high rate of blast exposures experienced by U.S. servicemembers (SMs) during the recent conflicts in Iraq and Afghanistan has resulted in frequent combat-related mild traumatic brain injuries (mTBIs). Dizziness and postural instability can persist after mTBI as a component of postconcussion syndrome, but also occur among the somatic complaints of posttraumatic stress disorder (PTSD). The goals of this study were to examine the use of computerized posturography (CPT) to objectively characterize chronic balance deficits after mTBI and to explore the utility of CPT in distinguishing between combat and blast-exposed participants with and without mTBI and PTSD. Data were analyzed from a subject pool of 166 combat-exposed SMs and Veterans who had a blast experience within the past 2 yr while deployed. Using nonparametric tests and measures of impairment, we found that balance was deficient in participants diagnosed with mTBI with posttraumatic amnesia (PTA) or PTSD versus those with neither and that deficits were amplified for participants with both diagnoses. In addition, unique deficiencies were found using CPT for individuals having isolated mTBI with PTA and isolated PTSD. Computerized balance assessment offers an objective technique to examine the physiologic effects and provide differentiation between participants with combat-associated mTBI and PTSD.

Neuroanatomical features in soldiers with post-traumatic stress disorder.

PubMed

Sussman, D; Pang, E W; Jetly, R; Dunkley, B T; Taylor, M J

2016-03-31

Posttraumatic stress disorder (PTSD), an anxiety disorder that can develop after exposure to psychological trauma, impacts up to 20 % of soldiers returning from combat-related deployment. Advanced neuroimaging holds diagnostic and prognostic potential for furthering our understanding of its etiology. Previous imaging studies on combat-related PTSD have focused on selected structures, such as the hippocampi and cortex, but none conducted a comprehensive examination of both the cerebrum and cerebellum. The present study provides a complete analysis of cortical, subcortical, and cerebellar anatomy in a single cohort. Forty-seven magnetic resonance images (MRIs) were collected from 24 soldiers with PTSD and 23 Control soldiers. Each image was segmented into 78 cortical brain regions and 81,924 vertices using the corticometric iterative vertex based estimation of thickness algorithm, allowing for both a region-based and a vertex-based cortical analysis, respectively. Subcortical volumetric analyses of the hippocampi, cerebellum, thalamus, globus pallidus, caudate, putamen, and many sub-regions were conducted following their segmentation using Multiple Automatically Generated Templates Brain algorithm. Participants with PTSD were found to have reduced cortical thickness, primarily in the frontal and temporal lobes, with no preference for laterality. The region-based analyses further revealed localized thinning as well as thickening in several sub-regions. These results were accompanied by decreased volumes of the caudate and right hippocampus, as computed relative to total cerebral volume. Enlargement in several cerebellar lobules (relative to total cerebellar volume) was also observed in the PTSD group. These data highlight the distributed structural differences between soldiers with and without PTSD, and emphasize the diagnostic potential of high-resolution MRI.

Sleep restoration is associated with reduced plasma C-reactive protein and depression symptoms in military personnel with sleep disturbance after deployment.

PubMed

Heinzelmann, Morgan; Lee, Hyunhwa; Rak, Hannah; Livingston, Whitney; Barr, Taura; Baxter, Tristin; Scattergood-Keepper, Lindsay; Mysliwiec, Vincent; Gill, Jessica

2014-12-01

Deployed military personnel are vulnerable to chronic sleep disturbance, which is highly comorbid with post-traumatic stress disorder (PTSD) and depression, as well as declines in health-related quality of life (HRQOL). Inflammation is associated with HRQOL declines and sleep-related comorbidities; however, the impact of sleep changes on comorbid symptoms and inflammation in this population is unknown. In this observational study, we examined the relationship between reported sleep changes and concentrations of inflammatory biomarkers, interleukin 6 (IL-6), and C-reactive protein (CRP) in peripheral blood. The sample was dichotomized into two groups: (1) decrease in Pittsburgh Sleep Quality Index (PSQI; restorative sleep) and (2) no change or increase in PSQI (no change). Mixed between-within subjects analysis of variance tests were used to determine group differences on changes of inflammation and comorbid symptoms. In our sample of 66 recently deployed military personnel with insomnia, 34 participants reported restorative sleep whereas 32 reported no sleep changes. The two groups did not differ in demographic or clinical characteristics, with the exception of PTSD diagnosis at baseline. The restorative sleep group had significant reductions in CRP concentrations and depression symptoms, as well as reduced fatigue and improvements in emotional well-being, social functioning, and physical functioning at follow-up. Military personnel who report sleep restoration after deployment have reduced CRP concentrations, decreased severity of depression, and improved HRQOL. These findings suggest that treatment for sleep disturbances may be associated with improvements in mental and physical health, thereby supporting continued study in this line of research. Copyright © 2014 Elsevier B.V. All rights reserved.

Toward Preventing Post-Traumatic Stress Disorder: Development and Testing of a Pilot Predeployment Stress Inoculation Training Program.

PubMed

Hourani, Laurel; Tueller, Stephen; Kizakevich, Paul; Lewis, Gregory; Strange, Laura; Weimer, Belinda; Bryant, Stephanie; Bishop, Ellen; Hubal, Robert; Spira, James

2016-09-01

The objective of this pilot study was to design, develop, and evaluate a predeployment stress inoculation training (PRESIT) preventive intervention to enable deploying personnel to cope better with combat-related stressors and mitigate the negative effects of trauma exposure. The PRESIT program consisted of three predeployment training modules: (1) educational materials on combat and operational stress control, (2) coping skills training involving focused and relaxation breathing exercises with biofeedback, and (3) exposure to a video multimedia stressor environment to practice knowledge and skills learned in the first two modules. Heart rate variability assessed the degree to which a subset of participants learned the coping skills. With a cluster randomized design, data from 351 Marines randomized into PRESIT and control groups were collected at predeployment and from 259 of these who responded to surveys on return from deployment. Findings showed that the PRESIT group reduced their physiological arousal through increased respiratory sinus arrhythmia during and after breathing training relative to controls. Logistic regression, corrected for clustering at the platoon level, examined group effects on post-traumatic stress disorder (PTSD) as measured by the Post-traumatic Stress Checklist after controlling for relevant covariates. Results showed that PRESIT protected against PTSD among Marines without baseline mental health problems. Although limited by a small number of participants who screened positive for PTSD, this study supports the benefits of PRESIT as a potential preventive strategy in the U.S. military personnel. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

The co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD.

PubMed

Armour, Cherie; Karstoft, Karen-Inge; Richardson, J Don

2014-08-01

A dissociative-posttraumatic stress disorder (PTSD) subtype has been included in the DSM-5. However, it is not yet clear whether certain socio-demographic characteristics or psychological/clinical constructs such as comorbid psychopathology differentiate between severe PTSD and dissociative-PTSD. The current study investigated the existence of a dissociative-PTSD subtype and explored whether a number of trauma and clinical covariates could differentiate between severe PTSD alone and dissociative-PTSD. The current study utilized a sample of 432 treatment seeking Canadian military veterans. Participants were assessed with the Clinician Administered PTSD Scale (CAPS) and self-report measures of traumatic life events, depression, and anxiety. CAPS severity scores were created reflecting the sum of the frequency and intensity items from each of the 17 PTSD and 3 dissociation items. The CAPS severity scores were used as indicators in a latent profile analysis (LPA) to investigate the existence of a dissociative-PTSD subtype. Subsequently, several covariates were added to the model to explore differences between severe PTSD alone and dissociative-PTSD. The LPA identified five classes: one of which constituted a severe PTSD group (30.5 %), and one of which constituted a dissociative-PTSD group (13.7 %). None of the included, demographic, trauma, or clinical covariates were significantly predictive of membership in the dissociative-PTSD group compared to the severe PTSD group. In conclusion, a significant proportion of individuals report high levels of dissociation alongside their PTSD, which constitutes a dissociative-PTSD subtype. Further investigation is needed to identify which factors may increase or decrease the likelihood of membership in a dissociative-PTSD subtype group compared to a severe PTSD only group.

Compulsive sexual behavior among male military veterans: prevalence and associated clinical factors.

PubMed

Smith, Philip H; Potenza, Marc N; Mazure, Carolyn M; McKee, Sherry A; Park, Crystal L; Hoff, Rani A

2014-12-01

Compulsive sexual behavior (CSB) is highly prevalent among men, often co-occurring with psychiatric disorders and traumatic experiences. Psychiatric disorders and trauma are highly prevalent among military veterans, yet there is a paucity of research on CSB among military samples. The aim of this study was to examine the prevalence of and factors associated with CSB among male military veterans. Surveys were administered to veterans of Operations Iraqi Freedom, Enduring Freedom, or New Dawn at baseline (n = 258), 3 months(n = 194), and 6 months (n = 136). Bivariate analyses and Generalized Estimating Equations were utilized to estimate associations between CSB and the following variables: psychiatric co-morbidity, childhood physical or sexual trauma, pre- and post-deployment experiences, TV/ Internet usage, and sociodemographics. Associations between CSB and specific PTSD symptom clusters were also examined. CSB was reported by 16.7% of the sample at baseline. Several variables were associated with CSB in bivariate analyses; however, only PTSD severity, childhood sexual trauma, and age remained significant in multivariable GEE models. The PTSD symptom cluster re-experiencing was most strongly associated with CSB. This exploratory study suggests that CSB is prevalent amongst veterans returning from combat and is associated with childhood trauma and PTSD, particularly re-experiencing. Further study is needed to identify the mechanisms linking PTSD and CSB, define the context and severity of CSB in veterans, and examine the best ways to assess and treat CSB in VA clinical settings.

Symptoms of Posttraumatic Stress Rather Than Mild Traumatic Brain Injury Best Account for Altered Emotional Responses in Military Veterans.

PubMed

Marquardt, Craig A; Goldman, Daniel J; Cuthbert, Bruce N; Lissek, Shmuel; Sponheim, Scott R

2018-02-01

Emotional dysfunction is evident in posttraumatic stress disorder (PTSD), yet it is unclear what aspects of the disorder most directly relate to aberrant emotional responding. Also, the frequent co-occurrence of blast-related mild traumatic brain injuries (mTBIs) among recently deployed U.S. military personnel complicates efforts to understand the basis for emotional disruption. We studied a cross-sectional sample (enriched for PTSD and mTBI) of 123 U.S. veterans of wars in Iraq and Afghanistan. We measured subjective affective evaluations and peripheral psychophysiological responses to images with pleasant, neutral, unpleasant, and combat-related aversive content. When compared with other postdeployment participants, those who had combat-related PTSD rated pleasant image content as less positive (ηp2 = .04) and less arousing (ηp2 = .06), and exhibited heightened physiological responsivity to combat image content (ηp2 = .07). Symptoms of PTSD were associated with elevated skin conductance responses (β = .28), reduced heart rate deceleration (β = .44 to .47), and increased corrugator facial muscle electromyography (β = .47). No effects for blast-related mTBI were observed across any affective modulation measures. These findings point to a greater impact of PTSD symptomatology than blast-related mTBI on emotional functioning and highlight the utility of dimensional assessments of psychopathology for understanding the effects of combat-stress conditions on adjustment to civilian life. Copyright © 2018 International Society for Traumatic Stress Studies.

Predictors of suicidal ideation among active duty military personnel with posttraumatic stress disorder.

PubMed

McLean, Carmen P; Zang, Yinyin; Zandberg, Laurie; Bryan, Craig J; Gay, Natalie; Yarvis, Jeffrey S; Foa, Edna B

2017-01-15

Given the alarming rate of military suicides, it is critical to identify the factors that increase risk of suicidal thoughts and behaviors among active duty military personnel. This study examined a predictive model of suicidal ideation among 366 treatment-seeking active duty military personnel with posttraumatic stress disorder (PTSD) following deployments to or near Iraq or Afghanistan. Structural equation modeling was employed to examine the relative contribution of combat exposure, social support, PTSD severity, depressive symptoms, guilt, and trauma-related cognitions on suicidal ideation. The final structural equation model had a highly satisfactory fit [χ 2 (2) =2.023, p=.364; RMSEA =.006; CFI =1; GFI =.998]. PTSD severity had an indirect effect on suicidal ideation via trauma-related cognitions. Depression had a direct positive effect on suicidal ideation; it also had an indirect effect via trauma-related cognitions and interpersonal support. Among participants who had made a previous suicide attempt, only depression symptom severity was significantly linked to suicidal ideation. Data are cross-sectional, precluding causal interpretations. Findings may only generalize to treatment seeking active duty military personnel with PTSD reporting no more than moderate suicidal ideation. These findings suggest that depression and trauma-related cognitions, particularly negative thoughts about the self, play an important role in suicidal ideation among active duty military personnel with PTSD. Negative cognitions about the self and interpersonal support may be important targets for intervention to decrease suicidal ideation. Copyright © 2016 Elsevier B.V. All rights reserved.

Invisible Wounds: Serving Service Members and Veterans with PTSD and TBI

ERIC Educational Resources Information Center

National Council on Disability, 2009

2009-01-01

More than 1.6 million American service members have deployed to Iraq and Afghanistan in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). As of December 2008, more than 4,000 troops have been killed and over 30,000 have returned from a combat zone with visible wounds and a range of permanent disabilities. In addition, an…

Validating the Primary Care Posttraumatic Stress Disorder Screen and the Posttraumatic Stress Disorder Checklist with Soldiers Returning from Combat

ERIC Educational Resources Information Center

Bliese, Paul D.; Wright, Kathleen M.; Adler, Amy B.; Cabrera, Oscar; Castro, Carl A.; Hoge, Charles W.

2008-01-01

The purpose of the research was to assess the diagnostic efficiency of the Primary Care Posttraumatic Stress Disorder Screen (PC-PTSD) and the Posttraumatic Stress Disorder Checklist (PCL) as clinical screening tools for active duty soldiers recently returned from a combat deployment. A secondary goal was to examine the item-level characteristics…

Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: relationships with spouses' perceptions of veterans' experiences and symptoms.

PubMed

Renshaw, Keith D; Rodrigues, Camila S; Jones, David H

2008-08-01

Much research has shown that spouses of combat veterans with posttraumatic stress disorder (PTSD) have higher rates of psychological and marital distress than do spouses of veterans without PTSD; however, very few studies have examined potential mechanisms of this increased vulnerability. The current study examined spouses of National Guard soldiers recently returned from deployments in Iraq. In addition to documenting elevated levels of psychological symptoms in these spouses, the authors found that spouses experienced greater symptom severity when they perceived high levels of symptoms in soldiers but the soldiers endorsed low levels of symptoms. Furthermore, spouses' marital satisfaction was negatively linked to soldiers' self-reported symptom severity only when spouses perceived that soldiers had experienced low levels of combat activity while deployed. When spouses perceived high levels of such activity, soldiers' self-reported symptoms had no relationship with spouses' marital satisfaction. These findings highlight the importance of interpersonal perceptions in intimate relationships and are consistent with the notion that uncontrollable attributions for a relative's mental health problems may provide a buffer against relationship distress. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

Effects of OEF/OIF-Related Physical and Emotional Co-Morbidities on Associative Learning: Concurrent Delay and Trace Eyeblink Classical Conditioning

PubMed Central

McGlinchey, Regina E.; Fortier, Catherine B.; Venne, Jonathan R.; Maksimovskiy, Arkadiy L.; Milberg, William P.

2014-01-01

This study examined the performance of veterans and active duty personnel who served in Operation Enduring Freedom and/or Operation Iraqi Freedom (OEF/OIF) on a basic associative learning task. Eighty-eight individuals participated in this study. All received a comprehensive clinical evaluation to determine the presence and severity of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). The eyeblink conditioning task was composed of randomly intermixed delay and trace conditioned stimulus (CS) and unconditioned stimulus (US) pairs (acquisition) followed by a series of CS only trials (extinction). Results revealed that those with a clinical diagnosis of PTSD or a diagnosis of PTSD with comorbid mTBI acquired delay and trace conditioned responses (CRs) to levels and at rates similar to a deployed control group, thus suggesting intact basic associative learning. Differential extinction impairment was observed in the two clinical groups. Acquisition of CRs for both delay and trace conditioning, as well as extinction of trace CRs, was associated with alcoholic behavior across all participants. These findings help characterize the learning and memory function of individuals with PTSD and mTBI from OEF/OIF and raise the alarming possibility that the use of alcohol in this group may lead to more significant cognitive dysfunction. PMID:24625622

Web intervention for OEF/OIF veterans with problem drinking and PTSD symptoms: a randomized clinical trial.

PubMed

Brief, Deborah J; Rubin, Amy; Keane, Terence M; Enggasser, Justin L; Roy, Monica; Helmuth, Eric; Hermos, John; Lachowicz, Mark; Rybin, Denis; Rosenbloom, David

2013-10-01

Veterans who served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) commonly experience alcohol misuse and symptoms of posttraumatic stress disorder (PTSD) following their return from deployment to a war zone. We conducted a randomized clinical trial to evaluate the efficacy of a newly developed, 8-module, self-management web intervention (VetChange) based on motivational and cognitive-behavioral principles to reduce alcohol consumption, alcohol-related problems, and PTSD symptoms in returning combat veterans. Six hundred participants, recruited through targeted Facebook ads, were randomized to either an Initial Intervention Group (IIG; n = 404) or a Delayed Intervention Group (DIG; n = 196) that waited 8 weeks for access to VetChange. Primary outcome measures were Drinks per Drinking Day, Average Weekly Drinks, Percent Heavy Drinking Days, and PTSD symptoms. Intent-to-treat analyses compared changes in outcome measures over time between IIG and DIG as well as within-group changes. IIG participants demonstrated greater reductions in drinking (p < .001 for each measure) and PTSD symptoms (p = .009) between baseline and end-of-intervention than did DIG participants between baseline and the end of the waiting period. DIG participants showed similar improvements to those in IIG following participation in VetChange. Alcohol problems were also reduced within each group between baseline and 3-month follow-up. Results indicate that VetChange is effective in reducing drinking and PTSD symptoms in OIF/OEF veterans. Further studies of VetChange are needed to assess web-based recruitment and retention methods and to determine VetChange's effectiveness in demographic and clinical sub-populations of returning veterans. (c) 2013 APA, all rights reserved.

Lower health related quality of life in U.S. military personnel is associated with service-related disorders and inflammation.

PubMed

Gill, Jessica; Lee, Hyunhwa; Barr, Taura; Baxter, Tristin; Heinzelmann, Morgan; Rak, Hannah; Mysliwiec, Vincent

2014-04-30

Military personnel who have combat exposures are at increased risk for the service-related disorders of post-traumatic stress disorder (PTSD), depression, sleep disturbances and decreased health related quality of life (HRQOL). Those with a traumatic brain injury (TBI) are at even greater risk. Inflammation is associated with these disorders and may underlie the risk for health declines. We evaluated 110 recently deployed, military personnel presenting with sleep disturbances for service-related disorders (TBI, PTSD, and depression) as well as HRQOL. ANOVA models were used to examine differences among military personnel with two or more service-related disorders (high comorbid group), or one or no disorders (low comorbid group). Logistic regression models were used to determine associations among interleukin-6 (IL-6) to HRQOL and service-related disorders. Approximately one-third of the sample had two or more service-related disorders. HRQOL was lower and IL-6 concentrations were higher in military personnel with PTSD or depression, with the most profound differences in those with more service-related disorders, regardless of sleep disorder. Having symptoms of depression and PTSD resulted in a 3.5-fold risk to be in the lower quartile of HRQOL and the highest quartile of IL-6. In a linear regression model, 41% of the relationship between HRQOL and IL-6 concentrations was mediated by PTSD and depression. Military personnel with PTSD and depression are at high risk for lower HRQOL, and higher IL-6 concentrations. Comprehensive treatment is required to address co-occurring service-related disorders in military personnel to promote health and well-being. Copyright © 2014. Published by Elsevier Ireland Ltd.

Genomewide Association Studies of Posttraumatic Stress Disorder in Two Cohorts of US Army Soldiers

PubMed Central

Stein, Murray B.; Chen, Chia-Yen; Ursano, Robert J.; Cai, Tianxi; Gelernter, Joel; Heeringa, Steven; Jain, Sonia; Jensen, Kevin P.; Maihofer, Adam; Mitchell, Colter; Nievergelt, Caroline M.; Nock, Matthew K.; Neale, Benjamin M.; Polimanti, Renato; Ripke, Stephan; Sun, Xiaoying; Thomas, Michael L.; Wang, Qian; Ware, Erin B.; Borja, Susan; Kessler, Ronald C.; Smoller, Jordan W.

2016-01-01

Importance Posttraumatic stress disorder (PTSD) is a prevalent, serious public health concern, particularly in the military. The identification of genetic risk factors for PTSD may provide important insights into the biological basis of vulnerability and comorbidity. Objective To discover genetic loci associated with lifetime PTSD risk in two cohorts from the Army Study To Assess Risk and Resilience in Servicemembers (Army STARRS). Design, Setting and Participants Two coordinated genomewide association studies of mental health in the US military: New Soldier Study (NSS, N=3167 cases and 4607 trauma-exposed controls) and Pre/Post Deployment Study (PPDS, N=947 cases and 4969 trauma-exposed controls). The primary analysis compared lifetime DSM-IV PTSD cases to trauma-exposed controls without lifetime PTSD. Main Outcomes and Measures Association analyses were conducted for PTSD using logistic regression models within each of 3 ancestral groups (European, African, Latino) by study and then meta-analyzed. Heritability and genetic correlation and pleiotropy with other psychiatric and immune-related disorders were estimated. Results We observed a genomewide significant locus in ANKRD55 on chromosome 5 (rs159572; odds ratio [OR] = 1.62, p-value =2.43×10−8; adjusted for cumulative trauma exposure [AOR] = 1.68, p-value = 1.18×10−8) in the African American samples from NSS. We also observed a genomewide significant locus in or near ZNF626 on chromosome 19 (rs11085374; OR = 0.77, p-value = 4.59 ×10−8) in the European American samples from NSS. We did not find similar results for either SNP in the corresponding ancestry group from the PPDS sample, or in other ancestral groups or trans-ancestral meta-analyses. SNP-based heritability was non-significant, and no significant genetic correlations were observed between PTSD and six mental disorders and nine immune-related disorders. Significant evidence of pleiotropy was observed between PTSD and rheumatoid arthritis and, to a lesser extent, psoriasis. Conclusions and Relevance In the largest GWAS of PTSD to date, involving a US military sample, we found limited evidence of association for specific loci. Further efforts are needed to replicate the genomewide significant association with ANKRD55 – associated in prior research with several autoimmune and inflammatory disorders – and to clarify the nature of the genetic overlap observed between PTSD and rheumatoid arthritis and psoriasis. PMID:27167565

Effects of combat deployment on risky and self-destructive behavior among active duty military personnel.

PubMed

Thomsen, Cynthia J; Stander, Valerie A; McWhorter, Stephanie K; Rabenhorst, Mandy M; Milner, Joel S

2011-10-01

Although research has documented negative effects of combat deployment on mental health, few studies have examined whether deployment increases risky or self-destructive behavior. The present study addressed this issue. In addition, we examined whether deployment effects on risky behavior varied depending on history of pre-deployment risky behavior, and assessed whether psychiatric conditions mediated effects of deployment on risky behavior. In an anonymous survey, active duty members of the U.S. Marine Corps and U.S. Navy (N = 2116) described their deployment experiences and their participation in risky recreational activities, unprotected sex, illegal drug use, self-injurious behavior, and suicide attempts during three time frames (civilian, military pre-deployment, and military post-deployment). Respondents also reported whether they had problems with depression, anxiety, or PTSD during the same three time frames. Results revealed that risky behavior was much more common in civilian than in military life, with personnel who had not deployed, compared to those who had deployed, reporting more risky behavior and more psychiatric problems as civilians. For the current time period, in contrast, personnel who had deployed (versus never deployed) were significantly more likely to report both risky behavior and psychiatric problems. Importantly, deployment was associated with increases in risky behavior only for personnel with a pre-deployment history of engaging in risky behavior. Although psychiatric conditions were associated with higher levels of risky behavior, psychiatric problems did not mediate associations between deployment and risky behavior. Implications for understanding effects of combat deployment on active duty personnel and directions for future research are discussed. Published by Elsevier Ltd.

Post-Traumatic Stress Disorder among French Armed Forces Members in Afghanistan: A New Approach.

PubMed

Paul, Frédéric; Marimoutou, Catherine; Pommier de Santi, Vincent; Clervoy, Patrick

2016-01-01

During the 20th century, the management of war-related psychological trauma shifted from neurology to psychiatry. After September 11, 2001, the French forces participated in a multinational force deployed in Afghanistan to fight against terrorism. Post-traumatic stress disorder (PTSD) became a priority. We report the daily work of the psychiatrists involved in this mission and the organization developed to psychologically support wounded military personnel. The doctrine of early intervention psychiatrization and the technique of collective debriefing are the key points of this procedure. The psychiatrist is also responsible for the healthcare community, particularly vulnerable when confronted with severe ballistic injuries. One aim of this organization is also to screen PTSD in soldiers returning from Afghanistan. The military general practitioner is a pivotal point of this procedure built to detect PTSD, anxiety, depressive reaction and behavioral problems. The French health service has developed a genuine care strategy aimed at identifying patients, accompanying them in the formalities for recognition and compensation, and offering them treatment locally by arranging clinical psychology consultations near their home. © 2016 S. Karger AG, Basel.

Demographic, Maltreatment, and Neurobiological Correlates of PTSD Symptoms in Children and Adolescents

PubMed Central

Hooper, Stephen R.; Woolley, Donald P.; Shenk, Chad E.

2010-01-01

Objective To examine the relationships of demographic, maltreatment, neurostructural and neuropsychological measures with total posttraumatic stress disorder (PTSD) symptoms. Methods Participants included 216 children with maltreatment histories (N = 49), maltreatment and PTSD (N = 49), or no maltreatment (N = 118). Participants received diagnostic interviews, brain imaging, and neuropsychological evaluations. Results We examined a hierarchical regression model comprised of independent variables including demographics, trauma and maltreatment-related variables, and hippocampal volumes and neuropsychological measures to model PTSD symptoms. Important independent contributors to this model were SES, and General Maltreatment and Sexual Abuse Factors. Although hippocampal volumes were not significant, Visual Memory was a significant contributor to this model. Conclusions Similar to adult PTSD, pediatric PTSD symptoms are associated with lower Visual Memory performance. It is an important correlate of PTSD beyond established predictors of PTSD symptoms. These results support models of developmental traumatology and suggest that treatments which enhance visual memory may decrease symptoms of PTSD. PMID:20008084

Prospectively Assessed Posttraumatic Stress Disorder and Associated Physical Activity

DTIC Science & Technology

2011-05-01

combat, persistent risk, and multiple protracted deployments. Increased psychological symptom reporting has engen - dered heightened concern for the...have pointed to the mental health benefits of physical activity, and researchers have postulated a number of mechanisms by which physical activity may...PTSD. Because researchers have postulated a number of mechanisms by which physical activity may modulate mood and the stress response, it is possible

The Minnesota Multiphasic Personality Inventory-2 Restructured Form in National Guard Soldiers Screening Positive for Posttraumatic Stress Disorder and Mild Traumatic Brain Injury

ERIC Educational Resources Information Center

Arbisi, Paul A.; Polusny, Melissa A.; Erbes, Christopher R.; Thuras, Paul; Reddy, Madhavi K.

2011-01-01

The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2 RF) was administered to 251 National Guard soldiers who had recently returned from deployment to Iraq. Soldiers were also administered questionnaires to identify posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). On the basis of responses to the…

The Root Cause of Post-traumatic and Developmental Stress Disorder

DTIC Science & Technology

2013-03-01

Post - traumatic and Developmental Stress Disorder PRINCIPAL INVESTIGATOR: Keith A...28 Feb 2013 4. TITLE AND SUBTITLE The Root Cause of Post - traumatic and Developmental Stress Disorder 5a. CONTRACT NUMBER W81XWH-­‐07-­‐1-­‐0244...goal of Project 1 is to describe the progression of post -deployment stress disorders ( PTSD , major depression, suicidality) in active duty troops

Risk Factors for the Development of PTSD Symptoms Among Deployed US Male Marines

DTIC Science & Technology

2010-01-01

Post - traumatic stress disorder in the community: an epidemiological study. Psychol Med 1991, 21(3):713...721. 4. Helzer JE, Robins LN, McEvoy L: Post - traumatic stress disorder in the general population. Findings of the epidemiologic catchment area survey...symptomatology. J Clin Psychiatry 2006, 67(9):1346-1353. 8. Foy DW, Card JJ: Combat-related post - traumatic stress disorder etiology:

Mortuary Affairs Soldiers: Early Intervention and Altering Barriers to Care for Traumatic Stress and PTSD

DTIC Science & Technology

2014-11-01

military populations and have implications for interventions with disaster workers and others exposed to the dead. Keywords US Army, soldier... military deployment can be high (Cigrang et al., 2014; Hoge et al., 2004; Prigerson, Maciejewski & Rosenheck, 2002; Ursano & Norwood, 1996...have documented the psychological effects of working with human remains on military personnel and disaster workers (Bryant & Harvey, 1996; Clohessy

Posttraumatic stress disorder related to postpartum haemorrhage: A systematic review.

