Trauma, symptoms of posttraumatic stress disorder, and associated problems among incarcerated veterans.

OBJECTIVE: To help improve treatment for incarcerated veterans, the study examined exposure to trauma, symptoms of posttraumatic stress disorder (PTSD), functional status, and treatment history in a group of incarcerated veterans. METHODS: A convenience sample of 129 jailed veterans who agreed to receive outreach contact completed the Life Event History Questionnaire, the PTSD Checklist-Civilian Version (PCL-C), and the Addiction Severity Index. Participants who had scores of 50 or above on the PCL-C, designated as screening positive for PTSD, were compared with those whose scores were below 50, designated as screening negative for PTSD. RESULTS: Some 112 veterans (87 percent) reported traumatic experiences. A total of 51 veterans (39 percent) screened positive for PTSD, and 78 veterans (60 percent) screened negative. Compared with veterans who screened negative for PTSD, those who screened positive reported a greater variety of traumas; more serious current legal problems; a higher lifetime use of alcohol, cocaine, and heroin; higher recent expenditures on drugs; more psychiatric symptoms; and worse general health despite more previous psychiatric and medical treatment as well as treatment for substance abuse. CONCLUSIONS: The findings encourage the development of an improved treatment model to keep jailed veterans with PTSD from repeated incarceration.     

Combat-related PTSD and psychosocial adjustment problems among substance abusing veterans

The purpose of this study were the following: a) to determine the prevalence of combat-related posttraumatic stress disorder (PTSD) symptoms among veterans seeking assistance at a Veterans Administration medical center substance abuse treatment facility, b) to examine the relative contribution of Vietnam war zone variables to PTSD symptom development, and c) to study psychosocial adjustment problems associated with Vietnam combat exposure and with PTSD symptoms among help-seeking substance abusing men. Of 489 male veterans presenting for treatment, 10.7% had significant Vietnam combat-related PTSD symptoms as measured by the Mississippi Scale for Combat-Related PTSD. Clinically significant PTSD symptoms occurred among 46% of the subsample of combat-exposed Vietnam veterans with substance abuse problems. Degree of combat exposure was the most important military stressor that distinguished Vietnam veterans with PTSD from those without PTSD, but the groups also differed on age of war zone duty, duration of war zone duty, and whether they were wounded. Veterans who served in Vietnam did not differ from veterans who had no war zone duty on various parameters of psychosocial adjustment. However, the subgroup of Vietnam veterans with PTSD symptoms reported significantly greater psychosocial adjustment problems than their counterparts who did not have PTSD. The deleterious effects associated with combat-related PTSD appeared to be confined to adjunctive psychiatric difficulties and unemployment and did not increase risk of arrests for antisocial conduct beyond that found for veterans without PTSD. Methodological and clinical implications of these findings are discussed.     

The effect of prior trauma exposure on the development of PTSD following spinal cord injury

Posttraumatic stress disorder (PTSD) occurs in only a subset of individuals who sustain traumatic spinal cord injuries (SCIs). Several previous studies have examined the effects of additive trauma on the development of PTSD and found that a history of prior trauma increases the risk for later development of PTSD. The present study examines additive trauma by investigating the effects of previous combat exposure on the development of PTSD following spinal cord injury. Significant differences in prevalence rates for current PTSD were found for the comparisons of war theater (both combat and noncombat) versus non-war theater veterans but not for the comparison between combat and noncombat war theater veterans. Moreover, for all the comparisons, no significant differences were found in lifetime PTSD diagnoses. This implies that veterans with SCI who served in a war zone have increased difficulty recovering from their PTSD following a spinal cord injury than do non-war theater veterans.     

