Breathing‐Based Meditation Decreases Posttraumatic Stress Disorder Symptoms in U.S. Military Veterans: A Randomized Controlled Longitudinal Study

Given the limited success of conventional treatments for veterans with posttraumatic stress disorder (PTSD), investigations of alternative approaches are warranted. We examined the effects of a breathing‐based meditation intervention, Sudarshan Kriya yoga, on PTSD outcome variables in U.S. male veterans of the Iraq or Afghanistan war. We randomly assigned 21 veterans to an active (n = 11) or waitlist control (n = 10) group. Laboratory measures of eye‐blink startle and respiration rate were obtained before and after the intervention, as were self‐report symptom measures; the latter were also obtained 1 month and 1 year later. The active group showed reductions in PTSD scores, d = 1.16, 95% CI [0.20, 2.04], anxiety symptoms, and respiration rate, but the control group did not. Reductions in startle correlated with reductions in hyperarousal symptoms immediately postintervention (r = .93, p < .001) and at 1‐year follow‐up (r = .77, p = .025). This longitudinal intervention study suggests there may be clinical utility for Sudarshan Kriya yoga for PTSD.     

Posttraumatic Stress Disorder and Depression Among U.S. Military Health Care Professionals Deployed in Support of Operations in Iraq and Afghanistan

Limited prospective studies exist that evaluate the mental health status of military health care professionals who have deployed. This study used prospective data from the Millennium Cohort Study with longitudinal analysis techniques to examine whether health care professionals deployed in support of the operations in Iraq and Afghanistan were more likely to screen positive for new‐onset posttraumatic stress disorder (PTSD) or depression after deployment than individuals from other occupations. Of 65,108 subjects included, 9,371 (14.4%) reported working as health care professionals. The rates of new positive screens for PTSD or depression were similar for those in health care occupations (4.7% and 4.3%) compared with those in other occupations (4.6% and 3.9%) for the first and second follow‐up, respectively. Among military personnel deployed with combat experience, health care professionals did not have increased odds for new‐onset PTSD or depression over time. Among deployed health care professionals, combat experience significantly increased the odds: adjusted odds ratio = 2.01; 95% confidence interval [1.06, 3.83] for new‐onset PTSD or depression. These results suggest that combat experience, not features specific to being a health care professional, was the key exposure explaining the development of these outcomes.     

Punishment Learning in U.S. Veterans With Posttraumatic Stress Disorder

Learning processes have been implicated in the development and course of posttraumatic stress disorder (PTSD); however, little is currently known about punishment‐based learning in PTSD. The current study investigated impairments in punishment‐based learning in U.S. veterans. We expected that veterans with PTSD would demonstrate greater punishment‐based learning compared to a non‐PTSD control group. We compared a PTSD group with and without co‐occurring depression (n = 27) to a control group (with and without trauma exposure) without PTSD or depression (n = 29). Participants completed a computerized probabilistic punishment‐based learning task. Compared to the non‐PTSD control group, veterans with PTSD showed significantly greater punishment‐based learning. Specifically, there was a significant Block × Group interaction, F(1, 54) = 4.12, p = .047, η² = .07. Veterans with PTSD demonstrated greater change in response bias for responding toward a less frequently punished stimulus across blocks. The observed hypersensitivity to punishment in individuals with PTSD may contribute to avoidant responses that are not specific to trauma cues.     

Couple Treatment for Alcohol Use Disorder and Posttraumatic Stress Disorder: Pilot Results From U.S. Military Veterans and Their Partners