PubMed

Zaat, Tjitske R; van Steijn, Minouk E; de Haan-Jebbink, Jiska M; Olff, Miranda; Stramrood, Claire A I; van Pampus, Mariëlle G

2018-06-01

In some cases childbirth leads to negative psychological responses such as posttraumatic stress disorder (PTSD). Postpartum hemorrhage (PPH) is a common and major complication of childbirth, which occasionally requires emergency hysterectomy in severe cases. Patients often describe these complications as a traumatic experience. It is unknown whether PPH is a risk factor for developing PTSD. In this systematic review we summarize the current knowledge about the association between PPH with or without emergency hysterectomy and posttraumatic stress symptoms or PTSD. If PPH is a risk factor for PTSD, this will allow adequate preventive measures with the aim to reduce the long-term effects and socioeconomic problems associated with PTSD. To conduct this review MEDLINE, EMBASE, Web of Science, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Library and PsycINFO databases were searched for publications between January 1986 and October 2017. Manuscripts evaluating the association between PPH and peripartum emergency hysterectomy and PTSD or posttraumatic stress symptoms were included. Fifty-two articles met the criteria for full-text review. Seven articles were included in this review. Five studies focused on the association between PPH and PTSD and two studies evaluated the association between emergency hysterectomy and PTSD. Three studies found no association between PPH and PTSD. Two studies reported a higher risk of developing PTSD or posttraumatic stress symptoms after PPH. Two studies reported a higher risk of developing PTSD after emergency hysterectomy. Meta-analysis was not possible due to the heterogeneity of these studies. Based on the results of these studies there may be an association between PPH and PTSD. Secondly, it seems likely that an association exists between emergency postpartum hysterectomy and PTSD, but the strength of this conclusion is limited by the small amount of studies included. Copyright © 2018 Elsevier B.V. All rights reserved.

Patients With Co-Occurring Bipolar Disorder and Posttraumatic Stress Disorder: A Rapid Review of the Literature.

PubMed

Cerimele, Joseph M; Bauer, Amy M; Fortney, John C; Bauer, Mark S

2017-05-01

To summarize the current literature on epidemiology, clinical correlates, and treatment of individuals with co-occurring bipolar disorder and posttraumatic stress disorder (PTSD). We conducted a focused, time-sensitive review called "rapid review" in November 2015, using keyword searches (including keywords bipolar disorder, post-traumatic stress disorder, PTSD, and others) in PubMed for studies of adults with co-occurring bipolar disorder and PTSD. Results were sorted and systematically searched. An article was excluded if it did not describe adult patients with co-occurring PTSD and bipolar disorder or did not report original data on epidemiology, clinical correlates, or treatment. Information on study characteristics including population studied and key findings were extracted onto a data collection tool. Thirty-two articles were included. Over two-thirds of articles reported epidemiology of co-occurring bipolar disorder and PTSD. Prevalence of PTSD among individuals with bipolar disorder ranged from 4% to 40%, with women and those with bipolar I versus bipolar II disorder experiencing higher prevalence of PTSD. Prevalence of bipolar disorder among individuals with PTSD ranged from 6% to 55%. Baseline PTSD or bipolar disorder was associated with incidence of the other illness. Individuals with co-occurring bipolar disorder and PTSD experienced high symptom burden and low quality of life. No studies evaluated prospective treatment of patients with co-occurring bipolar disorder and PTSD. Bipolar disorder and PTSD commonly co-occur and result in greater symptom burden than either condition alone. Few published treatment strategies exist for patients with both conditions. © Copyright 2017 Physicians Postgraduate Press, Inc.

Examining the latent structure mechanisms for comorbid posttraumatic stress disorder and major depressive disorder.

PubMed

Hurlocker, Margo C; Vidaurri, Desirae N; Cuccurullo, Lisa-Ann J; Maieritsch, Kelly; Franklin, C Laurel

2018-03-15

Posttraumatic stress disorder (PTSD) is a complex psychiatric illness that can be difficult to diagnose, due in part to its comorbidity with major depressive disorder (MDD). Given that researchers have found no difference in prevalence rates of PTSD and MDD after accounting for overlapping symptoms, the latent structures of PTSD and MDD may account for the high comorbidity. In particular, the PTSD Negative Alterations in Cognition and Mood (NACM) and Hyperarousal factors have been characterized as non-specific to PTSD. Therefore, we compared the factor structures of the Diagnostic and Statistical Manual of Mental Disorders, 5 th edition (DSM-5) PTSD and MDD and examined the mediating role of the PTSD NACM and Hyperarousal factors on the relationship between MDD and PTSD symptom severity. Participants included 598 trauma-exposed veterans (M age = 48.39, 89% male) who completed symptom self-report measures of DSM-5 PTSD and MDD. Confirmatory factor analyses indicated an adequate-fitting four-factor DSM-5 PTSD model and two-factor MDD model. Compared to other PTSD factors, the PTSD NACM factor had the strongest relationship with the MDD Affective factor, and the PTSD NACM and Hyperarousal factors had the strongest association with the MDD Somatic factor. Further, the PTSD NACM factor explained the relationship between MDD factors and PTSD symptom severity. More Affective and Somatic depression was related to more NACM symptoms, which in turn were related to increased severity of PTSD. Limitations include the reliance on self-report measures and the use of a treatment-seeking, trauma-exposed veteran sample which may not generalize to other populations. Implications concerning the shared somatic complaints and psychological distress in the comorbidity of PTSD and MDD are discussed. Published by Elsevier B.V.

Lifetime trauma exposure in veterans with military-related posttraumatic stress disorder: association with current symptomatology.

PubMed

Clancy, Carolina P; Graybeal, Anna; Tompson, Whitney P; Badgett, Kourtni S; Feldman, Michelle E; Calhoun, Patrick S; Erkanli, Alaattin; Hertzberg, Michael A; Beckham, Jean C

2006-09-01

This study examined whether trauma exposure before, during, and/or after military service contributed to current levels of post-traumatic stress disorder (PTSD) and adjustment. Further, we investigated whether trauma exposure before military service was mediated or moderated by military trauma in its effects on current PTSD and adjustment. In this retrospective study, archival data from the medical records of 422 male veterans diagnosed with PTSD between December 2001 and July 2004 at a Veterans Administration Medical Center PTSD clinic were analyzed. Measures included the Clinician-Administered PTSD Scale interview as well as self-report measures assessing trauma history, health problems, and general psychopathology (including PTSD). Findings indicated that nonmilitary-related trauma was prevalent in this sample (90%). Regression analyses for PTSD symptom severity revealed that age, greater combat exposure, and a history of physical assault after military service were significantly associated with more severe PTSD symptoms. Childhood physical abuse, adult sexual trauma, and a history of being physically assaulted during military service were also significantly associated with PTSD symptom severity. Mediational analyses indicated that childhood trauma was associated with both adult trauma and increased symptomatology on various outcome measures. Moderational analyses indicated that adult trauma exposure moderated the effect of childhood trauma exposure on health complaints. Results suggest that several variables, including age, greater combat exposure, and premilitary and postmilitary traumas, are associated with increased PTSD symptomatology. This finding underscores the importance of conducting a thorough assessment of trauma when diagnosing PTSD.

Factor structure of posttraumatic stress disorder symptoms in OEF/OIF veterans presenting to a polytrauma clinic.

PubMed

Maestas, Kacey Little; Benge, Jared F; Pastorek, Nicholas J; Lemaire, Ashley; Darrow, Rachel

2011-11-01

A significant number of Operation Iraqi Freedom/Operation Enduring Freedom (OEF/OIF) veterans are returning from deployment and presenting to Veterans Health Administration (VHA) polytrauma clinics with elevated rates of posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). Inherent to the accurate assessment and treatment of this diagnostically complex group of veterans is the assumption that the construct of PTSD is the same in this population as in other trauma groups. To our knowledge, no previous study has examined the structure of PTSD in this relevant and fast-growing population of treatment-seeking OEF/OIF veterans. Evidence suggests that the latent structure of PTSD symptoms is best represented by a four-factor model, rather than the three-factor model found in the current DSM-IV-TR. Thus, we examined the three and four-factor models using the PTSD Check List-Civilian (PCL-C) in a sample of treatment-seeking OEF/OIF veterans seen through a VHA polytrauma clinic. A chart review was conducted for OEF/OIF veterans (N = 361) seen through a VHA outpatient polytrauma clinic from September 2007 through August 2008. Participants completed the PCL-C as part of a comprehensive polytrauma evaluation. Confirmatory factor analyses showed that the DSM-IV-TR three-factor model did not fit the data well. A direct comparison showed that the four-factor model provided a superior fit relative to the three-factor model. Results extend the generalizability of the four-factor model to OEF/OIF veterans presenting to Veterans Health Administration (VHA) polytrauma clinics.

Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence

PubMed Central

Boyd, Jenna E.; Lanius, Ruth A.; McKinnon, Margaret C.

2018-01-01

Mindfulness-based treatments for posttraumatic stress disorder (PTSD) have emerged as promising adjunctive or alternative intervention approaches. A scoping review of the literature on PTSD treatment studies, including approaches such as mindfulness-based stress reduction, mindfulness-based cognitive therapy and metta mindfulness, reveals low attrition with medium to large effect sizes. We review the convergence between neurobiological models of PTSD and neuroimaging findings in the mindfulness literature, where mindfulness interventions may target emotional under- and overmodulation, both of which are critical features of PTSD symptomatology. Recent emerging work indicates that mindfulness-based treatments may also be effective in restoring connectivity between large-scale brain networks among individuals with PTSD, including connectivity between the default mode network and the central executive and salience networks. Future directions, including further identification of the neurobiological mechanisms of mindfulness interventions in patients with PTSD and direct comparison of these interventions to first-line treatments for PTSD are discussed. PMID:29252162

Mental health treatment among soldiers with current mental disorders in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

PubMed Central

Colpe, Lisa J.; Naifeh, James A.; Aliaga, Pablo; Sampson, Nancy A.; Heeringa, Steven G.; Stein, Murray B.; Ursano, Robert J.; Fullerton, Carol S.; Nock, Matthew K.; Schoenbaum, Michael L.; Zaslavsky, Alan M.; Kessler, Ronald C.

2015-01-01

A representative sample of 5,428 non-deployed Regular Army soldiers completed a self-administered questionnaire (SAQ) and consented to linking SAQ data with administrative records as part of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). The SAQ included information about prevalence and treatment of mental disorders among respondents with current DSM-IV internalizing (anxiety, mood) and externalizing (disruptive behavior, substance) disorders. 21.3% of soldiers with any current disorder reported current treatment. Seven significant predictors of being in treatment rates were identified. Four of these 7 were indicators of psychopathology (bipolar disorder, panic disorder, PTSD, 8+ months duration of disorder). Two were socio-demographics (history of marriage, not being Non-Hispanic Black). The final predictor was history of deployment. Treatment rates varied between 4.7 and 71.5% depending on how many positive predictors the soldier had. The vast majority of soldiers had a low number of these predictors. These results document that most non-deployed soldiers with mental disorders are not in treatment and that untreated soldiers are not concentrated in a particular segment of the population that might be targeted for special outreach efforts. Analysis of modifiable barriers to treatment is needed to help strengthen outreach efforts. PMID:26444466

Dissociative symptoms mediate the relation between PTSD symptoms and functional impairment in a sample of military members, veterans, and first responders with PTSD.

PubMed

Boyd, Jenna E; Protopopescu, Alina; O'Connor, Charlene; Neufeld, Richard W J; Jetly, Rakesh; Hood, Heather K; Lanius, Ruth A; McKinnon, Margaret C

2018-01-01

Background : Posttraumatic Stress Disorder (PTSD) is associated with significant functional impairment in important areas, including interpersonal relationships and occupational or educational roles. Preliminary evidence suggests that the dissociative subtype of PTSD (PTSD+DS), characterized by marked symptoms of depersonalization and derealization, is associated with increased functional impairment and disease severity, including among military members and veterans diagnosed with PTSD. Similarly, first responders (e.g. police, fire, paramedics) have also been found to experience dissociative symptoms. Despite these findings, little work has investigated whether dissociative symptoms are related to heightened functional impairment among these populations. Objective : We examined the relation between functional impairment and symptom level variables, including dissociative symptoms of depersonalization and derealization among military members, veterans, and first responders with probable PTSD. We further investigated the hypothesis that dissociative symptoms mediate the relation between PTSD symptomatology and functional impairment. Method : Eighty-one medical charts of inpatients at a residential PTSD treatment programme were accessed via retrospective review. Sixty-two were included in the present analyses. Comparison of means on symptom measures between first responders and military members/veterans were conducted, followed by correlational and mediation analyses. Results : Compared with first responders, military members and veterans showed higher levels of derealization, functional impairment, alexithymia, anxiety, and depression. Within the total sample, dissociative symptoms emerged as the strongest correlate of functional impairment and, among the dissociative symptom clusters, derealization symptoms demonstrated the strongest relation with impairment. Mediation analyses revealed that total dissociative symptoms and derealization symptoms significantly mediated the relation between PTSD symptoms and functional impairment. Conclusions : These findings highlight the importance of assessing and treating dissociative symptoms, consistent with the dissociative subtype of PTSD, among military members, veterans, and first responders with PTSD. Successful recovery on a functional and symptomatic level may necessitate treatment of dissociative symptoms, particularly derealization.

Dissociative symptoms mediate the relation between PTSD symptoms and functional impairment in a sample of military members, veterans, and first responders with PTSD

PubMed Central

Protopopescu, Alina; O’Connor, Charlene; Neufeld, Richard W. J.; Jetly, Rakesh; Hood, Heather K.; Lanius, Ruth A.; McKinnon, Margaret C.

2018-01-01

ABSTRACT Background: Posttraumatic Stress Disorder (PTSD) is associated with significant functional impairment in important areas, including interpersonal relationships and occupational or educational roles. Preliminary evidence suggests that the dissociative subtype of PTSD (PTSD+DS), characterized by marked symptoms of depersonalization and derealization, is associated with increased functional impairment and disease severity, including among military members and veterans diagnosed with PTSD. Similarly, first responders (e.g. police, fire, paramedics) have also been found to experience dissociative symptoms. Despite these findings, little work has investigated whether dissociative symptoms are related to heightened functional impairment among these populations. Objective: We examined the relation between functional impairment and symptom level variables, including dissociative symptoms of depersonalization and derealization among military members, veterans, and first responders with probable PTSD. We further investigated the hypothesis that dissociative symptoms mediate the relation between PTSD symptomatology and functional impairment. Method: Eighty-one medical charts of inpatients at a residential PTSD treatment programme were accessed via retrospective review. Sixty-two were included in the present analyses. Comparison of means on symptom measures between first responders and military members/veterans were conducted, followed by correlational and mediation analyses. Results: Compared with first responders, military members and veterans showed higher levels of derealization, functional impairment, alexithymia, anxiety, and depression. Within the total sample, dissociative symptoms emerged as the strongest correlate of functional impairment and, among the dissociative symptom clusters, derealization symptoms demonstrated the strongest relation with impairment. Mediation analyses revealed that total dissociative symptoms and derealization symptoms significantly mediated the relation between PTSD symptoms and functional impairment. Conclusions: These findings highlight the importance of assessing and treating dissociative symptoms, consistent with the dissociative subtype of PTSD, among military members, veterans, and first responders with PTSD. Successful recovery on a functional and symptomatic level may necessitate treatment of dissociative symptoms, particularly derealization. PMID:29805778

Early Intervention for Post-Traumatic Stress Disorder, Depression, and Quality of Life in Mortuary Affairs Soldiers Postdeployment.

PubMed

Biggs, Quinn M; Fullerton, Carol S; McCarroll, James E; Liu, Xian; Wang, Leming; Dacuyan, Nicole M; Zatzick, Douglas F; Ursano, Robert J

2016-11-01

U.S. Army mortuary affairs (MA) soldiers experience stressors of deployment and exposure to the dead, increasing risk for post-traumatic stress and depression. This study examines Troop Education for Army Morale, a postdeployment early intervention based on Psychological First Aid. MA soldiers (N = 126) were randomized to intervention or comparison groups 1-month postdeployment. Intervention sessions were held at 2, 3, 4, and 7 months. Assessments of post-traumatic stress disorder (PTSD), depression, and quality of life (QOL) were conducted at 1, 2, 3, 4, 7, and 10 months for both groups. At baseline, 25.0% of the total sample had probable PTSD (17-item PTSD Checklist M = 35.4, SD = 16.9) and 23.6% had probable depression (9-item Patient Health Questionnaire Depression Scale M = 7.8, SD = 6.9). Over 10 months, PTSD and depression symptoms decreased and QOL improved for the total sample. At study conclusion, intervention and comparison groups were not different. Intervention group males showed a transient symptom increase at 2 to 3 months. Males attended fewer intervention sessions than females. Lower attendance was associated with more symptoms and lower QOL. Higher attendance was associated with greater intervention benefits. Findings highlight the need for better understanding postdeployment interventions and facilitating attendance. Further intervention for MA soldiers is indicated. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Combat veterans with comorbid PTSD and mild TBI exhibit a greater inhibitory processing ERP from the dorsal anterior cingulate cortex.

PubMed

Shu, I-Wei; Onton, Julie A; O'Connell, Ryan M; Simmons, Alan N; Matthews, Scott C

2014-10-30

Posttraumatic stress disorder (PTSD) is common among combat personnel with mild traumatic brain injury (mTBI). While patients with either PTSD or mTBI share abnormal activation of multiple frontal brain areas, anterior cingulate cortex (ACC) activity during inhibitory processing may be particularly affected by PTSD. To further test this hypothesis, we recorded electroencephalography from 32 combat veterans with mTBI-17 of whom were also comorbid for PTSD (mTBI+PTSD) and 15 without PTSD (mTBI-only). Subjects performed the Stop Task, a validated inhibitory control task requiring inhibition of initiated motor responses. We observed a larger inhibitory processing eventrelated potential (ERP) in veterans with mTBI+PTSD, including greater N200 negativity. Furthermore, greater N200 negativity correlated with greater PTSD severity. This correlation was most dependent on contributions from the dorsal ACC. Support vector machine analysis demonstrated that N200 and P300 amplitudes objectively classified veterans into mTBI-only or mTBI+PTSD groups with 79.4% accuracy. Our results support a model where, in combat veterans with mTBI, larger ERPs from cingulate areas are associated with greater PTSD severity and likely related to difficulty controlling ongoing brain processes, including trauma-related thoughts and feelings. Published by Elsevier Ireland Ltd.

Examining the effectiveness of an intensive, 2-week treatment program for military personnel and veterans with PTSD: Results of a pilot, open-label, prospective cohort trial.

PubMed

Bryan, Craig J; Leifker, Feea R; Rozek, David C; Bryan, AnnaBelle O; Reynolds, Mira L; Oakey, D Nicolas; Roberge, Erika

2018-06-19

This study aimed to examine the effectiveness of cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) when administered on a daily basis during a 2-week period of time. In an open-label, prospective cohort pilot trial, 20 U.S. military personnel and veterans diagnosed with PTSD or subthreshold PTSD participated in 12 daily sessions of CPT. Primary outcomes included Clinician Administered PTSD Scale for DSM-5 and PTSD Checklist for DSM-5 scores. Secondary outcomes included Patient Health Questionnaire-8 and Beck Scale for Suicide Ideation (BSSI) scores. Interviews and self-report scales were completed at pretreatment, posttreatment, and 6 months after the treatment. Relative to baseline, PTSD symptom severity and rates of PTSD diagnosis were significantly reduced at posttreatment and 6-month follow-up. Depression symptom severity did not significantly improve, but suicide ideation significantly decreased at 6-month follow-up. Daily administration of CPT is associated with significant reductions in PTSD and suicide ideation. © 2018 Wiley Periodicals, Inc.

Can Post mTBI Neurological Soft Signs Predict Postconcussive and PTSD Symptoms : A Pilot Study

DTIC Science & Technology

2014-02-01

disorders , including post - traumatic stress disorder ( PTSD ), but they have scarcely been studied in TBI. The present study measured NSS in the...including post - traumatic stress disorder ( PTSD ), but they have scarcely been studied in TBI. The present study measured NSS in the acute aftermath of...Can Post mTBI Neurological Soft Signs Predict Postconcussive and PTSD Symptoms?: A Pilot Study 5a. CONTRACT NUMBER E-Mail:

A Comparison of Psychological Symptoms in Survivors of Sex and Labor Trafficking.

PubMed

Hopper, E K; Gonzalez, L D

2018-03-20

Human trafficking is a form of interpersonal trauma that has significant mental health impacts on survivors. This study examined psychological symptoms in 131 survivors of sex and labor trafficking, including people trafficked into or within the U.S. High rates of depression (71%) and PTSD (61%) were identified. Two thirds of survivors also met criteria for multiple categories of Complex PTSD (C-PTSD), including affect dysregulation and impulsivity; alterations in attention and consciousness; changes in interpersonal relationships; revictimization; somatic dysregulation; and alterations in self-perception. Although there were not significant differences in the prevalence rates of diagnoses of PTSD or depression between survivors of sex and labor trafficking, important group differences were identified. Compared to survivors of labor trafficking, sex trafficking survivors had higher prevalence rates of pre-trafficking childhood abuse and a higher incidence of physical and sexual violence during trafficking. They reported more severe post-trauma reactions than labor trafficking survivors, including more PTSD and C-PTSD symptoms. They were also more likely to meet criteria for comorbid PTSD and depression, while labor trafficking survivors were more likely than sex trafficking survivors to meet criteria for depression alone. An analysis of gender differences found that trafficking survivors who identified as transgender endorsed more PTSD and C-PTSD symptoms, than male or female survivors. Childhood abuse exposure was linked to PTSD and C-PTSD in trafficking survivors, and trafficking type was predictive of the number of trauma-related symptoms beyond the role of pre-trafficking child abuse. Implications for assessment and intervention with trafficking survivors are discussed.

Treatment of PTSD-Related Anger in Troops Returning from Hazardous Deployments

DTIC Science & Technology

2007-03-01

adapt an existing evidenced- based cognitive- behavioral intervention (CBI) for the treatment of anger to specific needs of military personnel...related anger problems. The specific objectives are to adapt an existing evidenced-based cognitive- behavioral intervention (CBI) for the treatment of anger...objectives are to 1) adapt an existing evidenced- based cognitive- behavioral intervention (CBI) for the treatment of anger to specific needs of military

Project VALOR: Trajectories of Change in PTSD in Combat-Exposed Veterans

DTIC Science & Technology

2015-10-01

Affairs electronic records of Iraq and Afghanistan veterans. Journal of consulting and clinical psychology , 82(4), 569. PRESENTATIONS Barretto...Veterans. Poster presented at the 49th Annual Meeting of the Association of Behavioral and Cognitive Therapies, Chicago, IL. Bovin, M. J., Marx, B...comparison of Operation Iraqi Freedom Deployment Phases. Poster presented at the 49th Annual Meeting of the Association of Behavioral and Cognitive

Stabilometric Platform Measurements to Determine Post-Deployment Adaptation

DTIC Science & Technology

2011-04-01

conflict that utilized major advances in tactics and 2 weaponry. As a result of this technological development, psychological symptoms became a...the form of sexual assault and child abuse, while men were more likely to experience war, witnessing a death, a disaster, and getting an injury (Tolin...ultimately still experience symptoms of PTSD (Friedman, Schnurr, & McDonough Coyle, 1994). These symptoms may still impact marital , family, and social

Improving Deployment-Related Primary Care Provider Assessments of PTSD and Mental Health Conditions

DTIC Science & Technology

2011-10-01

opinions more frequently, give more biomedical information, have less negative affect (Levinson & Roter, 1993), show improved overall communication...patients, modeling (i.e., positive and negative examples), and allowing participants to explore their own feelings regarding the desired skills (Merckaert...archinte.1995.00430170071009 Wissow, L. S., Gadomski, A., Roter, D., Larson, S., Brown, J., Zachary, C., et al. (2008). Improving child and parent mental

DOD Health Care: Domestic Health Care for Female Servicemembers

DTIC Science & Technology

2013-01-01

installations reported offering female- specific programs or activities, such as a post -deployment group for female servicemembers or a postpartum...that they will disseminate their findings through peer- reviewed publications and post this information on the Internet to make it available to the...National Institutes of Health PHA periodic health assessment PTSD post -traumatic stress disorder This is a work of the U.S. government and is not

Dissemination Of Evidence-Based CBT Intervention Components: Online Self-Administered Training For Providers Treating Military Deployment-Related PTSD

DTIC Science & Technology

2010-08-01

eye movement desensitization and reprocessing ( EMDR ), fluoxetine, and pill placebo in the treatment of posttraumatic...stress disorder: treatment effects and long-term maintenance. J Clin Psychiatry;68(1):37-46. 2007. 5. Shapiro F. Eye movement desensitization and ... reprocessing : Basic principles, protocols, and procedures (2nd edition). New York: Guilford Press. 2001. 6. Monson CM, Schnurr PP, Resick

Influence of spirituality on depression, posttraumatic stress disorder, and suicidality in active duty military personnel.

PubMed

Hourani, Laurel L; Williams, Jason; Forman-Hoffman, Valerie; Lane, Marian E; Weimer, Belinda; Bray, Robert M

2012-01-01

Understanding the role of spirituality as a potential coping mechanism for military personnel is important given growing concern about the mental health issues of personnel returning from war. This study seeks to determine the extent to which spirituality is associated with selected mental health problems among active duty military personnel and whether it moderates the relationship between combat exposure/deployment and (a) depression, (b) posttraumatic stress disorder (PTSD), and (c) suicidality in active duty military personnel. Data were drawn from the 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel. Over 24,000 randomly selected active duty personnel worldwide completed an anonymous self-report questionnaire. High spirituality had a significant protective effect only for depression symptoms. Medium, as opposed to high or low, levels of spirituality buffered each of the mental health outcomes to some degree. Medium and low spirituality levels predicted depression symptoms but only among those with moderate combat exposure. Medium spirituality levels also predicted PTSD symptoms among those with moderate levels of combat exposure and predicted self-reported suicidal ideation/attempt among those never deployed. These results point to the complex relationship between spirituality and mental health, particularly among military personnel and the need for further research.

Can mental health and readjustment be improved in UK military personnel by a brief period of structured postdeployment rest (third location decompression)?

PubMed

Jones, Norman; Jones, Margaret; Fear, Nicola T; Fertout, Mohammed; Wessely, Simon; Greenberg, Neil

2013-07-01

Third Location Decompression (TLD) is an activity undertaken by UK Armed Forces (UK AF) personnel at the end of an operational deployment which aims to smooth the transition between operations and returning home. We assessed whether TLD impacted upon both mental health and postdeployment readjustment. Data collected during a large cohort study was examined to identify personnel who either engaged in TLD or returned home directly following deployment. Propensity scores were generated and used to calculate inverse probability of treatment weights in adjusted regression analyses to compare mental health outcomes and postdeployment readjustment problems. TLD had a positive impact upon mental health outcomes (post-traumatic stress disorder (PTSD) and multiple physical symptoms) and levels of harmful alcohol use. However, when the samples were stratified by combat exposure, although postdeployment readjustment was similar for all exposure levels, personnel experiencing low and moderate levels of combat exposure experienced the greatest positive mental health effects. We found no evidence to suggest that TLD promotes better postdeployment readjustment; however, we found a positive impact upon alcohol use and mental health with an interaction with degree of combat exposure. This study suggests that TLD is a useful postdeployment transitional activity that may help to improve PTSD symptoms and alcohol use in UK AF personnel.

Exposure to dysfunctional parenting and trauma events and posttraumatic stress profiles among a treatment sample with coexisting depression and alcohol use problems.