Interpersonal trauma and posttraumatic stress disorder in patients with severe mental illness: demographic, clinical, and health correlates

This study's purpose was to evaluate the prevalence and correlates of posttraumatic stress disorder (PTSD) in persons with severe mental illness. Standardized assessments of interpersonal trauma and PTSD were conducted in 782 patients with severe mental illness receiving services in one of five inpatient and outpatient treatment settings. Analyses examined the prevalence of PTSD and the demographic, clinical, and health correlates of PTSD diagnosis. The overall rate of current PTSD in the sample was 34.8 percent. For demographic characteristics, the prevalence of PTSD was higher in patients who were younger, white, homeless, and unemployed. For clinical and health variables, PTSD was more common in patients with major mood disorders (compared to schizophrenia or schizoaffective disorders), alcohol use disorder, more recent psychiatric hospitalizations, more health problems, more visits to doctors for health problems, and more nonpsychiatric hospitalizations over the past year. The results support prior research documenting the high rates of PTSD in patients with severe mental illness and suggest that PTSD may contribute to substance abuse, psychiatric and medical comorbidity, and psychiatric and health service utilization.     

Age differences in posttraumatic stress disorder, psychiatric disorders, and healthcare service use among veterans in Veterans Affairs primary care clinics.

OBJECTIVE: To expand our understanding of posttraumatic stress disorder (PTSD) prevalence, its psychiatric characteristics, and service use among elderly veterans in Veterans Affairs (VA) primary care clinics. METHODS: A cross-sectional, epidemiological design (N = 745) incorporating self-report measures, structured interviews, and chart reviews was used to obtain relevant information for analyses. RESULTS: The oldest group of veterans (>or=65 years; N = 318) had lower prevalence of most psychiatric diagnoses than the youngest (18-44 years; N = 69) and middle-aged (45-64 years; N = 358) groups. Despite having higher rates of combat exposure, veterans in the oldest group (6.3%) had one-third the prevalence of PTSD than those in the middle-aged group (18.6%). A similar pattern was found across other psychiatric diagnoses. For example, those in the oldest group (7.5%) had one-third the prevalence of major depression as those in the two younger groups (21.7% and 22.9%). These differences were maintained after controlling for relevant demographic covariates (race, sex). Results from examination of VA health care service use across the three groups were consistent with the findings that the oldest veteran group is functioning significantly better across mental health domains. CONCLUSION: Elderly veterans who use VA primary care services evidence lower rates of PTSD and other psychiatric disorders, and they use significantly less VA mental health services. They also do not appear to show evidence of worse physical health functioning or use VA health care services or disability benefits at a meaningfully higher rate than their younger counterparts.     

Intermittent explosive disorder: Associations with PTSD and other Axis I disorders in a US military veteran sample

This study examined the prevalence of intermittent explosive disorder (IED) and its associations with trauma exposure, posttraumatic stress disorder (PTSD), and other psychiatric diagnoses in a sample of trauma-exposed veterans (n = 232) with a high prevalence of PTSD. Structural associations between IED and latent dimensions of internalizing and externalizing psychopathology were also modeled to examine the location of IED within this influential structure. Twenty-four percent of the sample met criteria for a lifetime IED diagnosis and those with the diagnosis were more likely to meet criteria for lifetime PTSD than those without (30.3% vs. 14.3% respectively). Furthermore, regression analyses revealed lifetime PTSD severity to be a significant predictor of IED severity after controlling for combat, trauma exposure, and age. Finally, confirmatory factor analysis revealed significant cross-loadings of IED on both the externalizing and distress dimensions of psychopathology, suggesting that the association between IED and other psychiatric disorders may reflect underlying tendencies toward impulsivity and aggression and generalized distress and negative emotionality, respectively.     

Post-traumatic Stress Disorder in Older U.S. Military Veterans: Prevalence,Characteristics, and Psychiatric and Functional Burden

