Hope, coping, and social support in combat-related posttraumatic stress disorder

Dispositional hope, coping, and perceived social support were assessed among Vietnam combat veterans upon admission to and discharge from inpatient treatment for posttraumatic stress disorder (PTSD). Veterans reported lower dispositional hope than any previously described sample, and hope did not increase at discharge from treatment. At admission, higher hope was correlated with greater perceived social support coming from family (this relationship persisted when controlling for depression and PTSD symptoms). At discharge, higher hope was associated with greater perceived social support coming from family and friends and the use of adaptive coping strategies. Results indicate that hope confers a beneficial effect once veterans undergo treatment for combat-related PTSD, a finding that suggests that hope may be "gone but not lost" for these individuals.     

Social support in Vietnam veterans with posttraumatic stress disorder: A comparative analysis.

Conducted a comparative analysis of the social-support systems of 45 Vietnam-era veterans (mean age 36.69 yrs), including 15 Ss in a program designed to evaluate and treat combat-related posttraumatic stress disorder (PTSD), 15 well-adjusted Ss with no symptoms of PTSD, and 15 medical-service inpatients without combat exposure or PTSD. Retrospective reports of social support were obtained from each group for 3 life periods: 1–3 mo prior to entering the service, 1–3 mo following discharge from the service, and at the present time. Indexes of social support included social network size, material support, physical support, sharing, advice, and positive social interactions. Prior to Vietnam, all 3 groups reported comparable levels of support across all dimensions. For PTSD Ss, qualitative and quantitative measures of social support systematically declined over time to low levels at the present time period. For the remaining Ss, the social support was either stable or improved over time. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vietnam combat veterans with Posttraumatic Stress Disorder: Analysis of marital and cohabitating adjustment.

21 help-seeking Vietnam combat veterans (mean age 34.71 yrs) with a diagnosis of posttraumatic stress disorder (PTSD) were compared with 18 help-seeking combat veterans (mean age 33.44 yrs) without evidence of PTSD and 21 help-seeking veterans (mean age 33.4 yrs) with minimal combat experience on indexes of cohabitating and marital adjustment. Also, premilitary adjustment was assessed and validated by relative's reports. The PTSD group reported significantly more problems than did the other groups with self-disclosure and expressiveness to their partners, physical aggression toward their partners, and global relationship adjustment. The PTSD group did not differ from the other groups on measures of intimacy and affectionate behavior. The findings were not attributable to premilitary adjustment, response style, or demographic factors. Previous reports that combat veterans have special difficulties expressing positive emotions were not supported by present findings. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Combat-related posttraumatic stress disorder symptoms in older men.

Nearly 25% of US men aged 55 yrs or older served in combat, yet its impact on aging is unknown. The relationship of posttraumatic stress disorder (PTSD) symptoms to combat exposure was examined in 1,210 veterans of World War II (WWII) and the Korean War, who were participants in the Normative Aging Study. Over 54% of WWII and 19% of Korean veterans reported combat experience. The relationship between combat exposure and PTSD symptoms was stronger in the WWII cohort. The sample prevalence of PTSD by combat exposure ranged from 0% to 12.4%, differing by the PTSD measure. WWII veterans exposed to moderate or heavy combat had 13.3 times greater risk of PTSD symptoms measured 45 yrs later, compared with noncombat veterans. It is suggested that military service in general, and combat exposure in particular, is a "hidden variable" in the study of aging men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Twenty-four-hour ambulatory blood pressure and heart rate monitoring in combat-related posttraumatic stress disorder

This study examined the cardiovascular correlates of posttraumatic stress disorder (PTSD) in Vietnam combat veterans using 24-hr ambulatory blood pressure and heart rate monitoring. Veterans with PTSD (n = 11) exhibited significantly higher heart rate and diastolic blood pressure across the 24 hr than veterans without PTSD (n = 7) (80.8 vs. 71.9 bpm, and 80.1 vs. 71.5 mm Hg, respectively). Heart rate during sleep was also significantly higher among veterans with PTSD, compared to veterans without PTSD (71.0 vs. 62.7 bpm). These results, based on a more naturalistic measurement methodology used outside the laboratory, support an association between PTSD and increased chronic cardiovascular arousal.     

