Prevalence of somatic and psychiatric disorders among former prisoners of war

American former prisoners of war (POWs) are an aging group who seek health care with increasing frequency. To examine the prevalence of long-term physical and emotional consequences of captivity in this population, the authors analyzed medical and psychiatric examination data for 426 former POWs. Detailed psychiatric diagnostic criteria were used to assess the POWs' mental health. Compared with general population groups, POWs had moderately elevated lifetime prevalence rates of depressive disorders and greatly elevated rates of posttraumatic stress disorder (PTSD), although their rates of hypertension, diabetes, myocardial infarction, bipolar disorder, schizophrenia, and alcoholism were not elevated. POWs who lost more than 35 percent of their body weight during captivity had higher rates of anxiety disorder, depressive disorders, PTSD, and schizophrenia, compared with other POWs.     

Age,education, maltreatment,and social support as predictors of chronic depression in former prisoners of war

Summary This study examined the relationships of prisoner of war captivity trauma variables and individual protective variables to current depressive symptoms as indexed by the CES-D and its components. The sample consisted of 989 U.S. former POWs of World War II and the Korean War, who have been followed since the mid 1950s. Depressive symptoms persisted over 40 years later. Age, education, medical symptoms during captivity, and level of social support were related to later levels of adjustment. Theoretical and methodological implications of the findings were discussed.This work was funded in part by the Medical Follow-up Agency of Institute of Medicine, National Academy of Sciences under contract to the U.S. Department of Veterans Affairs. We wish to express our appreciation for the participation of the former POWs themselves, who made this research possible.     

Secondary traumatization among wives of Israeli POWs: the role of POWs' distress

Background The aim of the study is to examine secondary traumatization of wives of former prisoners of war (POWs) as manifested in posttraumatic stress disorder (PTSD) symptoms, additional psychiatric symptoms, and marital adjustment. In addition, it assessed the role of several contributors to the wives' secondary traumatization: the husband's PTSD, the level of his verbal and physical aggression, and the wife's level of self-disclosure. Methods The study compared three groups of Israeli wives: wives of POWs with PTSD (N=18), wives of POWs without PTSD, (N=64), and a control group of wives of veterans without PTSD (N=72). Results The highest level of distress in all measures was endorsed by the wives of POWs with PTSD. Moreover, in addition to husband's PTSD and captivity, both the man's aggression and the wife's self-disclosure played a role in the wife's level of distress. Conclusions The findings show that the husbands' PTSD was more strongly associated with the wives' secondary traumatization than their captivity.     

Posttraumatic stress disorder among Israeli ex-prisoners of war 18 and 30 years after release

BACKGROUND: The psychological responses to captivity were measured in a sample of former prisoners of war (POWs) 18 and 30 years after release from captivity. METHOD: 209 Israeli veterans of the 1973 Yom Kippur War (103 ex-POWs and 106 controls) who had taken part in a previous study conducted in 1991 participated in the current study conducted in 2003. The study assessed current rates of posttraumatic stress disorder (PTSD), changes in PTSD over time, and the contribution of captivity severity (objective and subjective), sociode-mographic variables, and psychological appraisal and coping with captivity to predicting PTSD using standardized self-report questionnaires. RESULTS: Twenty-three percent of the ex-POWs met PTSD criteria and were 10 times more likely than controls to experience deterioration in their psychological condition in the 12-year interval between the 2 assessments. Almost 20% of ex-POWs who did not meet PTSD criteria in 1991 met criteria in the current assessment, in comparison to almost 1% of the controls. Current PTSD was predicted by younger age at the time of captivity, by loss of emotional control and higher subjective appraisal of suffering in captivity, and by a greater number of PTSD symptoms in the 1991 assessment. CONCLUSION: It is important to follow up and offer treatment to former POWs. Special attention should be paid to those who lost emotional control in captivity and to those who felt that the conditions of their captivity were severe.     

