Posttraumatic stress disorder and quality of life: Extension of findings to veterans of the wars in Iraq and Afghanistan

National Center for PTSD, Executive Division, United States.
Clinical psychology review (Impact Factor: 7.18). 09/2009; 29(8):727-35. DOI: 10.1016/j.cpr.2009.08.006
Source: PubMed


The wars in Iraq and Afghanistan-Operation Iraqi Freedom and Operation Enduring Freedom, or OEF/OIF-have created unique conditions for promoting the development of psychological difficulties such as posttraumatic stress disorder (PTSD). PTSD is an important outcome because it can affect quality of life, impairing psychosocial and occupational functioning and overall well-being. The literature on PTSD and quality of life in OEF/OIF Veterans is at an early stage, but the consistency of the evidence is striking. Our review indicates that the findings on PTSD and quality of life in OEF/OIF veterans are comparable to findings obtained from other war cohorts and from nonveterans as well. Even though the duration of PTSD in OEF/OIF Veterans is much shorter than in Vietnam Veterans, for example, those with PTSD in both cohorts are likely to experience poorer functioning and lower objective living conditions and satisfaction. The review ends with discussion of the implications of the evidence for research and clinical practice.

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    • "mptoms , hazardous drinking , and relationship stress , which persist for at least 9 months after returning home ( Cigrang et al . , 2014 ) . PTSD symptoms resulting from combat - related events can impair quality of life and functional status ( e . g . , degree of disability across domains of health and behav - ior ) among service members ( SMs ; Schnurr et al . , 2009 ) , includ - ing those who are subthreshold , or lacking a sufficient num - ber or distribution of symptoms to meet full criteria for PTSD ( Magruder et al . , 2004 ; Grubaugh et al . , 2005 ; Cukor et al . , 2010 ) . PTSD symptom clusters include re - experiencing ( e . g . , intru - sive memories and bad dreams ) , avoidance ( e . g ."
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    ABSTRACT: Posttraumatic stress disorder (PTSD) symptoms can result in functional impairment among service members (SMs), even in those without a clinical diagnosis. The variability in outcomes may be related to underlying catecholamine mechanisms. Individuals with PTSD tend to have elevated basal catecholamine levels, though less is known regarding catecholamine responses to trauma-related stimuli. We assessed whether catecholamine responses to a virtual combat environment impact the relationship between PTSD symptom clusters and elements of functioning. Eighty-seven clinically healthy SMs, within 2 months after deployment to Iraq or Afghanistan, completed self-report measures, viewed virtual-reality (VR) combat sequences, and had sequential blood draws. Norepinephrine responses to VR combat exposure moderated the relationship between avoidance symptoms and scales of functioning including physical functioning, physical-role functioning, and vitality. Among those with high levels of avoidance, norepinephrine change was inversely associated with functional status, whereas a positive correlation was observed for those with low levels of avoidance. Our findings represent a novel use of a virtual environment to display combat-related stimuli to returning SMs to elucidate mind-body connections inherent in their responses. The insight gained improves our understanding of post-deployment symptoms and quality of life in SMs and may facilitate enhancements in treatment. Further research is needed to validate these findings in other populations and to define the implications for treatment effectiveness.
    Frontiers in Psychology 04/2015; 6. DOI:10.3389/fpsyg.2015.00256 · 2.80 Impact Factor
    • "life after military service. Disability in occupational functioning , social functioning, and quality of life has been related to psychiatric symptoms in returning veterans (Erbes, Kaler, Schult, Polusny, & Arbisi, 2011; Pietrzak, Goldstein, Malley, Johnson, & Southwick, 2009; Pittman, Goldsmith, Lemmer, Kilmer, & Baker, 2012; Schnurr, Lunney, Bovin, & Marx, 2009). This cohort of veterans could potentially have many years of productive contribution to society ahead, or in some cases, significant, costly disability. "