Personality patterns among Black, White, and Hispanic combat veterans.

Little is known about racial and ethnic differences in personality pathology in combat veterans. This investigation explored the relationship between race, ethnicity, and personality disorders (PDs) in a sample of 96 combat veterans. Ethnoracial group status was based on self-identification, and the groups were mutually exclusive. PDs were assessed with the MCMI-III, posttraumatic stress disorder (PTSD) was assessed with the Clinician Administered PTSD scale, and combat exposure was assessed with the Combat Exposure Scale. The findings suggest that Hispanic veterans were more likely to have cluster A PDs compared to non-Hispanic veterans, even after controlling for demographics, level of combat exposure, and current PTSD. Implications of the results for the research and treatment of culturally diverse individuals with PDs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurocognitive function in monozygotic twins discordant for combat exposure: Relationship to posttraumatic stress disorder.

Neuropsychological deficits have been reported among trauma survivors with posttraumatic stress disorder (PTSD). It is often assumed that these cognitive difficulties are toxic consequences of trauma exposure. Alternatively, they may reflect preexisting characteristics that contribute to the likelihood of developing PTSD. To address this possibility, the authors evaluated cognitive performance in monozygotic twin pairs who were discordant for combat exposure. Pairs were grouped according to whether the combat-exposed brother developed PTSD. The combat-unexposed cotwins of combat veterans with PTSD largely displayed the same performance as their brothers, which was significantly lower than that of non-PTSD combat veterans and their brothers. The results support the notion that specific domains of cognitive function may serve as premorbid risk or protective factors in PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physician-diagnosed medical disorders in relation to PTSD symptoms in older male military veterans.

The association between physician-diagnosed medical disorders and combat-related posttraumatic stress disorder (PTSD) symptoms was examined in 605 male combat veterans of World War II and the Korean conflict. Physician exams were performed at periodic intervals beginning in the 1960s. PTSD symptoms were assessed in 1990. Cox regression was used to examine the onset of each of 12 disorder categories as a function of PTSD symptoms, controlling for age, smoking, alcohol use, and body weight at study entry. Even with control for these factors, PTSD symptoms were associated with increased onset of arterial, lower gastrointestinal, dermatologic, and musculoskeletal disorders. There was only weak evidence that PTSD mediated the effects of combat exposure on morbidity. Possible mediators of the relationship between combat exposure, PTSD, and physical morbidity are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans

A study was conducted to investigate chronic pain patterns in Vietnam veterans with posttraumatic stress disorder (PTSD). Combat veterans with PTSD completed standardized PTSD severity, pain, somatization, and depression measures. Of 129 consecutive out-patient combat veterans with PTSD, 80% reported chronic pain. In descending order were limb pain (83%), back pain (77%), torso pain (50%), and headache pain (32%). Compared to PTSD combat veterans without chronic pain, PTSD veterans who reported chronic pain reported significantly higher somatization as measured by the Minnesota Multiphasic Inventory 2 hypochondriasis and hysteria subscales. In the sample of 103 combat veterans with PTSD and chronic pain, MMPI 2 hypochondriasis scores and B PTSD symptoms (reexperiencing symptoms) were significantly related to pain disability, overall pain index, and current pain level MMPI 2 hypochondriasis and depression scores were also significantly related to percent body pain. These results are discussed in the context of current conceptualizations of PTSD.     

Cholinergic/serotonergic interactions in hypothermia: implications for rat models of depression

Vietnam combat veterans (N = 151) with chronic posttraumatic stress disorder (PTSD) completed measures of atrocities exposure, combat exposure, PTSD symptom severity, guilt and interpersonal violence. PTSD symptom severity, guilt and interpersonal violence rates were similar to previously reported studies that examined treatment seeking combat veterans with PTSD. Controlling for combat exposure, endorsement of atrocities exposure was related to PTSD symptom severity, PTSD B (reexperiencing) symptoms, Global Guilt, Guilt Cognitions, and cognitive subscales of Hindsight-Bias/Responsibility and Wrongdoing. These results are discussed in the context of previous research conducted regarding atrocities exposure and PTSD.     