We studied 13 U.S. male military veterans and their female partners who consented to participate in an uncontrolled trial of couple treatment for alcohol use disorder and posttraumatic stress disorder (CTAP). CTAP is a 15‐session, manualized therapy, integrating behavioral couples therapy for alcohol use disorder (AUD) with cognitive–behavioral conjoint therapy for posttraumatic stress disorder (PTSD). Due to ineligibility (n = 1) and attrition (n = 3), 9 couples completed the study, and 7 completed 12 or more sessions. There were 8 veterans who showed clinically reliable pre‐ to posttreatment reduction of PTSD outcomes. There were also significant group‐level reductions in clinician‐, veteran‐, and partner‐rated PTSD symptoms (d = 0.94 to 1.71). Most veterans showed clinically reliable reductions in percentage days of heavy drinking. Group‐level reduction in veterans’ percentage days of heavy drinking was significant (d = 1.01). There were 4 veterans and 3 partners with clinically reliable reductions in depression, and group‐level change was significant for veterans (d = 0.93) and partners (d = 1.06). On relationship satisfaction, 3 veterans and 4 partners had reliable improvements, and 2 veterans and 1 partner had reliable deterioration. Group‐level findings were nonsignificant for veteran relationship satisfaction (d = 0.26) and for partners (d = 0.52). These findings indicate that CTAP may be a promising intervention for individuals with comorbid PTSD and AUD who have relationship partners.     

Treatment Outcomes for Military Veterans With Posttraumatic Stress Disorder: Response Trajectories by Symptom Cluster

Although effective posttraumatic stress disorder (PTSD) treatments are available, outcomes for veterans with PTSD are relatively modest. Previous researchers have identified subgroups of veterans with different response trajectories but have not investigated whether PTSD symptom clusters (based on a four‐factor model) have different patterns of response to treatment. The importance of this lies in the potential to increase treatment focus on less responsive symptoms. We investigated treatment outcomes by symptom cluster for 2,685 Australian veterans with PTSD. We used Posttraumatic Stress Disorder Checklist scores obtained at treatment intake, posttreatment, and 3‐ and 9‐month follow‐ups to define change across symptom clusters. Repeated measures effect sizes indicated that arousal and numbing symptoms exhibited the largest changes between intake and posttreatment, d_RM = ?0.61 and d_RM = ?0.52, respectively, whereas avoidance and intrusion symptoms showed more modest reductions, d_RM = ?0.36 and d_RM = ?0.30, respectively. However, unlike the other symptom clusters, the intrusions cluster continued to show significant changes between posttreatment and 3‐month follow‐up, d_RM = ?0.21. Intrusion and arousal symptoms also showed continued changes between 3‐ and 9‐month follow‐ups although these effects were very small, d_RM = ?0.09. Growth curve model analyses produced consistent findings and indicated modest initial changes in intrusion symptoms that continued posttreatment. These findings may reflect the longer time required for emotional processing, relative to behavioral changes in avoidance, numbing, and arousal, during the program; they also reinforce the importance of prioritizing individual trauma‐focused therapy directly targeting intrusions as the core component of programmatic treatment.     

Validation of the Pittsburgh Sleep Quality Index Addendum for Posttraumatic Stress Disorder (PSQI‐A) in U.S. Male Military Veterans

Sleep disturbances are core symptoms of posttraumatic‐stress disorder (PTSD), yet they bear less stigma than other PTSD symptoms. Given the growing number of returning military veterans, brief, valid assessments that identify PTSD in a minimally stigmatizing way may be useful in research and clinical practice. The study purpose was to evaluate the psychometric properties of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI‐A), and to examine its ability to identify PTSD cases among U.S. male military veterans. Male military veterans (N = 119) completed the PSQI‐A, as well as measures of sleep quality, combat exposure, posttraumatic stress, depression, and anxiety. Veterans with PTSD had higher PSQI‐A identified disruptive nocturnal behaviors than veterans without PTSD. The PSQI‐A had good internal consistency and convergent validity with sleep quality, combat exposure, PTSD symptoms, depression, and anxiety. A cutoff score ≥ 4 provided an area under the curve = .81, with 71% sensitivity, 82% specificity, and 60% positive and 83% negative predictive value for a clinical diagnosis of PTSD; correct classification was 74%. The PSQI‐A is a valid measure to possibly detect PTSD among male military veterans. Assessment of disruptive nocturnal behaviors may provide a cost‐effective, nonstigmatizing approach to PTSD screening without directly probing for trauma exposure(s).     