PubMed

Bailey, Kylie; Webster, Rosemary; Baker, Amanda L; Kavanagh, David J

2012-06-01

Trauma exposure (including experiencing dysfunctional parenting when a child) and posttraumatic stress disorder (PTSD) frequently coexist with major depressive disorder (MDD) and alcohol use disorders (AUD), with the impact of this comorbidity usually studied as a dual disorder (i.e. PTSD-MDD or PTSD-AUD). This study explores trauma exposure (including to dysfunctional parenting), PTSD symptom severity and PTSD in people seeking treatment for coexisting depressive symptoms and alcohol use problems. Participants (n = 221) with current depression and alcohol use problems were recruited. Trauma exposure, PTSD symptoms and PTSD were assessed using the Posttraumatic Stress Diagnostic Scale. The Measure of Parenting Style assessed dysfunctional parenting (neglect/over-control/abuse) experienced as a child. Most participants experienced trauma (71.6%, n = 159), with more than one-third reaching DSM-IV criteria for current PTSD (38.0%, n = 84). Unique to this study was that there were no gender differences in rates of trauma exposure, number of traumatic events and PTSD. More severe PTSD symptoms and PTSD were associated with: childhood neglect; earlier depression onset; more severe depression and alcohol problems; and lower general functioning. More severe problems with alcohol were related to Intrusion and Avoidance symptoms, while severe alcohol dependence symptoms were related to hyperarousal. PTSD symptoms and PTSD are highly prevalent in those with coexisting depression and alcohol use problems and are associated with a history of childhood neglect and higher levels of comorbidity. Trauma, PTSD symptoms and PTSD should be assessed and addressed among people seeking treatment for coexisting depression and alcohol problems. © 2011 Australasian Professional Society on Alcohol and other Drugs.

The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis.

PubMed

Yildiz, Pelin Dikmen; Ayers, Susan; Phillips, Louise

2017-01-15

Previous reviews have provided preliminary insights into risk factors and possible prevalence of Post-traumatic Stress Disorder (PTSD) postpartum with no attempt to examine prenatal PTSD. This study aimed to assess the prevalence of PTSD during pregnancy and after birth, and the course of PTSD over this time. PsychINFO, PubMed, Scopus and Web of Science were searched using PTSD terms crossed with perinatal terms. Studies were included if they reported the prevalence of PTSD during pregnancy or after birth using a diagnostic measure. 59 studies (N =24267) met inclusion criteria: 35 studies of prenatal PTSD and 28 studies of postpartum PTSD (where 4 studies provided prevalence of PTSD in pregnancy and postpartum). In community samples the mean prevalence of prenatal PTSD was 3.3% (95%, CI 2.44-4.54). The majority of postpartum studies measured PTSD in relation to childbirth with a mean prevalence of 4.0% (95%, CI 2.77-5.71) in community samples. Women in high-risk groups were at more risk of PTSD with a mean prevalence of 18.95% (95%, CI 10.62-31.43) in pregnancy and 18.5% (95%, CI 10.6-30.38) after birth. Using clinical interviews was associated with lower prevalence rates in pregnancy and higher prevalence rates postpartum. Limitations include use of stringent diagnostic criteria, wide variability of PTSD rates, and inadequacy of studies on prenatal PTSD measured in three trimesters. PTSD is prevalent during pregnancy and after birth and may increase postpartum if not identified and treated. Assessment and treatment in maternity services is recommended. Copyright © 2016 Elsevier B.V. All rights reserved.

The role of stress sensitization in progression of posttraumatic distress following deployment.

PubMed

Smid, Geert E; Kleber, Rolf J; Rademaker, Arthur R; van Zuiden, Mirjam; Vermetten, Eric

2013-11-01

Military personnel exposed to combat are at risk for experiencing post-traumatic distress that can progress over time following deployment. We hypothesized that progression of post-traumatic distress may be related to enhanced susceptibility to post-deployment stressors. This study aimed at examining the concept of stress sensitization prospectively in a sample of Dutch military personnel deployed in support of the conflicts in Afghanistan. In a cohort of soldiers (N = 814), symptoms of post-traumatic stress disorder (PTSD) were assessed before deployment as well as 2, 7, 14, and 26 months (N = 433; 53 %) after their return. Data were analyzed using latent growth modeling. Using multiple group analysis, we examined whether high combat stress exposure during deployment moderated the relation between post-deployment stressors and linear change in post-traumatic distress after deployment. A higher baseline level of post-traumatic distress was associated with more early life stressors (standardized regression coefficient = 0.30, p < 0.001). In addition, a stronger increase in posttraumatic distress during deployment was associated with more deployment stressors (standardized coefficient = 0.21, p < 0.001). A steeper linear increase in posttraumatic distress post-deployment (from 2 to 26 months) was predicted by more post-deployment stressors (standardized coefficient = 0.29, p < 0.001) in high combat stress exposed soldiers, but not in a less combat stress exposed group. The group difference in the predictive effect of post-deployment stressors on progression of post-traumatic distress was significant (χ²(1) = 7.85, p = 0.005). Progression of post-traumatic distress following combat exposure may be related to sensitization to the effects of post-deployment stressors during the first year following return from deployment.

Predictors of recovery from post-traumatic stress disorder after the dongting lake flood in China: a 13-14 year follow-up study.

PubMed

Dai, Wenjie; Wang, Jieru; Kaminga, Atipatsa C; Chen, Long; Tan, Hongzhuan; Lai, Zhiwei; Deng, Jing; Liu, Aizhong

2016-11-08

Floods are some of the most common and destructive natural disasters in the world, potentially leading to both physical injuries and psychological disorders, including post-traumatic stress disorder (PTSD). PTSD can damage functional capacity and interfere with social functioning. However, little is known about recovery from PTSD after floods. This study used 2013-2014 follow-up data on survivors of the 1998 Dongting Lake flood who were diagnosed with PTSD in 2000 to measure the prevalence rate of PTSD at follow-up and identify predictors of recovery from the PTSD diagnosis in 2000. Participants included survivors who had been diagnosed as having PTSD in 2000 after the 1998 Dongting Lake flood. PTSD at follow-up was reassessed using the PTSD Checklist-Civilian version. Information on demographics, trauma-related stressors, post-trauma stressors, social support, and coping style were collected through face-to-face interviews. The association between the independent variables and PTSD at follow-up was analyzed using logistic regression analyses. A total of 201 participants with a PTSD diagnosis in 2000 were included in this study. A total of 19.4 % of the flood survivors with PTSD in 2000 continued to suffer from PTSD in 2013-2014. In the multivariable logistic regression model, individuals who had lost relatives (OR = 12.37, 95 % CI = 2.46-62.16), suffered from bodily injury (OR = 5.01, 95 % CI = 1.92-13.08), had a low level of social support (OR = 5.47, 95 % CI = 1.07-27.80), or had a negative coping style (OR = 4.92, 95 % CI = 1.89-12.81) were less likely to recover from PTSD. The prevalence rate of PTSD at follow-up indicates that natural disasters such as floods may have a negative influence on survivors' mental health for an extended period of time. Individuals who have lost relatives, suffered from bodily injury, had a low level of social support, or had a negative coping style were less likely to recover from PTSD. Therefore, effective psychological intervention measures are necessary for facilitating the recovery process from PTSD, especially for individuals with adverse prognostic factors.

Post Traumatic Stress Disorder: Implications for Seasonal Lifeguards.

ERIC Educational Resources Information Center

Grosse, Susan J.

2001-01-01

Discusses the importance of including information on posttraumatic stress disorder (PTSD) in preseason and inservice training for lifeguards as well as critical information on stress management. The article defines PTSD; examines lifeguard-related causes of PTSD; discusses the recognition, treatment, and prevention of PTSD; and notes implications…

Women's experiences of symptoms of posttraumatic stress disorder (PTSD) after traumatic childbirth: a review and critical appraisal.

PubMed

James, Stella

2015-12-01

This paper critically analyses nine studies on postnatal posttraumatic stress disorder (PTSD) following traumatic childbirth, in order to find common themes of PTSD symptoms, using the cognitive model of PTSD as a guide; it critically appraised one of the studies in depth and it attempted to explain the lived experience of women suffering from postnatal PTSD following traumatic childbirth and the suitability of cognitive behavioural therapy (CBT) for postnatal PTSD. This paper found that women following traumatic childbirth do experience postnatal PTSD; postnatal PTSD symptoms are similar to PTSD symptoms of other events and that CBT for PTSD of other events is just as effective for postnatal PTSD. Future recommendations include more qualitative studies with interpretative phenomenological approach in order to establish evidence-based CBT treatment for this client group, and more referrals need to be sent to the psychological services for CBT intervention.

Effectiveness of virtual reality exposure therapy for active duty soldiers in a military mental health clinic.

PubMed

Reger, Greg M; Holloway, Kevin M; Candy, Colette; Rothbaum, Barbara O; Difede, JoAnn; Rizzo, Albert A; Gahm, Gregory A

2011-02-01

Exposure therapy is an evidence-based treatment for posttraumatic stress disorder (PTSD), but research evaluating its effectiveness with active duty service members is limited. This report examines the effectiveness of virtual reality exposure therapy (VRE) for active duty soldiers (N = 24) seeking treatment following a deployment to Iraq or Afghanistan. Relative to their pretreatment self-reported symptoms on the PTSD Checklist, Military Version (M = 60.92; SD = 11.03), patients reported a significant reduction at posttreatment (M = 47.08; SD = 12.70; p < .001). Sixty-two percent of patients (n = 15) reported a reliable change of 11 points or more. This study supports the effectiveness of exposure therapy for active duty soldiers and extends previous research on VRE to this population. Copyright © 2011 International Society for Traumatic Stress Studies.

Evidence of the dissociative PTSD subtype: A systematic literature review of latent class and profile analytic studies of PTSD.

PubMed

Hansen, Maj; Ross, Jana; Armour, Cherie

2017-04-15

The dissociative PTSD (D-PTSD) subtype was first introduced into the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. Prior to this, studies using latent profile analysis (LPA) or latent class analysis (LCA), began to provide support for the D-PTSD construct and associated risk factors. This research is important, because dissociative symptoms in the context of PTSD may potentially interfere with treatment course or outcome. The aims of the present study were twofold: to systematically review the LCA and LPA studies investigating support for the D-PTSD construct; and to review the associated research on the risk factors or covariates of D-PTSD in the identified studies. Six databases (PubMed, Web of Science, Scopus, PILOTS, PsychInfo, and Embase) were systematically searched for relevant papers. Eleven studies were included in the present review. The majority of the studies were supportive of the D-PTSD subtype; primarily characterized by depersonalization and derealization. Several covariates of the D-PTSD subtype have been investigated with mixed results. Many limitations relate to the state of the current literature, including a small number of studies, the use of self-report measurements of PTSD, and heterogeneity across the samples in investigated covariates. The results were overall supportive of the D-PTSD construct. Future research on D-PTSD and associated risk factors is needed to shed light on the possibilities of facilitating preventive actions, screening, and implications on treatment effects. Copyright © 2017 Elsevier B.V. All rights reserved.

Is Post-Traumatic Stress Disorder Associated with Premature Senescence? A Review of the Literature

PubMed Central

Lohr, James B.; Palmer, Barton W.; Eidt, Carolyn A.; Aailaboyina, Smitha; Mausbach, Brent T.; Wolkowitz, Owen M.; Thorp, Steven R.; Jeste, Dilip V.

2015-01-01

Post-Traumatic Stress Disorder (PTSD) has major public health significance. Evidence that PTSD may be associated with premature senescence (early or accelerated aging) would have major implications for quality of life and healthcare policy. We conducted a comprehensive review of published empirical studies relevant to early aging in PTSD. Our search included the PubMed, PsycINFO and PILOTS databases for empirical reports published since the year 2000 relevant to early senescence and PTSD, including: (1) biomarkers of senescence (leukocyte telomere length (LTL) and pro-inflammatory markers), (2) prevalence of senescence-associated medical conditions, and (3) mortality rates. All six studies examining LTL indicated reduced LTL in PTSD (pooled Cohen’s d = 0.76). We also found consistent evidence of increased pro-inflammatory markers in PTSD (mean Cohen’s ds), including C-reactive protein = 0.18, Interleukin-1 beta = 0.44, Interleukin-6 = 0.78, and tumor necrosis factor alpha = 0.81. The majority of reviewed studies also indicated increased medical comorbidity among several targeted conditions known to be associated with normal aging, including cardiovascular disease, type 2 diabetes mellitus, gastrointestinal ulcer disease, and dementia. We also found seven of 10 studies indicated PTSD to be associated with earlier mortality (average HR = 1.29). In short, evidence from multiple lines of investigation suggests that PTSD may be associated with a phenotype of accelerated senescence. Further research is critical to understand the nature of this association. There may be a need to re-conceptualize PTSD beyond the boundaries of mental illness, and instead as a full systemic disorder. PMID:25959921

Pharmacological treatment of comorbid PTSD and substance use disorder: recent progress.

PubMed

Sofuoglu, Mehmet; Rosenheck, Robert; Petrakis, Ismene

2014-02-01

Previous research has identified a strong association between posttraumatic stress disorder (PTSD) and substance use disorder (SUD), necessitating the development of treatments that address both conditions. Some pharmacotherapies are effective for the treatment of PTSD and SUD alone, however; no medications have been proven to be effective for the combination of these conditions. We review the recent advances in pharmacological treatment of comorbid PTSD and SUD. A randomized clinical trial of sertraline, a serotonin reuptake inhibitor (SSRI), did not show overall efficacy for comorbid PTSD and alcohol dependence (AD), although it may have efficacy among light drinkers. Another clinical trial demonstrated the efficacy of both disulfiram and naltrexone for the treatment of AD in individuals with PTSD. A more recent clinical trial suggested that norepinephrine uptake inhibitors may also have efficacy for the treatment of comorbid PTSD and AD. In animal and preliminary human studies, brain norepinephrine and glutamate/GABA have emerged as potential treatment targets for comorbid PTSD and SUD. Noradrenergic medications that are promising for comorbid PTSD and SUD include prazosin, guanfacine, and atomoxetine. Promising glutamate/GABA medications include topiramate, memantine, acamprosate, N-acetylcysteine (NAC), and ketamine. The safety and efficacy of these medications for the treatment of PTSD and SUD need to be tested in controlled clinical trials. Published by Elsevier Ltd.

Natural Course of Co-Occurring PTSD and Alcohol Use Disorder Among Recent Combat Veterans.

PubMed

Possemato, Kyle; Maisto, Stephen A; Wade, Michael; Barrie, Kimberly; Johnson, Emily M; Ouimette, Paige C

2017-06-01

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur in veterans, yet little is known about the longitudinal course of PTSD and drinking in comorbid populations. This study assessed the natural course of daily alcohol consumption and weekly changes in PTSD symptoms in 112 recent combat veterans over the course of 11 months. Latent class growth mixture modeling was used to classify individuals into distinct classes with similar PTSD symptom and alcohol use growth trajectories. We then investigated theorized predictors of class membership including sociodemographics; pre-, peri-, and postdeployment factors; coping; symptom severity; and number of mental health/substance use appointments attended. Results revealed that most participants had severe and nonremitting PTSD. Trajectories for alcohol use included gradual and drastic declines, and chronic low-level drinking. The use of behavioral health services (odds ratio = 2.47) and fewer current stressors (odds ratio = 0.42) predicted AUD remission. Because little variation was observed in the PTSD course, our study did not observe coordinated fluctuations of PTSD symptoms and heavy drinking. Our findings suggest that treatment impacts the course of AUD and that recent combat veterans who do not seek PTSD treatment may have chronic and severe PTSD symptoms. Copyright © 2017 International Society for Traumatic Stress Studies.

Development and Validation of a Computerized-Adaptive Test for PTSD (P-CAT).

PubMed

Eisen, Susan V; Schultz, Mark R; Ni, Pengsheng; Haley, Stephen M; Smith, Eric G; Spiro, Avron; Osei-Bonsu, Princess E; Nordberg, Sam; Jette, Alan M

2016-10-01

The primary purpose was to develop, field test, and validate a computerized-adaptive test (CAT) for posttraumatic stress disorder (PTSD) to enhance PTSD assessment and decrease the burden of symptom monitoring. Data sources included self-report and interviewer-administered diagnostic interviews. The sample included 1,288 veterans. In phase 1, 89 items from a previously developed PTSD item pool were administered to a national sample of 1,085 veterans. A multidimensional graded-response item response theory model was used to calibrate items for incorporation into a CAT for PTSD (P-CAT). In phase 2, in a separate sample of 203 veterans, the P-CAT was validated against three other self-report measures (PTSD Checklist, Civilian Version; Mississippi Scale for Combat-Related PTSD; and Primary Care PTSD Screen) and the PTSD module of the Structured Clinical Interview for DSM-IV. A bifactor model with one general PTSD factor and four subfactors consistent with DSM-5 (reexperiencing, avoidance, negative mood-cognitions, and arousal), yielded good fit. The P-CAT discriminated veterans with PTSD from those with other mental health conditions and those with no mental health conditions (Cohen's d effect sizes >.90). The P-CAT also discriminated those with and without a PTSD diagnosis and those who screened positive versus negative for PTSD. Concurrent validity was supported by high correlations (r=.85-.89) with the validation measures. The P-CAT appears to be a promising tool for efficient and accurate assessment of PTSD symptomatology. Further testing is needed to evaluate its responsiveness to change. With increasing availability of computers and other technologies, CAT may be a viable and efficient assessment method.

Latent-level relations between DSM-5 PTSD symptom clusters and problematic smartphone use.

PubMed

Contractor, Ateka A; Frankfurt, Sheila B; Weiss, Nicole H; Elhai, Jon D

2017-07-01

Common mental health consequences following the experience of potentially traumatic events include Posttraumatic Stress Disorder (PTSD) and addictive behaviors. Problematic smartphone use is a newer manifestation of addictive behaviors. People with anxiety severity (such as PTSD) may be at risk for problematic smartphone use as a means of coping with their symptoms. Unique to our knowledge, we assessed relations between PTSD symptom clusters and problematic smartphone use. Participants ( N = 347), recruited through Amazon's Mechanical Turk (MTurk), completed measures of PTSD and smartphone addiction. Results of the Wald tests of parameter constraints indicated that problematic smartphone use was more related to PTSD's negative alterations in cognitions and mood (NACM) than to PTSD's avoidance factor, Wald χ 2 (1, N = 347) = 12.51, p = 0.0004; and more to PTSD's arousal compared to PTSD's avoidance factor, Wald χ 2 (1, N = 347) = 14.89, p = 0.0001. Results indicate that problematic smartphone use is most associated with negative affect and arousal among trauma-exposed individuals. Implications include the need to clinically assess problematic smartphone use among trauma-exposed individuals presenting with higher NACM and arousal severity; and targeting NACM and arousal symptoms to mitigate the effects of problematic smartphone use.

Bomb blast, mild traumatic brain injury and psychiatric morbidity: a review.

PubMed

Rosenfeld, Jeffrey V; Ford, Nick L

2010-05-01

Traumatic brain injury (TBI) arising from blast exposure during war is common, and frequently complicated by psychiatric morbidity. There is controversy as to whether mild TBI from blast is different from other causes of mild TBI. Anxiety and affective disorders such as Post-traumatic Stress Disorder (PTSD) and depression are common accompaniments of blast injury with a significant overlap in the diagnostic features of PTSD with post-concussive syndrome (PCS). This review focuses on this overlap and the effects of mild TBI due to bomb blast. Mild TBI may have been over diagnosed by late retrospective review of returned servicemen and women using imprecise criteria. There is therefore a requirement for clear and careful documentation by health professionals of a TBI due to bomb blast shortly after the event so that the diagnosis of TBI can be made with confidence. There is a need for the early recognition of symptoms of PCS, PTSD and depression and early multi-disciplinary interventions focussed on expected return to duties. There also needs to be a continued emphasis on the de-stigmatization of psychological conditions in military personnel returning from deployment. (c) 2009 Elsevier Ltd. All rights reserved.

Examining a Comprehensive Model of Disaster-Related Posttraumatic Stress Disorder in Systematically Studied Survivors of 10 Disasters

PubMed Central

Oliver, Julianne; Pandya, Anand

2012-01-01

Objectives. Using a comprehensive disaster model, we examined predictors of posttraumatic stress disorder (PTSD) in combined data from 10 different disasters. Methods. The combined sample included data from 811 directly exposed survivors of 10 disasters between 1987 and 1995. We used consistent methods across all 10 disaster samples, including full diagnostic assessment. Results. In multivariate analyses, predictors of PTSD were female gender, younger age, Hispanic ethnicity, less education, ever-married status, predisaster psychopathology, disaster injury, and witnessing injury or death; exposure through death or injury to friends or family members and witnessing the disaster aftermath did not confer additional PTSD risk. Intentionally caused disasters associated with PTSD in bivariate analysis did not independently predict PTSD in multivariate analysis. Avoidance and numbing symptoms represented a PTSD marker. Conclusions. Despite confirming some previous research findings, we found no associations between PTSD and disaster typology. Prospective research is needed to determine whether early avoidance and numbing symptoms identify individuals likely to develop PTSD later. Our findings may help identify at-risk populations for treatment research. PMID:22897543

The Psychological Adaptation of CF Augmentees: Effects of Personality, Situational Appraisals, Social Support, and Prior Stressors on Operational Readiness

DTIC Science & Technology

2004-08-01

Manning, Williams, & Wolfe, 1988). Hardiness appears to mitigate the stress -health relationship in several ways. Hardiness facilitates the use of...significant predictors of PTSD years after missions end, even after controlling for the effects of combat exposure, earlier trauma, and present stressful ... self - reports of somatic complaints as an indicator of operational readiness to deploy. Commitment Commitment to a relationship , idea, role or

Relationship Factors Contributing to the Progression of Combat Related PTSD and Suicidality Over Time

DTIC Science & Technology

2017-05-01

for military couples. This study consisted of confidential online surveys , which were completed by active duty Army males post deployment, along...with their significant romantic partner. The study consisted of a total of 5 surveys each for the service members and their female partners. Final...participation rates are as follows: 1430 individuals (i.e., 715 couples) passed screening and were invited to complete Survey 1 and 1242 individuals (576

Retrospective Study: Sleep, Mental Disorders, and TBI in Deployed Military Members

DTIC Science & Technology

2014-12-06

177(11), 1254-1260. Elnitsky, C. A., Chapman, P. L., Thurman, R. M., Pitts, B. L., Figley, C., & Unwin, B. (2013). Gender differences in combat... Gender differences in depression and PTSD symptoms following combat exposure. Depression and Anxiety, 27(11), 1027-1033. Macera, C. A., Aralis, H...MCAS Telephone 252-466-0500 Mobile Telephone 267-243-0801 E-mail Address Pamela.wall@med.navy.mil PI Home Contact Information Address 112

VA/DoD Joint Executive Council FY 2009: Joint Strategic Plan FY 2010-2012

DTIC Science & Technology

2009-01-01

through the Military Health System (MHS) Population Health Portal . HEC Traumatic Brain Injury and Psychological Health In FY 2009, VA and DoD made...available using the Deployment Occupational and Environmental Health Surveillance Portal . TBI and MH assessment tools were evaluated and monitored through...with increased access, VA maintained the frequency of encounters for treatment of PTSD and other MH conditions in Veterans of prior eras. To forecast

The DSM-5 dissociative-PTSD subtype: can levels of depression, anxiety, hostility, and sleeping difficulties differentiate between dissociative-PTSD and PTSD in rape and sexual assault victims?

PubMed

Armour, Cherie; Elklit, Ask; Lauterbach, Dean; Elhai, Jon D

2014-05-01

The DSM-5 currently includes a dissociative-PTSD subtype within its nomenclature. Several studies have confirmed the dissociative-PTSD subtype in both American Veteran and American civilian samples. Studies have begun to assess specific factors which differentiate between dissociative vs. non-dissociative PTSD. The current study takes a novel approach to investigating the presence of a dissociative-PTSD subtype in its use of European victims of sexual assault and rape (N=351). Utilizing Latent Profile Analyses, we hypothesized that a discrete group of individuals would represent a dissociative-PTSD subtype. We additionally hypothesized that levels of depression, anger, hostility, and sleeping difficulties would differentiate dissociative-PTSD from a similarly severe form of PTSD in the absence of dissociation. Results concluded that there were four discrete groups termed baseline, moderate PTSD, high PTSD, and dissociative-PTSD. The dissociative-PTSD group encompassed 13.1% of the sample and evidenced significantly higher mean scores on measures of depression, anxiety, hostility, and sleeping difficulties. Implications are discussed in relation to both treatment planning and the newly published DSM-5. Copyright © 2014 Elsevier Ltd. All rights reserved.

Roles of inter-individual differences and intra-individual acute elevations in early smoking lapse in people with posttraumatic stress disorder.

PubMed

Dedert, Eric A; Hicks, Terrell A; Dennis, Paul A; Calhoun, Patrick S; Beckham, Jean C

2016-09-01

Existing models of the role of posttraumatic stress disorder (PTSD) symptoms and smoking have almost exclusively examined mean symptom levels, rather than the acute elevations that might trigger smoking lapse immediately or increase risk of a smoking lapse in the next few hours. We examined ecological momentary assessments (EMA) of PTSD symptom clusters and smoking in the first week of a quit attempt in 52 people with PTSD. In multilevel models including PTSD symptom means, acute elevations, and lagged acute elevations together as simultaneous predictors of odds of smoking in the same models, pre-quit smoking occasions were significantly related to acute elevations in symptoms, including PTSD totals (OR=1.20; 95% CI, 1.10 to 1.31), PTSD re-experiencing symptoms (OR=1.16; 95% CI, 1.06 to 1.27), PTSD avoidance symptoms (OR=1.20; 95% CI, 1.10 to 1.31), PTSD numbing symptoms (OR=1.14; 95% CI, 1.04 to 1.24), and PTSD hyperarousal symptoms (OR=1.20; 95% CI, 1.09 to 1.31). In contrast, post-quit smoking was related to lagged acute elevations in PTSD re-experiencing (OR=1.24, 95% CI, 1.03 to 1.50) avoidance (OR=1.27, 95% CI, 1.05 to 1.53), and numbing symptoms (OR=1.24, 95% CI, 1.02 to 1.51). During a quit attempt, individuals with PTSD delayed smoking in response to acute elevations in PTSD re-experiencing and Avoidance. This period presents an opportunity to use mobile health interventions to prevent smoking lapse and to use coping skills acquired in trauma-focused therapy to respond to acute PTSD symptom elevation. Published by Elsevier Ltd.

Pharmacologic management of comorbid post-traumatic stress disorder and addictions.

PubMed

Shorter, Daryl; Hsieh, John; Kosten, Thomas R

2015-12-01

Post-traumatic Stress Disorder (PTSD) and substance use disorders (SUD) frequently co-occur, and their combination can increase poor health outcomes as well as mortality. Using PUBMED and the list of references from key publications, this review article covered the epidemiology, neurobiology and pharmacotherapy of PTSD with comorbid alcohol, opiate, and cannabis use disorders. These SUD represent two with and one without FDA approved pharmacotherapies. SUD is two to three times more likely among individuals with lifetime PTSD, and suicide, which is made more likely by both of these disorders, appears to be additively increased by having this comorbidity of SUD and PTSD. The shared neurobiological features of these two illnesses include amygdalar hyperactivity with hippocampal, medial prefrontal and anterior cingulate cortex dysfunction. Medications for comorbid PTSD and SUD include the PTSD treatment sertraline, often used in combination with anticonvulsants, antipsychotics, and adrenergic blockers. When PTSD is comorbid with alcohol use disorder (AUD), naltrexone, acamprosate or disulfiram may be combined with PTSD treatments. Disulfiram alone may treat both PTSD and AUD. For PTSD combined with opiate use disorder methadone or buprenorphine are most commonly used with sertraline. Marijuana use has been considered by some to be a treatment for PTSD, but no FDA treatment for this addiction is approved. Pregabalin and D-cycloserine are two innovations in pharmacotherapy for PTSD and SUD. Comorbid PTSD and SUD amplifies their lethality and treatment complexity. Although they share important neurobiology, these patients uncommonly respond to a single pharmacotherapy such as sertraline or disulfiram and more typically require medication combinations and consideration of the specific type of SUD. © American Academy of Addiction Psychiatry.

Clinician Documentation on Receipt of Trauma-Focused Evidence-Based Psychotherapies in a VA PTSD Clinic.

PubMed

Lu, Mary W; Plagge, Jane M; Marsiglio, Mary C; Dobscha, Steven K

2016-01-01

The U.S. Department of Veterans Affairs (VA) is implementing two trauma-focused, evidence-based psychotherapies (TF-EBPs) for posttraumatic stress disorder (PTSD): cognitive processing therapy and prolonged exposure therapy (PE). Veterans with PTSD often do not receive these treatments, and little is known about the reasons veterans may not receive TF-EBPs. The aim of this qualitative study was to summarize clinician-reported reasons in medical records for nonreceipt of TF-EBPs. All veterans (N = 63) identified through PTSD screening who were newly engaged in mental health care and received individual evaluations in a PTSD specialty clinic in fiscal year 2008 were included in the sample. Content analysis of electronic medical records revealed multiple potential reasons for nonreceipt of TF-EBPs including referral to other PTSD treatments, other clinical priorities, poor engagement in care, practical barriers, negative beliefs, and receipt of care in other settings. Eight veterans (13%) initiated TF-EBPs. Further interventions to promote engagement in PTSD treatment are warranted.

