Prenatal Stress Exposure and Post-traumatic Stress Disorder Associated With Risk of Postpartum Alcohol Misuse Among Women Veterans

ObjectivesMaternal alcohol misuse during the postpartum period is associated with negative maternal and infant outcomes. This study examined whether greater stress exposure in the year before the baby's birth and maternal post-traumatic stress disorder (PTSD) were associated with postpartum alcohol misuse among a sample of women veterans. Maternal PTSD was also examined as a moderator of the association between stress exposure and postpartum alcohol misuse.MethodsData were drawn from the Center for Maternal and Infant Outcomes Research in Translation study, a multisite prospective cohort study of pregnant and postpartum women veterans. Interviews were conducted within 12 weeks after birth. At this post-birth interview, women reported whether they experienced stressful events (e.g., loss of job, military deployment, separation/divorce) in the year before birth. PTSD diagnosis and postpartum scores on the Alcohol Use Disorders Identification Test (AUDIT-C) were derived from the Department of Veterans Affairs medical records.ResultsModels testing main and interaction effects showed a statistically significant association of both PTSD (p = .02) and stress exposure (p = .04), as well as significant interaction of PTSD and stress exposure (p = .03) with AUDIT-C scores postpartum, after controlling for marital status, age, and race. Specifically, compared with women without PTSD, those with PTSD had higher overall AUDIT-C scores postpartum, regardless of stress exposure. For women without PTSD, more stress exposure before birth was associated with higher AUDIT-C scores during the postpartum phase.ConclusionsPTSD diagnosis and life stressors before infant birth predicted maternal alcohol misuse during the postpartum period. Identifying such risk factors is an initial step in preventing alcohol misuse, with the goal of enhancing postpartum health for the birthing parent and infant.     

Alcohol misuse,depressive symptoms,and HIV/STI risks of US Hispanic women

Objectives: Alcohol misuse and depressive symptoms have been linked to HIV/STI risk, but studies have rarely included Hispanic women, who have over four times greater HIV incidence than white, non-Hispanic women. Understanding the connections among alcohol misuse, depressive symptoms, and HIV/STI risks may suggest ways to meet specific needs of Hispanic women. This study’s objective is to examine the relationships among alcohol misuse, depressive symptoms, and seven HIV/STI risk factors.

Design: Five hundred forty-eight US Hispanic women with intake data from a randomized trial were assessed for alcohol misuse (CAGE) and depressive symptoms (CES-D). GZLM and path analyses tested relationships between alcohol misuse or depressive symptoms and HIV/STI risk factors.

Results: Self-efficacy and condom use were not related to alcohol misuse or depressive symptoms, but only 15% of women reported consistent condom use. After controlling for demographics, women with alcohol misuse had significantly more perceived HIV/STI risk (OR?=?2.15) and better HIV/STI knowledge (β?=??.54); and women with depressive symptoms had significantly more perceived HIV/STI risk (OR?=?1.76) and worse HIV/STI knowledge (β?=?.37).

Conclusions: Interventions to increase condom use for Hispanic women are needed, regardless of mental disorders. Working with Hispanic women with alcohol misuse or depressive symptoms presents a need (and opportunity) to address issues directly related to HIV/STI risk. Women’s health practitioners have an excellent opportunity to reach women by implementing regular screening programs in clinics that serve Hispanic women. For women with high depressive symptoms, poor HIV/STI knowledge should also be addressed. Future studies should test whether integrated and tailored risk reduction interventions affect these factors and lower HIV/STI risk for Hispanic women.     

Medical downgrading, self-perception of health, and psychological symptoms in the British Armed Forces

Objective

To investigate the contribution of psychological symptoms to limited employability for medical reasons in the British Armed Forces.

Methods

A sample of 4500 military personnel was randomly selected to receive either a full or an abridged questionnaire. The questionnaires asked whether the participant was medically downgraded and if yes, the reason for it. The full questionnaire included the General Health Questionnaire‐12 (GHQ‐12), the post‐traumatic stress disorder (PTSD) checklist, 15 symptoms to assess somatisation, and selected items of the quality of life SF‐36 questionnaire. The abridged questionnaire included the GHQ‐4, a 14 item PTSD checklist, five symptoms, and the item on self‐perception of health from the SF‐36. Subjects above a threshold score for GHQ, PTSD, and symptoms were considered to have psychological symptoms.