Predictors of Emotional Numbing in Posttraumatic Stress Disorder

Little is known about the mechanisms underlying emotional numbing (EN). The functional relationship between other classes of posttraumatic stress disorder (PTSD) symptoms and EN is also not well understood. In the present study, we examined the statistical predictors of EN. We hypothesized that the severity of EN would be most strongly associated with the hyperarousal symptoms rather than the avoidance symptoms of PTSD, or comorbid depression or substance abuse. This prediction was derived from psychological and biological models that posit EN to be a product of the depletion of emotional resources subsequent to chronic hyperarousal. Using hierarchical multiple regression in two separate samples of Vietnam combat veterans, we found hyperarousal symptoms to be the most robust predictor of EN. These data suggest that there is a substantive relationship between hyperarousal symptoms and EN in PTSD.     

Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in DSM‐5 and ICD‐11: Clinical and Behavioral Correlates

The American Psychiatric Association and the World Health Organization provide distinct trauma‐based diagnoses in the fifth edition of the Diagnostic and Statistical Manual (DSM‐5), and the forthcoming 11th version of the International Classification of Diseases (ICD‐11), respectively. The DSM‐5 conceptualizes posttraumatic stress disorder (PTSD) as a single, broad diagnosis, whereas the ICD‐11 proposes two “sibling” disorders: PTSD and complex PTSD (CPTSD). The objectives of the current study were to: (a) compare prevalence rates of PTSD/CPTSD based on each diagnostic system; (b) identify clinical and behavioral variables that distinguish ICD‐11 CPTSD and PTSD diagnoses; and (c) examine the diagnostic associations for ICD‐11 CPTSD and DSM‐5 PTSD. Participants in a predominately female clinical sample (N = 106) completed self‐report scales to measure ICD‐11 PTSD and CPTSD, DSM‐5 PTSD, and depression, anxiety, borderline personality disorder, dissociation, destructive behaviors, and suicidal ideation and self‐harm. Significantly more people were diagnosed with PTSD according to the DSM‐5 criteria (90.4%) compared to those diagnosed with PTSD and CPTSD according to the ICD‐11 guidelines (79.8%). An ICD‐11 CPTSD diagnosis was distinguished from an ICD‐11 PTSD diagnosis by higher levels of dissociation (d = 1.01), depression (d = 0.63), and borderline personality disorder (d = 0.55). Diagnostic associations with depression, anxiety, and suicidal ideation and self‐harm were higher for ICD‐11 CPTSD compared to DSM‐5 PTSD (by 10.7%, 4.0%, and 7.0%, respectively). These results have implications for differential diagnosis and for the development of targeted treatments for CPTSD.     

ICD‐11 Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in the United States: A Population‐Based Study

The primary aim of this study was to provide an assessment of the current prevalence rates of International Classification of Diseases (11th rev.) posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) among the adult population of the United States and to identify characteristics and correlates associated with each disorder. A total of 7.2% of the sample met criteria for either PTSD or CPTSD, and the prevalence rates were 3.4% for PTSD and 3.8% for CPTSD. Women were more likely than men to meet criteria for both PTSD and CPTSD. Cumulative adulthood trauma was associated with both PTSD and CPTSD; however, cumulative childhood trauma was more strongly associated with CPTSD than PTSD. Among traumatic stressors occurring in childhood, sexual and physical abuse by caregivers were identified as events associated with risk for CPTSD, whereas sexual assault by noncaregivers and abduction were risk factors for PTSD. Adverse childhood events were associated with both PTSD and CPTSD, and equally so. Individuals with CPTSD reported substantially higher psychiatric burden and lower levels of psychological well‐being compared to those with PTSD and those with neither diagnosis.     