Recovery from PTSD following Hurricane Katrina.

PubMed

McLaughlin, Katie A; Berglund, Patricia; Gruber, Michael J; Kessler, Ronald C; Sampson, Nancy A; Zaslavsky, Alan M

2011-06-01

We examined patterns and correlates of speed of recovery of estimated posttraumatic stress disorder (PTSD) among people who developed PTSD in the wake of Hurricane Katrina. A probability sample of prehurricane residents of areas affected by Hurricane Katrina was administered a telephone survey 7-19 months following the hurricane and again 24-27 months posthurricane. The baseline survey assessed PTSD using a validated screening scale and assessed a number of hypothesized predictors of PTSD recovery that included sociodemographics, prehurricane history of psychopathology, hurricane-related stressors, social support, and social competence. Exposure to posthurricane stressors and course of estimated PTSD were assessed in a follow-up interview. An estimated 17.1% of respondents had a history of estimated hurricane-related PTSD at baseline and 29.2% by the follow-up survey. Of the respondents who developed estimated hurricane-related PTSD, 39.0% recovered by the time of the follow-up survey with a mean duration of 16.5 months. Predictors of slow recovery included exposure to a life-threatening situation, hurricane-related housing adversity, and high income. Other sociodemographics, history of psychopathology, social support, social competence, and posthurricane stressors were unrelated to recovery from estimated PTSD. The majority of adults who developed estimated PTSD after Hurricane Katrina did not recover within 18-27 months. Delayed onset was common. Findings document the importance of initial trauma exposure severity in predicting course of illness and suggest that pre- and posttrauma factors typically associated with course of estimated PTSD did not influence recovery following Hurricane Katrina. © 2011 Wiley-Liss, Inc.

Prevalence of psychiatric morbidity in United States military spouses: The Millennium Cohort Family Study.

PubMed

Steenkamp, Maria M; Corry, Nida H; Qian, Meng; Li, Meng; McMaster, Hope Seib; Fairbank, John A; Stander, Valerie A; Hollahan, Laura; Marmar, Charles R

2018-05-10

Approximately half of US service members are married, equating to 1.1 million military spouses, yet the prevalence of psychiatric morbidity among military spouses remains understudied. We assessed the prevalence and correlates of eight mental health conditions in spouses of service members with 2-5 years of service. We employed baseline data from the Millennium Cohort Family Study, a 21-year longitudinal survey following 9,872 military-affiliated married couples representing all US service branches and active duty, Reserve, and National Guard components. Couples were surveyed between 2011 and 2013, a period of high military operational activity associated with Operation Iraqi Freedom and Operation Enduring Freedom. Primary outcomes included depression, anxiety, posttraumatic stress disorder (PTSD), panic, alcohol misuse, insomnia, somatization, and binge eating, all assessed with validated self-report questionnaires. A total of 35.90% of military spouses met criteria for at least one psychiatric condition. The most commonly endorsed conditions were moderate-to-severe somatization symptoms (17.63%) and moderate-to-severe insomnia (15.65%). PTSD, anxiety, depression, panic, alcohol misuse, and binge eating were endorsed by 9.20%, 6.65%, 6.05%, 7.07%, 8.16%, and 5.23% of spouses, respectively. Having a partner who deployed with combat resulted in higher prevalence of anxiety, insomnia, and somatization. Spouses had lower prevalence of PTSD, alcohol misuse, and insomnia but higher rates of panic and binge eating than service members. Both members of a couple rarely endorsed having the same psychiatric problem. One third of junior military spouses screened positive for one or more psychiatric conditions, underscoring the need for high-quality prevention and treatment services. © 2018 Wiley Periodicals, Inc.

Male veterans with PTSD exhibit aberrant neural dynamics during working memory processing: an MEG study

PubMed Central

McDermott, Timothy J.; Badura-Brack, Amy S.; Becker, Katherine M.; Ryan, Tara J.; Khanna, Maya M.; Heinrichs-Graham, Elizabeth; Wilson, Tony W.

2016-01-01

Background Posttraumatic stress disorder (PTSD) is associated with executive functioning deficits, including disruptions in working memory. In this study, we examined the neural dynamics of working memory processing in veterans with PTSD and a matched healthy control sample using magnetoencephalography (MEG). Methods Our sample of recent combat veterans with PTSD and demographically matched participants without PTSD completed a working memory task during a 306-sensor MEG recording. The MEG data were preprocessed and transformed into the time-frequency domain. Significant oscillatory brain responses were imaged using a beamforming approach to identify spatiotemporal dynamics. Results Fifty-one men were included in our analyses: 27 combat veterans with PTSD and 24 controls. Across all participants, a dynamic wave of neural activity spread from posterior visual cortices to left frontotemporal regions during encoding, consistent with a verbal working memory task, and was sustained throughout maintenance. Differences related to PTSD emerged during early encoding, with patients exhibiting stronger α oscillatory responses than controls in the right inferior frontal gyrus (IFG). Differences spread to the right supramarginal and temporal cortices during later encoding where, along with the right IFG, they persisted throughout the maintenance period. Limitations This study focused on men with combat-related PTSD using a verbal working memory task. Future studies should evaluate women and the impact of various traumatic experiences using diverse tasks. Conclusion Posttraumatic stress disorder is associated with neurophysiological abnormalities during working memory encoding and maintenance. Veterans with PTSD engaged a bilateral network, including the inferior prefrontal cortices and supramarginal gyri. Right hemispheric neural activity likely reflects compensatory processing, as veterans with PTSD work to maintain accurate performance despite known cognitive deficits associated with the disorder. PMID:26645740

Examining the uniqueness of frequency and intensity symptom ratings in posttraumatic stress disorder assessment.

PubMed

Elhai, Jon D; Lindsay, Brenda M; Gray, Matt J; Grubaugh, Anouk L; North, Terry C; Frueh, B Christopher

2006-12-01

Data from two studies are presented, investigating the relative effectiveness of posttraumatic stress disorder (PTSD) symptom frequency and intensity rating dimensions, in assessing overall PTSD severity and diagnosis. We assessed frequency and intensity ratings using 1) the Modified PTSD Symptom Scale with 298 trauma-exposed college students, and 2) the Clinician-Administered PTSD Scale with 130 combat-exposed military veterans. Results demonstrated little empirical justification for separating frequency and intensity ratings when measuring PTSD. Large overlaps in variance were evidenced between the dimensions (suggesting construct redundancy), with little meaningful contribution to diagnosing PTSD using one dimension over the other. Implications for future PTSD clinical and research assessment are discussed, including the potential to decrease administration time for these commonly used PTSD measures, given their time-consuming nature.

The intervening role of urgency on the association between childhood maltreatment, PTSD, and substance-related problems

PubMed Central

Mirhashem, Rebecca; Allen, Holley C.; Adams, Zachary W.; van Stolk-Cooke, Katherine; Legrand, Alison; Price, Matthew

2017-01-01

A range of risk factors lead to opioid use and substance-related problems (SRP) including childhood maltreatment, elevated impulsivity, and psychopathology. These constructs are highly interrelated such that childhood maltreatment is associated with elevated impulsivity and traumarelated psychopathology such as posttraumatic stress disorder (PTSD), and impulsivity—particularly urgency—and PTSD are related. Prior work has examined the association between these constructs and substance-related problems independently and it is unclear how these multifaceted constructs (i.e., maltreatment types and positive and negative urgency) are associated with one another and SRP. The current study used structural equation modeling (SEM) to examine the relations among childhood maltreatment, trait urgency, PTSD symptoms, and SRP in a sample of individuals with a history of opioid use. An initial model that included paths from each type of childhood maltreatment, positive and negative urgency, PTSD and SRP did not fit the data well. A pruned model with excellent fit was identified that suggested emotional abuse, positive urgency, and negative urgency were directly related to PTSD symptoms and only PTSD symptoms were directly related to SRP. Furthermore, significant indirect effects suggested that emotional abuse and negative urgency were related to SRP via PTSD symptom severity. These results suggest that PTSD plays an important role in the severity of SRP. PMID:28219827

Optimizing fitness for duty and post-combat clinical services for military personnel and combat veterans with ADHD—a systematic review of the current literature

PubMed Central

Ivanov, Iliyan; Yehuda, Rachel

2014-01-01

Background Attention deficit hyper activity disorder (ADHD) is a developmental disorder, most often diagnosed in childhood, and characterized by hyperactivity and inattention that negatively impacts one's ability to function and fulfill social and personal obligations. Individuals with past history of ADHD may enlist in the military under certain conditions, however the full impact of military training and deployment of later in life ADHD symptoms is unclear. It is of particular interest how military experience may affect ADHD in remission and if such individuals might be at elevated risk for relapse of ADHD symptoms. Method We performed a systematic review f the available literature including the Department of Defense (DOD) guidelines for both eligibility to enlist and fitness for deployment based on reported history and current symptomatology of ADHD. Results The after care for veterans with ADHD relapse is inconsistent and presents with number of challenges. We evaluate the DOD policies regarding the implications of ADHD for fitness for military service and post-combat mental health. Conclusion The full extend of the interaction between pre-existing ADHD and post-combat PTSD are not fully understood. The development of comprehensive and clear algorithms for diagnosing and treating ADHD in the military before and after deployment will have a strong positive impact on the quality of care delivered to soldiers and veterans. PMID:25206949

Diagnosis and management of post-traumatic stress disorder.

PubMed

Grinage, Bradley D

2003-12-15

Although post-traumatic stress disorder (PTSD) is a debilitating anxiety disorder that may cause significant distress and increased use of health resources, the condition often goes undiagnosed. The lifetime prevalence of PTSD in the United States is 8 to 9 percent, and approximately 25 to 30 percent of victims of significant trauma develop PTSD. The emotional and physical symptoms of PTSD occur in three clusters: re-experiencing the trauma, marked avoidance of usual activities, and increased symptoms of arousal. Before a diagnosis of PTSD can be made, the patient's symptoms must significantly disrupt normal activities and last for more than one month. Approximately 80 percent of patients with PTSD have at least one comorbid psychiatric disorder. The most common comorbid disorders include depression, alcohol and drug abuse, and other anxiety disorders. Treatment relies on a multidimensional approach, including supportive patient education, cognitive behavior therapy, and psychopharmacology. Selective serotonin reuptake inhibitors are the mainstay of pharmacologic treatment.

Coverage of Posttraumatic Stress Disorder in the New York Times, 1950-2012.

PubMed

Houston, J Brian; Spialek, Matthew L; Perreault, Mildred F

2016-01-01

Posttraumatic stress disorder (PTSD) is a mental health disorder that occurs for some individuals following a traumatic experience and that can cause significant health, mental health, and functioning problems. The concept of PTSD has multiple components (cause, reactions, and treatment), which provides for great variety in the experience of an individual with PTSD. Given this complexity, the news media's construction of PTSD is likely an important influence in determining how the public understands PTSD, but research has yet to investigate how the news media depict PTSD. This study addresses that gap in the literature by examining New York Times coverage of PTSD from 1950 to 2012. Results indicate that the number of PTSD articles during this time period increased, with coverage spikes related to U.S. military conflicts and the September 11, 2001, terrorist attacks. Almost half (49.14%) of all PTSD articles included military service as a PTSD cause. Military PTSD articles were more likely than civilian PTSD articles to depict the disorder as causing anger/irritability/rage, homicide/violence/rape, suicide, substance abuse, and home/work/relationship problems. PTSD news stories were almost always (94.8%) situated in the current time and most frequently (46.6%) used a community frame. Implications for public understanding of PTSD are discussed.

PTSD and Sexual Dysfunction in Men and Women.

PubMed

Yehuda, Rachel; Lehrner, Amy; Rosenbaum, Talli Y

2015-05-01

Difficulties in sexual desire and function often occur in persons with posttraumatic stress disorder (PTSD), but many questions remain regarding the mechanisms underlying the occurrence of sexual problems in PTSD. The aim of this review was to present a model of sexual dysfunction in PTSD underpinned by an inability to regulate and redirect the physiological arousal needed for healthy sexual function away from aversive hyperarousal and intrusive memories. A literature review pertaining to PTSD and sexual function was conducted. Evidence for the comorbidity of sexual dysfunction and PTSD is presented, and biological and psychological mechanisms that may underlie this co-occurrence are proposed. This manuscript presents evidence of sexual dysfunction in conjunction with PTSD, and of the neurobiology and neuroendocrinology of PTSD and sexual function. Sexual dysfunction following trauma exposure may be mediated by PTSD-related biological, cognitive, and affective processes. The treatment of PTSD must include attention to sexual dysfunction and vice versa. © 2015 International Society for Sexual Medicine.

The Renin-Angiotensin Pathway in PTSD: ACE inhibitor and ARB medications are associated with fewer traumatic stress symptoms

PubMed Central

Khoury, Nayla; Marvar, Paul J.; Gillespie, Charles F.; Wingo, Aliza; Schwartz, Ann; Bradley, Bekh; Kramer, Michael; Ressler, Kerry J

2014-01-01

Objective PTSD is a debilitating stress-related illness associated with trauma exposure. The peripheral and central mechanisms mediating stress response in PTSD are incompletely understood. Recent data suggest that the renin-angiotensin pathway, essential to cardiovascular regulation, is also involved in mediating stress and anxiety. In this study, the authors examined the relationship between active treatment with blood pressure medication, including angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs), and PTSD symptom severity within a highly traumatized civilian medical population. Method Cross-sectional, observational data was analyzed from a larger study, recruiting patients from Grady Memorial Hospital's outpatient population from 2006 to November 2010. Multi-variable linear regression models were fit to statistically evaluate the independent association of being prescribed an ACE-I or ARB with PTSD symptoms, using a sub-set of patients for whom medical information was available (n=505). PTSD diagnosis was assessed using the modified PTSD Symptom Scale (PSS) based on DSM-IV criteria with PTSD symptoms based on PSS and Clinician Administered PTSD Scale (CAPS). Results A significant association was determined between presence of ACE-I / ARB medication and decreased PTSD symptoms (mean PSS score 11.4 vs 14.9 for individuals prescribed vs not prescribed ACE-I/ARBs, respectively (p = 0.014)). After adjustment for covariates, ACE-I/ARB treatment remained significantly associated with decreased PTSD symptoms (p = 0.044). Notably, other blood pressure medications, including beta-blockers, calcium channel blockers, and diuretics, were not significantly associated with reduced PTSD symptoms. Conclusions These data provide the first clinical evidence supporting a role for the reninangiotensin system in the regulation of stress response in patients diagnosed with PTSD. Further studies should examine whether available medications targeting this pathway should be considered for future treatment and potential protection against PTSD symptoms. PMID:22687631

Prevalence rate, predictors and long-term course of probable posttraumatic stress disorder after major trauma: a prospective cohort study

PubMed Central

2012-01-01

Background Among trauma patients relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found. To identify opportunities for prevention and early treatment, predictors and course of PTSD need to be investigated. Long-term follow-up studies of injury patients may help gain more insight into the course of PTSD and subgroups at risk for PTSD. The aim of our long-term prospective cohort study was to assess the prevalence rate and predictors, including pre-hospital trauma care (assistance of physician staffed Emergency Medical Services (EMS) at the scene of the accident), of probable PTSD in a sample of major trauma patients at one and two years after injury. The second aim was to assess the long-term course of probable PTSD following injury. Methods A prospective cohort study was conducted of 332 major trauma patients with an Injury Severity Score (ISS) of 16 or higher. We used data from the hospital trauma registry and self-assessment surveys that included the Impact of Event Scale (IES) to measure probable PTSD symptoms. An IES-score of 35 or higher was used as indication for the presence of probable PTSD. Results One year after injury measurements of 226 major trauma patients were obtained (response rate 68%). Of these patients 23% had an IES-score of 35 or higher, indicating probable PTSD. At two years after trauma the prevalence rate of probable PTSD was 20%. Female gender and co-morbid disease were strong predictors of probable PTSD one year following injury, whereas minor to moderate head injury and injury of the extremities (AIS less than 3) were strong predictors of this disorder at two year follow-up. Of the patients with probable PTSD at one year follow-up 79% had persistent PTSD symptoms a year later. Conclusions Up to two years after injury probable PTSD is highly prevalent in a population of patients with major trauma. The majority of patients suffered from prolonged effects of PTSD, underlining the importance of prevention, early detection, and treatment of injury-related PTSD. PMID:23270522

The Incidence of Posttraumatic Stress Disorder After Floods: A Meta-Analysis.

PubMed

Chen, Long; Liu, Aizhong

2015-06-01

This study analyzes the incidence of posttraumatic stress disorder (PTSD) among flood victims, between different flood intensities, and between different time points after a flood. A search of several electronic literature databases was conducted to collect data on the incidence of PTSD after a flood. Loney criteria for research quality were used to evaluate the quality of selected search results. The combined incidence of PTSD was estimated using the Freeman-Tukey double arcsine transformation method. Subgroup analyses were conducted on different trauma intensities and different time points after a flood. Sensitivity analysis was performed to evaluate the impact of research quality. Fourteen articles were included in this meta-analysis, including a total of 40 600 flood victims; 3862 victims were diagnosed with PTSD. The combined incidence of PTSD was 15.74%. The subgroup analyses showed that the incidence of PTSD in victims who experienced severe and moderate flood intensity was higher than that in victims who experienced mild flood intensity. The incidence of PTSD was lower at 6 or more months after a flood (11.45%) than within 6 months (16.01%) of a flood. In conclusion, the incidence of PTSD among floods of different trauma intensities was statistically significant.

Pilot study of Creating Change, a new past-focused model for PTSD and substance abuse.

PubMed

Najavits, Lisa M; Johnson, Kay M

2014-01-01

Creating Change (CC) is a new past-focused behavioral therapy model developed for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD). It was designed to address current gaps in the field, including the need for a past-focused PTSD/SUD model that has flexibility, can work with complex clients, responds to the staffing and resource limitations of SUD and other community-based treatment programs, can be conducted in group or individual format, and engages clients and clinicians. It was designed to follow the style, tone, and format of Seeking Safety, a successful present-focused PTSD/SUD model. CC can be used in conjunction with SS and/or other models if desired. We conducted a pilot outcome trial of the model with seven men and women outpatients diagnosed with current PTSD and SUD, who were predominantly minority and low-income, with chronic PTSD and SUD. Assessments were conducted pre- and post-treatment. Significant improvements were found in multiple domains including some PTSD and trauma-related symptoms (eg, dissociation, anxiety, depression, and sexual problems); broader psychopathology (eg, paranoia, psychotic symptoms, obsessive symptoms, and interpersonal sensitivity); daily life functioning; cognitions related to PTSD; coping strategies; and suicidal ideation (altogether 19 variables, far exceeding the rate expected by chance). Effect sizes were consistently large, including for both alcohol and drug problems. No adverse events were reported. Despite study methodology limitations, CC is promising. Clients can benefit from past-focused therapy that addresses PTSD and SUD in integrated fashion. © American Academy of Addiction Psychiatry.

Peak high-frequency HRV and peak alpha frequency higher in PTSD.

PubMed

Wahbeh, Helané; Oken, Barry S

2013-03-01

Posttraumatic stress disorder (PTSD) is difficult to treat and current PTSD treatments are not effective for all people. Despite limited evidence for its efficacy, some clinicians have implemented biofeedback for PTSD treatment. As a first step in constructing an effective biofeedback treatment program, we assessed respiration, electroencephalography (EEG) and heart rate variability (HRV) as potential biofeedback parameters for a future clinical trial. This cross-sectional study included 86 veterans; 59 with and 27 without PTSD. Data were collected on EEG measures, HRV, and respiration rate during an attentive resting state. Measures were analyzed to assess sensitivity to PTSD status and the relationship to PTSD symptoms. Peak alpha frequency was higher in the PTSD group (F(1,84) = 6.14, p = 0.01). Peak high-frequency HRV was lower in the PTSD group (F(2,78) = 26.5, p < 0.00005) when adjusting for respiration rate. All other EEG and HRV measures and respiration were not different between groups. Peak high-frequency HRV and peak alpha frequency are sensitive to PTSD status and may be potential biofeedback parameters for future PTSD clinical trials.

Peak High-Frequency HRV and Peak Alpha Frequency Higher in PTSD

PubMed Central

Oken, Barry S.

2012-01-01

Posttraumatic stress disorder (PTSD) is difficult to treat and current PTSD treatments are not effective for all people. Despite limited evidence for its efficacy, some clinicians have implemented biofeedback for PTSD treatment. As a first step in constructing an effective biofeedback treatment program, we assessed respiration, electroencephalography (EEG) and heart rate variability (HRV) as potential biofeedback parameters for a future clinical trial. This cross-sectional study included 86 veterans; 59 with and 27 without PTSD. Data were collected on EEG measures, HRV, and respiration rate during an attentive resting state. Measures were analyzed to assess sensitivity to PTSD status and the relationship to PTSD symptoms. Peak alpha frequency was higher in the PTSD group (F(1,84) = 6.14, p = 0.01). Peak high-frequency HRV was lower in the PTSD group (F(2,78) = 26.5, p<0.00005) when adjusting for respiration rate. All other EEG and HRV measures and respiration were not different between groups. Peak high-frequency HRV and peak alpha frequency are sensitive to PTSD status and may be potential biofeedback parameters for future PTSD clinical trials. PMID:23178990

Combating the Enemy Within: Building Trust, Leading Change and Defeating the Mental Health Stigma

DTIC Science & Technology

2013-12-16

deployment are “affected by Post-Traumatic Stress Disorder (PTSD) or depression .” 4 One national survey reported that “about 6% of employees...experience symptoms of depression in any given year.” 5 When considering stressors faced by the military, one can safely assume the percentage of service...members suffering from depression is greater than the civil sector. Despite existing services, Airmen are reluctant to seek help. Air Force

Recovery from PTSD following Hurricane Katrina

PubMed Central

McLaughlin, Katie A.; Berglund, Patricia; Gruber, Michael J.; Kessler, Ronald C.; Sampson, Nancy A.; Zaslavsky, Alan M.

2011-01-01

Background We examined patterns and correlates of speed of recovery of estimated posttraumatic stress disorder (PTSD) among people who developed PTSD in the wake of Hurricane Katrina. Method A probability sample of pre-hurricane residents of areas affected by Hurricane Katrina was administered a telephone survey 7-19 months following the hurricane and again 24-27 months post-hurricane. The baseline survey assessed PTSD using a validated screening scale and assessed a number of hypothesized predictors of PTSD recovery that included socio-demographics, pre-hurricane history of psychopathology, hurricane-related stressors, social support, and social competence. Exposure to post-hurricane stressors and course of estimated PTSD were assessed in a follow-up interview. Results An estimated 17.1% of respondents had a history of estimated hurricane-related PTSD at baseline and 29.2% by the follow-up survey. Of the respondents who developed estimated hurricane-related PTSD, 39.0% recovered by the time of the follow-up survey with a mean duration of 16.5 months. Predictors of slow recovery included exposure to a life-threatening situation, hurricane-related housing adversity, and high income. Other socio-demographics, history of psychopathology, social support, social competence, and post-hurricane stressors were unrelated to recovery from estimated PTSD. Conclusions The majority of adults who developed estimated PTSD after Hurricane Katrina did not recover within 18-27 months. Delayed onset was common. Findings document the importance of initial trauma exposure severity in predicting course of illness and suggest that pre- and post-trauma factors typically associated with course of estimated PTSD did not influence recovery following Hurricane Katrina. PMID:21308887

A Review of Posttraumatic Stress Disorder and Obesity: Exploring the Link.

PubMed

Masodkar, Kanaklakshmi; Johnson, Justine; Peterson, Michael J

The incidence of posttraumatic stress disorder (PTSD) and obesity are on the rise, and evidence continues to support the observation that individuals who have symptoms of PTSD are more likely to develop obesity in their lifetime. The incidence of obesity in individuals with PTSD, including war veterans, women, and children exposed to trauma, is not solely attributable to psychotropic medications, but actual pathophysiologic mechanisms have not been fully delineated. Additionally, there are no studies to date demonstrating that obese individuals are predisposed to developing PTSD compared to the general population. This review explores the pathogenic pathways common to both PTSD and obesity, which include inflammation, the renin-angiotensin-aldosterone system, cellular structures, and neuroendocrine activation. A PubMed search for the years 2000-2015 with the keywords PTSD and obesity was performed. There were no language restrictions. More research is needed in human subjects to understand the pathogenic pathways common to both PTSD and obesity and to further clarify the direction of identified associations. Ideally, in the future, clinical interventions targeting these pathways may be able to modify the course of PTSD and obesity. The outcome of studies investigating the utility of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the treatment of PTSD symptoms will be relevant to control both PTSD and obesity. Importantly, outcomes assessing inflammation, obesity, and cardiac function in the same subjects also should be determined. Research is needed to reveal the multidimensional and intricate relationship between PTSD and obesity. The implications of this research would be essential for treatment, prevention, and potential public health reforms.

Cognitive function in Japanese women with posttraumatic stress disorder: Association with exercise habits.

PubMed

Narita-Ohtaki, Ryoko; Hori, Hiroaki; Itoh, Mariko; Lin, Mingming; Niwa, Madoka; Ino, Keiko; Imai, Risa; Ogawa, Sei; Sekiguchi, Atsushi; Matsui, Mie; Kunugi, Hiroshi; Kamo, Toshiko; Kim, Yoshiharu

2018-08-15

Posttraumatic stress disorder (PTSD) has been associated with cognitive impairments, yet little is documented on the cognitive function of PTSD patients in Asian countries. It is shown that regular exercise can reduce PTSD symptoms, while no study has investigated the association between exercise and cognition in PTSD patients. This study aimed to examine cognitive functions of Japanese women with PTSD, and to explore the association between regular exercise and cognitive functions. Forty-two women with DSM-IV PTSD and 66 demographically matched healthy control women participated in this study. Most of the patients developed PTSD after experiencing interpersonal violence. Cognitive functions were assessed by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Regular exercise habit was assessed by a self-reported questionnaire. Compared to controls, PTSD patients performed significantly more poorly in all cognitive domains examined, including immediate memory, visuospatial construction, language, attention, delayed memory, as well as the total score of RBANS (all p < 0.001). Compared to PTSD patients without the habit of exercise, those who habitually exercised showed significantly better performance on delayed memory (p = 0.006), which survived after controlling for potentially confounding variables in a multiple regression model. The cross-sectional design and relatively small sample size limited our findings. PTSD in Japanese women is associated with pervasively impaired cognitive functions, including notable impairments in verbal memory. Such memory deficits might be improved by regular exercise, although further studies are needed to investigate the causal relationship between exercise and cognition in PTSD. Copyright © 2018 Elsevier B.V. All rights reserved.

THE ATTENUATING EFFECT OF EMPOWERMENT ON IPV-RELATED PTSD SYMPTOMS IN BATTERED WOMEN LIVING IN DOMESTIC VIOLENCE SHELTERS

PubMed Central

Perez, Sara; Johnson, Dawn M.; Wright, Caroline Vaile

2010-01-01

Intimate partner violence (IPV) is associated with significant psychological distress, including posttraumatic stress disorder (PTSD). However, factors that attenuate the impact of IPV on PTSD remain largely unknown. Using hierarchical regression, this investigation explored the impact of resource acquisition and empowerment on the relationship between IPV and PTSD. Empowerment demonstrated greater relative importance over resource acquisition. Specifically, empowerment was found to attenuate the impact of IPV severity on PTSD at low and moderate levels of violence. The importance of fostering empowerment and addressing PTSD in addition to provision of resources in battered women is discussed. PMID:22411301

The Dissociative Subtype of Post-traumatic Stress Disorder: Research Update on Clinical and Neurobiological Features.

PubMed

van Huijstee, Jytte; Vermetten, Eric

2017-10-21

Recently, a dissociative subtype of post-traumatic stress disorder (PTSD) has been included in the DSM-5. This review focuses on the clinical and neurobiological features that distinguish the dissociative subtype of PTSD from non-dissociative PTSD. Clinically, the dissociative subtype of PTSD is associated with high PTSD severity, predominance of derealization and depersonalization symptoms, a more significant history of early life trauma, and higher levels of comorbid psychiatric disorders. Furthermore, PTSD patients with dissociative symptoms exhibit different psychophysiological and neural responses to the recall of traumatic memories. While individuals with non-dissociative PTSD exhibit an increased heart rate, decreased activation of prefrontal regions, and increased activation of the amygdala in response to traumatic reminders, individuals with the dissociative subtype of PTSD show an opposite pattern. It has been proposed that dissociation is a regulatory strategy to restrain extreme arousal in PTSD through hyperinhibition of limbic regions. In this research update, promises and pitfalls in current research studies on the dissociative subtype of PTSD are listed. Inclusion of the dissociative subtype of PTSD in the DSM-5 stimulates research on the prevalence, symptomatology, and neurobiology of the dissociative subtype of PTSD and poses a challenge to improve treatment outcome in PTSD patients with dissociative symptoms.