Results

12.4% of the participants were medically downgraded. The majority (70.4%) had social or work limitations. Medically downgraded personnel had higher odds ratios in comparison to non‐downgraded personnel for psychological distress 1.84 (95% CI 1.43 to 2.37), PTSD 3.06 (95% CI 1.82 to 5.15), and number of symptoms 2.37 (95% CI 2.37 1.62 to 3.47). GHQ, PTSD, and symptoms scores were mainly, but not exclusively, related to chronic physical injury.

Conclusions

Psychological symptoms are common among medically downgraded personnel. Although the mechanisms involved are unclear, tackling issues of psychological symptoms among these subjects could contribute to faster restitution to full employability in the Armed Forces.     

Getting beyond "Don't ask; don't tell": an evaluation of US Veterans Administration postdeployment mental health screening of veterans returning from Iraq and Afghanistan

Objectives. We sought to evaluate outcomes of the Veterans Administration (VA) Afghan and Iraq Post-Deployment Screen for mental health symptoms.Methods. Veterans Administration clinicians were encouraged to refer Iraq or Afghanistan veterans who screened positive for posttraumatic stress disorder, depression, or high-risk alcohol use to a VA mental health clinic. Multivariate methods were used to determine predictors of screening, the proportions who screened positive for particular mental health problems, and predictors of VA mental health clinic attendance.Results. Among 750 Iraq and Afghanistan veterans who were referred to a VA medical center and 5 associated community clinics, 338 underwent postdeployment screening; 233 (69%) screened positive for mental health problems. Having been seen in primary care (adjusted odd ratio [AOR]=13.3; 95% confidence interval [CI]=8.31, 21.3) and at a VA community clinic (AOR=3.28; 95% CI=2.03, 5.28) predicted screening. African American veterans were less likely to have been screened than were White veterans (AOR=0.45; 95% CI=0.22, 0.91). Of 233 veterans who screened positive, 170 (73%) completed a mental health follow-up visit.Conclusions. A substantial proportion of veterans met screening criteria for co-occurring mental health problems, suggesting that the VA screens may help overcome a “don’t ask, don’t tell” climate that surrounds stigmatized mental illness. Based on data from 1 VA facility, VA postdeployment screening increases mental health clinic attendance among Iraq and Afghanistan veterans.High levels of exposure to combat have characterized the conflicts principally in Iraq and Afghanistan—Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Improvised explosive devices and frequent, unexpected mortar attacks have brought the “front line” to most OIF and OEF military service personnel.1 In the Vietnam and Persian Gulf wars, level of combat exposure was strongly associated with posttraumatic stress disorder (PTSD), depression, and substance use disorders.2^,3 Similarly, an epidemic of mental health disorders is emerging among veterans of OIF and OEF.4^,5 Early intervention with evidence-based mental health treatment has been shown to prevent chronic mental illness and associated disability.6 Mental health screening of combat veterans has the potential to increase early detection of symptoms and early intervention.Since World War I, the US military has conducted mass mental health screening primarily to exclude psychologically vulnerable recruits from service, yet these programs have failed to reduce the incidence of psychological casualties.7 This experience, coupled with high rates of psychiatric disorders in the aftermath of the Vietnam and Persian Gulf wars, shifted the focus of screening to the detection of mental health symptoms during and after deployment.8 Recent reports have indicated that service members are more likely to report mental health problems 3 to 4 months after returning from deployment, and delayed presentations of mental health disorders have been documented years after military service.9^,10 Accordingly, in June 2004, the Veterans Administration (VA) issued a national directive to initiate the Afghan and Iraq Post-Deployment Screen.11 The screen consists of brief, previously validated instruments to detect symptoms of PTSD, depression, and high-risk alcohol use among veterans of OIF and OEF who seek VA healthcare. Veterans Administration clinicians are expected to complete the screen and to assess whether veterans who meet screening criteria for depression and high-risk alcohol use require a mental health referral. Veterans Administration clinicians are encouraged to refer patients who meet screening criteria for PTSD for further mental health assessment and treatment.Clinicians at 1 VA medical center and its affiliated community-based clinics were encouraged to refer Iraq and Afghanistan veterans who met screening criteria for PTSD, depression, or high-risk drinking for follow-up mental health assessment. Based on data from this facility, we sought to determine (1) the frequency and predictors of implementation of the VA postdeployment screen; (2) the proportion of veterans with positive screens for PTSD, depression, or high-risk alcohol use; and (3) the proportion of veterans who were seen in a VA mental health clinic within 90 days of screening and beyond.     