Associations Among Childhood Trauma,Childhood Mental Disorders,and Past‐Year Posttraumatic Stress Disorder in Military and Civilian Men

To identify early life factors associated with posttraumatic stress disorder (PTSD), we investigated the association between childhood trauma and mental disorders with International Classification of Diseases (ICD)‐diagnosed past‐year PTSD in employed military and civilian men. Data were derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study (N = 1,356) and the 2007 Australian Bureau of Statistics (ABS) National Survey of Mental Health and Wellbeing Study (N = 2,120) and analyzed using logistic regression and generalized structural equation modeling. After controlling for demographics, PTSD was associated with childhood anxiety, adjusted odds ratio (AOR) = 3.94, 95% CI [2.36, 6.58]; and depression, AOR = 7.01, 95% CI [2.98, 16.49], but not alcohol use disorders, in the ADF. In civilians, PTSD was associated with childhood anxiety only, AOR = 7.06, 95% CI [3.50, 14.22]. These associations remained significant after controlling for childhood and adult trauma in both populations and service factors and deployment, combat, or adult trauma in the ADF. In both populations, PTSD was associated with more than three types of childhood trauma: AOR = 2.97, 95% CI [1.53, 5.75] for ADF and AOR = 5.92, 95% CI [3.00, 11.70] for ABS; and childhood interpersonal, but not noninterpersonal, trauma: AOR = 3.08, 95% CI [1.61, 5.90] for ADF and AOR = 6.63, 95% CI [2.74, 16.06] for ABS. The association between childhood trauma and PTSD was fully mediated by childhood disorder in the ADF only. Taking a lifetime perspective, we have identified that the risk of PTSD from childhood trauma and disorder is potentially predictable and, therefore, modifiable.     

The Complex Trauma Inventory: A Self‐Report Measure of Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder

The work group revising the criteria for trauma‐related disorders in the International Classification of Diseases (ICD‐11) made several changes. Specifically, they simplified the criteria for posttraumatic stress disorder (PTSD) and added a new trauma disorder called complex PTSD (CPTSD). These proposed changes to taxonomy require new instruments to assess these novel constructs. We developed a measure of PTSD and CPTSD (the Complex Trauma Inventory; CTI) according to the proposed domains, creating several items to assess each domain. We examined the factor structure of the CTI in two separate samples of diverse college students (n ₁ = 391; n ₂ = 391) who reported exposure to at least one traumatic event and at least occasional functional impairment. After reducing the original 50 items in the item pool to 20 items, confirmatory factor analyses supported two highly correlated second‐order factors—PTSD and disturbances in self‐organization (DSO)—with PTSD (i.e., reexperiencing, avoidance, sense of threat) and DSO (i.e., affect dysregulation, negative self‐concept, and disturbances in relationships), each loading on three of the six ICD‐11‐consistent first‐order factors, root mean square error of approximation (RMSEA) = .056, 95% confidence interval (CI) [.048, .064], comparative fit index (CFI) = .956, Tucker‐Lewis index (TLI) = .948, standardized root mean square residual (SRMR) = .043, Bayesian information criterion (BIC) = 641.55, χ²(163) = 361.02, p < .001. Internal consistencies for PTSD and DSO were good to excellent (Cronbach's αs = .89 to .92). Supplementary analyses supported the gender invariance of the CFA model, as well as convergent and discriminant validity of the CTI. The validity of the CTI supports the distinction between CPTSD and PTSD. Moreover, the CTI will assist clinicians with diagnosis, symptom tracking, treatment planning, and assessing outcomes.     

Mindfulness,Self‐Compassion,Posttraumatic Stress Disorder Symptoms,and Functional Disability in U.S. Iraq and Afghanistan War Veterans

Mindfulness and self‐compassion are overlapping, but distinct constructs that characterize how people relate to emotional distress. Both are associated with posttraumatic stress disorder (PTSD) and may be related to functional disability. Although self‐compassion includes mindful awareness of emotional distress, it is a broader construct that also includes being kind and supportive to oneself and viewing suffering as part of the shared human experience—a potentially powerful way of dealing with distressing situations. We examined the association of mindfulness and self‐compassion with PTSD symptom severity and functional disability in 115 trauma‐exposed U.S. Iraq/Afghanistan war veterans. Mindfulness and self‐compassion were each uniquely, negatively associated with PTSD symptom severity. After accounting for mindfulness, self‐compassion accounted for unique variance in PTSD symptom severity (f² = .25; medium ES). After accounting for PTSD symptom severity, mindfulness and self‐compassion were each uniquely negatively associated with functional disability. The combined association of mindfulness and self‐compassion with disability over and above PTSD was large (f² = .41). After accounting for mindfulness, self‐compassion accounted for unique variance in disability (f² = .13; small ES). These findings suggest that interventions aimed at increasing mindfulness and self‐compassion could potentially decrease functional disability in returning veterans with PTSD symptoms.     

