Convergent validity of measures of PTSD in Vietnam combat veterans

The authors evaluated the convergent validity of several widely used psychometric tests of posttraumatic stress disorder (PTSD) symptoms against DSM-III-R criteria for PTSD in 130 Vietnam combat veterans. Significant positive correlations were found between these instruments and the number of DSM-III-R symptoms endorsed, supporting the validity of psychometric instruments as continuous measures of PTSD symptom severity. The various psychometric measures also correlated moderately with one another, suggesting that they assess related but somewhat separate PTSD phenomena. Finally, predicted relationships between stressors and symptoms were supported by significant correlations between degree of traumatic combat exposure and DSM-III-R and psychometric indexes of PTSD.     

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.     

PTSD and utilization of medical treatment services among male Vietnam veterans

This study investigated the effect of posttraumatic stress disorder (PTSD) on help-seeking for physical problems. Merging two large data sets resulted in a sample of 1773 male Vietnam veterans from white, black, Hispanic, Native Hawaiian, and Japanese American ethnic groups. Predictors of utilization included PTSD, other axis I disorders, and substance abuse. In analyses that adjusted only for age, PTSD was related to greater utilization of recent and lifetime VA medical services, and with recent inpatient care from all sources. Further analysis showed that the increased utilization associated with PTSD was not merely due to the high comorbidity between PTSD and other axis I disorders. The uniqueness of the association between PTSD and medical utilization is discussed in terms of somatization and physical illness.     

Trauma, PTSD, and physical health: an epidemiological study of Australian Vietnam veterans

OBJECTIVE: This study aimed to examine the relative contributions to physical health of combat trauma exposure and posttraumatic stress disorder (PTSD), which have both been implicated separately in poorer physical health but whose unconfounded effects have not been teased out. METHODS: Data from an epidemiological study of Australian Vietnam veterans, which used personal interviews and standardized physical and psychiatric health assessments, provided the means to assess the independent and joint effects of psychological trauma exposure and PTSD on a wide range of self-reported measures of physical health. Trauma exposure was measured by published scales of combat exposure and peritraumatic dissociation. Logistic regression modeling was used to assess the relative importance of trauma exposure and PTSD to health while controlling for a set of potential confounders including standardized psychiatric diagnoses. RESULTS: Greater health service usage and more recent health actions were associated more strongly with PTSD, which was also associated with a range of illness conditions coded by the World Health Organization International Classification of Diseases, 9th Edition (asthma, eczema, arthritis, back and other musculoskeletal disorders, and hypertension) both before and after controlling for potential confounders. In contrast, combat exposure and peritraumatic dissociation were more weakly associated with a limited number of unconfounded physical health outcomes. CONCLUSIONS: This study provided evidence that PTSD, rather than combat exposure and peritraumatic dissociation, is associated with a pattern of physical health outcomes that is consistent with altered inflammatory responsiveness.     

Frequency of symptoms and concurrent psychiatric disorder in Vietnam veterans with chronic PTSD

The frequency of symptoms of posttraumatic stress disorder within each of three categories--reexperiencing, avoidance or numbing, and physiological arousal--was examined in 116 Vietnam combat veterans with a diagnosis of PTSD. The prevalence of all PTSD symptoms was greater than 50 percent except for flashbacks, psychogenic amnesia, and sense of foreshortened future. Comorbidity in a subgroup of 48 patients was assessed using operational criteria for DSM-III-R mental disorders. Mood disorders, psychoactive substance abuse disorders, and other anxiety disorders frequently co-occurred with PTSD, but psychotic disorders were uncommon. These findings provide empirical validation of the DSM-III-R diagnostic criteria for PTSD.     

Urinary catecholamine excretion and severity of PTSD symptoms in Vietnam combat veterans.

In the present study, we replicated and extended our previous findings of increased 24-hour urinary catecholamine excretion in posttraumatic stress disorder (PTSD). Dopamine, norepinephrine, and epinephrine concentrations were measured in 22 male patients with PTSD (14 inpatients and eight outpatients) and in 16 nonpsychiatric normal males. The PTSD inpatients showed significantly higher excretion of all three catecholamines compared with both outpatients with PTSD and normal controls. Dopamine and norepinephrine, but not epinephrine, levels were significantly correlated with severity of PTSD symptoms in the PTSD group as a whole. In particular, these catecholamines seemed related to intrusive symptoms. None of the catecholamines were correlated with severity of depression. The findings support the hypothesis of an enhanced sympathetic nervous system activation in PTSD, and suggest that increased sympathetic arousal may be closely linked to severity of certain PTSD symptom clusters.     