Getting a peace of the action: measures of post traumatic stress in UK military peacekeepers

Objectives This study aimed to measure prevalence of post traumatic stress disorder (PTSD) in a sample of UK Armed Forces peacekeepers. The study also aimed to explore the influence of deploying without an established peer group (deployment status) upon health outcomes using an accepted diagnostic tool for PTSD (PCL-M) and an alternative measure of post-traumatic distress.

Design Using a sub-sample of the King's military cohort we surveyed personnel that deployed on peacekeeping operations between 1991 and 2000 (n=1198).

Setting Respondents' mean age was 36 years (min, 23 to max, 60) and 81% (n=964) were serving in the Armed Forces at the time of participation.

Main outcome measures PTSD prevalence was determined in British military peacekeepers using the PLC-M (cut-offs 44 and 50), the General Health Questionnaire (GHQ-12) and a composite brief measure of potential post traumatic symptomology, ‘PostTraumatic Stress Reaction’ (PTSR) for comparison.

Results PTSD prevalence varied from 3.6 to 5.5%. Officers and married personnel were less likely to be cases. Neither gender, age or deployment status influenced PTSD prevalence.

Conclusions PTSD was an uncommon disorder in this sample of British military peacekeepers, with prevalence rates being lower than those reported by other nations. Deploying without an established peer group was not associated with developing PTSD. We postulate that differences in culture and operational practices may account for the lower rates of PTSD.

     

Mental Health Comorbidity Patterns and Impact on Quality of Life Among Veterans Serving During the First Gulf War

Purpose: To examine the patterns of coexisting (comorbid) mental disorders and whether comorbidity influences quality of life ratings in a sample of U.S. veterans. Patients and Methods: The Iowa Gulf War Study Case Validation study evaluated 602 military personnel, two-thirds of whom had symptoms of depression, cognitive dysfunction, or chronic widespread pain, who were activated or on active duty sometime during the first Gulf War (GW). Mental health disorders were defined using the SCID-IV, and the Health Utilities Index Mark 3 (HUI3) was used to measure health-related quality of life (HRQoL). Comorbidity was defined as having two or more mental disorders that spanned across at least two separate categories (e.g., depressive disorders and anxiety disorders). Results: Over 35% of veterans with a current mental disorder had at least one other comorbid mental disorder. Those with mental disorder comorbidity had lower HUI scores than veterans with only one or less mental disorders (mean 0.41 ± 0.30 vs. 0.72 ± 0.25, p < 0.0001). Conclusion: The co-occurrence of mental disorders that span at least two mental disorder categories is associated with impaired HRQoL in this veteran population. Early identification of mental health comorbidity may lead to interventions to enhance HRQoL among military personnel.     

Ethnic differences in women’s use of mental health services: do social networks play a role? Findings from a national survey

Objectives: The reasons for ethnic differences in women’s mental health service use in England remain unclear. The aims of this study were to ascertain: ethnic differences in women’s usage of mental health services, if social networks are independently associated with service use, and if the association between women’s social networks and service use varies between ethnic groups.

Design: Logistic regression modelling of nationally representative data from the Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) survey conducted in England. The analytic sample (2260 women, aged 16–74 years) was drawn from the representative subsample of 2340 women in EMPIRIC for whom data on mental health services, and social networks were available.

