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.     

Unresolved grief in combat veterans with PTSD

Clinicians have documented the importance of loss of comrades during combat as a significant source of distress. However, empirical studies have not focused on unresolved grief as a possible outcome of combat experiences. Consequently, unresolved grief has often been treated "after the fact" in the context of treating PTSD and depressive symptoms. In this study, we therefore, sought to demonstrate the prominence of combat-related grief-specific symptoms in a sample of Vietnam veterans being treated for PTSD. Our results indicated that indeed this sample of veterans reported high levels of grief-specific symptoms comparable to that found in bereaved individuals whose spouse had recently died, verifying its prominence as an important component of combat-related stress. Furthermore, grief severity was uniquely associated with losses of comrades during combat whereas no such relationship was shown for trauma or depressive symptoms. The latter finding suggested that in fact higher levels of grief stemmed from interpersonal losses during the war and was not simply an artifact of current general distress level.     

Personality and PTSD II: Personality assessment of PTSD-diagnosed Vietnam veterans using the Cloninger Tridimensional Personality Questionnaire (TPQ)

Examined Tridimensional Personality Questionnaire (TPQ) responses of 53 Vietnam veterans with Combat-Related Posttraumatic stress disorder. When compared with normative data, veterans were found to be high on harm avoidance (HA), low on reward dependence (RD), and high on novelty seeking (NS). High HA and high NS scores were predictive of increased PTSD symptom severity as assessed by the MMPI-2 PK (PTSD)scale, Mississippi Combat Scale for PTSD (M-PTSD), and Beck Depression Inventory (BDI). Low RD was associated with higher scores on both the MMPI-2 PK and M-PTSD scales. The observed “high HA-low RD-high NS” TPQ configuration is consistent with previous research findings/clinical observations, and provides insights into a pattern of dysfunctional personality traits often observed in this population. Depression and Anxiety 6:70–77, 1997. © 1997 Wiley-Liss, Inc.     

Rorschach patterns of response in Vietnam veterans with posttraumatic stress disorder versus combat and normal controls

To further evaluate Rorschach indicators of posttraumatic stress disorder (PTSD), test protocols of 16 combat veterans so diagnosed were compared with those of 9 combat controls and 12 noncombat subjects. Results replicated Rorschach abnormalities previously associated with this disorder, including signs of low stress tolerance, poor affect modulation, perceptual distortion, and interpersonal disengagement. However, only two indicators, EB (Erlebnistypus) and CC (combat-related content), differentiated PTSD subjects from controls (P < .05). Examination of negative findings revealed that all three groups similarly deviated from Exner nonpatient norms (Exner, 1993: The Rorschach, Vol 1. New York: John Wiley and Sons) on many Rorschach variables. Possible explanations for these findings are considered, and the need for control subjects in Rorschach investigation is underscored. Depression and Anxiety 8:104–111, 1998. © 1998 Wiley-Liss, Inc.     

The impact of posttraumatic stress disorder on partners and children of Australian Vietnam veterans

OBJECTIVE: This study explored the emotional and physical health of a group of families of Australian Vietnam veterans suffering posttraumatic stress disorder (PTSD). The aim was to study the impact of PTSD upon the families of the sufferers. METHOD: The families of a random sample of Vietnam veterans receiving treatment at a specialist PTSD Unit were invited to participate in this study. Partners of the veterans and children over the age of 15 years were eligible to participate. Four self-report psychometric inventories were administered assessing psychological distress, social climate within their families, self-esteem, and a range of lifestyle issues, including physical health. A control group, consisting of a sample of volunteers, was also surveyed. RESULTS: The partners of the Vietnam veterans showed significantly higher levels of somatic symptoms, anxiety and insomnia, social dysfunction and depression than the control group. They reported significantly less cohesion and expressiveness in their families and significantly higher levels of conflict. The partners also had significantly lower levels of self-esteem. The children of the veterans reported significantly higher levels of conflict in their families. However, the children showed no significant differences on measures of psychological distress and self-esteem from their matched counterparts. CONCLUSIONS: These findings support overseas studies that indicate that the families of PTSD sufferers are also impacted by the disorder. In this study, the families of Australian Vietnam veterans experienced more conflict and their partners were significantly more psychologically distressed (i.e. somatic symptoms, anxiety, insomnia, social dysfunction, depression and low self-esteem) than a matched control group.     