Trauma exposure, resilience, social support, and PTSD construct validity among former prisoners of war

  Background: The aim of this study was to investigate predictors of persistent symptoms of posttraumatic stress disorder (PTSD) and to examine the construct validity of PTSD in a national sample of 270 World War II and Korean Conflict prisoners of war (POWs). Method: POWs were interviewed at two points in time (1965 and 1990). Predictors included PTSD symptomatology measured in 1965 by items from the Cornell Medical Index (CMI), severity of captivity trauma, resilience factors, and post-trauma social support. The criterion, symptomatology in the early 1990s, was evaluated with the PTSD module of the Structured Clinical Interview for DSM (SCID). Results: The CMI provided only partial coverage of PTSD criteria and appeared to provide only a general index of distress. Clustering of SCID items in two-dimensional space via multidimensional scaling analysis offers some construct validation for the DSM's differentiation of PTSD symptoms into criterion groups, although there was not a perfect match. Trauma severity is best related to PTSD symptomatology experienced in 1990, mitigated in part by greater education level and age at the time of trauma exposure. Surprisingly, 1965 distress added only a modest amount to the prediction of current distress, while post-trauma social support added none. Conclusions: These findings support previous work showing the severe psychological sequelae of POW status 40–50 years after captivity, and indicate that trauma severity during captivity is the best predictor of current PTSD symptomatology. Results also add to our understanding of the conceptual differentiation of PTSD symptoms into separate and distinct symptom clusters. Accepted: 25 August 1999     

Posttraumatic residues of captivity: a follow-up of Israeli ex-prisoners of war

BACKGROUND: This article examines the long-term impact of wartime captivity. METHOD: One hundred sixty-four prisoners of war (POWs) and 189 matched combatants of the 1973 Yom Kippur War filled out a series of questionnaires that assessed posttraumatic stress disorder (PTSD), general psychiatric symptomatology, and social functioning according to DSM-III-R criteria. RESULTS: Almost 2 decades after the war, ex-POWs exhibited higher rates and greater intensity of posttraumatic stress reactions, more general psychiatric symptomatology, and more severe problems in functioning at home, at work, and in the military than did the control group (Israeli veterans who were not POWs). They were also more likely to obtain official disability recognition and to seek psychological help. Their recovery was slower and professional help less effective. In addition, the veterans with PTSD in both groups had high rates of comorbid general psychiatric symptomatology. CONCLUSION: These findings point to the depth, range, and persistence of the stress residuals of wartime captivity.     

Posttraumatic distress and growth among wives of prisoners of war: the contribution of husbands' posttraumatic stress disorder and wives' own attachments

This study examined distress and growth among wives of former combat veterans and prisoners of war (POWs), and the contribution of their husband's posttraumatic stress disorder (PTSD) and the wives' own attachment style to these outcomes. Two groups of wives participated in the study: 87 wives of former POWs, and 74 wives of control veterans. The wives of POWs reported significantly higher levels of distress and growth than did the wives of the controls. Husbands' PTSD symptomatology, as well as higher levels of avoidance and anxiety dimensions of attachment, contributed positively to distress and to growth. Further studies on the unique predictors of growth are needed.     

Posttraumatic stress disorder as a consequence of the POW experience

To estimate the relative contributions of trauma and premorbid disposition in the development and persistence of posttraumatic stress disorder (PTSD) symptoms, we conducted structured psychiatric interviews of 62 former World War II POWs. Half these men satisfied DSM-III criteria for PTSD in the year following repatriation. Eighteen (29%) continued to meet the criteria for PTSD 40 years later. Family history of mental illness and preexisting psychopathology were at best only weakly correlated with persistent PTSD symptoms. The strongest predictors of PTSD were proportion of body weight lost and the experience of torture during captivity. This study demonstrates that former POWs frequently develop posttraumatic stress disorder and that for one half of those who develop the symptoms, they persist for over 40 years. Familial risk factors and preexisting psychopathology are superseded by the overwhelming nature of the trauma. The persistence of the symptoms for many years is a reflection of the severity of the trauma.     

Comorbidity of psychiatric disorders and personality profiles of American World War II prisoners of war

To characterize the effects of trauma sustained more than 40 years ago, prevalence of psychiatric disorders and personality dimensions were examined in a sample of 62 former World War II POWs. The negative effects of their experiences are reflected in their multiple lifetime diagnoses and in their current personality profiles. Fifty percent met DSM-III posttraumatic stress disorder (PTSD) criteria within 1 year of release; 18 (29%) continued to meet the criteria 40 years later at examination (chronic PTSD). A lifetime diagnosis of generalized anxiety disorder was found for over half the entire sample; in 42% of those who never had PTSD, 38% of those with recovery from PTSD, and 94% of those with chronic PTSD. Ten percent of those without a PTSD diagnosis had experienced a depressive disorder, as had 23% of those with recovery from PTSD and 61% of the POWs with chronic PTSD. The combination of depressive and anxiety disorders also was frequent in the total sample (61%). Current MMPIs of three groups with psychiatric diagnosis were compared with those of POWs who had no diagnoses and with a group of Minnesota normal men. Profile elevations for the groups, from highest to lowest, were: POWs with chronic PTSD, POWs with recovery from PTSD, POWs with other psychiatric diagnoses, POWs with no disorders, and Minnesota normal men. Symptoms of anxiety, depression, and somatic concerns combined with the personality styles of suppression and denial characterize the current adjustment of negatively affected POWs.     

