Article

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

ABSTRACT

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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    • "Acute Stress Disorder (presence of intrusive traumatic memories, avoidance of traumatic reminders, hyper-arousal, and alterations in mood) (Kok et al., 2012). If "
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    ABSTRACT: Combat deployment enhances risk for posttraumatic stress symptoms. We assessed whether attention bias modification training (ABMT), delivered immediately prior to combat, attenuates the association between combat exposure and stress-related symptoms. 99 male soldiers preparing for combat were randomized to receive either an ABMT condition designed to enhance vigilance toward threat or an attention control training (ACT) designed to balance attention deployment between neutral and threat words. Frequency of combat events, and symptoms of PTSD and depression were measured prior to deployment and at a two-month follow-up.
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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). "

    Full-text · Chapter · Dec 2015
    • "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.
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