The intervening role of urgency on the association between childhood maltreatment, PTSD, and substance-related problems.

PubMed

Mirhashem, Rebecca; Allen, Holley C; Adams, Zachary W; van Stolk-Cooke, Katherine; Legrand, Alison; Price, Matthew

2017-06-01

A range of risk factors lead to opioid use and substance-related problems (SRP) including childhood maltreatment, elevated impulsivity, and psychopathology. These constructs are highly interrelated such that childhood maltreatment is associated with elevated impulsivity and trauma-related psychopathology such as posttraumatic stress disorder (PTSD), and impulsivity-particularly urgency-and PTSD are related. Prior work has examined the association between these constructs and substance-related problems independently and it is unclear how these multi-faceted constructs (i.e., maltreatment types and positive and negative urgency) are associated with one another and SRP. The current study used structural equation modeling (SEM) to examine the relations among childhood maltreatment, trait urgency, PTSD symptoms, and SRP in a sample of individuals with a history of opioid use. An initial model that included paths from each type of childhood maltreatment, positive and negative urgency, PTSD and SRP did not fit the data well. A pruned model with excellent fit was identified that suggested emotional abuse, positive urgency, and negative urgency were directly related to PTSD symptoms and only PTSD symptoms were directly related to SRP. Furthermore, significant indirect effects suggested that emotional abuse and negative urgency were related to SRP via PTSD symptom severity. These results suggest that PTSD plays an important role in the severity of SRP. Copyright © 2017 Elsevier Ltd. All rights reserved.

Combat veterans with PTSD after mild TBI exhibit greater ERPs from posterior-medial cortical areas while appraising facial features.

PubMed

Shu, I-Wei; Onton, Julie A; Prabhakar, Nitin; O'Connell, Ryan M; Simmons, Alan N; Matthews, Scott C

2014-02-01

Posttraumatic stress disorder (PTSD) worsens prognosis following mild traumatic brain injury (mTBI). Combat personnel with histories of mTBI exhibit abnormal activation of distributed brain networks-including emotion processing and default mode networks. How developing PTSD further affects these abnormalities has not been directly examined. We recorded electroencephalography in combat veterans with histories of mTBI, but without active PTSD (mTBI only, n=16) and combat veterans who developed PTSD after mTBI (mTBI+PTSD, n=16)-during the Reading the Mind in the Eyes Test (RMET), a validated test of empathy requiring emotional appraisal of facial features. Task-related event related potentials (ERPs) were identified, decomposed using independent component analysis (ICA) and localized anatomically using dipole modeling. We observed larger emotional face processing ERPs in veterans with mTBI+PTSD, including greater N300 negativity. Furthermore, greater N300 negativity correlated with greater PTSD severity, especially avoidance/numbing and hyperarousal symptom clusters. This correlation was dependent on contributions from the precuneus and posterior cingulate cortex (PCC). Our results support a model where, in combat veterans with histories of mTBI, larger ERPs from over-active posterior-medial cortical areas may be specific to PTSD, and is likely related to negative self-referential activity. © 2013 Published by Elsevier B.V.

Positive posttraumatic stress disorder screens among first-time medical cannabis patients: prevalence and association with other substance use.

PubMed

Bohnert, Kipling M; Perron, Brian E; Ashrafioun, Lisham; Kleinberg, Felicia; Jannausch, Mary; Ilgen, Mark A

2014-10-01

Twenty-one states and the District of Columbia have passed legislation allowing for the use of medical cannabis for those individuals with qualifying medical conditions, which include posttraumatic stress disorder (PTSD) for a growing number of states. Little information is available regarding PTSD among medical cannabis patients. This study seeks to provide initial data on this topic by examining the prevalence and correlates of positive PTSD screens among a sample of patients seeking medical cannabis certification for the first time (n=186). Twenty-three percent (42/186; 95% confidence interval [CI] =17%-29%) of the patients in the study sample screened positive for PTSD. Moreover, the group that screened positive for PTSD had higher percentages of lifetime prescription opioid, cocaine, prescription sedative, and street opioid use, as well as a higher percentage of recent prescription sedative use, than the group that screened negative for PTSD. These findings highlight the relatively common use of other substances among medical cannabis patients with significant PTSD symptoms, even when compared with other patients seeking medical cannabis for the first time. As a growing number of states include PTSD among the list of qualifying medical conditions for medical cannabis, additional research is needed to better characterize the longitudinal relationship between medical cannabis use and PTSD symptoms. Published by Elsevier Ltd.

Increased Resilience is Associated with Positive Treatment Outcomes for Veterans with Comorbid PTSD and Substance Use Disorders.

PubMed

McGuire, Adam P; Mota, Natalie P; Sippel, Lauren M; Connolly, Kevin M; Lyons, Judith A

2018-04-18

Resilience has been associated with less severe psychiatric symptomatology and better treatment outcomes among individuals with posttraumatic stress disorder (PTSD) and substance use disorders. However, it remains unknown whether resilience increases during psychotherapy within the comorbid PTSD and substance use disorder population with unique features of dual diagnosis, including trauma cue-related cravings. We tested whether veterans seeking psychotherapy for comorbid PTSD and substance use disorder reported increased resilience from pre- to posttreatment. We also tested whether increased resilience was associated with greater decreases in posttreatment PTSD and substance use disorder symptoms. Participants were 29 male veterans (M age = 49.07 years, SD = 11.24 years) receiving six-week residential day treatment including cognitive processing therapy for PTSD and cognitive behavioral therapy for substance use disorder. Resilience, PTSD symptoms, and trauma cue-related cravings were assessed at pre- and posttreatment. Veterans reported a large, significant increase in resilience posttreatment (M diff = 14.24, t = -4.22, p < .001, d = 0.74). Greater increases in resilience were significantly associated with fewer PTSD symptoms (β = -0.37, p = .049, sr = -.36) and trauma-cued cravings (β = -0.39, p = .006, sr = -.38) posttreatment when controlling for pretreatment scores and baseline depressive symptoms. Results suggest that evidence-based psychotherapy for comorbid PTSD and substance use disorder may facilitate strength-based psychological growth, which may further promote sustained recovery.

Positive posttraumatic stress disorder screens among first-time medical cannabis patients: Prevalence and association with other substance use

PubMed Central

Bohnert, Kipling M.; Perron, Brian E.; Ashrafioun, Lisham; Kleinberg, Felicia; Jannausch, Mary; Ilgen, Mark A.

2014-01-01

Twenty-one states and the District of Columbia have passed legislation allowing for the use of medical cannabis for those individuals with qualifying medical conditions, which include posttraumatic stress disorder (PTSD) for a growing number of states. Little information is available regarding PTSD among medical cannabis patients. This study seeks to provide initial data on this topic by examining the prevalence and correlates of positive PTSD screens among a sample of patients seeking medical cannabis certification for the first time (n=186). Twenty-three percent (42/186; 95% Confidence Interval [CI] = 17%–29%) of the patients in the study sample screened positive for PTSD. Moreover, the group that screened positive for PTSD had higher percentages of lifetime prescription opioid, cocaine, prescription sedative, and street opioid use, as well as a higher percentage of recent prescription sedative use, than the group that screened negative for PTSD. These findings highlight the relatively common use of other substances among medical cannabis patients with significant PTSD symptoms, even when compared with other patients seeking medical cannabis for the first time. As a growing number of states include PTSD among the list of qualifying medical conditions for medical cannabis, additional research is needed to better characterize the longitudinal relationship between medical cannabis use and PTSD symptoms. PMID:24930048

Coping strategies as mediators in relation to resilience and posttraumatic stress disorder.

PubMed

Thompson, Nicholas J; Fiorillo, Devika; Rothbaum, Barbara O; Ressler, Kerry J; Michopoulos, Vasiliki

2018-01-01

Resilience has been shown to protect against the development of posttraumatic stress disorder (PTSD) in the aftermath of trauma. However, it remains unclear how coping strategies influence resilience and PTSD development in the acute aftermath of trauma. The current prospective, longitudinal study investigated the relationship between resilience, coping strategies, and the development of chronic PTSD symptoms. A sample of patients was recruited from an emergency department following a Criterion A trauma. Follow-up assessments were completed at 1-, 3-, and 6-months post-trauma to assess PTSD symptom development (N = 164). Resilience at 1-month positively correlated with the majority of active coping strategies (all p < .05) and negatively correlated with the majority of avoidant coping strategies (all p < .05), as well as future PTSD symptoms (p < .001). Additionally, all avoidant coping strategies, including social withdrawal, positively correlated with future PTSD symptoms (all p < .01). After controlling for demographic and clinical variables, social withdrawal at 3-months fully mediated the relationship between resilience at 1-month and PTSD symptoms at 6-months. Limitations include participant drop out and the conceptual overlap between avoidant coping and PTSD. These data suggest that resilience and social withdrawal may be possible therapeutic targets for mitigating the development of chronic PTSD in the aftermath of trauma. Copyright © 2017 Elsevier B.V. All rights reserved.

Stress reactivity in war-exposed young children with and without posttraumatic stress disorder: relations to maternal stress hormones, parenting, and child emotionality and regulation.

PubMed

Feldman, Ruth; Vengrober, Adva; Eidelman-Rothman, Moranne; Zagoory-Sharon, Orna

2013-11-01

The current study examined biomarkers of stress in war-exposed young children and addressed maternal and child factors that may correlate with children's stress response. Participants were 232 Israeli children aged 1.5-5 years, including 148 children exposed to continuous war. Similarly, 56 were diagnosed with posttraumatic stress disorder (PTSD) and 92 were defined as exposed-no-PTSD. Child cortisol (CT) and salivary alpha amylase (sAA), biomarkers of the hypothalamic-pituitary-adrenal and sympathetic-adrenal-medullary arms of the stress response, were measured at baseline, following challenge, and at recovery. Maternal CT and sAA, PTSD symptoms, and reciprocal parenting, and child negative emotionality and regulatory strategies were assessed. Differences between war-exposed children and controls emerged, but these were related to child PTSD status. Children with PTSD exhibited consistently low CT and sAA, exposed-no-PTSD displayed consistently high CT and sAA, and controls showed increase in CT following challenge and decrease at recovery and low sAA. Exposed children showed higher negative emotionality; however, whereas exposed-no-PTSD children employed comfort-seeking strategies, children with PTSD used withdrawal. Predictors of child CT included maternal CT, PTSD symptoms, low reciprocity, and negative emotionality. Findings suggest that high physiological arousal combined with approach strategies may be associated with greater resilience in the context of early trauma.

Posttraumatic stress disorder symptoms mediate the relationship between traumatic experiences and drinking behavior among women attending alcohol-serving venues in a South African township.

PubMed

Watt, Melissa H; Ranby, Krista W; Meade, Christina S; Sikkema, Kathleen J; MacFarlane, Jessica C; Skinner, Donald; Pieterse, Desiree; Kalichman, Seth C

2012-07-01

South Africa has high rates of traumatic experiences and alcohol abuse or dependence, especially among women. Traumatic experiences often result in symptoms of posttraumatic stress disorder (PTSD), and PTSD has been associated with hazardous drinking. This article examines the relationship between traumatic events and hazardous drinking among women who patronized alcohol-serving venues in South Africa and examines PTSD as a mediator of this relationship. A total of 560 women were recruited from a Cape Town township. They completed a computerized assessment that included alcohol consumption, history of traumatic events, and PTSD symptoms. Mediation analysis examined whether PTSD symptoms mediated the relationship between the number of traumatic event categories experienced (range: 0-7) and drinking behavior. The mean Alcohol Use Disorders Identification Test score in the sample was 12.15 (range: 0-34, SD = 7.3), with 70.9% reaching criteria for hazardous drinking (AUDIT > 8). The mean PTSD score was 36.32 (range: 17-85, SD = 16.3),with 20.9% meeting symptom criteria for PTSD (PTSD Checklist with 20.9% meeting symptom criteria for PTSD (PTSD Checklist-Civilian Version ≥ 50). Endorsement of traumatic experiences was high, including adult emotional (51.8%), physical (49.6%), and sexual (26.3%) abuse; childhood physical (35.0%) and sexual (25.9%) abuse; and other types of trauma (83%). All categories of traumatic experiences, except the "other" category, were associated with hazardous drinking. PTSD symptoms mediated 46% of the relationship between the number of traumatic categories experienced and drinking behavior. Women reported high rates of hazardous drinking and high levels of PTSD symptoms, and most had some history of traumatic events. There was a strong relationship between traumatic exposure and drinking levels, which was largely mediated by PTSD symptoms. Substance use interventions should address histories of trauma in this population, where alcohol may be used in part to cope with past traumas.

Predicting post-traumatic stress disorder treatment response in refugees: Multilevel analysis.

PubMed

Haagen, Joris F G; Ter Heide, F Jackie June; Mooren, Trudy M; Knipscheer, Jeroen W; Kleber, Rolf J

2017-03-01

Given the recent peak in refugee numbers and refugees' high odds of developing post-traumatic stress disorder (PTSD), finding ways to alleviate PTSD in refugees is of vital importance. However, there are major differences in PTSD treatment response between refugees, the determinants of which are largely unknown. This study aimed at improving PTSD treatment for adult refugees by identifying PTSD treatment response predictors. A prospective longitudinal multilevel modelling design was used to predict PTSD severity scores over time. We analysed data from a randomized controlled trial with pre-, post-, and follow-up measurements of the safety and efficacy of eye movement desensitization and reprocessing and stabilization in asylum seekers and refugees suffering from PTSD. Lack of refugee status, comorbid depression, demographic, trauma-related and treatment-related variables were analysed as potential predictors of PTSD treatment outcome. Treatment outcome data from 72 participants were used. The presence (B = 6.5, p = .03) and severity (B = 6.3, p < .01) of a pre-treatment depressive disorder predicted poor treatment response and explained 39% of the variance between individuals. Refugee patients who suffer from PTSD and severe comorbid depression benefit less from treatment aimed at alleviating PTSD. Results highlight the need for treatment adaptations for PTSD and comorbid severe depression in traumatized refugees, including testing whether initial targeting of severe depressive symptoms increases PTSD treatment effectiveness. There are differences in post-traumatic stress disorder (PTSD) treatment response between traumatized refugees. Comorbid depressive disorder and depression severity predict poor PTSD response. Refugees with PTSD and severe depression may not benefit from PTSD treatment. Targeting comorbid severe depression before PTSD treatment is warranted. This study did not correct for multiple hypothesis testing. Comorbid depression may differentially impact alternative PTSD treatments. © 2016 The British Psychological Society.

Connecting the pathology of posttraumatic stress and substance use disorders: monoamines and neuropeptides

PubMed Central

Enman, Nicole M.; Zhang, Yong; Unterwald, Ellen M.

2014-01-01

Posttraumatic stress disorder (PTSD) co-occurs highly with substance use disorders (SUD), yet the neurobiological basis for this comorbid relationship remains unclear. PTSD and SUDs result in similar pathological states including impulsive behavior, reward deficiency, and heightened stress sensitivity. Hence, PTSD and SUD may depend on overlapping dysfunctional neurocircuitry. Here we provide a short overview of the relationship between comorbid PTSD and SUD, as well as the potential role of select neurotransmitter systems that may underlie enhanced vulnerability to drug abuse in the context of PTSD. PMID:24333548

Enhancing self-report assessment of PTSD: development of an item bank.

PubMed

Del Vecchio, Nicole; Elwy, A Rani; Smith, Eric; Bottonari, Kathryn A; Eisen, Susan V

2011-04-01

The authors report results of work to enhance self-report posttraumatic stress disorder (PTSD) assessment by developing an item bank for use in a computer-adapted test. Computer-adapted tests have great potential to decrease the burden of PTSD assessment and outcomes monitoring. The authors conducted a systematic literature review of PTSD instruments, created a database of items, performed qualitative review and readability analysis, and conducted cognitive interviews with veterans diagnosed with PTSD. The systematic review yielded 480 studies in which 41 PTSD instruments comprising 993 items met inclusion criteria. The final PTSD item bank includes 104 items representing each of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association [APA], 1994), PTSD symptom clusters (reexperiencing, avoidance, and hyperarousal), and 3 additional subdomains (depersonalization, guilt, and sexual problems) that expanded the assessment item pool. Copyright © 2011 International Society for Traumatic Stress Studies.

Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2-3 years after the September 11, 2001 terrorist attacks.

PubMed

DiGrande, Laura; Perrin, Megan A; Thorpe, Lorna E; Thalji, Lisa; Murphy, Joseph; Wu, David; Farfel, Mark; Brackbill, Robert M

2008-06-01

Manhattan residents living near the World Trade Center may have been particularly vulnerable to posttraumatic stress disorder (PTSD) after the September 11, 2001 (9/11) terrorist attacks. In 2003-2004, the authors administered the PTSD Checklist to 11,037 adults who lived south of Canal Street in New York City on 9/11. The prevalence of probable PTSD was 12.6% and associated with older age, female gender, Hispanic ethnicity, low education and income, and divorce. Injury, witnessing horror, and dust cloud exposure on 9/11 increased risk for chronic PTSD. Postdisaster risk factors included evacuation and rescue and recovery work. The results indicate that PTSD is a continued health problem in the local community. The relationship between socioeconomic status and PTSD suggests services must target marginalized populations. Followup is necessary on the course and long-term consequences of PTSD.

Chronic probable PTSD in police responders in the world trade center health registry ten to eleven years after 9/11.

PubMed

Cone, James E; Li, Jiehui; Kornblith, Erica; Gocheva, Vihra; Stellman, Steven D; Shaikh, Annum; Schwarzer, Ralf; Bowler, Rosemarie M

2015-05-01

Police enrolled in the World Trade Center Health Registry (WTCHR) demonstrated increased probable posttraumatic stress disorder (PTSD) after the terrorist attack of 9/11/2001. Police enrollees without pre-9/11 PTSD were studied. Probable PTSD was assessed by Posttraumatic Stress Check List (PCL). Risk factors for chronic, new onset or resolved PTSD were assessed using multinomial logistic regression. Half of police with probable PTSD in 2003-2007 continued to have probable PTSD in 2011-2012. Women had higher prevalence of PTSD than men (15.5% vs. 10.3%, P = 0.008). Risk factors for chronic PTSD included decreased social support, unemployment, 2+ life stressors in last 12 months, 2+ life-threatening events since 9/11, 2+ injuries during the 9/11 attacks, and unmet mental health needs. Police responders to the WTC attacks continue to bear a high mental health burden. Improved early access to mental health treatment for police exposed to disasters may be needed. © 2015 Wiley Periodicals, Inc.

Less is more? Assessing the validity of the ICD-11 model of PTSD across multiple trauma samples

PubMed Central

Hansen, Maj; Hyland, Philip; Armour, Cherie; Shevlin, Mark; Elklit, Ask

2015-01-01

Background In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the symptom profile of posttraumatic stress disorder (PTSD) was expanded to include 20 symptoms. An alternative model of PTSD is outlined in the proposed 11th edition of the International Classification of Diseases (ICD-11) that includes just six symptoms. Objectives and method The objectives of the current study are: 1) to independently investigate the fit of the ICD-11 model of PTSD, and three DSM-5-based models of PTSD, across seven different trauma samples (N=3,746) using confirmatory factor analysis; 2) to assess the concurrent validity of the ICD-11 model of PTSD; and 3) to determine if there are significant differences in diagnostic rates between the ICD-11 guidelines and the DSM-5 criteria. Results The ICD-11 model of PTSD was found to provide excellent model fit in six of the seven trauma samples, and tests of factorial invariance showed that the model performs equally well for males and females. DSM-5 models provided poor fit of the data. Concurrent validity was established as the ICD-11 PTSD factors were all moderately to strongly correlated with scores of depression, anxiety, dissociation, and aggression. Levels of association were similar for ICD-11 and DSM-5 suggesting that explanatory power is not affected due to the limited number of items included in the ICD-11 model. Diagnostic rates were significantly lower according to ICD-11 guidelines compared to the DSM-5 criteria. Conclusions The proposed factor structure of the ICD-11 model of PTSD appears valid across multiple trauma types, possesses good concurrent validity, and is more stringent in terms of diagnosis compared to the DSM-5 criteria. PMID:26450830

Less is more? Assessing the validity of the ICD-11 model of PTSD across multiple trauma samples.

PubMed

Hansen, Maj; Hyland, Philip; Armour, Cherie; Shevlin, Mark; Elklit, Ask

2015-01-01

In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the symptom profile of posttraumatic stress disorder (PTSD) was expanded to include 20 symptoms. An alternative model of PTSD is outlined in the proposed 11th edition of the International Classification of Diseases (ICD-11) that includes just six symptoms. The objectives of the current study are: 1) to independently investigate the fit of the ICD-11 model of PTSD, and three DSM-5-based models of PTSD, across seven different trauma samples (N=3,746) using confirmatory factor analysis; 2) to assess the concurrent validity of the ICD-11 model of PTSD; and 3) to determine if there are significant differences in diagnostic rates between the ICD-11 guidelines and the DSM-5 criteria. The ICD-11 model of PTSD was found to provide excellent model fit in six of the seven trauma samples, and tests of factorial invariance showed that the model performs equally well for males and females. DSM-5 models provided poor fit of the data. Concurrent validity was established as the ICD-11 PTSD factors were all moderately to strongly correlated with scores of depression, anxiety, dissociation, and aggression. Levels of association were similar for ICD-11 and DSM-5 suggesting that explanatory power is not affected due to the limited number of items included in the ICD-11 model. Diagnostic rates were significantly lower according to ICD-11 guidelines compared to the DSM-5 criteria. The proposed factor structure of the ICD-11 model of PTSD appears valid across multiple trauma types, possesses good concurrent validity, and is more stringent in terms of diagnosis compared to the DSM-5 criteria.

Post-traumatic stress disorder and incidence of coronary heart disease: a twin study.

PubMed

Vaccarino, Viola; Goldberg, Jack; Rooks, Cherie; Shah, Amit J; Veledar, Emir; Faber, Tracy L; Votaw, John R; Forsberg, Christopher W; Bremner, J Douglas

2013-09-10

The aim of this study was to determine whether post-traumatic stress disorder (PTSD) is associated with coronary heart disease (CHD) using a prospective twin study design and objective measures of CHD. It has long been hypothesized that PTSD increases the risk of CHD, but empirical evidence using objective measures is limited. We conducted a prospective study of middle-aged male twins from the Vietnam Era Twin Registry. Among twin pairs without self-reported CHD at baseline, we selected pairs discordant for a lifetime history of PTSD, pairs discordant for a lifetime history of major depression, and pairs without either condition. All underwent a clinic visit after a median follow-up of 13 years. Outcomes included clinical events (myocardial infarction, other hospitalizations for CHD and coronary revascularization) and quantitative measures of myocardial perfusion by [(13)N] ammonia positron emission tomography, including a stress total severity score and coronary flow reserve. A total of 562 twins (281 pairs) with a mean age of 42.6 years at baseline were included in this study. The incidence of CHD was more than double in twins with PTSD (22.6%) than in those without PTSD (8.9%; p < 0.001). The association remained robust after adjusting for lifestyle factors, other risk factors for CHD, and major depression (odds ratio: 2.2; 95% confidence interval: 1.2 to 4.1). Stress total severity score was significantly higher (+95%, p = 0.001) and coronary flow reserve was lower (-0.21, p = 0.02) in twins with PTSD than in those without PTSD, denoting worse myocardial perfusion. Associations were only mildly attenuated in 117 twin pairs discordant for PTSD. Among Vietnam-era veterans, PTSD is a risk factor for CHD. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Comorbid Trends in World Trade Center Cough Syndrome and Probable Posttraumatic Stress Disorder in Firefighters

PubMed Central

Niles, Justin K.; Gustave, Jackson; Cohen, Hillel W.; Zeig-Owens, Rachel; Kelly, Kerry J.; Glass, Lara; Prezant, David J.

2011-01-01

Background: We describe the relationship between World Trade Center (WTC) cough syndrome symptoms, pulmonary function, and symptoms consistent with probable posttraumatic stress disorder (PTSD) in WTC-exposed firefighters in the first year post-September 11, 2001 (baseline), and 3 to 4 years later (follow-up). Methods: Five thousand three hundred sixty-three firefighters completed pulmonary function tests (PFTs) and questionnaires at both times. Relationships among WTC cough syndrome, probable PTSD, and PFTs were analyzed using simple and multivariable models. We also examined the effects of cofactors, including WTC exposure. Results: WTC cough syndrome was found in 1,561 firefighters (29.1%) at baseline and 1,186 (22.1%) at follow-up, including 559 with delayed onset (present only at follow-up). Probable PTSD was found in 458 firefighters (8.5%) at baseline and 548 (10.2%) at follow-up, including 343 with delayed onset. Baseline PTSD symptom counts and probable PTSD were associated with WTC cough syndrome at baseline, at follow-up, and in those with delayed-onset WTC cough syndrome. Similarly, WTC cough syndrome symptom counts and WTC cough syndrome at baseline were associated with probable PTSD at baseline, at follow-up, and in those with delayed-onset probable PTSD. WTC arrival time and work duration were cofactors of both outcomes. A small but consistent association existed between pulmonary function and WTC cough syndrome, but none with PTSD. Conclusions: The study showed a moderate association between WTC cough syndrome and probable PTSD. The presence of one contributed to the likelihood of the other, even after adjustment for shared cofactors such as WTC exposure. PMID:21546435

Affect and neural activity in women with PTSD during a task of emotional interference.

PubMed

Brown, Wilson J; Wojtalik, Jessica A; Dewey, Daniel; Bruce, Steven E; Yang, Zhen; Sheline, Yvette I

2016-11-01

The current study sought to determine the relationship between self-reported dimensions of affect and activation in brain regions associated with emotion regulation in PTSD during a task of non-conscious emotional processing in interpersonal trauma survivors with PTSD and healthy controls. Participants included 52 women diagnosed with PTSD and 18 female healthy controls. All participants completed a clinical assessment including the SCID, CAPS, and PANAS followed by a functional MRI assessment including a task of implicit emotional conflict. When PTSD participants were oriented to fearful faces, negative affect (NA) was inversely related to activation in the left amygdala and positive affect (PA) was inversely related to activation in the right amygdala. When ignoring fearful faces, NA was positively associated with activation in the right parahippocampal gyrus and PA was inversely related to activation in the left hippocampus. Similar results were observed in healthy controls regarding PA. However, NA was not significantly related to any region of interest in healthy controls. Limitations include the homogeneity of the healthy controls with regard to racial diversity, results may only be specific to female interpersonal trauma survivors with PTSD, and neutral faces within the conflict task may be perceived as negative by clinical samples. Persistent, increased NA may represent a proxy for disruptions in emotional processing in interpersonal trauma survivors with PTSD. As such, clinicians may prioritize increasing emotional awareness through emotion regulation and/or distress tolerance strategies in this population. Copyright © 2016 Elsevier B.V. All rights reserved.

Prevalence of delayed-onset posttraumatic stress disorder in military personnel: is there evidence for this disorder?: Results of a prospective UK cohort study.

PubMed

Goodwin, Laura; Jones, Margaret; Rona, Roberto J; Sundin, Josefin; Wessely, Simon; Fear, Nicola T

2012-05-01

Delayed-onset posttraumatic stress disorder (PTSD) is defined as onset at least 6 months after a traumatic event. This study investigates the prevalence of delayed-onset PTSD in 1397 participants from a two-phase prospective cohort study of UK military personnel. Delayed-onset PTSD was categorized as participants who did not meet the criteria for probable PTSD (assessed using the PTSD Checklist Civilian version) at phase 1 but met the criteria by phase 2. Of the participants, 3.5% met the criteria for delayed-onset PTSD. Subthreshold PTSD, common mental disorder (CMD), poor/fair self-reported health, and multiple physical symptoms at phase 1 and the onset of alcohol misuse or CMD between phases 1 and 2 were associated with delayed-onset PTSD. Delayed-onset PTSD exists in this UK military sample. Military personnel who developed delayed-onset PTSD were more likely to have psychological ill-health at an earlier assessment, and clinicians should be aware of the potential comorbidity in these individuals, including alcohol misuse. Leaving the military or experiencing relationship breakdown was not associated.

Glutamate Dysregulation and Glutamatergic Therapeutics for PTSD: Evidence from Human Studies

PubMed Central

Averill, Lynnette A.; Purohit, Prerana; Averill, Christopher L.; Boesl, Markus A.; Krystal, John H.; Abdallah, Chadi G.