The Influence of Posttraumatic Stress Disorder on Health Functioning in Active‐Duty Military Service Members

Researchers have suggested that posttraumatic stress disorder (PTSD) is associated with significant healthcare burden and utilization of medical services. The purpose of this study was to examine the impact of PTSD symptoms on health functioning among active‐duty military personnel. Participants in the study were 366 treatment‐seeking service members who had returned from deployment and were participating in a larger PTSD treatment study. Assessments included measures of PTSD symptom severity, combat experiences, life stress, health functioning, alcohol use, and depression. We hypothesized that at baseline, PTSD severity and its symptom clusters would be significantly associated with poorer physical and mental health functioning. We conducted separate hierarchical multiple regressions to examine the predictive contribution the hypothesized factors would have on the variance in physical and mental health scores. Consistent with previous literature, we found that PTSD severity was significantly associated with poorer mental health functioning, B = ?0.25, SE = 0.08, β = ?0.15, t(342) = ?3.07, R² = .37, p = .002; however, contrary to our hypotheses, PTSD severity was not associated with poorer physical health functioning. Further, the hyperarousal symptom cluster was significantly associated with poorer physical health functioning, B = ?0.83, SE = 0.26, β = ?0.18, t(340) = ?3.16, R² = .11, p = .002, but not mental health functioning. Limitations of our study included the use of self‐report measures only and lack of objective measures. Future directions for study include examination of how health functioning perceptions change over a longer duration of PTSD symptoms and after treatment.     

Attachment,Personality Characteristics,and Posttraumatic Stress Disorder in U.S. Veterans of Iraq and Afghanistan

U.S. veterans of Iraq and/or Afghanistan (N = 116) completed an Internet survey with questions related to attachment style in intimate relationships, personality factors, and posttraumatic stress disorder (PTSD). Participants completed the PTSD Checklist‐Military, Experiences in Close Relationships Scale‐Short Form, and the International Personality Item Pool Big Five Short Form Questionnaire. Most participants were male and Caucasian. Hierarchical linear regression analysis results indicated that emotional stability (β = ?.46, p < .001) and attachment avoidance (β = .20, p < .05) were associated with PTSD symptom severity (adjusted R² = .63). An interaction between conscientiousness and attachment anxiety was found (β = ?.26, p < .001; ΔR² = .06), with secure attachment moderating the relationship between conscientiousness and PTSD symptom severity. Results of this study indicate that emotional stability, conscientiousness, and secure relationship attachment styles (low attachment anxiety and avoidance) are important for postcombat mental health.     

Posttraumatic Stress Disorder Symptom Clusters in Service Members Predict New‐Onset Depression Among Military Spouses

Military operations in Iraq and Afghanistan have brought increased attention to posttraumatic stress disorder (PTSD) among service members and, more recently, its impact on spouses. Existing research has demonstrated that PTSD among service members is associated with depression among military spouses. In the current study, we extended these findings by using data from service member–spouse dyads enrolled in the Millennium Cohort Family Study for which the service member had evidence of PTSD (n = 563). Prospective analyses identified the association between PTSD symptom clusters reported by the service member and new‐onset depression among military spouses. Over the 3‐year study period, 14.4% of these military spouses met the criteria for new‐onset depression. In adjusted models, service member ratings of symptoms in the effortful avoidance cluster, odds ratio (OR) = 1.61, 95% CI [1.03, 2.50], predicted an increased risk of new‐onset depression among military spouses, whereas reexperiencing symptoms, adjusted OR = 0.57; 95% CI [0.32, 1.01], were marginally protective. These findings suggest that PTSD symptom clusters in service members differentially predict new‐onset depression in military spouses, which has implications for treatment provision.     