Major depression and depressive symptomatology among the physically disabled. Assessing the role of chronic stress

Although it is generally agreed that life stress represents a risk factor for depressive symptomatology, there is less agreement on the significance of such stress for the occurrence of major depression. Indeed, it has been suggested that stress factors of importance for depressive symptoms may be irrelevant for major depression. We report results based on a large sample of physically disabled and nondisabled adults that contradict this suggestion. The physically disabled show seriously elevated rates of both depressive symptomatology and major depressive disorder. Subgroup analyses confirmed the finding on depressive symptomatology within all age-gender groupings and the finding on major depression for young and middle-aged men and women but not for the aged. It is argued that these findings can be attributed to differences in chronic stress associated with disability status. We conclude that chronic stress represents a significant risk factor with respect to both depressive symptomatology and major depressive disorder.     

Gender differences in depressive symptoms among Spanish elderly

The aim of this study is to describe gender differences in depressive symptomatology among an elderly Spanish population and to see whether women are more at risk than men and whether the effects of known risk factors for depression differ between the genders. Data come from the study Envejecer en Leganés (Growing Old in Leganés), where a representative sample of community residing elderly was screened by an at-home interview for high depressive symptomatology using the Center for Epidemiologic Studies Depression Scale (CES-D). Sociodemographic characteristics, health status, Activities of Daily Living and Instrumental Activities of Daily Living, disability, social support, and locus of control were measured as possible correlates of depressive symptoms. Screening was completed in 1116 subjects. The prevalence of high depressive symptomatology varied, being 19.6% for men and 46% for women (OR=3.4; 95% CI=2.6; 4.5). In addition to gender, comorbidity, low emotional support from children, lack of a confidant, few social activities, and a sense of lack of control were independently associated with high levels of depressive symptoms. None of the interactions of gender by the known risk factors of depression was significant. Although the prevalence of depressive symptomatology is higher in women than in men, the known risk factors do not totally explain the difference between genders in this population of Spanish elderly. This difference could be due to the cultural definitions of gender roles that have affected them throughout their lives. Accepted: 22 July 1997     

Twenty-Seven-Year Follow-Up of Vietnam Air War USAF POWs and Matched Controls Not Captured: A Qualitative Study

Objective: To provide a follow up of a 1976 study of the impact of captivity on U.S. Air Force (USAF) POWs and USAF Controls matched for time in Southeast Asia, military rank and aircraft crew position. Method: Qualitative study of replies to open ended questions of positive and negative changes due to their captivity/combat experiences made by participants (POWs and Controls) who replied in both 1976 and in 2003. Results: Both groups acknowledged positive and negative effects of the experiences in 1976. In 1976 and 2003 the POWs mainly reported negative effects on career and family domains but positive effects of individual development and growth. Controls reported mild negative effects on family in 1976, and benefits to their careers and sense of self in both 1976 and 2003. Conclusion: Captivity during the Vietnam War for USAF included two types of extreme duress which were the incarceration itself; and the repatriation experience which entailed re-assimilation despite loss of occupation and disrupted families. Despite these obstacles, POWs exhibited substantial resilience in achieving self-growth and how they regarded themselves psychologically in comparison to their matched control fellow aviators who while also suffering a lesser separation from family, tended to prosper in their careers and were proud of their accomplishments. Long term separation from work, family and friends and the inability to return to their families and careers with the effectiveness demanded by their ambition were a more devastating ongoing consequence of their captivity than the immediate suffering of their imprisonment.     

Gender differences in the relationship between depression and suicidal ideation in young adolescents

OBJECTIVE: This study examined the risk relationship between depressive symptomatology and suicidal ideation for young adolescent males and females. METHOD: A large cohort of students in their first year of high school completed the Center for Epidemiological Studies Depression Scale (CES-D) and the Adolescent Suicide Questionnaire. The risk relationship between depressive symptomatology and suicidal ideation was modelled using non-parametric kernel-smoothing techniques. RESULTS: Suicidal ideation was more frequently reported by females compared with males which was partly explained by females having higher mean depression scores. At moderate levels of depression females also had a significantly higher risk of suicidal ideation compared with males and this increased risk contributed to the overall higher levels of female ideation. CONCLUSIONS: The risk relationship between depressive symptomatology and suicidal ideation is different for young adolescent males and females. The results indicate that moderate levels of depressive symptomatology can be associated with suicidal ideation (especially among young females) and that for these young people a suicide risk assessment is required.     

