Posttraumatic Stress Disorder Associated With Combat Service in Iraq or Afghanistan

Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.
The Journal of nervous and mental disease (Impact Factor: 1.69). 05/2012; 200(5):444-50. DOI: 10.1097/NMD.0b013e3182532312
Source: PubMed


Studies of posttraumatic stress disorder (PTSD) prevalence associated with deployment to Iraq or Afghanistan report wide variability, making interpretation and projection for research and public health purposes difficult. This article placed this literature within a military context. Studies were categorized according to deployment time-frame, screening case definition, and study group (operational infantry units exposed to direct combat versus population samples with a high proportion of support personnel). Precision weighted averages were calculated using a fixed-effects meta-analysis. Using a specific case definition, the weighted postdeployment PTSD prevalence was 5.5% (95% CI, 5.4-5.6) in population samples and 13.2% (12.8-13.7) in operational infantry units. Both population-level and unit-specific studies provided valuable and unique information for public health purposes; understanding the military context is essential for interpreting prevalence studies.

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    • "Several systematic reviews have highlighted the wide variation in PTSD prevalence estimates and examined methodological factors contributing these disparate findings (Griffith, 2010; Kok, Herrell, Thomas, & Hoge, 2012; Ramchand et al., 2010). Three meta-analyses have examined differences in PTSD prevalence estimates between active duty and NG/R components (Cohen, Fink, Sampson, & Galea, 2015; Hines, Sundin, Rona, Wessely, & Fear, 2014; Sundin, Fear, Iversen, Rona, & Wessely, 2010). "
    Comprehensive Guide to Post-Traumatic Stress Disorder, Edited by C Martin, V Preedy, V Patel, 12/2015; Springer.
    • "The estimated prevalence of post-traumatic stress disorder (PTSD) in veterans deployed to Afghanistan and Iraq since 2000 has ranged from 2 to 26% (Hoge et al. 2006; Hotopf et al. 2006; Smith et al. 2008b; Thomas et al. 2010; Davy et al. 2012; Dobson et al. 2012; Kok et al. 2012; Elbogen et al. 2014). While a number of studies have shown that events over the life cycle (including adversity in childhood and deployment stressors), are associated with increased rates of PTSD (Brailey et al. 2007; Phillips et al. 2010; Horesh et al. 2011; Jones et al. 2013), fewer studies have focused on the underlying events associated with PTSD diagnoses or the time taken for PTSD symptoms to appear and subside after traumatic events. "
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    ABSTRACT: Understanding the time-course of post-traumatic stress disorder (PTSD), and the underlying events, may help to identify those most at risk, and anticipate the number of individuals likely to be diagnosed after exposure to traumatic events. Data from two health surveys were combined to create a cohort of 1119 Australian military personnel who deployed to the Middle East between 2000 and 2009. Changes in PTSD Checklist Civilian Version (PCL-C) scores and the reporting of stressful events between the two self-reported surveys were assessed. Logistic regression was used to examine the association between the number of stressful events reported and PTSD symptoms, and assess whether those who reported new stressful events between the two surveys, were also more likely to report older events. We also assessed, using linear regression, whether higher scores on the Kessler Psychological Distress Scale or the Alcohol Use Disorder Identification Test were associated with subsequent increases in the PCL-C in those who had experienced a stressful event, but who initially had few PTSD symptoms. Overall, the mean PCL-C scores in the two surveys were similar, and 78% of responders stayed in the same PCL-C category. Only a small percentage moved from having few symptoms of PTSD (PCL-C < 30) in Survey 1 to meeting the criteria for PTSD (PCL-C ≥ 50) at Survey 2 (1% of all responders, 16% of those with PCL-C ≥ 50 at Survey 2). Personnel who reported more stressful lifetime events were more likely to score higher on the PCL-C. Only 51% reported the same stressful event on both surveys. People who reported events occurring between the two surveys were more likely to record events from before the first survey which they had not previously mentioned (OR 1.48, 95% CI (1.17, 1.88), p < 0.001), than those who did not. In people who initially had few PTSD symptoms, a higher level of psychological distress, was significantly associated with higher PCL-C scores a few years later. The reporting of stressful events varied over time indicating that while the impact of some stressors endure, others may increase or decline in importance. When screening for PTSD, it is important to consider both traumatic experiences on deployment and other stressful life events, as well as other mental health problems among military personnel, even if individuals do not exhibit symptoms of PTSD on an initial assessment.
    Epidemiology and Psychiatric Sciences 06/2015; -1:1-10. DOI:10.1017/S2045796015000517 · 3.91 Impact Factor
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    • "British studies are confidential but not anonymous, in order to enable records to be linked and followed up. By contrast the core US Land Combat Studies of Hoge and colleagues are genuinely anonymous (Kok, Herrell, Thomas, & Hoge, 2012). Sundin et al. performed a meta-analysis of 19 population-based studies of PTSD after deployment to Iraq (Sundin, Fear, Iversen, et al., 2010). "
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    ABSTRACT: A substantial amount of research has been conducted into the mental health of the UK military in recent years. This article summarises the results of the various studies and offers possible explanations for differences in findings between the UK and other allied nations. Post-traumatic stress disorder (PTSD) rates are perhaps surprisingly low amongst British forces, with prevalence rates of around 4% in personnel who have deployed, rising to 6% in combat troops, despite the high tempo of operations in recent years. The rates in personnel currently on operations are consistently lower than these. Explanations for the lower PTSD prevalence in British troops include variations in combat exposures, demographic differences, higher leader to enlisted soldier ratios, shorter operational tour lengths and differences in access to long-term health care between countries. Delayed-onset PTSD was recently found to be more common than previously supposed, accounting for nearly half of all PTSD cases; however, many of these had sub-syndromal PTSD predating the onset of the full disorder. Rates of common mental health disorders in UK troops are similar or higher to those of the general population, and overall operational deployments are not associated with an increase in mental health problems in UK regular forces. However, there does appear to be a correlation between both deployment and increased alcohol misuse and post-deployment violence in combat troops. Unlike for regular forces, there is an overall association between deployment and mental health problems in Reservists. There have been growing concerns regarding mild traumatic brain injury, though this appears to be low in British troops with an overall prevalence of 4.4% in comparison with 15% in the US military. The current strategies for detection and treatment of mental health problems in British forces are also described. The stance of the UK military is that psychological welfare of troops is primarily a chain of command responsibility, aided by medical advice when necessary, and to this end uses third location decompression, stress briefings, and Trauma Risk Management approaches. Outpatient treatment is provided by Field Mental Health Teams and military Departments of Community Mental Health, whilst inpatient care is given in specific NHS hospitals.
    European Journal of Psychotraumatology 08/2014; 5. DOI:10.3402/ejpt.v5.23617 · 2.40 Impact Factor
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