Suicide in Vietnam Veterans: The Suicide Wall

ABSTRACT

Although official data have reported an average number of suicides in the veterans of the Vietnam War, the veterans themselves estimate that the death toll from suicide may be 8 to 10 times the official toll. Attention is drawn to a website honoring those veterans of the war who have committed suicide: www.suicidewall.com     

Review of assessment and treatment of PTSD among elderly American armed forces veterans

BACKGROUND: The number of elderly combat veterans is steadily increasing in the US and estimates project that a notable percentage of these veterans experience symptoms of posttraumatic stress disorder (PTSD). Limited data exist specifically related to prevalence, assessment, and treatment of PTSD among the elderly veteran population. OBJECTIVE: This review summarizes the available research related to difficulties in assessment with the elderly American Armed Forces veteran population. In addition, both psychotherapeutic and pharmacological treatment interventions for PTSD are discussed. METHODS: A literature search was conducted using PsycINFO, Medline, and the National Center for PTSD's PILOTS database. RESULTS: Evidence suggests that elderly veterans generally present more somatic symptoms of PTSD. Medical and psychological comorbidities, such as depression, substance abuse, or cognitive deficits can further complicate the assessment process. Cut-scores for existing instruments need to be further established with elderly veterans. Use of exposure therapies with the elderly has not been adequately researched and mixed results have been obtained for supportive therapy for treatment of PTSD. Controlled research investigating pharmacological interventions for PTSD with the elderly is also limited. CONCLUSION: Evidence suggests that some psychotherapeutic and pharmacological interventions already utilized with younger individuals may be useful with the elderly veteran population. However, research indicates that modifications may be required for working with the elderly population and further research in the areas of assessment and treatment are necessary.     

Chronic posttraumatic stress disorder and family functioning of Vietnam veterans and their partners

OBJECTIVE: This study examines the association between posttraumatic stress disorder (PTSD), in terms of the three main symptom clusters (intrusion, avoidance and arousal), and the self-report of family functioning of Vietnam veterans and the self-report of family functioning of their partners. A second objective was to determine if depression, anger and alcohol abuse mediated between PTSD symptoms and family functioning. METHOD: Vietnam veterans and their partners completed a series of questionnaires as part of their participation in the inpatient and outpatient PTSD treatment program, in the Veterans Psychiatry Unit, at the Austin and Repatriation Hospital. RESULTS: Data from 270 veterans and partners were used in the final analyses. The PTSD subscales were initially correlated with family functioning for veterans and family functioning for partners. Then two path diagrams were constructed and analyzed using the statistical program AMOS to test for mediating effects between PTSD symptoms and family functioning. For veterans there were significant initial correlations with all three subscales of the PTSD measure. In the path analysis when the mediating variables were included only the avoidance subscale of the PTSD measure remained directly associated with family functioning. The arousal PTSD subscale was mediated by anger. The measures of depression and anger were significantly associated with poor family functioning and the anger and the avoidance subscales were significantly associated with depression. In the second set of analyses conducted on data from partners, the PTSD symptoms of avoidance and arousal were initially correlated with family functioning. When the test for mediation was conducted none of the PTSD subscales remained associated with partners' self-report of family functioning. Posttraumatic stress disorder arousal and alcohol abuse were mediated by anger for partners' self-report of family functioning. CONCLUSIONS: Posttraumatic stress disorder symptoms of avoidance for veterans, and comorbid symptoms of anger and depression for veterans, and anger on its own for partners appear to be important in the self-report of family functioning. These findings suggest that veterans and their partners have similar difficulties as couples with distressed relationships in the community.     