Results: Pakistani and Bangladeshi women were less likely than White women to have used mental health services (Pakistani OR?=?0.23, CI?=?0.08–0.65, p?=?.005; Bangladeshi OR?=?0.25, CI?=?0.07–0.86, p?=?.027). Frequent contact with relatives reduced mental health service use (OR?=?0.45, CI?=?0.23–0.89, p?=?.023). An increase in perceived inadequate support in women’s close networks was associated with increased odds of using mental health services (OR?=?1.91, CI?=?1.11–3.27, p?=?.019). The influence of social networks on mental health service use did not differ between ethnic groups.

Conclusions: The differential treatment of women from Pakistani and Bangladeshi ethnic groups in primary care settings could be a possible reason for the observed differences in mental health service use.     

Reproductive and Other Health Outcomes in Iraq and Afghanistan Women Veterans Using VA Health Care: Association with Mental Health Diagnoses

BackgroundAn increasing number of women serve in the military and are exposed to trauma during service that can lead to mental health problems. Understanding how these mental health problems affect reproductive and physical health outcomes will inform interventions to improve care for women veterans.MethodsWe analyzed national Department of Veterans Affairs (VA) data from women Iraq and Afghanistan veterans who were new users of VA healthcare from October 7, 2001, through December 31, 2010 (n = 71,504). We used ICD-9 codes to categorize veterans into five groups by mental health diagnoses (MH Dx): Those with no MH Dx, posttraumatic stress disorder (PTSD), depression, comorbid PTSD and depression, and a MH Dx other than PTSD and depression. We determined the association between mental health category and reproductive and other physical health outcomes defined by ICD-9 codes. Categories included sexually transmitted infections, other infections (e.g., urinary tract infections), pain-related conditions (e.g., dysmenorrhea and dsypareunia), and other conditions (e.g., polycystic ovarian syndrome, infertility, sexual dysfunction). Models were adjusted for sociodemographic and military service factors.ResultsThere were 31,481 patients (44%) who received at least one mental health diagnosis. Women veterans with any mental health diagnosis had significantly higher prevalences of nearly all categories of reproductive and physical disease diagnoses (p < .0001 for adjusted prevalences). There was a trend of increasing prevalence of disease outcomes in women with PTSD, depression, and comorbid PTSD and depression (p for trend <.0001 for all outcomes).ConclusionsIraq and Afghanistan women veterans with mental health diagnoses had significantly greater prevalences of several important reproductive and physical health diagnoses. These results provide support for VA initiatives to address mental and physical health concerns and improve comprehensive care for women veterans.     

中国8个长寿地区65岁及以上老年人抑郁症状影响因素分析

目的分析中国8个长寿地区老年人抑郁症状影响因素。方法利用"中国老年健康影响因素跟踪调查"子队列-"老年健康生物标志物队列研究"。2017年8个长寿地区数据,共纳入2180名≥65岁老年人,采用logistic回归分析老年人社会人口学特征、行为生活方式、慢性病患病情况、功能状况、亲友和社会支持对抑郁症状的影响。结果中国8个长寿地区≥65岁老年人抑郁症状检出率为15.0%,其中男、女性抑郁症状检出率分别为11.5%和18.5%。多因素logistic回归分析结果显示,锻炼身体(OR=0.44,95%CI:0.26~0.74)、经常吃鱼类(OR=0.57,95%CI:0.39~0.83)、参加文娱活动(OR=0.65,95%CI:0.44~0.96)、参加社会活动(OR=0.28,95%CI:0.11~0.73)和能够享受社区服务(OR=0.68,95%CI:0.50~0.93)的老年人抑郁症状检出率较低。睡眠不足(OR=2.04,95%CI:1.49~2.80)、视力障碍(OR=1.54,95%CI:1.08~2.18)、患胃肠溃疡(OR=2.97,95%CI:1.53~5.77)、患关节炎(OR=2.63,95%CI:1.61~4.32)、家庭支出大于收入(OR=1.80,95%CI:1.17~2.78)和自评经济条件差(OR=4.58,95%CI:2.48~8.47)的老年人抑郁症状检出率较高。结论老年人是否锻炼身体、饮食有鱼类、参加文娱和社会活动、享受社区服务、睡眠时长、视力情况、是否有胃肠溃疡和关节炎与抑郁症状的检出率相关。     

Coverage of Posttraumatic Stress Disorder in the New York Times, 1950–2012

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.     