2017-01-01

Posttraumatic stress disorder (PTSD) is a chronic and debilitating psychiatric disorder afflicting millions of individuals across the world. While the availability of robust pharmacologic interventions is quite lacking, our understanding of the putative neurobiological underpinnings of PTSD has significantly increased over the past two decades. Accumulating evidence demonstrates aberrant glutamatergic function in mood, anxiety, and trauma-related disorders and dysfunction in glutamate neurotransmission is increasingly considered a cardinal feature of stress-related psychiatric disorders including PTSD. As part of a PTSD Special Issue, this mini-review provides a concise discussion of (1) evidence of glutamatergic abnormalities in PTSD, with emphasis on human subjects data; (2) glutamate-modulating agents as potential alternative pharmacologic treatments for PTSD; and (3) selected gaps in the literature and related future directions. PMID:27916636

Symptoms Associated with Vestibular Impairment in Veterans with Posttraumatic Stress Disorder

PubMed Central

2016-01-01

Posttraumatic stress disorder (PTSD) is a chronic and disabling, anxiety disorder resulting from exposure to life threatening events such as a serious accident, abuse or combat (DSM IV definition). Among veterans with PTSD, a common complaint is dizziness, disorientation and/or postural imbalance in environments such as grocery stores and shopping malls. The etiology of these symptoms in PTSD is poorly understood and some attribute them to anxiety or traumatic brain injury. There is a possibility that an impaired vestibular system may contribute to these symptoms since, symptoms of an impaired vestibular system include dizziness, disorientation and postural imbalance. To our knowledge, this is the first report to describe the nature of vestibular related symptoms in veterans with and without PTSD. We measured PTSD symptoms using the Posttraumatic Stress Disorder Checklist (PCL-C) and compared it to responses on vestibular function scales including the Dizziness Handicap Inventory (DHI), the Vertigo Symptom Scale Short Form (VSS-SF), the Chambless Mobility Inventory (CMI), and the Neurobehavioral Scale Inventory (NSI) in order to identify vestibular-related symptoms. Our findings indicate that veterans with worse PTSD symptoms report increased vestibular related symptoms. Additionally veterans with PTSD reported 3 times more dizziness related handicap than veterans without PTSD. Veterans with increased avoidance reported more vertigo and dizziness related handicap than those with PTSD and reduced avoidance. We describe possible contributing factors to increased reports of vestibular symptoms in PTSD, namely, anxiety, a vestibular component as well as an interactive effect of anxiety and vestibular impairment. We also present some preliminary analyses regarding the contribution of TBI. This data suggests possible evidence for vestibular symptom reporting in veterans with PTSD, which may be explained by possible underlying vestibular impairment, worthy of further exploration. PMID:28033352

Mismatch of Posttraumatic Stress Disorder (PTSD) Symptoms and DSM-IV Symptom Clusters in a Cancer Sample: Exploratory Factor Analysis of the PTSD Checklist-Civilian Version

PubMed Central

Shelby, Rebecca A.; Golden-Kreutz, Deanna M.; Andersen, Barbara L.

2007-01-01

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994a) conceptualization of posttraumatic stress disorder (PTSD) includes three symptom clusters: reexperiencing, avoidance/numbing, and arousal. The PTSD Checklist-Civilian Version (PCL-C) corresponds to the DSM-IV PTSD symptoms. In the current study, we conducted exploratory factor analysis (EFA) of the PCL-C with two aims: (a) to examine whether the PCL-C evidenced the three-factor solution implied by the DSM-IV symptom clusters, and (b) to identify a factor solution for the PCL-C in a cancer sample. Women (N = 148) with Stage II or III breast cancer completed the PCL-C after completion of cancer treatment. We extracted two-, three-, four-, and five-factor solutions using EFA. Our data did not support the DSM-IV PTSD symptom clusters. Instead, EFA identified a four-factor solution including reexperiencing, avoidance, numbing, and arousal factors. Four symptom items, which may be confounded with illness and cancer treatment-related symptoms, exhibited poor factor loadings. Using these symptom items in cancer samples may lead to overdiagnosis of PTSD and inflated rates of PTSD symptoms. PMID:16281232

Altered resting-state amygdala functional connectivity in men with posttraumatic stress disorder

PubMed Central

Sripada, Rebecca K.; King, Anthony P.; Garfinkel, Sarah N.; Wang, Xin; Sripada, Chandra S.; Welsh, Robert C.; Liberzon, Israel

2012-01-01

Background Converging neuroimaging research suggests altered emotion neurocircuitry in individuals with posttraumatic stress disorder (PTSD). Emotion activation studies in these individuals have shown hyperactivation in emotion-related regions, including the amygdala and insula, and hypoactivation in emotion-regulation regions, including the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC). However, few studies have examined patterns of connectivity at rest in individuals with PTSD, a potentially powerful method for illuminating brain network structure. Methods Using the amygdala as a seed region, we measured resting-state brain connectivity using 3 T functional magnetic resonance imaging in returning male veterans with PTSD and combat controls without PTSD. Results Fifteen veterans with PTSD and 14 combat controls enrolled in our study. Compared with controls, veterans with PTSD showed greater positive connectivity between the amygdala and insula, reduced positive connectivity between the amygdala and hippocampus, and reduced anticorrelation between the amygdala and dorsal ACC and rostral ACC. Limitations Only male veterans with combat exposure were tested, thus our findings cannot be generalized to women or to individuals with non–combat related PTSD. Conclusion These results demonstrate that studies of functional connectivity during resting state can discern aberrant patterns of coupling within emotion circuits and suggest a possible brain basis for emotion-processing and emotion-regulation deficits in individuals with PTSD. PMID:22313617

Decreased left hippocampal volumes in parents with or without posttraumatic stress disorder who lost their only child in China.

PubMed

Luo, Yifeng; Shan, Hairong; Liu, Yu; Wu, Liwei; Zhang, Xiaojie; Ma, Tieliang; Zhu, Wenjiao; Yang, Yue; Wang, Jichen; Cao, Zhihong

2016-06-01

Limbic structural changes have been found in people with post-traumatic stress disorder (PTSD). However, the results were controversial, and no study has examined the hippocampal and amygdala volume changes in parents with or without PTSD who had lost their only child and could no longer conceive in China. Hippocampal and amygdala volumes of 57 parents with PTSD (PTSD+), 11 trauma-exposed parents without PTSD (PTSD-) and 39 non-traumatized controls were examined using magnetic resonance imaging. Correlations of the volumes with the time since trauma, Clinician-Administered PTSD Scale (CAPS) scores, age, gender and intracranial volume (ICV) were investigated in the PTSD+ group. left hippocampal volumes were significantly smaller in the PTSD+ and PTSD- groups than in the controls, but there were no significant differences between the PTSD+ and PTSD- groups. Furthermore, there was no significant difference in the right hippocampus or bilateral amygdala volumes. Additionally, the hippocampal and amygdala volumes showed no correlation with the time since trauma, CAPS score and gender, whereas the left hippocampal volumes were correlated with ICV, and the bilateral amygdala volumes were correlated with ICV and age in the PTSD+ group. The PTSD- group included only 11 participants. left hippocampal volumes decreased in parents who lost their only child, with or without PTSD. Our results suggest a potentially unique role of the trauma of losing an only child, which is extremely painful and may induce a decrease in the left hippocampal volume independent of PTSD effects. Copyright © 2016 Elsevier B.V. All rights reserved.

Heart rate variability of chronic posttraumatic stress disorder in the Korean veterans.

PubMed

Park, Joo Eon; Lee, Ji Yeon; Kang, Suk-Hoon; Choi, Jin Hee; Kim, Tae Yong; So, Hyung Seok; Yoon, In-Young

2017-09-01

Patients with post-traumatic stress disorder (PTSD) have lower heart rate variability (HRV) than the general population, but findings in this area have been inconsistent. This study was conducted to investigate the characteristics of HRV in patients with PTSD and to evaluate associations between PTSD symptoms and HRV indices. Sixty-eight patients with PTSD and 73 controls without PTSD were evaluated. HRV was measured in all subjects after they completed self-reported questionnaires. Patients with PTSD had significantly more depressed moods, anxiety, and poorer sleep quality than individuals in the non-PTSD group. Standard deviations of NN intervals (SDNN), the square root of the mean squared differences of successive NN intervals (RMSSD), and log high-frequency (LNHF) were significantly lower in the PTSD group than in the non-PTSD group. Comparisons of HRV indices among four sub-groups according to presence/absence of PTSD and experiences of combat-related or other trauma indicated that individuals in the PTSD group who had experienced combat-related trauma had the lowest HRV indices. These indices included SDNN, RMSSD, and LNHF. Further, SDNN, RMSSD, and HF power were significantly associated with symptoms of hyperarousal. HRV measures might be useful physiological parameters in assessing and monitoring sympathovagal function in patients with PTSD. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Intergenerational transmission of post-traumatic stress disorder in Australian Vietnam veterans' families.

PubMed

O'Toole, B I; Burton, M J; Rothwell, A; Outram, S; Dadds, M; Catts, S V

2017-05-01

To assess the association between parental post-traumatic stress disorder (PTSD) and offspring PTSD and its specificity for other disorders in a non-clinical epidemiological cohort of Australian Vietnam veterans, their partners and their sons and daughters. Veterans were interviewed twice, in 1992-1994 and 2005-2006; partners were interviewed in 2006-2007, and their offspring in 2012-2014. A total of 125 sons and 168 daughters were interviewed from 197 families, 137 of which also included partners who were the mothers of the children. Statistical analysis used multi-level modelling to compute odds ratios and 95% confidence intervals while controlling for clustering effects within families. Parent PTSD diagnoses were examined for associations with offspring trauma exposure, PTSD and other psychiatric diagnoses. Veteran PTSD increased the risk of PTSD and no other disorder in both sons and daughters; partner PTSD did not. Veteran depression was also a risk factor for sons' PTSD, and alcohol disorder was linked to alcohol dependence in sons and PTSD in daughters, but not when controlling for veteran PTSD. We conclude that PTSD in a Vietnam veteran father increases the risk specifically for PTSD in his sons and daughters. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

PTSD: from neurobiology to pharmacological treatments

PubMed Central

Kelmendi, Benjamin; Adams, Thomas G.; Yarnell, Stephanie; Southwick, Steven; Abdallah, Chadi G.; Krystal, John H.

2016-01-01

Posttraumatic stress disorder (PTSD) is a chronic debilitating psychiatric disorder characterized by symptoms of re-experience, avoidance, and hyperarousal that can arise immediately or many years after exposure to a traumatic event and injury. Although extensive research has been done over the past 30 years, the etiology of PTSD remains largely unknown. Several neurobiological systems have been implicated in the pathophysiology and vulnerability for developing PTSD; however, first-line pharmacotherapies are limited. Less than 30% achieve full remission, and even then, approved pharmacological treatments often take weeks for therapeutic effect. This article aims to review the pathophysiology of PTSD within multiple neurobiological systems and how these mechanisms are used as pharmacologic targets of treatment, as well as their potential for future targets of intervention. Highlights of the article We reviewed the neurobiological abnormalities in PTSD as they relate to well-established, preliminary, and future targets for pharmacological interventions. Abnormalities across different neurotransmitter systems have been implicated in the pathophysiology of PTSD but none of these systems function uniformly among all patients with PTSD First-line pharmacotherapy for PTSD provides a suboptimal response rates. Future pharmacological targets for PTSD include the cannabinoid and oxytocin systems, as well glutamatergic modulating agents. Drug development for PTSD should specifically address various dimensions of PTSD symptomatology. PMID:27837583

Altered resting state functional connectivity of fear and reward circuitry in comorbid PTSD and major depression.

PubMed

Zhu, Xi; Helpman, Liat; Papini, Santiago; Schneier, Franklin; Markowitz, John C; Van Meter, Page E; Lindquist, Martin A; Wager, Tor D; Neria, Yuval

2017-07-01

Individuals with comorbid posttraumatic stress disorder and major depressive disorder (PTSD-MDD) often exhibit greater functional impairment and poorer treatment response than individuals with PTSD alone. Research has not determined whether PTSD-MDD is associated with different network connectivity abnormalities than PTSD alone. We used functional magnetic resonance imaging (fMRI) to measure resting state functional connectivity (rs-FC) patterns of brain regions involved in fear and reward processing in three groups: patients with PTSD-alone (n = 27), PTSD-MDD (n = 21), and trauma-exposed healthy controls (TEHCs, n = 34). Based on previous research, seeds included basolateral amygdala (BLA), centromedial amygdala (CMA), and nucleus accumbens (NAcc). Regardless of MDD comorbidity, PTSD was associated with decreased connectivity of BLA-orbitalfrontal cortex (OFC) and CMA-thalamus pathways, key to fear processing, and fear expression, respectively. PTSD-MDD, compared to PTSD-alone and TEHC, was associated with decreased connectivity across multiple amygdala and striatal-subcortical pathways: BLA-OFC, NAcc-thalamus, and NAcc-hippocampus. Further, while both the BLA-OFC and the NAcc-thalamus pathways were correlated with MDD symptoms, PTSD symptoms correlated with the amygdala pathways (BLA-OFC; CMA-thalamus) only. Comorbid PTSD-MDD may be associated with multifaceted functional connectivity alterations in both fear and reward systems. Clinical implications are discussed. © 2016 Wiley Periodicals, Inc.

Predicting domestic and community violence by soldiers living in a conflict region.

PubMed

Nandi, Corina; Elbert, Thomas; Bambonye, Manassé; Weierstall, Roland; Reichert, Manfred; Zeller, Anja; Crombach, Anselm

2017-11-01

Past research revealed war trauma and posttraumatic stress disorder (PTSD) symptoms as potential predictors for domestic and community violence in crisis regions and among soldiers in different armed conflicts. The impact of family violence and other adversities experienced in childhood as well as of a combat-enhanced appeal for aggressive behavior (appetitive aggression) remains to be specified. In the present study, the authors separately predicted violence against children, intimate partner violence and community violence in 381 Burundian soldiers returning from foreign deployment and living in a post- conflict region. Using path analysis, they aimed to disentangle the independent contributions and pathways of the following variables: Exposure to war trauma and childhood familial violence, PTSD and depression symptom severity, and appetitive aggression. Childhood familial violence had an independent effect on all contexts of violence and was the only significant predictor for violence against the soldiers' own children. Intimate partner violence was additionally predicted by depression symptom severity, while community violence was additionally predicted by PTSD symptom severity and appetitive aggression. Besides war-related mental ill-health and appetitive aggression, violent experiences during childhood development must not be overlooked as a factor fueling the cycle of violence in conflict regions. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Co-Morbidity of PTSD and Immune System Dysfunction: Opportunities for Treatment

PubMed Central

Neigh, Gretchen N.; Ali, Fariya F.

2016-01-01

Posttraumatic stress disorder (PTSD) is defined as a psychiatric disorder; however, PTSD co-occurs with multiple somatic manifestations. People living with PTSD commonly manifest dysregulations in the systems that regulate the stress response, including the hypothalamic-pituitary-adrenal (HPA) axis, and development of a pro-inflammatory state. Additionally, somatic autoimmune and inflammatory diseases and disorders have a high rate of co-morbidity with PTSD. Recognition and understanding of the compounding effect that these disease states can have on each other, evidenced from poorer treatment outcomes and accelerated disease progression in patients suffering from co-morbid PTSD and/or other autoimmune and inflammatory diseases, has the potential to lead to additional treatment opportunities. PMID:27479489

Application of Short Screening Tools for Post-Traumatic Stress Disorder in the Korean Elderly Population

PubMed Central

Jang, Yu Jin; Chung, Hae Gyung; Choi, Jin Hee; Kim, Tae Yong; So, Hyung Seok

2016-01-01

Objective Post-traumatic stress disorder (PTSD) is often missed or incorrectly diagnosed in primary care settings. Although brief screening instruments may be useful in detecting PTSD, an adequate validation study has not been conducted with older adults. This study aimed to evaluate the reliability and validity of the Korean version of the primary care PTSD screen (PC-PTSD) and single-item PTSD screener (SIPS) in elderly veterans. Methods The PC-PTSD and SIPS assessments were translated into Korean, with a back-translation to the original language to verify accuracy. Vietnamese war veterans [separated into a PTSD group (n=41) and a non-PTSD group (n=99)] participated in several psychometric assessments, including the Korean versions of the PC-PTSD (PC-PTSD-K), SIPS (SIPS-K), a structured clinical interview from the Diagnostic and Statistical Manual of Mental Disorders-IV(SCID), and PTSD checklist(PCL). Results The PC-PTSD-K showed high internal consistency (Cronbach α=0.76), and the test-retest reliability of the PC-PTSD-K and SIPS-K were also high (r=0.97 and r=0.91, respectively). A total score of 3 from the PC-PTSD-K yielded the highest diagnostic efficiency, with sensitivity and specificity values of 0.90 and 0.86, respectively. The 'bothered a lot' response level from the SIPS-K showed the highest diagnostic efficiency, with sensitivity and specificity values of 0.85 and 0.89, respectively. Conclusion Our findings suggest that both PC-PTSD-K and SIPS-K have good psychometric properties with high validity and reliability for detecting PTSD symptoms in elderly Korean veterans. However, further research will be necessary to increase our understanding of PTSD characteristics in diverse groups with different types of trauma. PMID:27482241

The course of PTSD in naturalistic long-term studies: high variability of outcomes. A systematic review.

PubMed

Steinert, Christiane; Hofmann, Mareike; Leichsenring, Falk; Kruse, Johannes

2015-01-01

With a lifetime prevalence of 8% posttraumatic stress disorder (PTSD) is one of the most common mental disorders; nevertheless, its longitudinal course is largely unknown. Our aim was to conduct a systematic review summarizing available findings on the prospective, naturalistic long-term course of PTSD and its predictors. Databases MEDLINE and PsycINFO were searched. Main selection criteria were: 1) naturalistic cohort study with a follow-up period of at least 3 years, 2) adult participants with observer-rated or probable PTSD at baseline. Twenty-four cohorts (25 studies) were retrieved (14 with observer-assessed, 10 with probable PTSD). In total, they comprised about 10,500 participants with PTSD at baseline that were included in the long-term follow-ups. Studies investigating patient populations with observer-assessed PTSD found that between 18% and 50% of patients experienced a stable recovery within 3-7 years; the remaining subjects either facing a recurrent or a more chronic course. Outcomes of community studies and studies investigating probable PTSD varied considerably (remission rates 6-92%). Social factors (e.g. support) as well as comorbid physical or mental health problems seem to be salient predictors of PTSD long-term course and special focus should be laid on these factors in clinical settings. Included studies differed notably with regard to applied methodologies. The resulting large variability of findings is discussed. More standardized systematic follow-up research and more uniformed criteria for remission and chronicity are needed to gain a better insight into the long-term course of PTSD.

Posttraumatic stress disorder among low-income women exposed to perinatal intimate partner violence : Posttraumatic stress disorder among women exposed to partner violence.

PubMed

Kastello, Jennifer C; Jacobsen, Kathryn H; Gaffney, Kathleen F; Kodadek, Marie P; Bullock, Linda C; Sharps, Phyllis W

2016-06-01

Women exposed to intimate partner violence (IPV) and other forms of lifetime trauma may be at risk for negative mental health outcomes including posttraumatic stress disorder (PTSD). The purpose of this study was to examine potential predictors of PTSD among low-income women exposed to perinatal IPV. This study analyzed baseline cross-sectional data from 239 low-income pregnant women in the USA who participated in a nurse home visitation intervention between 2006 and 2012 after reporting recent IPV. PTSD was assessed with the Davidson Trauma Scale (DTS) in which participants answer questions about the most disturbing traumatic event (MDTE) in their lifetime that affected them the week before the interview. In total, 40 % of the women were identified as having PTSD (DTS ≥40). PTSD prevalence significantly increased with age to nearly 80 % of women ages 30 and older (n = 23). Age was also the strongest predictor of PTSD (p < 0.001). Most participants (65 %) identified non-IPV-related traumas as their MDTEs. Psychological (94 %), physical (82 %), and sexual (44 %) violence were not significantly associated with PTSD status. Despite recent exposure to IPV, most participants identified other traumatic events as more disturbing than IPV-related trauma. Further, the risk for PTSD increased with age, suggesting that the cumulative effect of trauma, which may include IPV, increases the risk for PTSD over a lifetime. Implementing comprehensive screening for trauma during prenatal care may lead to the early identification and treatment of PTSD during pregnancy in a community setting.

Longitudinal Examination of the Influence of Individual Posttraumatic Stress Disorder Symptoms and Clusters of Symptoms on the Initiation of Cigarette Smoking.

PubMed

Seelig, Amber D; Bensley, Kara M; Williams, Emily C; Armenta, Richard F; Rivera, Anna C; Peterson, Arthur V; Jacobson, Isabel G; Littman, Alyson J; Maynard, Charles; Bricker, Jonathan B; Rull, Rudolph P; Boyko, Edward J

2018-06-06

The aim of this study was to determine whether specific individual posttraumatic stress disorder (PTSD) symptoms or symptom clusters predict cigarette smoking initiation. Longitudinal data from the Millennium Cohort Study were used to estimate the relative risk for smoking initiation associated with PTSD symptoms among 2 groups: (1) all individuals who initially indicated they were nonsmokers (n = 44,968, main sample) and (2) a subset of the main sample who screened positive for PTSD (n = 1622). Participants were military service members who completed triennial comprehensive surveys that included assessments of smoking and PTSD symptoms. Complementary log-log models were fit to estimate the relative risk for subsequent smoking initiation associated with each of the 17 symptoms that comprise the PTSD Checklist and 5 symptom clusters. Models were adjusted for demographics, military factors, comorbid conditions, and other PTSD symptoms or clusters. In the main sample, no individual symptoms or clusters predicted smoking initiation. However, in the subset with PTSD, the symptoms "feeling irritable or having angry outbursts" (relative risk [RR] 1.41, 95% confidence interval [CI] 1.13-1.76) and "feeling as though your future will somehow be cut short" (RR 1.19, 95% CI 1.02-1.40) were associated with increased risk for subsequent smoking initiation. Certain PTSD symptoms were associated with higher risk for smoking initiation among current and former service members with PTSD. These results may help identify individuals who might benefit from more intensive smoking prevention efforts included with PTSD treatment.

Co-occurring Mental Health and Alcohol Misuse Symptoms: Dual Disorder Symptoms in Combat Injured Veterans

DTIC Science & Technology

2014-03-03

required from Department of Veterans Af fairs hospitals. The rate of alcohol misuse among veterans screening for PTSD or de pression in the present...facilities only (casualties treated at forward deployed Army facilities, and those transported directly to Combat Support Hospitals from the point of injury...Psychiatry, 163, 1777–1783. Hien, D. A., Jiang, H., Campbell, A. N. C., Hu, M. C., Miele , G. M., Cohen, L. R., et al. (2010). Do treatment improvements

Development and Evaluation of Veteran Supportive Supervisor Training (VSST): Improving Reintegration of the Oregon National Guard and Reserves in the Workplace

DTIC Science & Technology

2014-03-01

addressing stigma , stereotyping and discrimination in the workplace  Asking for or listening to all employees suggestions about the work environment...after deployment. o Military spouses and partners felt unprepared for their service member’s return from military duty o Suicide, PTSD and stigma ...Masters of Social Work and Public Health; Health Administration & Policy • Mental Health First Aid Training • Crisis Intervention Training, Crisis Clinic of

Improving Deployment-Related Primary Care Provider Assessments of PTSD and Mental Health Conditions

DTIC Science & Technology

2013-10-01

Palliative Care . Arch Intern Med, 167(5), 453-460. doi: 10.1001/archinte.167.5.453 Bickman L, Kelley SD, Leslie MW, Vides De Andrade AR, Hargraves RP...giving in medical care . Journal of Health and Social Behavior, 26(2), 81- 101. Willis, A. G., Willis, G. B., Male, A., Henderson, M., & Manderscheid, R...and Discussing Transitions to Palliative Care . Arch Intern Med, 167(5), 453-460. doi: 10.1001/archinte.167.5.453 Bickman L, Kelley SD, Leslie MW

An Internet-based writing intervention for PTSD in veterans: A feasibility and pilot effectiveness trial.

PubMed

Krupnick, Janice L; Green, Bonnie L; Amdur, Richard; Alaoui, Adil; Belouali, Anas; Roberge, Erika; Cueva, David; Roberts, Miguel; Melnikoff, Elizabeth; Dutton, Mary Ann

2017-07-01

[Correction Notice: An Erratum for this article was reported in Vol 9(4) of Psychological Trauma: Theory, Research, Practice, and Policy (see record 2016-54154-001). In the article, the names of authors Adil Alaoui and Anas Belouali were misspelled as Adil Aloui and Anas Beloui respectively. All versions of this article have been corrected.] Objective: Veterans suffering from posttraumatic stress disorder (PTSD) may avoid or fail to follow through with a full course of face-to-face mental health treatment for a variety of reasons. We conducted a pilot effectiveness trial of an online intervention for veterans with current PTSD to determine the feasibility, safety, and preliminary effectiveness of an online writing intervention (i.e., Warriors Internet Recovery & EDucation [WIRED]) as an adjunct to face-to-face psychotherapy. Method: Veterans ( N = 34) who had served in Iraq or Afghanistan with current PTSD subsequent to deployment-related trauma were randomized to Veterans Affairs (VA) mental health treatment as usual (TAU) or to treatment as usual plus the online intervention (TAU + WIRED). All research participants were recruited from the Trauma Services Program, VA Medical Center, Washington, DC. They completed baseline assessments as well as assessments 12 weeks and 24 weeks after the baseline assessment. The online intervention consisted of therapist-guided writing, using principles of prolonged exposure and cognitive therapy. The intervention was adapted from an evidence-based treatment used in The Netherlands and Germany for individuals who had been exposed to nonmilitary traumas. Results: In addition to showing that the online intervention was both feasible to develop and implement, as well as being safe, the results showed preliminary evidence of the effectiveness of the TAU + WIRED intervention in this patient population, with particular evidence in reducing PTSD symptoms of hyperarousal. Conclusion: With minor modifications to enhance the therapeutic alliance, this intervention should be tested in a larger clinical trial to determine whether this method of online intervention might provide another alternative to face-to-face treatment for veterans with PTSD. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Depression, Guilt, Anger: Know the Signs of PTSD | NIH MedlinePlus the Magazine

MedlinePlus

... Anger: Know the Signs of PTSD Follow us Depression, Guilt, Anger: Know the Signs of PTSD People who experience traumatic situations react in different ways. In general, people often ... symptoms include: Depression: Feeling sad most of the time or losing ...

Emotion and cognition interactions in PTSD: a review of neurocognitive and neuroimaging studies

PubMed Central

Hayes, Jasmeet P.; VanElzakker, Michael B.; Shin, Lisa M.

2012-01-01

Posttraumatic stress disorder (PTSD) is a psychiatric syndrome that develops after exposure to terrifying and life-threatening events including warfare, motor-vehicle accidents, and physical and sexual assault. The emotional experience of psychological trauma can have long-term cognitive effects. The hallmark symptoms of PTSD involve alterations to cognitive processes such as memory, attention, planning, and problem solving, underscoring the detrimental impact that negative emotionality has on cognitive functioning. As such, an important challenge for PTSD researchers and treatment providers is to understand the dynamic interplay between emotion and cognition. Contemporary cognitive models of PTSD theorize that a preponderance of information processing resources are allocated toward threat detection and interpretation of innocuous stimuli as threatening, narrowing one's attentional focus at the expense of other cognitive operations. Decades of research have shown support for these cognitive models of PTSD using a variety of tasks and methodological approaches. The primary goal of this review is to summarize the latest neurocognitive and neuroimaging research of emotion-cognition interactions in PTSD. To directly assess the influence of emotion on cognition and vice versa, the studies reviewed employed challenge tasks that included both cognitive and emotional components. The findings provide evidence for memory and attention deficits in PTSD that are often associated with changes in functional brain activity. The results are reviewed to provide future directions for research that may direct better and more effective treatments for PTSD. PMID:23087624

Neuroimaging the traumatized self: fMRI reveals altered response in cortical midline structures and occipital cortex during visual and verbal self- and other-referential processing in women with PTSD

PubMed Central

Frewen, Paul; Thornley, Elizabeth; Rabellino, Daniela; Lanius, Ruth

2017-01-01

ABSTRACT Background: Changes to the diagnostic criteria for PTSD in DSM-5 reflect an increased emphasis on negative cognition referring to self and other, including self-blame, and related pervasive negative affective states including for self-conscious emotions such as guilt and shame. Objective: Investigate the neural correlates of valenced self-referential processing (SRP) and other-referential processing (ORP) in persons with PTSD. Method: We compared response to the Visual-Verbal Self-Other Referential Processing Task in an fMRI study of women with (n = 20) versus without (n = 24) PTSD primarily relating to childhood and interpersonal trauma histories using statistical parametric mapping and group independent component analysis. Results: As compared to women without PTSD, women with PTSD endorsed negative words as more descriptive both of themselves and others, whereas positive words were endorsed as less descriptive both of themselves and others. Women with PTSD also reported a greater experience of negative affect and a lesser experience of positive affect during SRP specifically. Significant differences between groups were observed within independent components defined by ventral- and middle-medial prefrontal corte x, mediolateral parietal cortex, and visual cortex, depending on experimental conditions. Conclusions: This study reveals brain-based disturbances during SRP and ORP in women with PTSD related to interpersonal and developmental trauma. Psychological assessment and treatment should address altered sense of self and affective response to others in PTSD. PMID:28649298

Pathophysiological Bases of Comorbidity: Traumatic Brain Injury and Post-Traumatic Stress Disorder.

