Article

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: 16.38). 03/2008; 336(7640):366-71. DOI: 10.1136/bmj.39430.638241.AE
Source: PubMed

ABSTRACT 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.

0 Bookmarks
 · 
98 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Researchers often extrapolate posttraumatic stress disorder (PTSD) status from PTSD Checklist (PCL) data. When doing so, cut points should be based on samples with similar characteristics. This study assessed PCL diagnostic accuracy and postconcussive symptom levels within 106 Iraq/Afghanistan war Veterans and servicemembers with recent blast exposure. Two definitions of PTSD were applied: (1) "strict" Diagnostic and Statistical Manual of Mental Health Disorders (DSM), 4th edition (DSM-IV) criteria and (2) "relaxed" DSM-IV criteria dropping the A2 criterion as per the DSM, 5th edition (DSM-V). Using a structured interview for PTSD, we found moderate agreement with the PCL. Under strict criteria, PTSD prevalence was 16%, PCL cut point was 66 at peak kappa, and mean Rivermead Postconcussion Questionnaire (RPQ) score trended higher for those with PTSD than for those without PTSD (35.5 +/- 11.2 vs 30.5 +/- 10.7, respectively; p = 0.080). Under relaxed criteria, PTSD prevalence was 26.4%, PCL cut point was 58 at peak kappa, and those with PTSD had higher RPQ scores than those without PTSD (36.4 +/- 11.2 vs 29.5 +/- 10.2, respectively; p = 0.003). Participants diagnosed with blast-related mild traumatic brain injury (n = 90) did not differ from those without mild traumatic brain injury (n = 16) in symptom scores. In conclusion, persons with combat-related blast exposure need higher than conventional PCL cut points and those with PTSD have more severe postconcussive-type symptoms than those without PTSD.
    The Journal of Rehabilitation Research and Development 01/2014; 51(8):1203-16. DOI:10.1682/JRRD.2013.12.0271 · 1.69 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A wealth of research has examined psychological responses to trauma among male military service members, but few studies have examined sex differences in response to trauma, such as coping strategies. This study assessed coping strategies used by male and female U.S. service members completing an intensely stressful mock-captivity exercise, compared strategies by sex, and assessed the relationship between coping and posttraumatic stress symptoms (PTSS). Two hundred service members (78% male) completed self-report surveys before and after mock captivity. Surveys assessed demographics, service characteristics, PTSS, and coping strategies used during mock captivity. Participants used seven coping strategies: denial, self-blame, religion, self-distraction, behavioral disengagement, positive reframing, and planning. Women used denial (p≤.05), self-blame (p≤.05), and positive reinterpretation (p≤.05) strategies more frequently than men, and they had higher PTSS levels following the exercise. Structural equation modeling showed that the relationship between sex and PTSS was fully mediated by coping strategies. The results of this study suggest that reducing the use of maladaptive coping strategies may mitigate PTSS among females. Future efforts should target improving coping during highly stressful and traumatic experiences. Copyright © 2014. Published by Elsevier Ltd.
    Journal of Anxiety Disorders 10/2014; 29C:7-13. DOI:10.1016/j.janxdis.2014.10.005 · 2.96 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A large body of research has been produced in recent years investigating posttraumatic stress disorder (PTSD) among military personnel following deployment to Iraq and Afghanistan, resulting in apparent differences in PTSD prevalence. We compare prevalence estimates for current PTSD between military subgroups, providing insight into how groups may be differentially affected by deployment. Systematic literature searches using the terms PTSD, stress disorder, and acute stress, combined with terms relating to military personnel, identified 49 relevant papers. Studies with a sample size of less than 100 and studies based on data for treatment seeking or injured populations were excluded. Studies were categorized according to theatre of deployment (Iraq or Afghanistan), combat and noncombat deployed samples, sex, enlistment type (regular or reserve and [or] National Guard), and service branch (for example, army, navy, and air force). Meta-analysis was used to assess PTSD prevalence across subgroups. There was large variability in PTSD prevalence between studies, but, regardless of heterogeneity, prevalence rates of PTSD were higher among studies of Iraq-deployed personnel (12.9%; 95% CI 11.3% to 14.4%), compared with personnel deployed to Afghanistan (7.1%; 95% CI 4.6% to 9.6%), combat deployed personnel, and personnel serving in the Canadian, US, or UK army or the navy or marines (12.4%; 95% CI 10.9% to 13.4%), compared with the other services (4.9%; 95% CI 1.4% to 8.4%). Contrary to findings from within-study comparisons, we did not find a difference in PTSD prevalence for regular active-duty and reserve or National Guard personnel. Categorizing studies according to deployment location and branch of service identified differences among subgroups that provide further support for factors underlying the development of PTSD.
    Canadian journal of psychiatry. Revue canadienne de psychiatrie 09/2014; 59(9):468-79. · 2.41 Impact Factor

Preview

Download
5 Downloads
Available from