Posttraumatic Stress Symptoms and their Relationship to Drug and Alcohol use in an International Sample of Latino Immigrants

We identify the prevalence and correlates of posttraumatic stress (PTSD) symptoms and their relationship to alcohol and substance use disorders (AUD/SUD) among Latino immigrants in two countries. A screening battery assessing PTSD symptoms (PCL-C), alcohol use (AUDIT), drug abuse (DAST), and psychological measures was administered to 562 Latino immigrants recruited in clinics. We used logistical regression analyses to evaluate the relationship between PTSD symptoms and AUD/SUD. Prevalence of elevated PTSD symptoms was high (53.7 % in Boston, 47.9 % in Madrid and, 43.8 % in Barcelona). Screening positive for psychological measures was significantly correlated to screening positive on the PCL-C (p < 0.001). Significant gender differences in risk of AUD/SUD were moderated by PTSD symptoms. Presence of any PTSD symptoms predicted problems with benzodiazepine misuse. Given the high rates of co-morbidity between PTSD symptoms and AUD/SUD, we recommend early interventions for dual pathology for Latino immigrants with trauma history.     

Predictors of support service use by rural and regional men with cancer

Objective: The current study examined how sociodemographic, psychological, physical and social support variables predict participation in formal support services. Design: Cross‐sectional study. Setting: Participants were recruited from oncology clinics, cancer specialist clinics and cancer support groups. Participants: Seventy‐six men living outside major Australian cities, the majority with prostate cancer (n = 55). Main outcome measures: Participants completed the Brief Symptom Inventory, the List of Physical Complaints, the Social Support Subscale of the Coping Resources Inventory and questionnaires related to levels of awareness of, and participation in support services. Results: Most (82%) of the men were aware of at least one formal service offering emotional support, and 49% of the men had used such a service. Telephone‐ and Internet‐based services were the most used type of support. The only predictor of participation in a formal service was lower age. Conclusions: Use of a support service was not predicted by psychological or physical symptoms, levels of social support or distance from service centres. Attitudes to different types of services, and support services in general, might be more predictive of actual use. The current findings point to the potential of telephone‐ and Internet‐based support as an acceptable means of formal support for rural and regional men who experience cancer‐related distress.     

武汉市社区妇女家庭暴力与创伤后应激障碍的相关性研究

目的 了解武汉市社区妇女家庭暴力的流行特征，分析家庭暴力与创伤后应激障碍（PTSD）的关系，为提高女性心理健康水平提供依据。方法 采用横断面研究方法，以在武汉市某社区卫生服务中心进行妇科检查的女性作为研究对象，调查其一般特征、社会支持、伤害情况、家庭暴力及PTSD流行情况。采用 χ²检验、t检验、Cochran-Armitage趋势检验分析PTSD组与健康组间差异，logistic回归分析PTSD与家庭暴力的关系。结果 家庭暴力终身发生率为29.36%，心理暴力、身体暴力和性暴力的发生率分别为28.28%、6.60%和3.55%；PTSD的总患病率为4.73%。遭受家庭暴力的女性患PTSD的风险是未遭受暴力女性的2.11倍（OR=2.11，95%CI：1.04～4.29）；同时遭受身体与心理暴力的女性发生PTSD的风险是未受暴力女性的5.06倍（OR=5.06，95%CI：1.91～13.42）。结论 家庭暴力与PTSD存在较强的相关性，对遭受家庭暴力的妇女应进行心理疏导，降低PTSD的发生风险。     

Prospectively assessed posttraumatic stress disorder and associated physical activity

Objectives

We examined the association of physical activity with prospectively assessed posttraumatic stress disorder (PTSD) symptoms in a military cohort.

Methods

Using baseline and follow-up questionnaire data from a large prospective study of U.S. service members, we applied multivariable logistic regression to examine the adjusted odds of new-onset and persistent PTSD symptoms associated with light/moderate physical activity, vigorous physical activity, and strength training at follow-up.

