Comorbidity of PTSD and depression in Korean War veterans: Prevalence, predictors, and impairment

Monash Centre for Occupational and Environmental Health, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
Journal of Affective Disorders (Impact Factor: 3.38). 09/2010; 125(1-3):279-86. DOI: 10.1016/j.jad.2009.12.005
Source: PubMed


Rates of PTSD and depression are high in Korean War veterans. The prevalence and impact of the two disorders occurring comorbidly, however, has not been investigated. This paper aims to investigate the extent to which PTSD and depression co-occur in Australian veterans of the Korean War, the symptom severity characteristics of comorbidity, the impact on life satisfaction and quality, and the association with war-related predictors.
Veterans (N=5352) completed self-report questionnaires including the Posttraumatic Stress Disorder Checklist, the Hospital Anxiety and Depression Scale, the Life Satisfaction Scale, the brief World Health Organisation Quality of Life questionnaire and the Combat Exposure Scale.
Seventeen percent of veterans met criteria for comorbid PTSD and depression, 15% had PTSD without depression, and a further 6% had depression without PTSD. Compared with either disorder alone, comorbidity was associated with impaired life satisfaction, reduced quality of life, and greater symptom severity. Several war-related factors were associated with comorbidity and with PTSD alone, but not with depression alone.
The reliance on self-reported measures and the necessity for retrospective assessment of some deployment-related factors renders some study data vulnerable to recall bias.
Comorbid PTSD and depression, and PTSD alone, are prevalent among Korean War veterans, are both associated with war-related factors 50 years after the Korean War, and may represent a single traumatic stress construct. The results have important implications for understanding complex psychopathology following trauma.

