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)     

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.     

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)     

Vulnerability and resilience to combat exposure: Can stress have lifelong effects?

Examined whether appraisals of desirable and undesirable effects of military service mediated the effect of combat stress on posttraumatic stress disorder (PTSD) symptoms in later life in 1,287 male veterans (aged 44–91 yrs), 40% of whom had been in combat. The men reported more desirable effects of military service (e.g., mastery, self-esteem, and coping skills) than undesirable ones; both increased linearly with combat exposure. Path analysis revealed that the appraisals were independent and opposite mediators, with undesirable effects increasing and desirable effects decreasing the relationship between combat exposure and PTSD, even controlling for depression and response style. Although lifelong negative consequences of combat exposure were observed, perceiving positive benefits from this stressful experience mitigated the effect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lower precombat intelligence is a risk factor for posttraumatic stress disorder.

The authors examined the relation between intelligence and posttraumatic stress disorder (PTSD) by studying the association among precombat intelligence, current intelligence, and self-reported PTSD symptoms. Military aptitude test results were obtained in 59 PTSD and 31 non-PTSD Vietnam combat veterans who had undergone a psychodiagnostic interview and current intelligence testing. People with lower precombat intelligence were more likely to develop PTSD symptoms as assessed by the Clinician-Administered PTSD Scale even after adjustment for extent of combat exposure. The association between current intelligence and PTSD was no longer significant after adjusting for precombat intelligence. These results suggest that lower pretrauma intelligence increases risk for developing PTSD symptoms, not that PTSD lowers performance on intelligence tests. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal problems of Vietnam combat veterans with symptoms of posttraumatic stress disorder.

274 male veterans seeking treatment for substance abuse were divided on the basis of combat experience and DSM-III criteria of posttraumatic stress disorder (PTSD). Ss with evidence of PTSD were compared with a non-PTSD group of Vietnam combat veterans and a noncombat group of Vietnam-era veterans on measures of specific interpersonal problems using the Horowitz Interpersonal Problem Inventory, traditional measures of family and social adjustment, and the MMPI. The PTSD group scored significantly higher on clusters of problems dealing with intimacy and sociability than did either of the comparison groups. PTSD Ss also scored higher on the MMPI scales of Paranoia, Psychopathic Deviate, Social Introversion, Social Maladjustment, Family Problems, and Manifest Hostility, but did not differ from other groups on Family Environment Scale variables. Results, which were not attributable to premilitary adjustment differences or to confounding demographic variables, are compared to previous studies, and research questions that remain outstanding are discussed. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lipid lowering in a multidisciplinary clinic compared with primary physician management

OBJECTIVE: This study analyzed questionnaire items that address complaints about sleep from the National Vietnam Veterans Readjustment Study, a nationally representative sample of the 3.1 million men and women who served in Vietnam. This study compared the frequency of nightmares and difficulties with sleep onset and sleep maintenance in male Vietnam theater veterans with male Vietnam era veteran and male civilian comparison subjects. It focused on the role of combat exposure, nonsleep posttraumatic stress disorder (PTSD) symptoms, comorbid psychiatric and medical disorder, and substance abuse in accounting for different domains of sleep disturbance. METHOD: The authors undertook an archival analysis of the National Vietnam Veterans Readjustment Study database using correlations and linear statistical models. RESULTS: Frequent nightmares were found exclusively in subjects diagnosed with current PTSD at the time of the survey (15.0%). In the sample of veterans who served in Vietnam (N = 1,167), combat exposure was strongly correlated with frequency of nightmares, moderately correlated with sleep onset insomnia, and weakly correlated with disrupted sleep maintenance. A hierarchical multiple regression analysis showed that in Vietnam theater veterans, 57% of the variance in the frequency of nightmares was accounted for by war zone exposure and non-sleep-related PTSD symptoms. Alcohol abuse, chronic medical illnesses, panic disorder, major depression, and mania did not predict the frequency of nightmares after control for nonsleep PTSD symptoms. CONCLUSIONS: Frequent nightmares appear to be virtually specific for PTSD. The nightmare is the domain of sleep disturbance most related to exposure to war zone traumatic stress.     

Prewar factors in combat-related posttraumatic stress disorder: Structural equation modeling with a national sample of female and male Vietnam veterans.

Structural equation modeling was used to examine relationships among prewar factors, dimensions of war-zone stress, and current posttraumatic stress disorder (PTSD) symptomatology using data from 1,632 female and male participants in the National Vietnam Veterans Readjustment Study (R. A. Kulka et al; 1990). For men, previous trauma history (accidents, assaults, and natural disasters) directly predicted PTSD and also interacted with war-zone stressor level to exacerbate PTSD symptoms for high combat-exposed veterans. Male veterans who entered the war at a younger age displayed more symptoms. Family instability, childhood antisocial behavior and age had indirect effects on PTSD for men. For women, indirect prewar effects emanated from family instability. More attention should be given to critical developmental conditions, especially family instability and earlier trauma exposure, in conceptualizing PTSD in adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Etiology of Posttraumatic Stress Disorder in Vietnam veterans: Analysis of premilitary, military, and combat exposure influences.