Validation of an Electronic Medical Record–Based Algorithm for Identifying Posttraumatic Stress Disorder in U.S. Veterans

We developed an algorithm for identifying U.S. veterans with a history of posttraumatic stress disorder (PTSD), using the Department of Veterans Affairs (VA) electronic medical record (EMR) system. This work was motivated by the need to create a valid EMR‐based phenotype to identify thousands of cases and controls for a genome‐wide association study of PTSD in veterans. We used manual chart review (n = 500) as the gold standard. For both the algorithm and chart review, three classifications were possible: likely PTSD, possible PTSD, and likely not PTSD. We used Lasso regression with cross‐validation to select statistically significant predictors of PTSD from the EMR and then generate a predicted probability score of being a PTSD case for every participant in the study population (range: 0–1.00). Comparing the performance of our probabilistic approach (Lasso algorithm) to a rule‐based approach (International Classification of Diseases [ICD] algorithm), the Lasso algorithm showed modestly higher overall percent agreement with chart review than the ICD algorithm (80% vs. 75%), higher sensitivity (0.95 vs. 0.84), and higher accuracy (AUC = 0.95 vs. 0.90). We applied a 0.7 probability cut‐point to the Lasso results to determine final PTSD case‐control status for the VA population. The final algorithm had a 0.99 sensitivity, 0.99 specificity, 0.95 positive predictive value, and 1.00 negative predictive value for PTSD classification (grouping possible PTSD and likely not PTSD) as determined by chart review. This algorithm may be useful for other research and quality improvement endeavors within the VA.     

Stress‐Generative Effects of Posttraumatic Stress Disorder: Transactional Associations Between Posttraumatic Stress Disorder and Stressful Life Events in a Longitudinal Sample

Longitudinal studies have demonstrated transactional associations between psychopathology and stressful life events (SLEs), such that psychopathology predicts the occurrence of new SLEs, and SLEs in turn predict increasing symptom severity. The association between posttraumatic stress disorder (PTSD), specifically, and stress generation remains unclear. This study used temporally sequenced data from 116 veterans (87.9% male) to examine whether PTSD symptoms predicted new onset SLEs, and if these SLEs were associated with subsequent PTSD severity. The SLEs were objectively rated, using a clinician‐administered interview and consensus‐rating approach, to assess the severity, frequency, and personal dependence (i.e., if the event was due to factors that were independent of or dependent on the individual) of new‐onset SLEs. A series of mediation models were tested, and results provided evidence for moderated mediation whereby baseline PTSD severity robustly predicted personally dependent SLEs, B = 0.03, p = .006, and dependent SLEs predicted increases in follow‐up PTSD symptom severity, B = ?0.04, p = .003, among participants with relatively lower baseline PTSD severity. After we controlled for baseline PTSD severity, personality traits marked by low constraint (i.e., high impulsivity) were also associated with an increased number of dependent SLEs. Our results provide evidence for a stress‐generative role of PTSD and highlight the importance of developing interventions aimed at reducing the occurrence of personally dependent stressors.     

Patterns of Treatment Disengagement and Personality Traits Associated With Posttraumatic Stress Disorder in Recent‐Era U.S. Veterans Receiving Cognitive Processing Therapy