ObjectiveTo characterize the prevalence, characteristics, and comorbidities of subthreshold and full post-traumatic stress disorder (PTSD) in older U.S. military veterans.Design and SettingA nationally representative web-based survey of older U.S. military veterans who participated in the National Health and Resilience in Veterans Study (NHRVS) between November 18, 2019 and March 8, 2020.ParticipantsU.S. veterans aged 60 and older (n = 3,001; mean age = 73.2, SD: 7.9, range: 60–99).MeasurementsPTSD was assessed using the PTSD Checklist for DSM-5. Self-report measures assessed sociodemographic characteristics, trauma exposures, suicidal behaviors, psychiatric and substance use disorders, as well as mental, cognitive, and physical functioning. Multivariable analyses examined correlates of subthreshold and full PTSD.ResultsThe vast majority of the sample (n = 2,821; 92.7%) reported exposure to one or more potentially traumatic events. Of those exposed to such events, 262 (9.6%, 95% confidence interval [CI]: 8.4%–10.9%) and 68 (1.9%, 95% CI: 1.3%–2.6%) screened positive for subthreshold and full PTSD, respectively. The prevalence of subthreshold and full PTSD was significantly higher in female veterans and veterans who use VA as their primary healthcare. Subthreshold and full PTSD groups endorsed more adverse childhood experiences and total traumas than the no/minimal PTSD symptom group, the most common traumatic experiences endorsed were combat exposure, physical or sexual assault, and life-threatening illness or injury. Veterans with subthreshold and full PTSD were also more likely to screen positive for depression, substance use disorders, suicide attempts, nonsuicidal self-injury, and suicidal ideation, and reported lower mental, cognitive, and physical functioning.ConclusionSubthreshold PTSD and full PTSD are prevalent and associated with substantial clinical burden in older U.S. veterans. Results underscore the importance of assessing both subthreshold and full PTSD in this population.     

Multidimensional assessment of anger in Vietnam veterans with posttraumatic stress disorder.

This study examined the effects of combat exposure and posttraumatic stress disorder (PTSD) on dimensions of anger in Vietnam veterans. Vietnam combat veterans were compared with Vietnam era veterans without war zone duty on the Multidimensional Anger Inventory (MAI). Combat veterans were not significantly more angry than their veteran peers who did not serve in Southeast Asia. Additionally, various parameters of war zone duty were not highly associated with anger scores. However, combat veterans with PTSD scored significantly higher than veterans without PTSD on measures of anger arousal, range of anger-eliciting situations, hostile attitudinal outlook, and tendency to hold anger in. These results suggest that PTSD, rather than war zone duty, is associated with various dimensions of angry affect.     

Clinical characteristics and health service use of veterans with comorbid bipolar disorder and PTSD

OBJECTIVE: This study aimed to increase the understanding of the clinical characteristics and utilization of health services among veterans with comorbid bipolar disorder and posttraumatic stress disorder (PTSD). METHODS: A retrospective chart review was conducted that examined the clinical and health service use data of 139 male veterans with bipolar disorder (N=49), PTSD (N=49), or comorbid bipolar disorder and PTSD (N=41) who obtained services over two years from the Department of Veterans Affairs Salt Lake City Health Care System. RESULTS: Compared with patients with bipolar disorder or those with PTSD alone, those with both conditions had significantly higher mean Clinical Global Impression-Severity scores and required more frequent inpatient psychiatric treatment. Patients with both conditions and those with bipolar disorder were significantly less likely to have received psychotherapy and antidepressant pharmacotherapy than patients with PTSD. CONCLUSIONS: Patients with both conditions have a more severe illness course than those with bipolar disorder alone. Psychotherapy and antidepressant pharmacotherapy may be underutilized among patients with comorbid bipolar disorder and PTSD.     