Peritraumatic dissociation and posttraumatic stress in male Vietnam theater veterans

OBJECTIVE: The aim of this study was to determine the reliability and validity of a proposed measure of peritraumatic dissociation and, as part of that effort, to determine the relationship between dissociative experiences during disturbing combat trauma and the subsequent development of posttraumatic stress disorder (PTSD). METHOD: A total of 251 male Vietnam theater veterans from the Clinical Examination Component of the National Vietnam Veterans Readjustment Study were examined to determine the relationship of war zone stress exposure, retrospective reports of dissociation during the most disturbing combat trauma events, and general dissociative tendencies with PTSD case determination. RESULTS: The total score on the Peritraumatic Dissociation Experiences Questionnaire--Rater Version was strongly associated with level of posttraumatic stress symptoms, level of stress exposure, and general dissociative tendencies and weakly associated with general psychopathology scales from the MMPI-2. Logistic regression analyses supported the incremental value of dissociation during trauma, over and above the contributions of level of war zone stress exposure and general dissociative tendencies, in accounting for PTSD case determination. CONCLUSIONS: These results provide support for the reliability and validity of the Peritraumatic Dissociation Experiences Questionnaire--Rater Version and for a trauma-dissociation linkage hypothesis: the greater the dissociation during traumatic stress exposure, the greater the likelihood of meeting criteria for current PTSD.     

Posttraumatic stress disorder among U.S. Army Reserve Vietnam and Vietnam-era veterans.

Analysis of questionnaire data collected in the spring of 1982 from 935 randomly selected Vietnam and Vietnam-era veterans (mean age 36.7 yrs) assigned to US Army Reserve troops units nationwide revealed a posttraumatic stress disorder (PTSD) rate for Vietnam veteran reservists of 10.9%, which is midrange between estimates for civilian (18–54%) and active duty Army (5.1%) Vietnam veterans. Results suggest that the quality of social support received during Vietnam duty and the 1st yr back may serve to either moderate or exacerbate PTSD symptomatology associated with combat experience. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ambulatory cardiovascular activity in Vietnam combat veterans with and without posttraumatic stress disorder.

The present study investigated the relationship between daily diary affect ratings and ambulatory cardiovascular activity in 117 male Vietnam combat veterans (61 with posttraumatic stress disorder [PTSD] and 56 without PTSD). Participants completed 12–14 hr of ambulatory monitoring and daily diary affect ratings. Compared with veterans without PTSD, veterans with PTSD reported higher negative affect and lower positive affect in daily diary ratings. No differences were detected for mean laboratory initial recordings or mean ambulatory heart rate (HR), systolic blood pressure (SBP), or diastolic blood pressure (DBP). However, compared with veterans without PTSD, veterans with PTSD demonstrated higher SBP and DBP variability and a higher proportion of HR activity (compared with initial recording values) during daily activity. There was a significant Time of Day × Group interaction for mean HR, with a trend for PTSD participants to maintain HR levels during evening hours. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder: Silent problem among older combat veterans.

Examines posttraumatic stress disorder (PTSD) among older Vietnam combat veterans. It is suggested that PTSD among these veterans is generally chronic, silent, and exacerbated by the problems of aging. These Ss with PTSD can be divided into those with full PTSD and those with partial PTSD. Studies are cited showing prevalence rates for PTSD. The difficulties in measuring PTSD are described. Several moderating variables influence the expression of trauma problems at later life, including the presence of other stressors, health status, social support, and comorbidity. Several forms of therapy are considered, including cognitive behavioral therapy, reminiscence, and relaxational desensitization. Also, several treatment suggestions are given, advocating interventions of a stuck narrative in an aging population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An in vivo assessment of physiological arousal in posttraumatic stress disorder.