Racial differences in psychotic symptoms among combat veterans with PTSD

We tested the hypothesis that race may influence clinical presentation and symptomatology in combat veterans with posttraumatic stress disorder (PTSD). African-American and Caucasian veterans were administered the Psychotic Screen Module of the Structured Clinical Interview for DSM, Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and other psychometric measures at a Veterans Affairs outpatient PTSD clinic. Subjects were consecutive referrals who were not matched for level of combat trauma or preexisting trauma; however, there were no group differences in other relevant demographic or diagnostic variables. Significant racial differences, with modest effect sizes, were found on clinician ratings of psychotic symptoms, MMPI-2 scale 6 ("paranoia"), and a measure of dissociation. No significant differences were found for the MMPI-2 scale 8 ("schizophrenia"), or on measures that might suggest comorbid depression or anxiety. African-Americans with PTSD endorsed more items suggesting positive symptoms of psychosis, without higher rates of primary psychosis, depression, or anxiety than Caucasians.     

Disruption of bradycardia associated with discriminative conditioning in combat veterans with PTSD

The effects of combat-related posttraumatic stress disorder (PTSD) on heart rate (HR) responding associated with a discriminative delay eyeblink (EB) conditioning paradigm are reported. Combat PTSD+, Combat PTSD-, and Noncombat PTSD- veterans were assessed with psychometric self-report measures, and baseline heart rate variability (HRV) was measured before receiving a 72-trial session of discriminative EB classical conditioning. Two types (red or green light) of conditioned stimuli (CS) were used: one (CS+) predicted a tone, followed immediately by an aversive stimulus (corneal airpuff); the other (CS-) predicted a tone alone, not followed by the airpuff. The light signal was presented for 5 seconds, during which HR was measured. On all psychometric measures, the PTSD+ subgroup was significantly different from the PTSD- subgroups (Combat + Noncombat), and the PTSD- subgroups did not significantly differ from each other. A linear deceleration in HR to CS+ and CS- signals was found in the combined PTSD- subgroup and on CS- trials in the PTSD+ subgroup, but was not present on CS+ trials in the PTSD+ subgroup. Results are interpreted with respect to a behavioral stages model of conditioned bradycardia and in terms of neural substrates which are both critical to HR conditioning and known to be abnormal in PTSD.     

Sexuality in individuals with traumatic brain injury and their partners

Whilst previous research has detailed the impact of TBI on an individual’s sexuality, few studies have investigated couples’ sexuality where one partner has sustained a TBI. The study assessed sexual function in individuals with TBI and their partners. Fifty five individuals who had sustained TBI and their partners completed the Derogatis Interview for Sexual Function—Self Report (DISF-SR). All participants scored below the 50th percentile in relation to norms. Whilst participants with TBI obtained lower T-scores than partners on all subscales (except for sexual behaviour/experiences where scores were equivalent), as well as the total score, none of these differences was significant. Item analysis indicated that female participants with TBI reported significantly lower scores than female partners on frequency of having normal lubrication. Normative comparisons revealed that approximately one-third of individuals with TBI and one-fifth of their partners scored below the second percentile. Given the high frequency of sexual problems in individuals with TBI, which also impact their partners, addressing sexual problems should be a priority in rehabilitation and beyond.     

Subsyndromal posttraumatic stress disorder is associated with health and psychosocial difficulties in veterans of Operations Enduring Freedom and Iraqi Freedom

Background: This study examined health and psychosocial correlates of subsyndromal/partial posttraumatic stress disorder (PTSD) and full PTSD in veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). Methods: Five hundred and fifty‐seven OEF/OIF veterans in Connecticut completed measures of PTSD and health and psychosocial functioning. Results: A total 22.3% of the sample met screening criteria for partial PTSD and 21.5% for full PTSD. Veterans with partial PTSD reported an intermediate level of impairment (e.g., health ratings, work problems, relationship problems) relative to veterans without PTSD and veterans with full PTSD. Conclusions: These results suggest that subsyndromal/partial PTSD is associated with significant health and psychosocial difficulties and underscore the importance of assessing for partial PTSD in OEF/OIF veterans. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Memories of Vietnam: post-traumatic stress disorders in Australian veterans

We compared a random sample of Australian Vietnam veteran inpatients suffering from Post Traumatic Stress Disorder (PTSD) (N = 13) with veteran inpatients with other neurotic diagnoses. Those with PTSD had experienced substantially higher levels of combat stress, were more likely to have manifested conduct disorder in childhood, and had poorer work adjustment. Only three had been diagnosed as having traumatic or war neuroses by their original treating psychiatrist in the Veterans Affairs Department. Post traumatic stress disorder (or war neurosis) has possibly been under-diagnosed by treating psychiatrists in the Veterans Affairs Department, especially in the pre-DSM-III era.     