Results

Of the 38,883 participants, 89.4% reported engaging in at least 30 minutes of physical activity per week. At follow-up, those who reported proportionately less physical activity were more likely to screen positive for PTSD. Vigorous physical activity had the most consistent relationship with PTSD. Those who reported at least 20 minutes of vigorous physical activity twice weekly had significantly decreased odds for new-onset (odds ratio [OR] = 0.58, 95% confidence interval [CI] 0.49, 0.70) and persistent (OR=0.59, 95% CI 0.42, 0.83) PTSD symptoms.

Conclusions

Engagement in physical activity, especially vigorous activity, is significantly associated with decreased odds of PTSD symptoms among U.S. service members. While further longitudinal research is necessary, a physical activity component may be valuable to PTSD treatment and prevention programs.Recent military operations in Iraq and Afghanistan have been characterized by sustained ground combat, persistent risk, and multiple protracted deployments. Increased psychological symptom reporting has engendered heightened concern for the postdeployment mental health of service members and, in particular, the public health burden of posttraumatic stress disorder (PTSD).^1–4 A previous study using data from all U.S. service branches identified new-onset self-reported PTSD symptoms in 7.6%–8.7% of deployers who reported combat exposures, 1.4%–2.1% of deployers who did not report combat exposures, and 2.3%–3.0% of nondeployers.⁴PTSD is associated with poor physical health as well as negative health behaviors, such as tobacco use and problem alcohol drinking.^5–11 The extent to which behavioral correlates of PTSD mitigate or mediate PTSD symptoms and associated morbidities is currently under investigation.¹² While research has focused on adverse health behaviors, the relationship between positive health behaviors (e.g., physical activity) and PTSD has not been fully explored.Studies of depression and anxiety have pointed to the mental health benefits of physical activity, and researchers have postulated a number of mechanisms by which physical activity may modulate mood and the stress response.^13–19 While previous research indicates that physical activity may mitigate PTSD and related symptoms, other studies indicate that exercise habits of PTSD patients may be substandard.^20–23 In a retrospective study among Brazilians, physical activity levels decreased after the onset of PTSD.²⁴ These previous studies, however, were limited by small sample sizes, retrospective designs, and an inability to control for possible confounders.^20,22–25 The purpose of this study was to investigate new-onset, resolution, and persistence of PTSD symptoms in relation to type and quantity of physical activity in a large, population-based cohort of U.S. military service members.     

Demographic factors,mental health problems,and psychosocial resources influence women's AIDS risk

The aim of this study was to examine how depressive mood, posttraumatic stress disorder (PTSD) symptoms, self-efficacy, and social support are associated with HIV risk behaviors. Participants were sexually active women (N = 1488) recruited when attending gynecological consultations in primary care settings. Standardized questionnaires were administered to assess for depressive mood, abuse/assault-related PTSD, social support, self-efficacy, stress, and sexual risk behavior. The resulting association models showed that demographic factors, mental health problems, and resources are associated with sexual risk behavior. Detecting and treating mental health problems and interventions that bolster women's psychosocial resources are warranted.     

社会支持及应对方式对洪灾创伤后应激障碍慢性化的影响

目的 了解洪灾创伤后应激障碍(PTSD)慢性化,进一步研究社会支持及应对方式对洪灾后PTSD慢性化的影响。方法 2014年3-4月采用整群随机抽样方法对经历1998年洞庭湖洪灾,1999年初次调查确诊的PTSD患者分析其慢性化情况。调查中采用创伤后应激障碍量表平民版(PCL-C)将研究对象分为康复组和未康复组(慢性化组),采用社会支持评定量表(SSRS)、简易应对方式问卷(SCSQ)测评和比较两组研究对象。结果 120名研究对象中,14名(11.67%)诊断为PTSD患者。两组患者主观支持得分、客观支持得分、社会支持总分以及积极应对得分、应对方式总分的差异有统计学意义(P<0.05);多因素logistic回归显示:社会支持(OR=0.281,95% CI:0.117~0.678)、应对方式(OR=0.293,95% CI:0.128~0.672)是PTSD慢性化的保护因素;受灾经历(OR=1.626,95% CI:1.118~2.365)是PTSD慢性化的危险因素。结论 洪灾后PTSD患者慢性化值得重视,而良好的社会支持、积极的应对方式能显著改善其慢性化情况。     