Current combat-related disorders in the absence of PTSD among Australian Vietnam veterans

The research literature on the psychiatric consequences of the Vietnam War focuses primarily on the construct of Posttraumatic Stress Disorder (PTSD), after an initial focus in the 1970s on depression and alcohol and substance abuse. The present paper examines the hypothesis that among men without current PTSD, those with higher combat in Vietnam will be more likely to have current DSM-III-R illnesses. The Australian Vietnam Veterans' Health Study (AVVHS) collected a broad range of interview data on 641 Vietnam veterans throughout 1990–1993. Measures of combat exposure, age at embarkation to Vietnam, enlistment IQ and pre-Army personality problems were drawn from Army records of the era. Retrospective measures of combat were obtained at interview. The interview also involved the administration by trained lay interviewers of the DSM-III-R based Diagnostic Interview Schedule (DIS). This epidemiological instrument provides current psychiatric diagnoses as well as temporal (retrospective) symptom and diagnosis onset data. The results of this study show that current disorders (without PTSD comorbidity) with onsets within 5 years of embarkation to Vietnam are more likely among men who saw higher combat, as indexed by combat-exposure measures drawn from Army records of the era as well as retrospective self-report. This combat relatedness remains when age at embarkation, IQ at enlistment and pre-Army personality measures are used as covariates. No more than 11.4% of sampled Vietnam veterans currently meet DSM-III-R diagnostic criteria for PTSD, while a further 7.8% do not have current PTSD but do have some other current DIS diagnosis with onset in the 5-year period following (first) emabarkation to Vietnam. Our data support the hypothesis that the current illnesses of many of these men without PTSD are combat-related DSM-III-R illnesses. Accepted: 11 September 1997     

Basal and suppressed salivary cortisol in female Vietnam nurse veterans with and without PTSD

It has been suggested that discrepant findings regarding low basal cortisol levels and enhanced suppression of cortisol in response to dexamethasone (DEX) administration in post-traumatic stress disorder (PTSD) may reflect individual differences in gender, trauma type, stage of development at trauma occurrence (e.g., childhood vs. adulthood), early pre-traumatic risk factors, or other individual differences. This study examined salivary cortisol levels at 08.00h and 16.00h as well as cortisol response to 0.50 mg DEX in 40 female Vietnam nurse veterans who had current, chronic PTSD (Current) vs. 43 who never had PTSD (Never). Repeated measures analyses of covariance did not reveal significant group differences in cortisol levels or cortisol suppression. Given that nurses who served in Vietnam had similar exposures, ages at exposure, and duration since exposure to previously studied male Vietnam combat veterans, the present lack of evidence for low cortisol and cortisol hyper-suppression in nurses with PTSD suggests that previous findings of low cortisol and cortisol hyper-suppression in male Vietnam veterans, females sexually abused as children, and other populations may reflect risk factors beyond simply having PTSD.     

Risk factors for PTSD and other diagnoses in a general sample of Vietnam veterans

This study examined the contribution of premilitary, military, and postmilitary risk factors to posttraumatic stress disorder (PTSD) and other postwar diagnoses in a sample of Vietnam veterans. PTSD was explained primarily by war stressors, including threat to life and exposure to grotesque death, but premilitary and postmilitary factors also contributed to the likelihood of a current diagnosis of PTSD. Panic disorder was also highly predicted by war experiences, whereas prewar functioning played a stronger role in several non-PTSD diagnoses. The study supported the notion that PTSD is specifically linked to intense stressors. Mechanisms for interactions among risk factors are discussed.     

Mental health needs of cohabiting partners of Vietnam veterans with combat-related PTSD

The objectives of this study were to perform an initial needs assessment of partners of Vietnam veterans with combat-related posttraumatic stress disorder (PTSD) and to assess the partners' current rates of treatment use. A telephone survey was conducted with 89 cohabitating female partners of male combat veterans who were receiving outpatient PTSD treatment at two Department of Veterans Affairs medical centers. Although large majorities of partners rated individual therapy and family therapy to help cope with PTSD in the family as highly important, only about one-quarter of the partners had received any mental health care in the previous six months. The most commonly requested service was a women-only group.     

The effects of aerobic exercise on childhood PTSD, anxiety, and depression

The purpose of the present study was to investigate the effects of aerobic exercise on childhood PTSD, depression, and anxiety. Fifteen participants, ages 14 to 17, who met DSM-IV Criteria for PTSD were recruited from an all female residential treatment center Participants engaged in an aerobic exercise program for 40 minutes, three times per week, for a total of 8 weeks. Measures included were the Children's PTSD Inventory, the UCLA Post-Traumatic Stress Disorder Reaction Index for DSM-IV, Children's Depression Inventory, and the Revised Children's Manifest Anxiety Scale. Measures were administered twice at pre-intervention, again at mid-intervention, post-intervention, and at a one-month follow-up. This small n study utilized a staggered baseline, pre/post repeated measures design. Results of this study provided support for the positive effects of aerobic exercise on reducing PTSD, depression, and anxiety. Fewer participants met full criteria for PTSD after exercising. This research is a starting point toward satisfying the essential need to establish efficacious methods to treat PTSD and associated symptoms in child/adolescent populations.     