Measured physiological function (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], sublingual temperature, and respiration rate) in a nonresearch setting—the medical triage area of a large Veterans Affairs Medical Center while patients were awaiting physical examination. Ss were 32 Vietnam veterans with combat-related PTSD and 26 Vietnam-era veterans with no combat experience. Results indicated that PTSD veterans had significantly higher HR, SBP, and DBP, but not sublingual temperature or respiration rate. These data support the position that individuals with PTSD do indeed demonstrate higher levels of cardiovascular arousal across settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physiologic responses to loud tones in Vietnam veterans with posttraumatic stress disorder.

The authors evaluated eyeblink and autonomic components of the acoustic startle response in combat-related posttraumatic stress disorder (PTSD). Thirty-seven Vietnam combat veterans with current PTSD and 19 combat veterans without PTSD were exposed to 15 consecutive 95-dB, 500-ms, 1000-Hz tones with 0-ms rise and fall times, while orbicularis oculi electromyogram, skin conductance, and heart rate responses were measured. PTSD veterans produced larger averaged electromyographic and heart rate responses, and a slower decline in skin conductance responses, across the 15 tone presentations compared to non-PTSD veterans. Results of this study provide laboratory support for an exaggerated startle response in PTSD and replicate and extend previous findings of increased autonomic responses to loud tone stimuli in this disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validation of a multimethod assessment of posttraumatic stress disorders in Vietnam veterans.

There appears to be a high incidence of posttraumatic stress disorders (PTSD) in Vietnam veterans, yet there is little available information on the reliability and validity of any approach to the assessment of these combat-related stress disorders. The present study was designed to determine if responses to the presentation of mild combat stimuli would distinguish the following 3 carefully matched groups of veterans (N?=?30): (a) veterans (mean age 35 yrs) with an exclusive diagnosis of PTSD, (b) inpatients (mean age 36 yrs) on a psychiatry ward who clearly did not have PTSD, and (c) Vietnam veterans (mean age 35 yrs) with combat experience who were well-adjusted at the time of the study. Behavioral, physiological, and self-report measures of anxiety obtained through this laboratory-based assessment clearly distinguished the PTSD Ss from the remaining 2 groups. The utility of this tripartite assessment approach for the reliable identification of PTSD secondary to combat is discussed. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couple adjustment and posttraumatic stress disorder symptoms in National Guard veterans of the Iraq war.

Relationship adjustment and posttraumatic stress disorder (PTSD) symptoms were assessed across two time points in a sample of 313 married or partnered National Guard soldiers recently returned from combat duty in Iraq. Structural equation modeling using a four-factor model for PTSD found the latent variable dysphoria (reflecting generalized distress including aspects of emotional numbing and arousal) had the strongest independent contribution to predicting relationship adjustment at Time 1 and indirectly predicted poorer relationship adjustment at Time 2. Exploratory analysis of gender differences (n = 33 women; n = 280 men) suggested a different pattern of relations between PTSD factors and relationship adjustment among female soldiers at Time 1, with a trend toward trauma specific avoidance being more highly related to relationship adjustment. Clinical and research implications are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Anger, impulsivity, and anger control in combat-related posttraumatic stress disorder.

Examined the association of combat-related posttraumatic stress disorder (PTSD) with anger. 24 veterans of the Vietnam War with PTSD scored significantly higher on an Anger factor comprising multiple measures of anger than did comparison groups of 23 well-adjusted Vietnam combat veterans and 12 noncombat Vietnam-era veterans with psychiatric diagnoses. In contrast, the 3 groups did not differ significantly on orthogonal factors, one of which comprised cognitive impulsivity measures and the other of which reflected motor impulsivity. Changes in heart rate in response to provocation loaded positively on the Anger factor and negatively on the 2 Impulsivity factors. Concurrent depression and trait anxiety did not have an effect on level of anger in individuals with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)