Post-traumatic stress disorder among American Legionnaires in relation to combat experience in Vietnam: associated and contributing factors

The relationship between combat stress, DSM-III-defined post-traumatic stress disorder (PTSD), and a variety of behavioral factors was examined in a large nonclinical population. A total of 2858 randomly selected American Legion members who had served in Southeast Asia completed a questionnaire which elicited information on military service, personal health, and a variety of mental health outcomes. The data confirm the utility of the PTSD diagnosis as a distinct clinical entity. The frequency of PTSD and the extent of symptoms developed varied with the severity of criteria used for determining the extent of traumatic exposure. The PTSD rate ranged from 1.8 to 15.0% of the total sample, depending on whether "exposure" to combat was defined relatively narrowly or broadly. A distinct linear dose-response relationship between combat stress and a quantitative measure of PTSD intensity was observed. The frequency of PTSD diagnosis was not affected by the presence of either physical or mental health problems which predated military service. A strong, stable relationship was found between combat stress and PTSD intensity for cohorts with differing intervals since the experience of combat trauma, which persisted up to 20 years after discharge from the military. The data thus support a broader approach to defining traumatic events which recognizes individual differences in response to combat, as well as the existence of other behavioral outcomes as residual effects of combat. Implications of these findings and the importance of treating veterans with varying presentations of PTSD are discussed.     

Destabilising social inclusion and recovery,and pursuing 'lines of flight' in the mental health sector

People who have been diagnosed with serious mental illness have a long history of confinement, social stigma and marginalisation that has constrained their participation in society. Drawing upon the work of Gilles Deleuze and Felix Guattari, we have used the concepts of: assemblages, major and minor and deterritorialisation to critically analyse two pervasive and ‘taken-for-granted’ assemblages in mental health: recovery (including clinical recovery, social recovery and recovery-oriented practice) and social inclusion. Our analysis explores how dominant and oppressive forces have been entangled with liberating and transformative forces throughout both of these assemblages – with dominant forces engaging in ongoing processes of capture and control, and transformative forces resisting and avoiding capture. In pursuit of social transformation for people categorised with serious mental illness, deterritorialisation is posited as a potential way forward. To have transformation in the lives of mental health service users, we present the possibility that ongoing, disruptive movements of deterritorialisation can unsettle majoritarian practices of capture and control – producing liberating lines of flight.     

Benefits of Cognitive Behavioral Therapy for Insomnia for Women Veterans with and without Probable Post-Traumatic Stress Disorder

ObjectiveThis study compared the benefits of cognitive–behavioral therapy for insomnia for sleep, mental health symptoms, and quality of life (QoL) in a sample of women veterans with and without probable post-traumatic stress disorder (PTSD) comorbid with insomnia disorder.MethodsSeventy-three women veterans (30 with probable PTSD) received a manual-based 5-week cognitive–behavioral therapy for insomnia treatment as part of a behavioral sleep intervention study. Measures were completed at baseline, post-treatment, and 3-month follow-up. Sleep measures included the Insomnia Severity Index, Pittsburgh Sleep Quality Index, sleep efficiency measured by actigraphy, and sleep efficiency and total sleep time measured by sleep diary. Mental health measures included the PTSD Checklist-5, nightmares per week, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 scale. QoL was measured with the Short Form-12. Linear mixed models compared changes over time across groups. Independent t tests examined PTSD symptom changes in women veterans with probable PTSD.ResultsBoth groups demonstrated improvements across sleep (ps < .001–.040), mental health symptoms (ps < .001), and QoL measures (ps < .001). The probable PTSD group reported greater improvements in diary sleep efficiency (p = .046) and nightmares per week (p = .001) at post-treatment and in total sleep time (p = .029) and nightmares per week (p = .006) at follow-up. Most participants with probable PTSD experienced clinically significant reductions in PTSD symptoms at post-treatment (66.7%) and follow-up (60.0%). Significant reductions in intrusive and arousal/reactivity symptoms were maintained at follow-up.ConclusionsCognitive–behavioral therapy for insomnia improves insomnia, mental health symptoms, and QoL among women veterans, with greater improvement in those with probable PTSD.