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    • "The development and predictors of combat-related mental health issues, such as depression, are a key area of concern for defence and veterans' organisations. Mental health problems can have a substantial impact on combat readiness, service retention and health care requirements for serving personnel, as well as contributing to long-term disability after military careers have ended (Creamer et al., 2006; Hoge et al., 2005; Ikin et al., 2010). Most research and treatment in the field of combat-related psychiatric illness has focussed on posttraumatic stress disorder (PTSD), however there are a number of arguments for why combat-related depression warrants increased attention. "
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    ABSTRACT: Background: Risk of major depression (depression) was elevated in Australia's Gulf War veterans in a 2000-2002 (baseline) study. A follow up study has measured the Gulf War-related risk factors for depression, also the current prevalence and severity of depression, use of anti-depressant medication, and persistence, remittance or incidence of depression since baseline in Gulf War veterans and a military comparison group. Methods: Participants completed the Composite International Diagnostic Interview v.2.1, the 9-item Patient Health Questionnaire and the Military Service Experience Questionnaire, and consented to Repatriation Pharmaceutical Benefits Scheme (RPBS) and PBS linkage. Results: Prevalence of depression (9.7% Gulf War veterans and 7.7% comparison group; adj RR=1.2, 95% CI 0.8-1.7), and pattern of persistence, remittance and incidence of depression since baseline, were similar in the two groups, however veterans reported slightly more severe symptoms (adj median difference 1, 95% CI 0.26-1.74) and were more likely to have been dispensed anti-depressant medication (adj RR=1.56, 95% CI 1.05-2.32). Depression amongst veterans was associated with self-reported Gulf War-related stressors in a dose-response relationship (adj RR 1.06, 95% CI 1.02-1.09). Limitations: Lower participation rates at follow up resulted in reduced statistical power compared with baseline, Gulf War related stressor data collected at baseline was at risk of recall bias, and RPBS and PBS databases do not capture all dispensed Nervous System medications. Conclusions: More than 20 years after the Gulf War, veterans are experiencing slightly more severe depressive symptoms than a military comparison group, and depression continues to be associated with Gulf War-related stressors.
    Journal of Affective Disorders 09/2015; 189:77-84. DOI:10.1016/j.jad.2015.09.016 · 3.38 Impact Factor
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    • "According to a meta-analysis of 57 studies (N ¼ 6670) estimating the mean rate of MDD co-occurrence among PTSD samples, over half of individuals with PTSD (52%) had comorbid MDD (Rytwinski et al., 2013), which is corresponding to the rate of comorbidity between PTSD and MDD (48–55%) found in national epidemiological surveys (Elhai et al., 2008; Kessler et al., 1995). Meanwhile, co-occurring PTSD and MDD is generally associated with greater distress , impairment, and health care utilization than PTSD alone (Chan et al., 2009; Ikin et al., 2010; Momartin et al., 2004). Thus, given the high prevalence and serious clinical consequences of PTSD-MDD comorbidity, a better understanding of the relationship between PTSD and depression constructs is desperately needed. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) and depression are highly comorbid in association with serious clinical consequences. Nevertheless, to date, no study using latent class or latent profile analysis (LCA/LPA) has examined patterns of co-occurring PTSD and depression symptoms among natural disaster survivors, nor has the distinctiveness of DSM-5 PTSD and depression symptoms been clarified in the aftermath of trauma. This study was primarily aimed at filling these gaps. LPA was used to examine self-reported PTSD and depression symptoms in an epidemiological sample of 1196 Chinese earthquake survivors. A 4-class solution characterized by low symptoms (53.9%), predominantly depression (18.2%), predominantly PTSD (18.9%) and combined PTSD-depression (9.0%) patterns fit the data best. Demographic characteristics and earthquake-related exposures were specifically or consistently associated with the non-parallel profiles varying in physical health impairment. A sample exposed to specific traumatic events was assessed by self-report measures. The distinctiveness of DSM-5 PTSD and depression symptoms following an earthquake suggests that PTSD and depression may be independent sequelae of psychological trauma rather than a manifestation of a single form of psychopathology. The current findings support the distinction between PTSD and depression constructs, and highlight the need for identifications of natural disaster survivors at high risk for PTSD and/or depression, and interventions individually tailored to one's symptom presentations. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 07/2015; 186:58-65. DOI:10.1016/j.jad.2015.06.058 · 3.38 Impact Factor
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    • "Genes have been identified that are common to both disorders (Koenen et al., 2008; Lawford et al., 2006). Co-occurrence of these two disorders is associated with diminished quality of life, reduced life satisfaction and increased severity of PTSD symptomatology (Ikin et al., 2010). Suicidal behaviour is more common in individuals suffering both disorders compared to those with depressive disorder alone (Oquendo et al., 2003). "
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    ABSTRACT: BACKGROUND: Posttraumatic stress disorder (PTSD) and depressive disorder are over represented in combat veterans. Veterans with both disorders have an increased risk of suicide. The nitric oxide synthase 1 adaptor protein (NOS1AP) gene, which modulates stress-evoked N-methyl-d-aspartate (NMDA) activity, was investigated in combat veterans. METHODS: A comprehensive genetic analysis of NOS1AP and its association with PTSD was investigated in Vietnam combat veterans with PTSD (n=121) and a group of healthy control individuals (n=237). PTSD patients were assessed for symptom severity and level of depression using the Mississippi Scale for Combat-Related PTSD and the Beck Depression Inventory-II (BDI). RESULTS: The G allele of NOS1AP SNP rs386231 was significantly associated with PTSD (p=0.002). Analysis of variance revealed significant differences in BDI-II and Mississippi scores between genotypes for rs386231 with the GG genotype associated with increased severity of depression (p=0.002 F=6.839) and higher Mississippi Scale for Combat-Related PTSD scores (p=0.033). Haplotype analysis revealed that the C/G haplotype (rs451275/rs386231) was significantly associated with PTSD (p=0.001). LIMITATIONS: The sample sizes in our study were not sufficient to detect SNP associations with very small effects. In addition the study was limited by its cross sectional design. CONCLUSIONS: This is the first study reporting that a variant of the NOS1AP gene is associated with PTSD. Our data also suggest that a genetic variant in NOS1AP may increase the susceptibility to severe depression in patients with PTSD and increased risk for suicide.
    Journal of Affective Disorders 01/2014; 147:87-93. DOI:10.1016/j.jad.2012.10.013 · 3.38 Impact Factor
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