Posttraumatic stress disorder and psychiatric comorbidity among detained youths

OBJECTIVE: This study examined the prevalence of posttraumatic stress disorder (PTSD) and comorbid psychiatric disorders among juvenile detainees. METHODS: The sample consisted of a stratified random sample of 898 youths aged ten to 18 years who were arrested and detained in Chicago. RESULTS: Among participants with PTSD, 93% had at least one comorbid psychiatric disorder; however, among those without PTSD, 64% had at least one comorbid psychiatric disorder. Over half (54%) of the participants with PTSD had two or more types of comorbid disorders--that is, affective, anxiety, behavioral, or substance use disorders--and 11% had all four types of comorbid disorders. Among males, having any psychiatric diagnosis significantly increased the odds of having comorbid PTSD. Among females, alcohol use disorder and both alcohol and drug use disorders significantly increased the odds of having PTSD. No significant difference in prevalence rates of PTSD was found between males and females with specific psychiatric disorders. The prevalence of any comorbid psychiatric disorder was significantly greater for males with PTSD than that for females with PTSD (OR=3.4, CI=1.1-10.6, p<.05). CONCLUSIONS: Detection of comorbid PTSD among detained youths must be improved. PTSD is often missed because traumatic experiences are rarely included in standard screens or volunteered by patients. When planning treatment, clinicians must consider ramifications of comorbid PTSD.     

Duration and intensity of combat exposure and posttraumatic stress disorder in Vietnam veterans

We assessed whether a relationship exists between posttraumatic stress disorder (PTSD) and two quantitative aspects of war trauma: the duration of exposure to combat (expressed in months) and the intensity of combat (measured by ratings on the Laufer Combat Scale). These stressor characteristics were measured in relation to PTSD prevalence and persistence. Eighty-four veterans, inducted during the Vietnam War, who attended an orthopedic clinic participated in the study. A significant association was found between duration of combat exposure and prevalence and persistence of PTSD. The longest duration of combat exposure was found in patients who still suffered from PTSD. This duration was shorter for patients in remission and still shorter for patients who had never developed PTSD. Similarly, a significant association was found between combat scale ratings and PTSD. The highest rating was observed in subjects who still had PTSD. The rating was lower in patients in remission and still lower in those who had never experienced PTSD. Having been wounded, which is one of the Laufer Combat Scale items and could be considered particularly traumatic, was strongly associated with PTSD. The findings are discussed in relation to the reliability and validity of the PTSD construct and to the contribution of factors other than stressor characteristics to PTSD symptom expression.     

Do trauma type,stressful life events,and social support explain women veterans’ high prevalence of PTSD?

Objectives

To examine factors that account for women veterans’ higher prevalence of past-year DSM-5 posttraumatic stress disorder (PTSD) compared to women civilians and men veterans.

Methods

Cross-sectional analyses of the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Face-to-face interviews with 379 women veterans, 20,007 women civilians, and 2740 men veterans were conducted. Trauma type (child abuse, interpersonal violence, combat or war zone, and other), number of trauma types, past-year stressful life events, current social support, and DSM-5 PTSD were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Generalized linear models were used that accounted for the complex survey design.

Results

Women veterans had a higher unadjusted prevalence of past-year PTSD (11.40%) compared to their civilian (5.96%) and male (5.19%) counterparts. Individual predictor models indicated that the difference between women veterans’ and civilians’ prevalence of PTSD was attenuated when adjusting for number of trauma types, whereas the difference between men and women veterans was attenuated when adjusting for child abuse, interpersonal violence, and stressful life events. Nonetheless, while full adjustment in a multiple predictor model accounted for the difference in PTSD between women veterans and civilians, gender differences between men and women veterans remained.

Conclusions

Number of trauma types, type of trauma, and social factors may together help explain women veterans’ higher PTSD prevalence compared to women civilians, but do not fully account for differences between men and women veterans. Results highlight a need to explore additional explanatory factors and evaluate associations with longitudinal data.

     

Delayed onset of posttraumatic stress disorder among male combat veterans: a case series.

OBJECTIVE: Authors investigated the nature of delayed-onset posttraumatic stress disorder (PTSD) among combat veterans. METHODS: PTSD, along with cognitive and emotional functioning, was assessed in a case series of elderly Australian war veterans. RESULTS: Fifteen elderly male subjects consecutively referred to an outpatient psychiatric clinic were identified as having PTSD with significantly delayed onset. In most cases, the onset of PTSD symptoms was associated with unrelated medical complaints, psychosocial stress, and/or mild cognitive impairment. CONCLUSION: Environmental stressors, coupled with age-related neurodegeneration, may potentially contribute to the late-life recrudescence or emergence of PTSD symptoms in veterans exposed to combat-related trauma.     