PubMed

Kaplan, Gary B; Leite-Morris, Kimberly A; Wang, Lei; Rumbika, Kendra K; Heinrichs, Stephen C; Zeng, Xiang; Wu, Liquan; Arena, Danielle T; Teng, Yang D

2018-01-15

The high rates of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) diagnoses encountered in recent years by the United States Veterans Affairs Healthcare System have increased public awareness and research investigation into these conditions. In this review, we analyze the neural mechanisms underlying the TBI/PTSD comorbidity. TBI and PTSD present with common neuropsychiatric symptoms including anxiety, irritability, insomnia, personality changes, and memory problems, and this overlap complicates diagnostic differentiation. Interestingly, both TBI and PTSD can be produced by overlapping pathophysiological changes that disrupt neural connections termed the "connectome." The neural disruptions shared by PTSD and TBI and the comorbid condition include asymmetrical white matter tract abnormalities and gray matter changes in the basolateral amygdala, hippocampus, and prefrontal cortex. These neural circuitry dysfunctions result in behavioral changes that include executive function and memory impairments, fear retention, fear extinction deficiencies, and other disturbances. Pathophysiological etiologies can be identified using experimental models of TBI, such as fluid percussion or blast injuries, and for PTSD, using models of fear conditioning, retention, and extinction. In both TBI and PTSD, there are discernible signs of neuroinflammation, excitotoxicity, and oxidative damage. These disturbances produce neuronal death and degeneration, axonal injury, and dendritic spine dysregulation and changes in neuronal morphology. In laboratory studies, various forms of pharmacological or psychological treatments are capable of reversing these detrimental processes and promoting axonal repair, dendritic remodeling, and neurocircuitry reorganization, resulting in behavioral and cognitive functional enhancements. Based on these mechanisms, novel neurorestorative therapeutics using anti-inflammatory, antioxidant, and anticonvulsant agents may promote better outcomes for comorbid TBI and PTSD.

The health of UK civilians deployed to Iraq

PubMed Central

Fear, Nicola T.; Cawkill, Paul; Jones, Norman; Greenberg, Neil; Wessely, Simon

2017-01-01

Abstract Background: Modern military operations have incorporated deployed civilians in a variety of roles (e.g. diplomats, private security staff). Many of these roles expose individuals to potentially dangerous or traumatic events. Evidence has shown that such exposures can cause psychological health problems in military personnel. It is likely that the same would be seen among civilians working in such environments. There is however limited research into the health of civilians deployed to war zones. This study compared health outcomes and related behaviours among UK regular and reserve Army personnel with UK civilian personnel deployed in direct support of the UK military in Iraq. Methods: The study sample comprised of 159 Ministry of Defence civilians, 1542 Army regulars and 408 Army reservists, all of whom served in non-combat roles. Data were gathered by questionnaires which asked about deployment experiences, lifestyle factors and health outcomes [i.e. post-traumatic stress disorder (PTSD), general health, multiple physical symptoms and alcohol use]. Results: Fewer deployed UK civilians smoked than regular Army personnel (adjusted OR 0.83 95% CI 0.70–0.98). UK civilians had better overall health and were less likely to report multiple physical symptoms compared with reservists (adjusted ORs 0.64 95% CI 0.44–0.93 and 0.60 95% CI 0.39–0.93, respectively). Conclusions: Overall, the psychological health of deployed civilians appears to be better than that of Army personnel deployed in non-combat roles. Civilians are also less likely to engage in some risky behaviours. PMID:27452892

The influence of veteran race and psychometric testing on veterans affairs posttraumatic stress disorder (PTSD) disability exam outcomes.

PubMed

Marx, Brian P; Engel-Rebitzer, Eden; Bovin, Michelle J; Parker-Guilbert, Kelly S; Moshier, Samantha; Barretto, Kenneth; Szafranski, Derek; Gallagher, Matthew W; Holowka, Darren W; Rosen, Raymond C; Keane, Terence M

2017-06-01

This study examined the influence of veterans' race and examiners' use of psychometric testing during a Department of Veterans Affairs posttraumatic stress disorder (PTSD) disability examination on diagnostic and service connection status outcomes. Participants were 764 veterans enrolled in a national longitudinal registry. Current and lifetime PTSD diagnostic status was determined with the Structured Clinical Interview for DSM-IV (SCID) and was compared with PTSD diagnosis conferred upon veterans by their compensation and pension (C&P) examiners as well as with ultimate Veterans Affairs (VA) PTSD service connected status. The concordance rate between independent SCID current PTSD diagnosis and PTSD disability examination diagnosis was 70.4%, and between SCID lifetime PTSD diagnosis and PTSD disability examination diagnosis was 77.7%. Among veterans with current SCID diagnosed PTSD, Black veterans were significantly less likely than White veterans to receive a PTSD diagnosis from their C&P examiner (odds ratio [OR] = .39, p = .003, confidence interval [CI] = .20-.73). Among veterans without current SCID diagnosed PTSD, White veterans were significantly more likely than Black veterans to receive a PTSD diagnosis from their C&P examiner (OR = 4.07, p = .005, CI = 1.51-10.92). Splitting the sample by use of psychometric testing revealed that examinations that did not include psychometric testing demonstrated the same relation between veteran race and diagnostic concordance. However, for examinations in which psychometric testing was used, the racial disparity between SCID PTSD status and disability exam PTSD status was no longer significant. Results suggest that psychometric testing may reduce disparities in VA PTSD disability exam outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Post-Traumatic Stress Disorder among School Age Palestinian Children

ERIC Educational Resources Information Center

Khamis, Vivian

2005-01-01

Objectives: This study was designed to assess the prevalence of PTSD among Palestinian school-age children. Variables that distinguish PTSD and non-PTSD children were examined, including child characteristics, socioeconomic status, family environment, and parental style of influence. Method: Participants were 1,000 children aged 12 to 16 years.…

The emotional Stroop task and posttraumatic stress disorder: a meta-analysis.

PubMed

Cisler, Josh M; Wolitzky-Taylor, Kate B; Adams, Thomas G; Babson, Kimberly A; Badour, Christal L; Willems, Jeffrey L

2011-07-01

Posttraumatic stress disorder (PTSD) is associated with significant impairment and lowered quality of life. The emotional Stroop task (EST) has been one means of elucidating some of the core deficits in PTSD, but this literature has remained inconsistent. We conducted a meta-analysis of EST studies in PTSD populations in order to synthesize this body of research. Twenty-six studies were included with 538 PTSD participants, 254 non-trauma exposed control participants (NTC), and 276 trauma exposed control participants (TC). PTSD-relevant words impaired EST performance more among PTSD groups and TC groups compared to NTC groups. PTSD groups and TC groups did not differ. When examining within-subject effect sizes, PTSD-relevant words and generally threatening words impaired EST performance relative to neutral words among PTSD groups, and only PTSD-relevant words impaired performance among the TC groups. These patterns were not found among the NTC groups. Moderator analyses suggested that these effects were significantly greater in blocked designs compared to randomized designs, toward unmasked compared to masked stimuli, and among samples exposed to assaultive traumas compared to samples exposed to non-assaultive traumas. Theoretical and clinical implications are discussed. Copyright © 2011 Elsevier Ltd. All rights reserved.

Serum total oxidant and antioxidant status in earthquake survivors with post-traumatic stress disorder.

PubMed

Ozdemir, Pinar Guzel; Kaplan, İbrahim; Uysal, Cem; Bulut, Mahmut; Atli, Abdullah; Bez, Yasin; Kaya, Mehmet Cemal; Ozdemir, Osman

2015-06-01

Oxidative stress has been shown to play an important role in the pathogenesis of post-traumatic stress disorder (PTSD). Although there are some studies on oxidative stress and PTSD, there is no report available on the serum total oxidant and antioxidant status in earthquake survivors with PTSD. Therefore, this study aimed to investigate the serum total oxidant and antioxidant status in earthquake survivors with chronic PTSD. The study group included 45 earthquake survivors with PTSD and 40 earthquake survivors without PTSD. The oxidative status was determined using the total antioxidant status and total oxidant status (TOS) measurements and by calculating the oxidative stress index (OSI). There were no statistically significant differences in the total antioxidant status, TOS, or OSI when comparing individuals with and without PTSD (all, p>0.05). There were no correlations between Clinician-Administered PTSD Scale scores and oxidant and antioxidant stress markers (all, p>0.05). Our results suggest that the total oxidant and antioxidant status may not affect earthquake survivors with PTSD. This is the first study to evaluate the oxidative status in earthquake survivors with PTSD. Further studies are necessary to confirm these findings.

Attachment as a Moderator Between Intimate Partner Violence and PTSD Symptoms

PubMed Central

Scott, Shelby

2013-01-01

Post-traumatic stress disorder (PTSD) symptoms have been linked to traumatic experiences, including intimate partner violence. However, not all battered women develop PTSD symptoms. The current study tests attachment style as a moderator in the abuse–trauma link among a community sample women in violent and non-violent relationships. Both attachment anxiety and dependency were found to moderate the relation between intimate partner violence and PTSD symptoms. However, attachment closeness did not function as a moderator. Differences in attachment may help to explain why certain victims of domestic abuse may be more susceptible to experiencing PTSD symptoms. Clinically, these findings may aid in the prediction and prevention of PTSD symptoms in women victimized by intimate partner abuse. PMID:23710109

Attachment as a Moderator Between Intimate Partner Violence and PTSD Symptoms.

PubMed

Scott, Shelby; Babcock, Julia C

2010-01-01

Post-traumatic stress disorder (PTSD) symptoms have been linked to traumatic experiences, including intimate partner violence. However, not all battered women develop PTSD symptoms. The current study tests attachment style as a moderator in the abuse-trauma link among a community sample women in violent and non-violent relationships. Both attachment anxiety and dependency were found to moderate the relation between intimate partner violence and PTSD symptoms. However, attachment closeness did not function as a moderator. Differences in attachment may help to explain why certain victims of domestic abuse may be more susceptible to experiencing PTSD symptoms. Clinically, these findings may aid in the prediction and prevention of PTSD symptoms in women victimized by intimate partner abuse.

Assessment of posttraumatic stress disorder in Cambodian refugees using the Clinician-Administered PTSD Scale: psychometric properties and symptom severity.

PubMed

Hinton, Devon E; Chhean, Dara; Pich, Vuth; Pollack, M H; Orr, Scott P; Pitman, Roger K

2006-06-01

Posttraumatic stress disorder (PTSD) symptoms were assessed by using the Clinician-Administered PTSD Scale (CAPS) in a consecutive sample of Cambodian refugees attending a psychiatric clinic in the United States. Psychometric properties of the translated CAPS and severity of PTSD-related symptoms were examined. The CAPS demonstrated adequate psychometric properties, including coefficient alpha (.92) and item-total correlations (.48-.85). Of the sample 56% (101/179) met Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria for current PTSD. Those patients who met criteria for current PTSD had significantly higher CAPS total scores (M = 65.3, SD = 18.1) than those who did not meet the criteria (M = 13.9, SD = 16.7).

Relations between anger and DSM-5 posttraumatic stress disorder symptoms.

PubMed

Durham, Tory A; Byllesby, Brianna M; Armour, Cherie; Forbes, David; Elhai, Jon D

2016-10-30

The present study investigated the relationship between posttraumatic stress disorder (PTSD) and anger. Anger co-occurring with PTSD is found to have a severe effect across a wide range of traumatic experiences, making this an important relationship to examine. The present study utilized data regarding dimensions of PTSD symptoms and anger collected from a non-clinical sample of 247 trauma-exposed participants. Confirmatory factor analysis (CFA) was used to determine the underlying factor structure of both PTSD and anger by examining anger in the context of three models of PTSD. Results indicate that a five-factor representation of PTSD and one-factor representation of anger fit the data best. Additionally, anger demonstrated a strong relationship with the dysphoric arousal and negative alterations in cognitions and mood (NACM) factors; and dysphoric arousal was differentially related to anger. Clinical implications include potential need to reevaluate PTSD's diagnostic symptom structure and highlight the potential need to target and treat comorbid anger in individuals with PTSD. In regard to research, these results support the heterogeneity of PTSD. Copyright © 2016 Elsevier Ltd. All rights reserved.

No association between the serotonin transporter linked polymorphic region polymorphism and severity of posttraumatic stress disorder symptoms in combat veterans with or without comorbid depression.

PubMed

Kovacic Petrovic, Zrnka; Nedic Erjavec, Gordana; Nikolac Perkovic, Matea; Peraica, Tina; Pivac, Nela

2016-10-30

Since both posttraumatic stress disorder (PTSD) and depression are associated with disturbances in the serotoninergic system, the aim of the study was to determine the association between severity of PTSD symptoms, serotonin transporter polymorphism (5-HTTLPR) and platelet serotonin (5-HT) concentration, in male combat veterans with PTSD (n = 325), who were subdivided according to presence of comorbid depression. The methodological approach included the psychiatric diagnostic interviews and rating scales (SCID for DSM-IV, HDRS, CAPS), polymerase chain reaction for 5-HTTLPR genotyping and spectrophotofluorometric method for measuring the platelet 5-HT concentration. PTSD veterans without depression had more severe PTSD symptoms, and less severe depressive symptoms, than PTSD veterans with depression. 5-HTTLPR genotype frequencies did not differ between veterans with mild, moderate and severe PTSD symptoms, and between depressed and non-depressed PTSD veterans. No significant association was found between the severity of PTSD symptoms and 5-HTTLPR genotype. Platelet 5-HT concentration was similar in PTSD veterans, with or without comorbid depression, and between two groups subdivided according to the severity of PTSD symptoms or 5-HTTLPR genotype. The study confirmed, on ethnically homogenous groups of veterans with matched combat experience, a lack of association between the PTSD symptoms severity and 5-HTTLPR or platelet 5-HT concentration. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Biomarkers of PTSD: military applications and considerations.

PubMed

Lehrner, Amy; Yehuda, Rachel

2014-01-01

Although there are no established biomarkers for posttraumatic stress disorder (PTSD) as yet, biological investigations of PTSD have made progress identifying the pathophysiology of PTSD. Given the biological and clinical complexity of PTSD, it is increasingly unlikely that a single biomarker of disease will be identified. Rather, investigations will more likely identify different biomarkers that indicate the presence of clinically significant PTSD symptoms, associate with risk for PTSD following trauma exposure, and predict or identify recovery. While there has been much interest in PTSD biomarkers, there has been less discussion of their potential clinical applications, and of the social, legal, and ethical implications of such biomarkers. This article will discuss possible applications of PTSD biomarkers, including the social, legal, and ethical implications of such biomarkers, with an emphasis on military applications. Literature on applications of PTSD biomarkers and on potential ethical and legal implications will be reviewed. Biologically informed research findings hold promise for prevention, assessment, treatment planning, and the development of prophylactic and treatment interventions. As with any biological indicator of disorder, there are potentially positive and negative clinical, social, legal, and ethical consequences of using such biomarkers. Potential clinical applications of PTSD biomarkers hold promise for clinicians, patients, and employers. The search for biomarkers of PTSD should occur in tandem with an interdisciplinary discussion regarding the potential implications of applying biological findings in clinical and employment settings.

A Controlled Trial of Topiramate Treatment for Alcohol Dependence in Veterans with PTSD

DTIC Science & Technology

2015-10-01

Dieter J. Meyerhoff, Dr.rer.nat., UCSF Rationale and Content: Civilian and military personnel with posttraumatic stress disorder (PTSD) frequently...patients with PTSD, and for some patients alcohol use may be an attempt to “self-medicate” or cope or to respond to symptoms such as insomnia , anxiety...model of stress -enhanced fear learning which mimics several PTSD features, including increased voluntary alcohol intake, and set it in context to other

The relationship between posttraumatic stress disorder and smoking outcome expectancies among U.S. military veterans who served since September 11, 2001.

PubMed

Calhoun, Patrick S; Levin, Holly F; Dedert, Eric A; Johnson, Yashika; Beckham, Jean C

2011-06-01

Posttraumatic stress disorder (PTSD) is associated with increased rates of smoking although little is known regarding the mechanisms underlying this relationship. The current study examined expectations about smoking outcomes among smokers with and without PTSD. The sample included 96 veterans (mean age of 34 years) and included 17% women and 50% racial minorities. Smoking expectancies were measured with the Smoking Consequences Questionnaire-Adult (Copeland, Brandon, & Quinn, 1995). Consistent with previous work suggesting that smokers with PTSD smoke in an effort to reduce negative affect, unadjusted analyses indicated that smokers with PTSD (n = 38) had higher expectations that smoking reduces negative affect than smokers without PTSD (d = 0.61). Smokers with PTSD also had increased expectancies associated with boredom reduction (d = 0.48), stimulation (d = 0.61), taste/sensorimotor manipulation aspects of smoking (d = 0.73), and social facilitation (d = 0.61). Results of hierarchical linear regression analyses indicated that PTSD symptom severity was uniquely associated with these expectancies beyond the effects of gender and nicotine dependence. More positive beliefs about the consequences of smoking may increase risk of continued smoking among those with PTSD who smoke. Further understanding of smoking expectancies in this group may help in developing interventions tailored for this vulnerable population. Published 2011. This article is a US Government work and is in the public domain in the USA.

Longitudinal Changes in Combat-Related Posttraumatic Stress Disorder Among Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans With Hazardous Alcohol Use: The Role of Avoidance Coping.

PubMed

Lee, Joohyun; Possemato, Kyle; Ouimette, Paige C

2017-10-01

Military personnel who have experienced combat trauma are at risk for developing posttraumatic stress disorder (PTSD). A greater recognition of the complex array of vulnerability factors that contribute to PTSD severity has led researchers to examine other non-combat-related factors. This longitudinal study examined a number of pre-, peri-, and postdeployment factors hypothesized to contribute to PTSD symptomatology among returning Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans presenting with at least subthreshold PTSD symptoms and hazardous alcohol use in a primary care setting. Purported risk factors included childhood family environment, severity of combat exposure, postdeployment social support, alcohol dependence severity, and an avoidant coping style. At baseline, postdeployment social support and avoidant coping contributed to PTSD severity. Only avoidant coping was associated with changes in PTSD symptom at 1-year follow-up. Reducing avoidant coping may deter the maintenance of PTSD among veterans with PTSD symptoms and hazardous alcohol use.

PTSD symptoms and pain in Canadian military veterans: the mediating roles of anxiety, depression, and alcohol use.

PubMed

Irwin, Kara C; Konnert, Candace; Wong, May; O'Neill, Thomas A

2014-04-01

Symptoms of posttraumatic stress disorder (PTSD) and pain are often comorbid among veterans. The purpose of this study was to investigate to what extent symptoms of anxiety, depression, and alcohol use mediated the relationship between PTSD symptoms and pain among 113 treated male Canadian veterans. Measures of PTSD, pain, anxiety symptoms, depression symptoms, and alcohol use were collected as part of the initial assessment. The bootstrapped resampling analyses were consistent with the hypothesis of mediation for anxiety and depression, but not alcohol use. The confidence intervals did not include zero and the indirect effect of PTSD on pain through anxiety was .04, CI [.03, .07]. The indirect effect of PTSD on pain through depression was .04, CI [.02, .07]. These findings suggest that PTSD and pain symptoms among veterans may be related through the underlying symptoms of anxiety and depression, thus emphasizing the importance of targeting anxiety and depression symptoms when treating comorbid PTSD and pain patients. © 2014 International Society for Traumatic Stress Studies.

Metabolic, autonomic and immune markers for cardiovascular disease in posttraumatic stress disorder

PubMed Central

Kibler, Jeffrey L; Tursich, Mischa; Ma, Mindy; Malcolm, Lydia; Greenbarg, Rachel

2014-01-01

Posttraumatic stress disorder (PTSD) has been associated with significantly greater incidence of heart disease. Numerous studies have indicated that health problems for individuals with PTSD occur earlier in life than in the general population. Multiple mechanistic pathways have been suggested to explain cardiovascular disese (CVD) risk in PTSD, including neurochemical, behavioral, and immunological changes. The present paper is a review of recent research that examines cardiovascular and immune risk profiles of individuals with PTSD. First, we address the relatively new evidence that the constellation of risk factors commonly experienced in PTSD fits the profile of metabolic syndrome. Next we examine the findings concerning hypertension/blood pressure in particular. The literature on sympathetic and parasympathetic responsivity in PTSD is reviewed. Last, we discuss recent findings concerning immune functioning in PTSD that may have a bearing on the high rates of CVD and other illnesses. Our primary goal is to synthesize the existing literature by examining factors that overlap mechanistically to increase the risk of developing CVD in PTSD. PMID:24976918

General distress is more important than PTSD's cognition and mood alterations factor in accounting for PTSD and depression's comorbidity.

PubMed

Byllesby, Brianna M; Elhai, Jon D; Tamburrino, Marijo; Fine, Thomas H; Cohen, Gregory; Sampson, Laura; Shirley, Edwin; Chan, Philip K; Liberzon, Israel; Galea, Sandro; Calabrese, Joseph R

2017-03-15

Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are highly comorbid and exhibit strong correlations with each other at both the symptom level and latent factor level. Various theories have attempted to explain this relationship. Results have been inconsistent regarding whether PTSD's negative alterations in cognition and mood factor (NACM) is significantly more related to depression, in contrast to other factors of PTSD. Confirmatory factor analysis was used to attempt to address the relationships between PTSD and MDD in a large sample of trauma-exposed combat veterans from the Ohio National Guard as part of a larger longitudinal study. Confirmatory factor analysis was used to test a bifactor model of PTSD symptoms, testing relations between PTSD's factors and a latent depressive factor. After partitioning out the common variance into the bifactor, we found that in contrast to other PTSD factors, PTSD's NACM factor was not significantly more related to depression. Instead, only the general bifactor predicted depressive symptoms. The limitations of the present study include the following: the specific measures of PTSD and MDD used were based on self-report, and the sample consisted of non-clinical, non-treatment seeking veterans. The present study suggests that the high rate of comorbidity between posttraumatic stress disorder (PTSD) and major depressive disorder is more related to underlying general distress or negative affectivity than the symptom categories of the PTSD diagnostic criteria. Copyright © 2017 Elsevier B.V. All rights reserved.

Physical comorbidities of post-traumatic stress disorder in Australian Vietnam War veterans.

PubMed

McLeay, Sarah C; Harvey, Wendy M; Romaniuk, Madeline Nm; Crawford, Darrell Hg; Colquhoun, David M; Young, Ross McD; Dwyer, Miriam; Gibson, John M; O'Sullivan, Robyn A; Cooksley, Graham; Strakosch, Christopher R; Thomson, Rachel M; Voisey, Joanne; Lawford, Bruce R

2017-04-03

To determine whether the prevalence of physical comorbidities in Australian Vietnam War veterans with post-traumatic stress disorder (PTSD) is higher than in trauma-exposed veterans without PTSD. Cross-sectional analysis of the health status (based on self-reported and objective clinical assessments) of 298 Australian Vietnam War veterans enrolled by the Gallipoli Medical Research Institute (Brisbane) during February 2014 - July 2015, of whom 108 were confirmed as having had PTSD and 106 served as trauma-exposed control participants.Main outcomes and measures: Diagnostic psychiatric interview and psychological assessments determined PTSD status, trauma exposure, and comorbid psychological symptoms. Demographic data, and medical and sleep history were collected; comprehensive clinical examination, electrocardiography, spirometry, liver transient elastography, and selected pathology assessments and diagnostic imaging were performed. Outcomes associated with PTSD were identified; regression analysis excluded the effects of potentially confounding demographic and risk factors and comorbid symptoms of depression and anxiety. The mean total number of comorbidities was higher among those with PTSD (17.7; SD, 6.1) than in trauma-exposed controls (14.1; SD, 5.2; P < 0.001). For 24 of 171 assessed clinical outcomes, morbidity was greater in the PTSD group, including for conditions of the gastrointestinal, hepatic, cardiovascular, and respiratory systems, sleep disorders, and laboratory pathology measures. In regression analyses including demographic factors, PTSD remained positively associated with 17 adverse outcomes; after adjusting for the severity of depressive symptoms, it remained significantly associated with ten. PTSD in Australian Vietnam veterans is associated with comorbidities in several organ systems, independent of trauma exposure. A comprehensive approach to the health care of veterans with PTSD is needed.

Examining the association between posttraumatic stress disorder and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis.

PubMed

Spencer, Andrea E; Faraone, Stephen V; Bogucki, Olivia E; Pope, Amanda L; Uchida, Mai; Milad, Mohammed R; Spencer, Thomas J; Woodworth, K Yvonne; Biederman, Joseph

2016-01-01

To conduct a systematic review and meta-analysis examining the relationship between attention-deficit/hyperactivity disorder (ADHD) and posttraumatic stress disorder (PTSD). We reviewed literature through PubMed and PsycINFO without a specified date range, utilizing the search (posttraumatic stress disorder OR PTSD) AND (ADHD OR attention deficit hyperactivity disorder OR ADD OR attention deficit disorder OR hyperkinetic syndrome OR minimal brain dysfunction). References from relevant articles were reviewed. We identified 402 articles; 28 met criteria. We included original human research in English that operationalized diagnoses of ADHD and PTSD, evaluated the relationship between the disorders, and included controls. We excluded articles that failed to differentiate ADHD or PTSD from nonspecific or subsyndromal deficits or failed to compare their relationship. We extracted sample size, age, diagnostic methods, design, referral status, control type, and number of subjects with and without ADHD and PTSD alone and combined. We computed meta-analyses for 22 studies examining ADHD in PTSD and PTSD in ADHD using a random effects model and meta-analytic regression. We assessed for heterogeneity and publication bias and adjusted for intrastudy clustering. The relative risk (RR) for PTSD in ADHD was 2.9 (P < .0005); in samples using healthy controls, the RR was 3.7 (P = .001); and in samples using traumatized controls, the RR was 1.6 (P = .003). The RR for ADHD in PTSD was 1.7 (P < .0005); in samples using traumatized controls, the RR was 2.1 (P < .0005). The association was not significant in samples using psychiatric controls. Results indicate a bidirectional association between ADHD and PTSD, suggesting clinical implications and highlighting the need for neurobiological research that examines the mechanisms underlying this connection. © Copyright 2015 Physicians Postgraduate Press, Inc.

Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review

PubMed Central

Kar, Nilamadhab

2011-01-01

Background: Post-traumatic stress disorder (PTSD) is a psychiatric sequel to a stressful event or situation of an exceptionally threatening or catastrophic nature. Cognitive behavioral therapy (CBT) has been used in the management of PTSD for many years. This paper reviews the effectiveness of CBT for the treatment of PTSD following various types of trauma, its potential to prevent PTSD, methods used in CBT, and reflects on the mechanisms of action of CBT in PTSD. Methods: Electronic databases, including PubMed, were searched for articles on CBT and PTSD. Manual searches were conducted for cross-references in the relevant journal sites. Results: The current literature reveals robust evidence that CBT is a safe and effective intervention for both acute and chronic PTSD following a range of traumatic experiences in adults, children, and adolescents. However, nonresponse to CBT by PTSD can be as high as 50%, contributed to by various factors, including comorbidity and the nature of the study population. CBT has been validated and used across many cultures, and has been used successfully by community therapists following brief training in individual and group settings. There has been effective use of Internet-based CBT in PTSD. CBT has been found to have a preventive role in some studies, but evidence for definitive recommendations is inadequate. The effect of CBT has been mediated mostly by the change in maladaptive cognitive distortions associated with PTSD. Many studies also report physiological, functional neuroimaging, and electroencephalographic changes correlating with response to CBT. Conclusion: There is scope for further research on implementation of CBT following major disasters, its preventive potential following various traumas, and the neuropsychological mechanisms of action. PMID:21552319

Posttraumatic Stress Disorder Symptoms Mediate the Relationship Between Traumatic Experiences and Drinking Behavior Among Women Attending Alcohol-Serving Venues in a South African Township

PubMed Central

Watt, Melissa H.; Ranby, Krista W.; Meade, Christina S.; Sikkema, Kathleen J.; MacFarlane, Jessica C.; Skinner, Donald; Pieterse, Desiree; Kalichman, Seth C.