Cerebrovascular burden and depressive symptomatology interrelate over 18 years: support for the vascular depression hypothesis

Objective

Potentially incongruent research literatures suggest three divergent hypotheses about depressive symptomatology: (1) symptoms are recurrent; (2) later‐life depression results from high cerebrovascular burden (CVB); and (3) depressive symptoms contribute to comorbidities causing vascular burden. Past vascular depression research assumes that later‐life depressive symptoms relate uniquely to high CVB and not to prior, recurrent depression. This study examines these divergent hypotheses.

Methods

Data include 5175 participants across 18 years from the Wisconsin Longitudinal Study (mean age at 1993 baseline was 53 years; follow‐ups in 2004 and 2011). Depressive symptomatology was measured using the Center for Epidemiological Studies Depression. CVB was operationalized as hypertension, high blood sugar, diabetes, and other heart problems. Hypotheses were examined via a cross‐lagged structural equation model and logistic regression.

Results

Model fit was acceptable (root mean square error of approximation (RMSEA) = 0.047; comparative fit index = 0.963). Hypotheses 1 and 2 were supported. Depressive symptomatology at 2004 and 2011 follow‐ups was predicted by earlier depressive symptomatology and prior CVB. Hypothesis 3 was partially supported; depressive symptomatology in 2004 predicted subsequent CVB. Logistic regression results were that CVB predicted clinically significant depressive symptoms based on the Center for Epidemiological Studies Depression clinical cutoff.

Conclusions

Cerebrovascular burden in midlife predicts depressive symptomatology in later‐life, even after accounting for prior depressive symptomatology, supporting a fundamental assumption of the vascular depression hypothesis. Midlife depressive symptomatology also predicted escalation of CVB in later‐life. Results suggest a process model of later‐life depressive symptom development that interrelates CVB and depressive symptoms throughout the life span and have clinical implications for the interruption of this process through the integration of primary care and behavioral health specialists. Copyright © 2017 John Wiley & Sons, Ltd.     

The validity of screening for post-traumatic stress disorder and major depression among Vietnamese former political prisoners

The aim of this study was to investigate the validity of the Harvard Trauma Questionnaire (HTQ) and the depression sub-scale of the Hopkins Symptom Checklist-25 (HSCL-25) in screening for post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) among Vietnamese former political prisoners (POWs). The study population included Vietnamese POWs (n= 51) who migrated to the Boston metropolitan area between January 1990 and July 1992 under the Special Released Re-education Center Detainees Resettlement Program. The criterion validity of the HTQ in assessing PTSD and of the depression sub-scale of the HSCL-25 in assessing MDD is supported by the results. Consideration of an appropriate cut-off score should include examination of the utility of a given screening instrument for PTSD or MDD within different settings, such as refugee camps vs. countries of third asylum.     

Psychosocial determination of depressive symptoms in adolescence: sex differences

In a longitudinal study over four years, the links between psychosocial factors of the social network and depressive symptomatology were analysed in 107 adolescents. Separate regression analysis for each gender revealed different factors contributing to female and male depression in late adolescence. While females' psychological well-being seems to depend on psychosocial characteristics of their social world, which may serve as protective factors, male depression is primarily determined by former depression, whereas social factors serve as stressors.     

What makes a difference? Understanding the role of protective factors in Hungarian adolescents’ depressive symptomatology

Depressive symptomatology contributes to morbidity and mortality across the life course. Among factors predicting adolescent depressive symptomatology, it has become increasingly important to identify factors that prevent or minimize it, i.e., protective factors. This study examines protective factors operating in three contextual domains (parental, school-related and individual) that hold promise for explicating their role in the prevention of depressive symptomatology among a non-clinical adolescent population in Hungary. Data from this cross-sectional survey were gathered using self-administered questionnaires from adolescents (N = 881; aged between 14 and 20 years; 44.6% females) from five randomly selected high schools in Szeged, Hungary. Multiple regression analyses revealed that individual level variables (i.e., life satisfaction and optimism) were important predictors of adolescent depressive symptomatology. Among parental variables, social support from the same-sex parents lowered depressive symptoms. In addition, having dinner together with one’s family was a significant protective factor for boys, whereas talking about problems with parents was significant for girls. In our study, school-related factors played only a limited role in reducing depressive symptoms; being happy with school was a protective factor only for boys. As a consequence, our findings draw attention to important gender differences in the structuring of protective factors and their role in reducing depressive symptoms, which will likely continue to be an important part of the prevention conversation.     