War zone traumas and posttraumatic stress disorder symptomatology.

The diagnosis and clinical understanding of posttraumatic stress disorder (PTSD) rests upon the explicit identification of traumatic experiences that give rise to a well-defined constellation of symptoms. Most efforts to investigate the characteristics of these experiences have attempted to specify war zone stressors as objectively as possible. In this study, we add specification of the psychological meaning of war zone stressors to their objective specification. Eleven traumas are organized in terms of four roles that veterans played in the initiation of death and injury; namely, target, observer, agent, and failure. These roles can be ordered in terms of the degree of personal responsibility involved in the initiation of death and injury. The relationships of these roles to current symptomatology were examined in combination with a set of objective measures of war zone stressors. The sample consisted of the first 1709 Vietnam theater veterans who were assessed in a national evaluation of the PTSD Clinical Teams initiative of the Department of Veterans Affairs. Results show that having been a target of others' attempts to kill or injure is related more uniquely than any other role to symptoms that are diagnostic criteria for PTSD. On the other hand, having been an agent of killing and having been a failure at preventing death and injury are related more strongly than other roles to general psychiatric distress and suicide attempts.(ABSTRACT TRUNCATED AT 250 WORDS)     

Lifetime and current prevalence of specific psychiatric disorders among Vietnam veterans and controls

To determine if Vietnam theater veterans were more likely than controls to have a specific psychiatric disorder other than posttraumatic stress disorder, the rates of specific psychiatric disorders were estimated using the Diagnostic Interview Schedule for national samples of veterans who served in Vietnam, other veterans of the Vietnam era, and matched civilian controls. Overall, there were few differences in rates of disorder between theater and other veterans; there were somewhat more differences between theater veterans and civilians. There were striking differences, however, in rates for most disorders, both lifetime and current, between male theater veterans with high levels of exposure to war zone stress and other male veterans or civilians. Female veterans exposed to high levels of war zone stress also had higher rates than other female respondents for several disorders.     

Treatment-seeking veterans of Iraq and Afghanistan: comparison with veterans of previous wars

Differences in the characteristics and mental health needs of veterans of the Iraq/Afghanistan war when compared with those of veterans who served in the Persian Gulf war and in the Vietnam war may have important implications for Veterans Affairs (VA) program and treatment planning. Subjects were drawn from administrative data bases of veterans who sought treatment from specialized VA programs for treatment of posttraumatic stress disorder (PTSD). Current Iraq/Afghanistan veterans were compared with 4 samples of outpatient and inpatient Persian Gulf and Vietnam veterans whose admission to treatment was either contemporaneous or noncontemporaneous with their admission. A series of analyses of covariance was used hierachically to control for program site and age. In analyses of contemporaneous veterans uncontrolled for age, Iraq/Afghanistan veterans differed most notably from Vietnam veterans by being younger, more likely to be female, less likely to be either married or separated/divorced, more often working, less likely to have ever been incarcerated, and less likely to report exposure to atrocities in the military. Regarding clinical status, Iraq/Afghanistan veterans were less often diagnosed with substance abuse disorders, manifested more violent behavior, and had lower rates of VA disability compensation because of PTSD. Differences are more muted in comparisons with Persian Gulf veterans, particularly in those involving noncontemporaneous samples, or those that controlled for age differences. Among recent war veterans with PTSD, social functioning has largely been left intact. There is a window of opportunity, therefore, for developing and focusing on treatment interventions that emphasize the preservation of these social assets.     

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.     

