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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Available from: Tyler Smith, Jan 28, 2016
    • "All service members, regardless of occupation, are exposed to a similar set of values that include obedience; service; mission first; and never failing, quitting , or leaving another service member behind (Defense Health Board, 2015; Rondeau, 2011). Military health-care providers experience psychological problems similar to those seen in combat troops where stress, emotional instability, and family conflict are prominent upon return home (Jones et al., 2008; Kolkow, Spira, Morse, & Grieger, 2007; Milliken, Auchterlonie, & Hoge, 2007; Seal et al., 2009; Smith et al., 2008, Thomas et al., 2010). Even though over 75% of combat veterans recognize these problems, only 40% are interested in receiving help (Brown, Creel, Engel, Herrell, & Hoge, 2011). "
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    ABSTRACT: Our past lessons from war trauma have taught us that mental health-care stigma and other issues surrounding mental health–seeking behaviors can negatively impact the healing trajectory and long-term function for service members and their families. It can take years to decades before a service member seeks professional help for psychological distress, if he or she seeks it at all. Unfortunately, signs of personal and family problems can be subtle, and consequences, such as suicide, tragic. In this chapter, we consider the story one military health-care provider submitted in response to a study solicitation that read: Please provide your personal story telling me about any psychological distress you may have experienced after returning from deployment and your personal challenges accessing care and/or remaining in treatment. This story is analyzed to explore the moral implications of his experience for the military and for other service members. The main points to be highlighted are that altruism can leave altruists more vulnerable, military mental health stigma may exacerbate this risk, and military families may profoundly be affected.
    No preview · Chapter · Jan 2016
    • "DOI: 10.1002/jts.22055 Freedom (OIF) veterans range from about 5% to 20% (Kok, Herrell, Thomas, & Hoge, 2012; Ramchand et al., 2010; Smith et al., 2008); depression prevalence estimates range from about 2% to 16% (Tanielian & Jaycox, 2008; Wells et al., 2010). The experiences of OEF/OIF veterans suggest that the trajectories , or paths followed over time, of these disorders may reflect life-course civilian and combat experiences that depart from those of previous generations (Bonanno et al., 2012). "
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    ABSTRACT: To identify trajectories of depression and posttraumatic stress (PTS) symptom groups after deployment and determine the effect of alcohol use disorder on these trajectories, depression symptoms were modeled using the 9-item Patient Health Questionnaire in 727 Ohio National Guard members, and PTS symptoms were modeled using the PTSD Checklist in 472 Ohio National Guard members. There were 55.8% who were resistant to depression symptoms across the 4 years of study, and 41.5% who were resistant to PTS symptoms. There were 18.7% and 42.2% of participants who showed resilience (experiencing slightly elevated symptoms followed by a decline, according to Bonanno et al., 2002) to depression and PTS symptoms, respectively. Mild and chronic dysfunction constituted the smallest trajectory groups across disorders. Marital status, deployment to an area of conflict, and number of lifetime stressors were associated with membership into different latent groups for depression (unstandardized β estimates range = 0.69 to 1.37). Deployment to an area of conflict, number of lifetime traumatic events and education predicted membership into different latent groups for PTS (significant unstandardized β estimate range = 0.83 to 3.17). AUD was associated with an increase in both symptom outcomes (significant unstandardized β estimate range = 0.20 to 9.45). These results suggested that alcohol use disorder may have contributed substantially to trajectories of psychopathology in this population.
    No preview · Article · Dec 2015 · Journal of Traumatic Stress
    • "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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    ABSTRACT: The development of PTSD after military deployment is influenced by a combination of biopsychosocial risk and resilience factors. In particular, physiological factors may mark risk for symptom progression or resiliency. Research in civilian populations suggests elevated catecholamines after trauma are associated with PTSD months following the trauma. However, less is known regarding physiological markers of PTSD resilience among post-deployment service members (SM). We therefore assessed whether catecholamines obtained shortly after deployment were associated with combat-related PTSD symptoms three months later. Eighty-seven SMs completed the Clinician-Administered PTSD Scale for DSM-IV and blood draws within two months after return from deployment to Iraq or Afghanistan (“Time 1” or “T1”) and three months later (“Time 2” or “T2”). Linear regression analyses demonstrated that lower norepinephrine at T1 was associated with lower PTSD symptoms at T2. In particular, T1 norepinephrine was positively associated with T2 symptom intensity and avoidance symptoms. The present findings represent a biologically-informed method of assessing PTSD resilience after deployment, which may aid clinicians in providing tailored treatments for those in the greatest need. Further research is needed to validate these findings and incorporate physiological measures within an assessment battery.
    No preview · Article · Jul 2015
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