The relationship between acculturation factors and symptoms of depression: a cross-sectional study with immigrants living in Athens

The process of acculturation observed in immigrants is part of an adjustment to the values and norms of a new society, and possibly the loss of norms of the society of origin. Acculturation has been linked to stress-related psychological disorders such as depression. The present study investigates the relationship between three acculturation domains (everyday life behaviors, wishful orientation/nostos, and ethnic identity) and symptoms of depression in a sample of foreign immigrants living in Athens, Greece. The sample consisted of 317 immigrants who visited two non-governmental organization polyclinics. All participants were interviewed using the Immigrant Acculturation Scale (IAS) and the Center for Epidemiological Studies Depression Scale (CES-D). The results showed that 133 (42%) out of the 317 interviewees were in a depressive state (CES-D?>?15). The main finding was that high CES-D scores were related to low scores in the IAS Everyday Life and Wishful Orientation factors, while no relationship was found between depressive symptomatology and the IAS Identity factor. Short duration of stay in Greece, lack of steady job, and lack of residence permit were also related to high CES-D scores. In conclusion, adaptation to mainstream culture daily behaviors as well as the wish to integrate with individuals from the mainstream culture and settle permanently in the new country could be seen as part of an adaptive mechanism that protects the individual from experiencing depressive symptomatology.     

C-reactive protein,depressive symptoms,and risk of diabetes: Results from the English Longitudinal Study of Ageing (ELSA)

Objectives

Raised levels of C-reactive protein (CRP), an inflammatory biomarker, and depressive symptoms are both independently linked to risk of diabetes. The purpose of this study was to assess the joint association of CRP and depressive symptomatology with diabetes incidence in a representative sample of English people ≥ 50 years old.

Method

Data were from the English Longitudinal Study of Ageing, a prospective study of community-dwelling older adults. The sample was comprised of 4955 participants without self-reported doctor-diagnosed diabetes at baseline. High CRP level was dichotomized as > 3 mg/L. Elevated depressive symptomatology was defined as ≥ 4 using the 8-item Center for Epidemiologic Studies Depression Scale. Incident diabetes was determined based on newly self-reported doctor-diagnosed diabetes. Cox proportional hazard regressions were used to examine the association between CRP and depressive symptoms with incidence of type 2 diabetes.

Results

During approximately 63.2 months of follow-up, 194 participants reported diabetes diagnosis. After adjustment for socio-demographics, lifestyle behaviors, clinical factors, and BMI, the hazard ratio for diabetes was 1.63 (95% CI 0.88–3.01) for people with elevated depressive symptoms only, 1.43 (95% CI 0.99–2.07) for people with high CRP only, and 2.03 (95% CI 1.14–3.61) for people with both high CRP and elevated depressive symptoms.

Conclusion

The presence of both high CRP levels and elevated depressive symptoms was associated with risk of diabetes. Further investigation into this relationship could aid in understanding the mechanisms underlying inflammation, depression, and diabetes.     

Sociodemographic and Personal Factors Related to Depressive Symptomatology in the Mexican Population Aged 12 to 65

Objective: To describe the prevalence of depressive symptoms in the Mexican population, aged 12 to 65 years, by identifying the main related socio-demographic and personal factors. Methods: Data are drawn from the National Survey on Addictions 2008 (ENA 2008), a random, probabilistic, multistage study. A randomly selected sub-sample of 22,962 persons answered the section on depressive symptomatology, measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Results: The total prevalence for depressive symptomatology was 5.1%; the prevalence was 7.5% for women and 2.5% for men. For women, more evidence of depressive symptoms was seen in the central region, whereas for men, symptoms were homogeneous across the country. Factors related to the presence of depressive symptoms include being divorced (in women) or widowed (in men), having lower educational attainment, perceiving one's place of residence as unsafe, displaying alcohol abuse or dependence, being a regular drug consumer (in men) and having been sexually abused (males and females). Conclusions: The regional distribution of depressive symptomatology in women indicates the need for region-specific prevention programs that take into account the different social problems that affect women's emotional well-being. More research is also needed to support the early identification and intervention of men suffering from depression.