New Onset and Persistent Symptoms of Post-Traumatic Stress Disorder Self-Reported after Deployment and Combat Exposures: Prospective Population Based US Military Cohort Study

Department of Defense Center for Deployment Health Research at the Naval Health Research Center, San Diego, CA 92106, USA.
BMJ (online) (Impact Factor: 17.45). 03/2008; 336(7640):366-71. DOI: 10.1136/bmj.39430.638241.AE
Source: PubMed


To describe new onset and persistence of self reported post-traumatic stress disorder symptoms in a large population based military cohort, many of whom were deployed in support of the wars in Iraq and Afghanistan.
Prospective cohort analysis.
Survey enrolment data from the millennium cohort (July 2001 to June 2003) obtained before the wars in Iraq and Afghanistan. Follow-up (June 2004 to February 2006) data on health outcomes collected from 50 184 participants.
Self reported post-traumatic stress disorder as measured by the posttraumatic stress disorder checklist-civilian version using Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria.
More than 40% of the cohort were deployed between 2001 and 2006; between baseline and follow-up, 24% deployed for the first time in support of the wars in Iraq and Afghanistan. New incidence rates of 10-13 cases of post-traumatic stress disorder per 1000 person years occurred in the millennium cohort. New onset self reported post-traumatic stress disorder symptoms or diagnosis were identified in 7.6-8.7% of deployers who reported combat exposures, 1.4-2.1% of deployers who did not report combat exposures, and 2.3-3.0% of non-deployers. Among those with self reported symptoms of post-traumatic stress disorder at baseline, deployment did not affect persistence of symptoms.
After adjustment for baseline characteristics, these prospective data indicate a threefold increase in new onset self reported post-traumatic stress disorder symptoms or diagnosis among deployed military personnel who reported combat exposures. The findings define the importance of post-traumatic stress disorder in this population and emphasise that specific combat exposures, rather than deployment itself, significantly affect the onset of symptoms of post-traumatic stress disorder after deployment.

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    • "Military service members (SM) deployed to wars in Iraq and Afghanistan are more likely to experience posttraumatic stress disorder (PTSD) symptoms related to both warzone and homefront experiences (Smith et al., 2008; Vasterling et al., 2010) than those who did not deploy. Post-deployment PTSD symptoms are associated with reduced quality of life and functional status in SMs (Schnurr et al., 2009; Tsai et al., 2012), even for those whose symptoms fall short of meeting full diagnostic criteria for PTSD (Cukor et al., 2010; Grubaugh et al., 2005; Magruder et al., 2004). "
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    07/2015; 2:62-66. DOI:10.1016/j.ynstr.2015.07.001
    • "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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    • "Relatively, few prevalence studies of PTSD in the OEF/ OIF populations have examined the association between relationship status and mental health, and those that have have found mixed results. For example, some studies have found no relationship between marital status and PTSD (Riddle et al., 2007; Schell & Marshall, 2008), one suggested that marital status increases risk for development of PTSD (Grieger et al., 2006) and another found higher odds of new-onset PTSD (but not persistent PTSD) among never married or divorced personnel (Smith et al., 2008). It would be useful to go beyond the categorical marital status to investigate the potentially critical moderating role of marital/committed relationship quality. "
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    ABSTRACT: A series of recent articles has reported on well-designed studies examining base rates of posttraumatic stress disorder (PTSD) screenings within the Operation Enduring Freedom (Afghanistan conflict)/Operation Iraqi Freedom (Iraq conflict) (OEF/OIF) military population. Although these studies have a number of strengths, this line of research points out several key areas in need of further examination. Many OEF/OIF Veterans do not use available Veterans Affairs (VA) services, especially mental health care. This highlights the need to understand the differences between those who use and do not use the VA, especially as research with pre-OEF/OIF Veterans suggests that these two groups differ in significant ways. The high rates of PTSD-related concerns in non-VA users also points to a need to understand whether-and where-Veterans are seeking care outside the VA and the accessibility of evidence-based, trauma-focused treatments in the community and private sectors. Careful examination of relationship status is also paramount as little research has examined relationship status or other relationship context issues. Social support, especially from a spouse, can buffer the development of PTSD; however, relationship discord has the potential to greatly exacerbate PTSD symptomatology. Furthermore, given the additional risk factors for sexual minority Veterans to be exposed to trauma, the 2011 repeal of the US Military "Don't Ask, Don't Tell" policy, and the emergence of the VA as likely the largest health care provider for sexual minority Veterans, it will be critically important to study the trauma and mental health experiences of this group. Studies that examine prevalence rates of PTSD in the returning cohort contribute significantly to our understanding of the US OEF/OIF military population. Further study of PTSD in relation to demographic variables such as VA and non-VA use, relationship status, and sexual orientation will provide rich data that will enhance our ability to develop policy and practice to provide the best care to this population.
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