Anger, dissociation, and PTSD among male veterans entering into PTSD treatment

Prior research suggests that dissociation and anger are risk factors for the development of posttraumatic stress disorder (PTSD). Research found that trauma survivors with higher levels of anger also report more severe PTSD overall. Studies also support a relationship between PTSD severity and dissociation. Only one prior study of sexual assault survivors by Feeny, Zoellner, and Foa (2000) examined the relationships among dissociation, anger, and PTSD. While Veterans have been found to report high levels of anger and dissociation, the relationship between these factors and PTSD has not been examined among Veterans. This paper examines the relationship among anger, dissociation, and PTSD in treatment-seeking Veterans who presented for evaluation at the PTSD Clinic in the VA Ann Arbor Healthcare System during a four year period. Anger and dissociation predicted PTSD, hyperarousal, and avoidance/numbing severity while dissociation predicted intrusive severity. The implications of these results for clinical practice are discussed.     

Hippocampal volume, PTSD, and alcoholism in combat veterans

Studies imposing rigorous control over lifetime alcohol intake have usually not found smaller hippocampal volumes in persons with posttraumatic stress disorder. Because the majority of negative studies have used adolescent samples, it has been suggested that chronicity is a necessary condition for such findings. To test the hypothesis that a smaller hippocampus in PTSD is unrelated to comorbid alcoholism or to chronicity, this study estimated hippocampal volume in a relatively large group (N=99) of combat veterans in which PTSD, lifetime alcohol abuse/dependence, and Vietnam versus Gulf War service were crossed. In subjects with histories of alcoholism, unadjusted hippocampal volume was 9% smaller in persons with PTSD than in those without PTSD. In nonalcoholic subjects, the PTSD-related difference in hippocampal volume was 3%. The failure to observe a strong association between PTSD and hippocampal volume in nonalcoholic subjects was not ascribable to younger age, reduced PTSD chronicity, or lower PTSD symptom severity. The possibility that smaller hippocampal volume is limited to groups in which PTSD is compounded by comorbid alcoholism is not necessarily incompatible with results suggesting a smaller hippocampus is predispositional to PTSD. Further examination of the role of alcoholism and other comorbid conditions in studies of brain structure and function in PTSD appears warranted.     

PTSD and depression as predictors of physical health-related quality of life in tobacco-dependent veterans

ObjectiveSmoking, depression and PTSD are related to poor physical health outcomes and health-related quality of life (HRQoL). Previous studies examining the effects of quitting smoking on HRQoL have been mixed. This study aimed to examine the effects of PTSD, depressive symptoms and smoking cessation on HRQoL in a sample receiving treatment for PTSD.MethodThis study utilized archival interview and self-report data from a clinical trial (VA Cooperative Study 519) that recruited tobacco dependent veterans with chronic PTSD (N = 943).ResultsAnalyses were conducted using hierarchical linear modeling and indicated that PTSD and depressive symptoms differentially affected the various physical health status domains. Additionally, quitting smoking was associated with better self-perceived health status and social functioning.ConclusionOur findings further explain the interrelationships of PTSD, depression, and smoking in the prediction of physical HRQoL and advocate the importance of integrated care.     

Physiological evidence of exaggerated startle response in a subgroup of Vietnam veterans with combat-related PTSD

One of the diagnostic criteria for posttraumatic stress disorder (PTSD) is an exaggerated startle response; however, this phenomenon has not been verified empirically. The authors compared 20 Vietnam combat veterans with PTSD and 18 combat veterans without PTSD on the eyeblink reflex electromyographic response of the startle reaction. Subjects in both groups who failed to show an eyeblink response to the startle stimuli were eliminated from further analyses. Among the remaining subjects, the 13 with PTSD had a significantly greater startle response amplitude than the 12 control subjects at intermediate intensities of acoustic stimuli. The relationship between startle responsivity and both negative and positive symptoms was also investigated.     

Nightmares in Vietnam veterans

Repetitive traumatic dreams remain a curiosity in our working with patients. If dreams have a sleep protecting or problem solving function, the dream that does not resolve but repeats and that disturbs rather than protects sleep remains an important clinical problem. We see in individual patient experiences and in civilian disasters samples of individuals who are unable to return their dream life to a condition in which it no longer repeats or disturbs their sleep. Clearly the recent experience of combat survivors of Vietnam becomes a major concern.