Suicide and guilt as manifestations of PTSD in Vietnam combat veterans

OBJECTIVE: Although studies have suggested a disproportionate rate of suicide among war veterans, particularly those with postservice psychiatric illness, there has been little systematic examination of the underlying reasons. This study aimed to identify factors predictive of suicide among Vietnam combat veterans with posttraumatic stress disorder (PTSD). METHOD: Of 187 veterans referred to the study through a Veterans Administration hospital, 100 were confirmed by means of a structured questionnaire and five clinical interviews as having had combat experience in Vietnam and as meeting the DSM-III criteria for PTSD. The analysis is based on these 100 cases. RESULTS: Nineteen of the 100 veterans had made a postservice suicide attempt, and 15 more had been preoccupied with suicide since the war. Five factors were significantly related to suicide attempts: guilt about combat actions, survivor guilt, depression, anxiety, and severe PTSD. Logistic regression analysis showed that combat guilt was the most significant predictor of both suicide attempts and preoccupation with suicide. For a significant percentage of the suicidal veterans, such disturbing combat behavior as the killing of women and children took place while they were feeling emotionally out of control because of fear or rage. CONCLUSIONS: In this study, PTSD among Vietnam combat veterans emerged as a psychiatric disorder with considerable risk for suicide, and intensive combat-related guilt was found to be the most significant explanatory factor. These findings point to the need for greater clinical attention to the role of guilt in the evaluation and treatment of suicidal veterans with PTSD.     

Cognitive dysfunctions associated with PTSD: evidence from World War II prisoners of war

The authors aim to delineate cognitive dysfunction associated with posttraumatic stress disorder (PTSD) by evaluating a well-defined cohort of former World War II prisoners of war (POWs) with documented trauma and minimal comorbidities. The authors studied a cross-sectional assessment of neuropsychological performance in former POWs with PTSD, PTSD with other psychiatric comorbidities, and those with no PTSD or psychiatric diagnoses. Participants who developed PTSD had average IQ, while those who did not develop PTSD after similar traumatic experiences had higher IQs than average (approximately 116). Those with PTSD performed significantly less well in tests of selective frontal lobe functions and psychomotor speed. In addition, PTSD patients with co-occurring psychiatric conditions experienced impairment in recognition memory for faces. Higher IQ appears to protect individuals who undergo a traumatic experience from developing long-term PTSD, while cognitive dysfunctions appear to develop with or subsequent to PTSD. These distinctions were supported by the negative and positive correlations of these cognitive dysfunctions with quantitative markers of trauma, respectively. There is a suggestion that some cognitive decrements occur in PTSD patients only when they have comorbid psychiatric diagnoses.     

Prevalence of posttraumatic stress disorder in Veterans Affairs primary care clinics

Although posttraumatic stress disorder (PTSD) is relatively common in community epidemiologic surveys (5-6% for men, 10-12% for women), and psychiatric patients with PTSD are known to have poor functioning and high levels of psychiatric comorbidity, there are no studies that address PTSD prevalence, functioning, and burden in primary care settings. This article reports on (1) the prevalence of PTSD using Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition diagnostic criteria in Veterans Affairs (VA) primary care settings, (2) associated sociodemographic characteristics and comorbidities, (3) functional status related to PTSD, (4) the extent to which PTSD was recognized by providers and (5) health services use patterns (including specialty mental health) of PTSD patients. Patients were randomly selected from those who had an outpatient visit in FY 1999 at one of four VA hospitals; 888 patients consented (74.1% of 1198 contacted); 746 patients (84.0% of consenting patients; 62.3% of contacted patients) were reached for telephone diagnostic interviews. Diagnostic interviews with the Clinician Administered PTSD Scale yielded estimates of current PTSD prevalence of 11.5%. At statistically significant levels, PTSD was positively associated with a variety of comorbid psychiatric disorders, war zone service, age <65 years, not working, less formal education and decreased functioning. Of patients diagnosed with PTSD by study procedures, 12-month medical record review indicated that providers identified only 46.5% and only 47.7% had used mental health specialty services. PTSD-positive [PTSD(+)] patients who used mental health care in the past 12 months were more apt to be identified as having PTSD than nonmental health service users (78.0% vs. 17.8%). Although PTSD(+) patients had more medical record diagnoses than PTSD-negative [PTSD(-)] patients (6.28 vs. 4.95), their use of primary care, urgent care and inpatient care was not different from PTSD(-) patients.