Changes in brain anatomy during the course of posttraumatic stress disorder

The goal of this study was to determine whether posttraumatic stress disorder (PTSD) was associated with an increase in time-related decline in macrostructural brain volume and whether these changes were associated with accelerated cognitive decline. To quantify brain structure, three-dimensional T1−weighted MRI scans were performed at baseline and again after a minimum of 24 months in 25 patients with PTSD (PTSD+) and 22 controls (PTSD−). Longitudinal changes in brain volume were measured using deformation morphometry. For the group as a whole, PTSD+ patients did not show significant ongoing brain atrophy compared to PTSD−. PTSD+ patients were then subgrouped into those with decreasing or increasing symptoms. We found little evidence for brain markers of accelerated atrophy in PTSD+ veterans whose symptoms improved over time, with only a small left parietal region showing greater ongoing tissue loss than PTSD−. PTSD patients whose symptoms increased over time showed accelerated atrophy throughout the brain, particularly brainstem and frontal and temporal lobes. Lastly, for the sample as a whole, greater rates of brain atrophy were associated with greater rates of decline in verbal memory and delayed facial recognition.     

Suicidality among older male veterans in the United States: Results from the National Health and Resilience in Veterans Study

Older men have a higher rate of suicide than the general population, but little is known about the prevalence and correlates of suicidality among older male veterans. In this study, we evaluated the prevalence, and risk and protective factors associated with current suicidal ideation (SI) and past suicide attempt (SA) in a contemporary, nationally representative sample of older male veterans. We analyzed data from 1962 male veterans aged 60 or older who participated in the National Health and Resilience Veterans Survey (NHRVS) between October and December 2011. Bivariate analyses and multivariate logistic regression were used to evaluate risk and protective factors associated with current SI and past SA in the full sample, and separately among combat and non-combat veterans. Six percent of the sample reported past 2-week SI, and combat veterans were more likely to contemplate suicide (9.2%) than non-combat (4.0%) veterans. Lifetime SA was reported by 2.6% of respondents. Major depression and physical health difficulties were the strongest risk factors for SI in combat veterans, while generalized anxiety disorder (GAD) was the strongest risk factor for SI in non-combat veterans. Posttraumatic stress disorder (PTSD) was independently associated with SI in both groups of veterans, and social connectedness was negatively related to SI in both groups. These results suggest that a significant proportion of older male veterans in the United States contemplates suicide, with higher rates of SI among combat than non-combat veterans. Interventions designed to mitigate psychological distress and physical difficulties, and to promote social connectedness may help mitigate suicidality risk in this population.     

The incidence of epilepsy in a rural district of Vietnam: A community‐based epidemiologic study

Purpose: Epidemiologic studies of epilepsy from developing countries are scarce. As part of a population‐based epidemiologic project in Vietnam, EPIBAVI, we studied the incidence and etiology of epilepsy in people in a representative rural region of the country. Methods: Two identical field surveys were carried out 3 years apart (January to December 2005, and June to December 2008) in the same population of the Bavi District in Vietnam. On both occasions, close to 50,000 members of approximately 13,000 households were screened using a questionnaire for epilepsy. A clinical examination of all screened positive was performed by a neurologist to verify the epilepsy diagnosis, and all incident cases were offered EEG and a CT scan. Results: In the first survey 2.8% screened positive according to the questionnaire. Of these, 19 had epilepsy onset within 1 year preceding the screening, yielding an incidence rate of 40.2 per 100,000 [95% confidence interval (CI) 22.1–58.3]. In the second survey 1.8% were screened positive, and 21 of these had epilepsy onset within 1 year preceding the screening, giving an incidence rate of 42.9 per 100,000 (95% CI 24.5–61.2). The age‐adjusted incidence was 44.8 per 100,000 (95% CI 30.6–59.0). The incidence was higher in those younger than 16 years, among people with lower education, and among people with lower income. CT scan was performed in 29 cases and only two cases were found with some abnormalities. Discussion: The incidence rate of epilepsy in rural Vietnam in our study was lower than in developing countries in Latin America and Africa and similar to rates in Europe and North America.