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    ABSTRACT: Understanding the factors that influence veterans' functional outcome after deployment is critical to provide appropriately targeted care. Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) have been related to disability, but other psychiatric and behavioral conditions are not as well examined. We investigated the impact of deployment-related psychiatric and behavioral conditions on disability among 255 OEF/OIF/OND service members and veterans. Structured clinical interviews assessed TBI and the psychiatric conditions of depression, PTSD, anxiety, and substance use. Self-report questionnaires assessed disability and the behavioral conditions of sleep disturbance and pain. Over 90% of participants had a psychiatric and/or behavioral condition, with approximately half presenting with ≥ 3 conditions. Exploratory factor analysis revealed 4 clinically relevant psychiatric and behavioral factors which accounted for 76.9% of the variance: (a) depression, PTSD, and military mTBI (deployment trauma factor); (b) pain and sleep (somatic factor); (c) anxiety disorders, other than PTSD (anxiety factor); and (d) substance abuse or dependence (substance use factor). Individuals with the conditions comprising the deployment trauma factor were more likely to be substantially disabled than individuals with depression and PTSD, but no military mTBI, OR = 3.52; 95% CI [1.09, 11.37]. Depression, PTSD, and a history of military mTBI may comprise an especially harmful combination associated with high risk for substantial disability. Published 2015. This article is a US Government work and is in the public domain in the USA.
    Journal of Traumatic Stress 02/2015; 28(1). DOI:10.1002/jts.21979 · 2.72 Impact Factor
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    • "Available evidence indicates that PTSD can severely impact on a person's health-related quality of life (HRQOL), impairing psychosocial and occupational functioning and compromising overall well-being [4] [5] [6]. Data from 11 multicenter trials revealed that as much as 59% of the PTSD patients reported severe impairment in their HRQOL; in contrast, comparable figures for other anxiety disorders, such as panic disorder, obsessive compulsive disorder, and social phobia (20%, 26%, and 21%, respectively) [7], were considerably lower. "
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    ABSTRACT: There is a dearth of literature dealing with the impact of the severity of posttraumatic symptoms and of comorbid mental disorders on the health-related quality of life (HRQOL) of victims of civilian violence with a primary diagnosis of PTSD. To investigate the influence of the severity of posttraumatic symptoms and of presence of comorbid mental disorders on the HRQOL of treatment-seeking outpatients with PTSD. A sample of 65 PTSD patients was recruited in a specialized outpatient clinic. The volunteers had the diagnoses of PTSD and of comorbid mental disorders established with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). The severity of posttraumatic, depression and anxiety symptoms was measured with the PCL-C, BDI and BAI, respectively. HRQOL was assessed by means of the SF-36, a 36-item self-administered scale that measures eight domains of quality of life: vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, and mental health. Multiple linear regression models were fitted to investigate the relationship between the severity of posttraumatic, mood, and anxiety symptoms; the presence of specific current comorbid disorders and of psychotic symptoms, and the number of current comorbid conditions for each of the eight domains of HRQOL, after adjusting for the effect of sociodemographic characteristics. The severity of PTSD symptoms predicted worse HRQOL in all eight domains of SF-36, even after controlling for the severity of depression and anxiety symptoms, the presence of panic disorder, OCD, specific and social phobia, psychotic symptoms, and the number of comorbid disorders. The strongest negative association between PTSD symptoms severity and HRQOL was found in the Social Functioning domain. Although the inclusion of the depressive symptoms in the models led to a reduction of the magnitude of the negative association between the severity of PTSD symptoms and the HRQOL domain scores, the former still accounted for most of the explained variance of the latter. We found that even in the presence of comorbid mental disorders, the severity of posttraumatic symptoms remained the strongest predictor for impaired HRQOL in PTSD outpatients. Our results suggest that improvement of HRQOL should be considered a therapeutic objective and an essential outcome measure in the treatment of PTSD. Copyright © 2015 Elsevier Inc. All rights reserved.
    Comprehensive Psychiatry 01/2015; 58. DOI:10.1016/j.comppsych.2015.01.002 · 2.25 Impact Factor
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