43 Vietnam veterans seeking psychological services at a VA medical center were assigned to positive and negative groups of posttraumatic stress disorder (PTSD) based on the DSM-III. The average S was a 33-yr-old White male with 13 yrs of education. Ss were extensively assessed to examine the relative contributions of premilitary adjustment, military adjustment, and extent of combat exposure to the development of combat-related, chronic PTSD. In addition, groups were compared on profiles from the MMPI and a psychological problem checklist. Results of multiple regression analyses demonstrated that combat exposure and, to a lesser degree, military adjustment were significantly related to PTSD symptomatology, whereas premilitary adjustment was not. Discriminant function analyses showed that the MMPI had moderate ability to correctly classify Ss on the basis of PTSD diagnosis. However, problem checklist items indicative of anxiety-based disorders, particularly generalized anxiety and pervasive disgust, formed a discriminant function that correctly classified more than 90% of Ss. Results are discussed in terms of complications for an empirically derived conceptualization of PTSD. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and war-zone exposure as correlates of perceived health in female Vietnam war veterans.

Previous studies have identified traumatic exposure and posttraumatic stress disorder (PTSD) as predictors of physical health complaints without considering the relationship between exposure and PTSD. This study examined the unique associations of war-zone exposure and PTSD with perceived physical health outcomes in a nontreatment-seeking sample of 109 female veterans of the Vietnam War who responded to a series of psychological, exposure, and health questionnaires. Both PTSD and exposure were associated with reports of negative health outcomes when each variable was not adjusted for the other. The effects associated with exposure decreased when PTSD was controlled for, whereas the effects associated with PTSD remained when exposure was controlled for. Results suggest that effects of traumatic exposure on perceived health are partially mediated by increases in PTSD after exposure, supporting studies on the effects of stress on health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social relationships and PTSD symptomatology in combat veterans.

The primary purpose of this study is to determine if recent combat veterans discriminate between different sources of social support, and then preliminarily investigate the relationship of social support source on posttraumatic stress disorder (PTSD) symptomatology. Participants included 83 married male combat veterans. Principal-axis factor analysis with equamax rotation observed four distinct latent factors for each source of support examined. ANOVAs were performed to determine the relationship of each source of support from the distinct latent factors on the level of PTSD. Results indicate that the level of PTSD is related to support received from a significant other, F(1, 81) = 30.36, p F(1, 81) = 8.10, p = .006, and military peers, F(1, 81) = 6.70, p = .011, but not friends, F(1, 81) = 1.79, p = .18. In general, higher levels of support from each category were associated with lower levels of PTSD in combat veterans. The results suggest that combat veterans distinguish between specific sources of social support, which may have a protective effect on the level of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal problem solving and coping reactions of Vietnam veterans with posttraumatic stress disorder.

In order to assess the relation between posttraumatic stress disorder (PTSD) and interpersonal problem solving and coping, 43 Vietnam veterans were assigned to the following four groups: (a) combat veterans with PTSD, (b) combat veterans with severe adjustment problems but not PTSD-diagnosable (AP), (c) combat veterans who were well adjusted (WA), and (d) veterans with little or no combat exposure who served during the Vietnam era (ERA). Multivariate analyses of variance indicated that both the PTSD and AP groups reported less effective coping reactions and poorer problem solving than both the WA and ERA groups. The PTSD subjects also reported less effective problem solving and less problem-focused coping reactions than the AP veterans. Implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

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.     

Reliability and validity of Mississippi Scale for Combat-Related Posttraumatic Stress Disorder.

This study examined the reliability and validity of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder (M-PTSD) in a sample of Vietnam combat veterans with PTSD (n?=?101) and substance-abusing patients without combat-related PTSD (n?=?102). The M-PTSD was found to have high internal consistency, and a principle-components analysis indicated that its items measure three dimensions: intrusive reexperiencing/numbing-avoidance, anger/lability, and social alienation. Discriminant validity of the M-PTSD was supported by its high sensitivity in identifying PTSD patients (93%) and specificity in discriminating them from substance-abusing control subjects (88.2%). Finally, convergent validity of the M-PTSD was substantiated by significant correlations of the instrument with measures of combat exposure and interview and psychometric measures of PTSD symptomatology. The M-PTSD was shown to be a highly reliable and valid measure of the spectrum of PTSD symptoms in Vietnam combat veterans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and retrospectively reported stressor exposure: A longitudinal prediction model.

There has been recent concern about the degree to which posttraumatic stress disorder (PTSD) symptomatology influences reports of prior exposure to highly stressful life events. In this longitudinal study of 2,942 male and female Gulf War veterans, the authors documented change in stressor reporting across 2 occasions and the association between change and PTSD symptom severity. A regression-based cross-lagged analysis was used to examine the relationship between PTSD symptom severity and later reported stressor exposure. Shifts in reporting over time were modestly associated with PTSD symptom severity. The cross-lagged analysis revealed a marginal association between Time 1 PTSD symptom severity and Time 2 reported stressor exposure for men and suggested that later reports of stressor exposure are primarily accounted for by earlier reports and less so by earlier PTSD symptomatology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring exposure to racism: Development and validation of a Race-Related Stressor Scale (RRSS) for Asian American Vietnam veterans.

This article describes the development and validation of the Race-Related Stressor Scale (RRSS), a questionnaire that assesses exposure to race-related stressors in the military and war zone. Validated on a sample of 300 Asian American Vietnam veterans, the RRSS has high internal consistency and adequate temporal stability. Hierarchical regression analyses revealed that exposure to race-related stressors accounted for a significant proportion of the variance in posttraumatic stress disorder (PTSD) symptoms and general psychiatric symptoms, over and above (by 20% and 19%, respectively) that accounted for by combat exposure and military rank. The RRSS appears to be a psychometrically sound measure of exposure to race-related stressors for this population. Race-related stressors as measured by the RRSS appear to contribute uniquely and substantially to PTSD symptoms and generalized psychiatric distress. (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.     

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)     

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)