Low treatment engagement is a barrier to implementation of empirically supported treatments for posttraumatic stress disorder (PTSD) among veterans. Understanding personality traits that predict dropout may help focus attempts to improve engagement. The current study included 90 veterans who served in recent conflicts in Iraq and/or Afghanistan and participated in a trial of cognitive processing therapy for PTSD. Goals were to characterize (a) personality correlates of PTSD, (b) patterns of engagement (i.e., attendance and homework completion), and (c) personality correlates of reduced engagement. Higher levels of PTSD symptoms were associated with a range of characteristics, including affective lability, r = .44 p < .001; anxiety, r = .38, p < .001; identity problems, r = .57, p < .001; intimacy problems, r = .34, p = .001; low affiliation, r = .33, p = .002; oppositionality, r = .36, p = .001; restricted expression, r = .35, p = .001; and suspiciousness, r = .50, p < .001. Notably, veterans with worse PTSD symptoms endorsed more cognitive dysregulation, r = .40, p < .001; and less insecure attachment, r = .14, p = .190, than expected. Only 52.2% of veterans completed the 12‐session course of treatment and 31.0% of participants completed fewer than six sessions. Personality traits did not predict attendance or homework completion. Disengagement continues to be a significant issue in trauma‐focused treatment for veterans with PTSD. Understanding veteran‐level factors, such as personality traits, may be useful considerations for future research seeking to understand and improve engagement.     

The Influence of Depressive Symptoms on Suicidal Ideation Among U.S. Vietnam‐Era and Afghanistan/Iraq‐Era Veterans With Posttraumatic Stress Disorder

Major depressive disorder (MDD) co‐occurs frequently with posttraumatic stress disorder (PTSD), and both disorders are linked to suicidal ideation. An emergent literature examines suicidal ideation in U.S. Afghanistan/Iraq‐era veterans. Little research, however, has studied the role of PTSD and comorbid MDD on suicidal ideation across service eras. Therefore, this study aimed to examine the impact of depression on suicidal ideation in Afghanistan/Iraq‐era and Vietnam‐era veterans with PTSD. The sample included 164 Vietnam and 98 Afghanistan/Iraq veterans diagnosed with PTSD at a VA outpatient PTSD Clinic. Using structured interviews, 63% of the Vietnam sample and 45% of the Afghanistan/Iraq sample were diagnosed with comorbid current MDD. Measures included self‐report assessments of PTSD and depressive symptoms and the Personality Assessment Inventory. Results of analyses suggested that in veterans of both eras, PTSD, MDD, and their interaction were significantly related to suicidal ideation (PTSD: η² = .01; MDD: η² = .10; PTSD × MDD: η² = .02). For veterans reporting greater depressive symptoms, there was a stronger relationship between PTSD symptoms and suicidal ideation. These results suggest that veterans from both eras display a similar clinical presentation and highlight the need to consider depressive symptoms when assessing veterans with PTSD. Future research should examine suicidal ideation and behaviors as they change over time in these two cohorts.     

Screening for Posttraumatic Stress Disorder in Refugees: Comparison of the Diagnostic Efficiency of Two Self‐Rating Measures of Posttraumatic Stress Disorder

There is a high prevalence of posttraumatic stress disorder (PTSD) in the refugee population. In order to identify affected individuals and offer targeted help, there is an urgent need for easily understandable, reliable, valid, and efficient screening measures. The aim of the present study was to compare the diagnostic efficiency of the Process of Recognition and Orientation of Torture Victims in European Countries to Facilitate Care and Treatment (PROTECT) questionnaire (PQ) to that of the eight‐item short‐form Posttraumatic Diagnostic Scale (PDS‐8) and the Patient Health Questionnaire (PHQ‐9). Using structured clinical interviews, the prevalence rates of PTSD and major depression episode (MDE) were assessed in a refugee sample (N = 118), and receiver operating characteristic analyses were determined and compared. Of participants in the sample, 29.7%, 95% CI [22.0%, 38.5%], were diagnosed with PTSD and 33.1%, 95% CI [24.4%, 41.9%], were diagnosed with MDE. The area under the curve (AUC) for all measures was moderate, AUCs = 0.79–0.86; hence, measures did not differ in terms of their discriminatory abilities. Using the favored cutoff points, sensitivity and specificity were 80–97% and 60–70%, respectively. In terms of their discriminatory abilities, none of the investigated measures can be favored more than the others. Thus, for detection of these two disorders, the shorter PQ could be more efficient. Because the high co‐occurrence of PTSD and MDE might limit the explanatory power of results in the present study, the findings should be cross‐validated in the future.