2012-01-01

Objective: South Africa has high rates of traumatic experiences and alcohol abuse or dependence, especially among women. Traumatic experiences often result in symptoms of posttraumatic stress disorder (PTSD), and PTSD has been associated with hazardous drinking. This article examines the relationship between traumatic events and hazardous drinking among women who patronized alcohol-serving venues in South Africa and examines PTSD as a mediator of this relationship. Method: A total of 560 women were recruited from a Cape Town township. They completed a computerized assessment that included alcohol consumption, history of traumatic events, and PTSD symptoms. Mediation analysis examined whether PTSD symptoms mediated the relationship between the number of traumatic event categories experienced (range: 0–7) and drinking behavior. Results: The mean Alcohol Use Disorders Identification Test score in the sample was 12.15 (range: 0–34, SD = 7.3), with 70.9% reaching criteria for hazardous drinking (AUDIT ≥ 8). The mean PTSD score was 36.32 (range: 17–85, SD = 16.3), with 20.9% meeting symptom criteria for PTSD (PTSD Checklist with 20.9% meeting symptom criteria for PTSD (PTSD Checklist-Civilian Version ≥ 50). Endorsement of traumatic experiences was high, including adult emotional (51.8%), physical (49.6%), and sexual (26.3%) abuse; childhood physical (35.0%) and sexual (25.9%) abuse; and other types of trauma (83%). All categories of traumatic experiences, except the “other” category, were associated with hazardous drinking. PTSD symptoms mediated 46% of the relationship between the number of traumatic categories experienced and drinking behavior. Conclusions: Women reported high rates of hazardous drinking and high levels of PTSD symptoms, and most had some history of traumatic events. There was a strong relationship between traumatic exposure and drinking levels, which was largely mediated by PTSD symptoms. Substance use interventions should address histories of trauma in this population, where alcohol may be used in part to cope with past traumas. PMID:22630793

Posttraumatic stress disorder following traumatic injury at 6 months: associations with alcohol use and depression.

PubMed

Warren, Ann Marie; Foreman, Michael L; Bennett, Monica M; Petrey, Laura B; Reynolds, Megan; Patel, Sarita; Roden-Foreman, Kenleigh

2014-02-01

Posttraumatic stress disorder (PTSD) is progressively recognized as a psychological morbidity in injured patients. Participants in a longitudinal study were identified as PTSD positive or PTSD negative at 6 months following injury. Risky alcohol use, depression, demographic, and injury-related variables were explored. This prospective cohort included patients 18 years or older, admitted to our Level I trauma center. Outcome measures included PTSD Checklist-Civilian Version (PCL-C), Alcohol Use Disorders Identification Test (AUDIT-C), and Patient Health Questionnaire (PHQ-8). Demographic and injury variables were collected. A total of 211 participants enrolled in the study, and 118 participants completed measures at both baseline and 6 months. Of the participants, 25.4% (n = 30) screened positive for PTSD at 6 months. The entire sample showed a decline in risky alcohol use at 6 months (p = 0.0043). All PTSD-positive participants at 6 months were also positive for depression (p < 0.0001). For the entire sample, there was a 10% increase in depression from baseline to 6 months (p = 0.03). However, for those participants who were PTSD positive at 6 months, there was a 53% increase in depression from baseline (p = 0.0002) as compared with the group at 6 months without PTSD. Statistically significant differences were found between PTSD-positive and PTSD-negative participants regarding age (40.1 [15.9] vs. 50.9 [18.2], p = 0.0047), male (77% vs. 50%, p = 0.0109), penetrating injury (30% vs. 4%, p < 0.0001), PTSD history (17% vs. 4%, p = 0.0246), or other psychiatric condition (63% vs. 19%, p ≤ 0.001). PTSD was not associated with risky alcohol use at 6 months. Surprisingly, risky alcohol use declined in both groups. Incidence of PTSD (25.4%, n = 30) and risky alcohol use (25%, n = 29) were equal at 6 months. Although the American College of Surgeons' Committee on Trauma requires brief screening and intervention for risky alcohol use owing to societal impact, reinjury rates, and cost effectiveness, our study suggests that screening for psychological conditions may be equally important. Prognostic study, level III.

Delayed Diagnosis of Acromegaly in the Context of Post-Traumatic Stress Disorder due to Symptoms Mimicking Known Psychotropic Medication Side Effects.

PubMed

Portier, Ray-Bernard; Afarin, Afshin; Pope, Sara

2017-07-01

Acromegaly is caused by elevated secretion of human growth hormone, which is frequently because of intracranial tumors. This diagnosis is fairly uncommon with an incidence of 3 to 4 cases per million patients per year. We are presenting a case of acromegaly diagnosed in an active duty Chief Petty Officer. A 38-year-old male Chief Petty Officer with no previous mental health diagnosis experienced post-traumatic stress disorder (PTSD)-like symptoms in early 2012 after deploying to Iraq and Afghanistan from 2010 to 2011. Initially he self-managed his symptoms, but in July 2012 he required a reduction mammoplasty because of gynecomastia. The metabolic workup revealed elevated prolactin, but this was not further investigated. His recovery from anesthesia was complicated by intensified PTSD-like symptoms, which continued to worsen after the surgery. On self-referral to mental health, he was diagnosed with PTSD and managed for 6 months with cognitive behavioral therapy. Because of persistent and worsening symptoms, his therapy was augmented to include continued cognitive behavioral therapy, alpha-blockers, antidepressants, antihistamines, and sleep aids. Because of night sweats, the selective serotonin reuptake inhibitors doses were modified. Night sweats persisted, and the patient was re-evaluated for other potential etiologies. On evaluation, the patient endorsed a history of obstructive sleep apnea, cervicalgia, visual changes, depressed mood, as well as multiple physical symptoms including coarsened facial features, large hands/feet, and increased interdental distance. On laboratory analysis, insulin-like growth factor 1 was noted to be 3 times the upper limit of normal, and a prolactin level was five times the upper limit of normal. A brain magnetic resonance imaging revealed a cystic pituitary lesion with suprasellar extension, compression of the infundibulum without invasion of the cavernous sinus, or displacement of the optic chiasm. Based on clinical history, physical examination, laboratory data, and the pituitary lesion, this patient was diagnosed with acromegaly. He was referred to neurosurgery for further evaluation and management. This case shows that side effects of medications can easily mimic some medical conditions. The possibility of unrecognized disease should not be overlooked simply because a patient's symptoms that develop after starting a medication correspond well the side effect profile of the prescribed medications. This is especially true if side effects do not stop with alteration of medication dose, cessation of the medication, or changing to another medication. Pituitary adenomas are rare in patients treated for PTSD. However, attribution of PTSD patient's symptoms to the side effects of selective serotonin reuptake inhibitors therapy without considering a broader differential may lead to a missed diagnosis of an endocrine disease. In this case, the presence of an undiagnosed pituitary lesion resulted in ineffective medical management of PTSD in the patient. Mental health providers should remain allied with their primary care counterparts and consider directing patients to primary care for periodic physical re-evaluation to provide the most effective approach to symptom evaluation and management. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Neurofeedback as an adjunct therapy for treatment of chronic posttraumatic stress disorder related to refugee trauma and torture experiences: two case studies.

PubMed

Askovic, Mirjana; Watters, Anna J; Aroche, Jorge; Harris, Anthony W F

2017-08-01

The objective of this study was to describe the use of neurofeedback for refugee-related chronic posttraumatic stress disorder (PTSD) in two case studies. We describe the assessment and application of neurofeedback integrated into the treatment of two clients with chronic PTSD. We include details of our treatment schedule, symptoms and quantitative electrophysiological data for each case. Results All clients achieved significant reduction in symptoms of PTSD and improvement in daily functioning post-neurofeedback therapy. Quantitative electroencephalogric (EEG) measures indicate a normalisation of EEG markers relating to trauma, including overarousal at rest and working memory function. Conclusions Neurofeedback as an adjunct to trauma-informed therapy may help to remediate chronic PTSD relating to refugee experiences. If replicated then improvements demonstrated in this population would be generalisable to all chronic PTSD.

Complex sequelae of psychological trauma among Kosovar civilian war victims.

PubMed

Morina, Nexhmedin; Ford, Julian D

2008-09-01

The impact of war trauma on civilians may include, but also extend beyond, post-traumatic stress disorder (PTSD) to include complex sequelae such as those described by the syndrome of Disorders of Extreme Stress Not Otherwise Specified (DESNOS). In the present study, 102 civilian war victims were interviewed in Kosovo, assessing traumatic life events, PTSD, DESNOS, and depression. Full DESNOS rarely occurred (2% prevalence), however, clinically significant DESNOS symptoms of somatization, altered relationships, and altered systems of meaning were reported by between 24-42% of respondents. Although DESNOS symptoms were correlated with PTSD symptoms, DESNOS symptoms were associated with poorer overall psychological functioning, self-evaluations, satisfaction with life, and social support independent of the effects of PTSD. The findings suggest that DESNOS warrants attention in addition to PTSD in the assessment and treatment of civilians who have been exposed to war and genocide.

Post-traumatic stress disorder: cognitive hypnotherapy, mindfulness, and acceptance-based treatment approaches.

PubMed

Lynn, Steven Jay; Malakataris, Anne; Condon, Liam; Maxwell, Reed; Cleere, Colleen

2012-04-01

In this article, we describe how cognitive hypnotherapy can be used in conjunction with evidence-based practices for the treatment of post-traumatic stress disorder (PTSD). We review cognitive-behavioral interventions for PTSD, including mindfulness and acceptance-based approaches, and contend that (a) empirical support for the use of hypnosis in treating a variety of conditions is considerable; (b) hypnosis is fundamentally a cognitive-behavioral intervention; (c) psychological interventions with a firm footing in cognitive-behavioral therapy (CBT) are well-suited to treat the symptoms of PTSD; and (d) hypnosis can be a useful adjunct to evidence-based cognitive-behavioral approaches, including mindfulness and acceptance-based interventions, for treating PTSD.

Are hippocampal size differences in posttraumatic stress disorder mediated by sleep pathology?

PubMed

Mohlenhoff, Brian S; Chao, Linda L; Buckley, Shannon T; Weiner, Michael W; Neylan, Thomas C

2014-06-01

Posttraumatic stress disorder (PTSD) is associated with smaller volumes of the hippocampus, as has been demonstrated by meta-analyses. Proposed mechanistic relationships are reviewed briefly, including the hypothesis that sleep disturbances mediate the effects of PTSD on hippocampal volume. Evidence for this includes findings that insomnia and restricted sleep are associated with changes in hippocampal cell regulation and impairments in cognition. We present results of a new study of 187 subjects in whom neither PTSD nor poor sleep was associated with lower hippocampal volume. We outline a broad research agenda centered on the hypothesis that sleep changes mediate the relationship between PTSD and hippocampal volume. Copyright © 2014. Published by Elsevier Inc.

High rates of PTSD treatment dropout: A possible red herring?

PubMed

Szafranski, Derek D; Smith, Brian N; Gros, Daniel F; Resick, Patricia A

2017-04-01

Few studies have examined symptom change among dropouts from posttraumatic stress disorder (PTSD) treatment. However, dropout is widely considered a negative event needing to be addressed. The present study investigated PTSD and depression symptom change in patients with PTSD who discontinued psychotherapy. Female civilians (n=321) diagnosed with PTSD participated in two randomized clinical trials examining PTSD treatment outcomes. Of those, 53 were identified as dropouts and included in this study. Symptom change was assessed by clinically significant change (CSC) criteria and symptom end-state criteria. Results demonstrated that considerable proportions of participants (35.85-55.56%) displayed significant improvement and/or met good end-state criteria for PTSD and depression. Results also revealed that participants who displayed symptom improvement were younger, attended more treatment sessions, were married or partnered, and had higher annual household income. Although preliminary, these findings contradict belief that treatment dropouts do not display symptom improvement. Published by Elsevier Ltd.

The relevance of epigenetics to PTSD: implications for the DSM-V.

PubMed

Yehuda, Rachel; Bierer, Linda M

2009-10-01

Epigenetic modifications, such as DNA methylation, can occur in response to environmental influences to alter the functional expression of genes in an enduring and potentially, intergenerationally transmissible manner. As such, they may explain interindividual variation, as well as the long-lasting effects of trauma exposure. Although there are currently no findings that suggest epigenetic modifications that are specific to posttraumatic stress disorder (PTSD) or PTSD risk, many recent observations are compatible with epigenetic explanations. These include recent findings of stress-related gene expression, in utero contributions to infant biology, the association of PTSD risk with maternal PTSD, and the relevance of childhood adversity to the development of PTSD. The relevance of epigenetic mechanisms to formulations of PTSD for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is described. Copyright © 2009 International Society for Traumatic Stress Studies.

Emotional ambivalence and post-traumatic stress disorder (PTSD) in soldiers during military operations

PubMed Central

Jerg-Bretzke, Lucia; Walter, Steffen; Limbrecht-Ecklundt, Kerstin; Traue, Harald C.

2013-01-01

Objective: This pilot study examined the extent to which a specific mechanism of emotion regulation – namely, ambivalence concerning the expressiveness of German soldiers’ emotions – affects the severity of PTSD symptoms after a military operation. Methodology: A survey was conducted at three points in time among 66 soldiers deployed on military crisis operations. The Harvard Trauma Questionaire (HTQ), the Ambivalence over Emotional Expressiveness Questionnaire (AEQ-G18), and a questionnaire on the particular stress of German soldiers during military operations were used. Results: The study showed a significant correlation between emotional ambivalence and traumatization. Furthermore, it was shown that the subjective stress of soldiers leading up to deployment is more pronounced when emotional ambivalence is stronger in the context of military operations. This particular stress is greater before and during the military operation than after. Compared to a male control sample, the average AEQ-G18 scores of the soldier sample examined here are considerably lower. Conclusion: This pilot study clearly indicates that the AEQ-G18 could be a suitable predictor of the psychological burden on soldiers. The correlations between emotional ambivalence on the one hand and the particular and post-traumatic stressors on the other hand are not only statistically significant in the present pilot study, but may also be relevant as risk factors. It is, therefore, necessary to conduct more extensive studies on soldiers participating in military operations to verify the results of this pilot study. PMID:23798980

Differential Symptom Pattern of Post-traumatic Stress Disorder (PTSD) in Maltreated Children with and without Concurrent Depression.

ERIC Educational Resources Information Center

Runyon, Melissa K.; Faust, Jan; Orvaschel, Helen

2002-01-01

A study examined differences in the Post-Traumatic Stress Disorder (PTSD) symptomalogy among 96 abused children with and without concurrent depression. Analysis revealed that three post-trauma symptoms, including psychological amnesia, flashbacks/reenactments, and sleep difficulties, discriminated among groups. Children with PTSD and depression…

[Posttraumatic stress disorder in patients with psoriasis].

PubMed

Ogłodek, Ewa

2011-01-01

Posttraumatic stress disorder (PTSD) is an increasingly common medical condition. This anxiety disorder affects not only post war veterans but also those who suffered for extremely shocking situations, fear and hopelessness. Fundamental features of PTSD include the following: the symptoms are linked to the traumatic event and are not random, the symptoms were not present prior to the traumatic event, and the symptoms are present 1 month or later than completion of the traumatic event. There are some reports about the relatively frequent occurrence of PTSD in the case of psoriasis and some hypothesis about interactions between those two diseases. To assess the stress and increase of occurrence of PTSD symptoms in the group of patients suffering from psoriasis. 20 patients (10 males and 10 females) aged 40.9 with psoriasis and PTSD were examined by the questionnaire Mississippi-C Scale. In addition, 20 patients, including 9 males and 11 females, aged 39.6 were also examined and formed the control group. It was observed significant relationship between PTSD and psoriasis. The article also emphasize the early intervention role in preventing the negative effects of stress, especially in patients suffering from psoriasis.

EARLY INTERVENTIONS FOR PTSD: A REVIEW

PubMed Central

Kearns, Megan C.; Ressler, Kerry J.; Zatzick, Doug; Rothbaum, Barbara Olasov

2013-01-01

The high prevalence of trauma exposure and subsequent negative consequences for both survivors and society as a whole emphasize the need for secondary prevention of posttraumatic stress disorder. However, clinicians and relief workers remain limited in their ability to intervene effectively in the aftermath of trauma and alleviate traumatic stress reactions that can lead to chronic PTSD. The scientific literature on early intervention for PTSD is reviewed, including early studies on psychological debriefing, pharmacological, and psychosocial interventions aimed at preventing chronic PTSD. Studies on fear extinction and memory consolidation are discussed in relation to PTSD prevention and the potential importance of immediate versus delayed intervention approaches and genetic predictors are briefly reviewed. Preliminary results from a modified prolonged exposure intervention applied within hours of trauma exposure in an emergency room setting are discussed, along with considerations related to intervention reach and overall population impact. Suggestions for future research are included. Prevention of PTSD, although currently not yet a reality, remains an exciting and hopeful possibility with current research approaches translating work from the laboratory to the clinic. PMID:22941845

ABERRANT RESTING-STATE BRAIN ACTIVITY IN POSTTRAUMATIC STRESS DISORDER: A META-ANALYSIS AND SYSTEMATIC REVIEW.

PubMed

Koch, Saskia B J; van Zuiden, Mirjam; Nawijn, Laura; Frijling, Jessie L; Veltman, Dick J; Olff, Miranda

2016-07-01

About 10% of trauma-exposed individuals develop PTSD. Although a growing number of studies have investigated resting-state abnormalities in PTSD, inconsistent results suggest a need for a meta-analysis and a systematic review. We conducted a systematic literature search in four online databases using keywords for PTSD, functional neuroimaging, and resting-state. In total, 23 studies matched our eligibility criteria. For the meta-analysis, we included 14 whole-brain resting-state studies, reporting data on 663 participants (298 PTSD patients and 365 controls). We used the activation likelihood estimation approach to identify concurrence of whole-brain hypo- and hyperactivations in PTSD patients during rest. Seed-based studies could not be included in the quantitative meta-analysis. Therefore, a separate qualitative systematic review was conducted on nine seed-based functional connectivity studies. The meta-analysis showed consistent hyperactivity in the ventral anterior cingulate cortex and the parahippocampus/amygdala, but hypoactivity in the (posterior) insula, cerebellar pyramis and middle frontal gyrus in PTSD patients, compared to healthy controls. Partly concordant with these findings, the systematic review on seed-based functional connectivity studies showed enhanced salience network (SN) connectivity, but decreased default mode network (DMN) connectivity in PTSD. Combined, these altered resting-state connectivity and activity patterns could represent neurobiological correlates of increased salience processing and hypervigilance (SN), at the cost of awareness of internal thoughts and autobiographical memory (DMN) in PTSD. However, several discrepancies between findings of the meta-analysis and systematic review were observed, stressing the need for future studies on resting-state abnormalities in PTSD patients. © 2016 Wiley Periodicals, Inc.

Predator-based psychosocial stress animal model of PTSD: Preclinical assessment of traumatic stress at cognitive, hormonal, pharmacological, cardiovascular and epigenetic levels of analysis.

PubMed

Zoladz, Phillip R; Diamond, David M

2016-10-01

Research on post-traumatic stress disorder (PTSD) is faced with the challenge of understanding how a traumatic experience produces long-lasting detrimental effects on behavior and brain functioning, and more globally, how stress exacerbates somatic disorders, including cardiovascular disease. Moreover, the design of translational research needs to link animal models of PTSD to clinically relevant risk factors which address why only a subset of traumatized individuals develop persistent psychopathology. In this review, we have summarized our psychosocial stress rodent model of PTSD which is based on well-described PTSD-inducing risk factors, including a life-threatening experience, a sense of horror and uncontrollability, and insufficient social support. Specifically, our animal model of PTSD integrates acute episodes of inescapable exposure of immobilized rats to a predator with chronic daily social instability. This stress regimen produces PTSD-like effects in rats at behavioral, cognitive, physiological, pharmacological and epigenetic levels of analysis. We have discussed a recent extension of our animal model of PTSD in which stress exacerbated coronary pathology following an ischemic event, assessed in vitro. In addition, we have reviewed our research investigating pharmacological and non-pharmacological therapeutic strategies which may have value in clinical approaches toward the treatment of traumatized people. Overall, our translational approach bridges the gap between human and animal PTSD research to create a framework with which to enhance our understanding of the biological basis of trauma-induced pathology and to assess therapeutic approaches in the treatment of psychopathology. Copyright © 2016 Elsevier Inc. All rights reserved.

Differences in prevalence rates of PTSD in various European countries explained by war exposure, other trauma and cultural value orientation

PubMed Central

2014-01-01

Background Guided by previous explorations of historical and cultural influences on the occurrence of PTSD, the aim of the present study was to investigate the contributions of war victimisation (in particular, World War II) and other civil trauma on the prevalence of PTSD, as mediated by cultural value orientation. Secondary data analysis was performed for 12 European countries using data, including PTSD prevalence and number of war victims, crime victims, and natural disaster victims, from different sources. Ten single value orientations, as well as value aggregates for traditional and modern factors, were investigated. Results Whilst differences in PTSD prevalence were strongly associated with war victim rates, associations, albeit weaker, were also found between crime victims and PTSD. When cultural value orientations, such as stimulation and conformity as representatives of modern and traditional values, were included in the multivariate predictions of PTSD prevalence, an average of approximately 80% of PTSD variance could be explained by the model, independent of the type of trauma exposure. Conclusion The results suggest that the aftermath of war contributes to current PTSD prevalence, which may be explained by the high proportion of the older population who directly or indirectly experienced traumatic war experiences. Additional findings for other types of civil trauma point towards an interaction between value orientation and country-specific trauma rates. Particularly, being personally oriented towards stimulation appears to interact with differences in trauma prevalence. Thus, cultural value orientation might be viewed not only as an individual intrinsic process but also as a compensatory strategy after trauma exposure. PMID:24972489

Interpersonal Factors in Understanding and Treating Posttraumatic Stress Disorder

PubMed Central

Markowitz, John C.; Milrod, Barbara; Bleiberg, Kathryn; Marshall, Randall D.

2010-01-01

Exposure to reminders of trauma underlies the theory and practice of most treatments for posttraumatic stress disorder (PTSD), yet exposure may not be the sole important treatment mechanism. Interpersonal features of PTSD influence its onset, chronicity, and possibly its treatment. The authors review interpersonal factors in PTSD, including the critical but underrecognized role of social support as both protective posttrauma and as a mechanism of recovery. They discuss interpersonal psychotherapy (IPT) as an alternative treatment for PTSD and present encouraging findings from two initial studies. Highlighting the potential importance of attachment and interpersonal relationships, the authors propose a mechanism to explain why improving relationships may ameliorate PTSD symptoms. PMID:19339847

The interaction of BDNF Val66Met, PTSD, and child abuse on psychophysiological reactivity and HPA axis function in a sample of Gulf War Veterans.

PubMed

Young, Dmitri A; Neylan, Thomas C; O'Donovan, Aoife; Metzler, Thomas; Richards, Anne; Ross, Jessica A; Inslicht, Sabra S

2018-08-01

While the BDNF Val66Met polymorphism has been linked to various psychological disorders, limited focus has been on its relationship to posttraumatic stress disorder (PTSD) and early traumas such as child abuse. Therefore, we assessed whether Val66Met was associated with fear potentiated psychophysiological response and HPA axis dysfunction and whether PTSD status or child abuse history moderated these outcomes in a sample of Veterans. 226 and 173 participants engaged in a fear potentiated acoustic startle paradigm and a dexamethasone suppression test (DST) respectively. Fear conditions included no, ambiguous, and high threat conditions. Psychophysiological response measures included electromyogram (EMG), skin conductance response (SCR), and heart rate. The Clinician Administered PTSD Scale (CAPS) and the Trauma History Questionnaire (THQ) were used to assess PTSD status and child abuse history respectively. Met allele carriers exhibited greater SCR magnitudes in the no and ambiguous threat conditions (p < 0.01 and p < 0.05 respectively). Met carriers with PTSD exhibited greater physiological response magnitudes in the ambiguous (SCR, p < 0.001) and high threat conditions (SCR and heart rate, both p ≤ 0.005). Met carrier survivors of child abuse exhibited blunted heart rate magnitudes in the high threat condition (p < 0.01). Met allele carries with PTSD also exhibited greater percent cortisol suppression (p < 0.005). Limitations included small sample size and the cross-sectional nature of the data. The Val66met may impact PTSD susceptibility differentially via enhanced threat sensitivity and HPA axis dysregulation. Child abuse may moderate Val66Met's impact on threat reactivity. Future research should explore how neuronal mechanisms might mediate this risk. Published by Elsevier B.V.

The mental health and substance misuse needs of male ex-armed forces personnel in prison

PubMed Central

Wainwright, Verity; Lennox, Charlotte; McDonnell, Sharon; Shaw, Jenny; Senior, Jane

2018-01-01

Abstract Ex-armed forces personnel constitute the largest known occupational group in prison but there is little evidence regarding their mental health, or substance misuse, needs. A total of 105 participants were interviewed and measures assessing symptoms of common mental health (CMH) problems and substance misuse were completed along with a review of their health care records. Forty (38%) participants screened for current CMH problems (CCMH) and high levels of dual symptomology and alcohol misuse were assessed. Thirty-nine (37%) had a mental health diagnosis recorded, most commonly for post-traumatic stress disorder (PTSD), depression and personality disorder. Those who screened for a CCMH problem were more likely to have pre-service vulnerability to negative health outcomes and those with dual symptomology were more likely to have experienced deployment during their service. Findings suggest the mental health needs of this group are similar to the general prison population. Potentially higher prevalences of PTSD and alcohol misuse may direct service provision. PMID:29238268

PTSD: An Elusive Definition.

PubMed

Kirkbride, Jared F

2012-01-01

The Global War on Terrorism became the longest standing conflict in United States military history on June 7, 2010. It is estimated that 1.64 million U.S. troops have been deployed in support of Operation Enduring Freedom and Operation Iraqi Freedom (p xix).1 Both conflicts have produced high numbers of casualties as the result of ground combat. The amount of casualties though has been relatively low compared to other conflicts. Some of this can be attributed to the advances in body armor and emergency medicine that allow many servicemembers to survive conditions that previously led to death. Conversely, surviving these situations leaves those same members with memories that are psychologically difficult to live with and cause chronic difficulties. Unlike an amputee, or the victim of severe burns where the signs and symptoms of their injuries are obvious, patients with psychological disorders can have a range of signs and symptoms common in many other mental disorders, making it difficult to diagnose and treat Soldiers suffering from Post-traumatic Stress Disorder (PTSD). 2012.

The mental health and substance misuse needs of male ex-armed forces personnel in prison.

PubMed

Wainwright, Verity; Lennox, Charlotte; McDonnell, Sharon; Shaw, Jenny; Senior, Jane

2018-01-01

Ex-armed forces personnel constitute the largest known occupational group in prison but there is little evidence regarding their mental health, or substance misuse, needs. A total of 105 participants were interviewed and measures assessing symptoms of common mental health (CMH) problems and substance misuse were completed along with a review of their health care records. Forty (38%) participants screened for current CMH problems (CCMH) and high levels of dual symptomology and alcohol misuse were assessed. Thirty-nine (37%) had a mental health diagnosis recorded, most commonly for post-traumatic stress disorder (PTSD), depression and personality disorder. Those who screened for a CCMH problem were more likely to have pre-service vulnerability to negative health outcomes and those with dual symptomology were more likely to have experienced deployment during their service. Findings suggest the mental health needs of this group are similar to the general prison population. Potentially higher prevalences of PTSD and alcohol misuse may direct service provision.

Review of posttraumatic stress disorder and chronic pain: the path to integrated care.

PubMed

Gibson, Carri-Ann

2012-01-01

With the large number of Veterans experiencing posttraumatic stress disorder (PTSD) and chronic pain, the purpose of this article is to review the prevalence of PTSD and chronic pain, the theoretical models that explain the maintenance of both conditions, and the challenges faced by providers and families who care for these patients. The Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress with special attention to chronic pain is presented. Limited scientific evidence supports specific care and treatment of PTSD and chronic pain, and this challenges providers to investigate and research potential treatment options. Integrated care models designed for working with these patients are reviewed, including a focus on the techniques and strategies to address not only PTSD and chronic pain, but other conditions, including substance dependence and depression. A specific focus on headaches, back pain, and neuropathic pain follows, including treatment recommendations such as pharmacological, psychotherapeutic, and complementary approaches, given the high rates of these pain complaints for Veterans in PTSD clinical programs. Integrated care is presented as a viable solution and approach that challenges clinicians and researchers to develop innovative, scientifically based therapeutics and treatments to enhance the recovery and quality of life for Veterans with PTSD and chronic pain.