Posttraumatic stress disorder in a national sample of female and male Vietnam veterans: Risk factors, war-zone stressors, and resilience-recovery variables.

Relationships among pretrauma risk factors (e.g., family instability, childhood antisocial behavior), war-zone stressors (e.g., combat, perceived threat), posttrauma resilience-recovery variables (e.g., hardiness, social support), and posttraumatic stress disorder (PTSD) symptom severity were examined. Data from a national sample of 432 female and 1,200 male veterans were analyzed using structural equation modeling. For both genders, direct links to PTSD from pretrauma, war-zone, and posttrauma variable categories were found; several direct associations between pretrauma and posttrauma variables were documented. Although war-zone stressors appeared preeminent for PTSD in men, posttrauma resilience-recovery variables were more salient for women. Researchers, policymakers, and clinicians are urged to take a broad view on trauma and its sequelae, especially regarding possible multiple exposures over time and the depletion and availability of important resources. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An examination of family adjustment among Operation Desert Storm veterans.

This study examined interrelationships among combat exposure, symptoms of posttraumatic stress disorder (PTSD), and family adjustment in a sample of male and female Operation Desert Storm veterans (N = 1,512). In structural equation models for both male and female veterans, higher combat exposure was associated with higher PTSD symptoms, which in turn were associated with poorer family adjustment, although these indirect effects did not reach statistical significance. The model for female veterans evidenced a significant direct negative association between combat exposure and family adjustment when it statistically accounted for PTSD symptoms. When the relative impacts of separate PTSD symptom groupings were examined, those reflecting withdrawal/numbing symptoms and arousal/lack of control symptoms significantly and indirectly accounted for the negative effects of combat exposure on family adjustment. Study findings indicate a number of possible pathways through which war-zone deployments negatively impact military families and suggest several avenues for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disorders of extreme stress following war-zone military trauma: Associated features of posttraumatic stress disorder or comorbid but distinct syndromes?

Disorders of extreme stress not otherwise specified (DESNOS) and posttraumatic stress disorder (PTSD) were found to be comorbid but distinct among military veterans seeking inpatient PTSD treatment: 31% qualified for both conditions, 29% were diagnosed PTSD only, 26% were classified DESNOS only, and 13% met criteria for neither. PTSD diagnosis was associated with elevated levels of war-zone trauma exposure and witnessing atrocities and with impairment on the Mississippi Scale for Combat-Related PTSD and the Penn Inventory. DESNOS classification (but not PTSD) was associated with (a) early childhood trauma and participation in war-zone atrocities, (b) extreme levels of intrusive trauma reexperiencing, (c) impaired characterological functioning (object relations), and (d) use of intensive psychiatric services. PTSD and DESNOS may be comorbid but distinct posttraumatic syndromes and, as such, warrant careful clinical and scientific investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk Factors for Partner Violence Among a National Sample of Combat Veterans.

In this study, the authors identified potential risk factors for partner violence perpetration among a subsample (n=109) of men who participated in a national study of Vietnam veterans. Partner violent (PV) men with posttraumatic stress disorder (PTSD) were compared with PV men without PTSD and nonviolent men with PTSD on family-of-origin variables, psychiatric problems, relationship problems, and war-zone factors. PV men with PTSD were the highest of the 3 groups on every risk factor other than childhood abuse. Group contrasts and a classification tree analysis suggest some potential markers and mechanisms for the association between PTSD and partner violence among military veterans and highlight the need for theory development in this area of inquiry. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of immediate-onset and delayed-onset posttraumatic stress disorder in military veterans.

Differences in symptoms, trauma exposure, dissociative and emotional reactions to trauma, and subsequent life stress in war veterans reporting immediate-onset or delayed-onset posttraumatic stress disorder (PTSD) or no PTSD were investigated. The role of life stress in delayed-onset PTSD was also studied. Retrospective interviews were conducted with 142 United Kingdom veterans receiving a war pension for PTSD or physical disability. Immediate-onset and delayed-onset PTSD were similar in the number and type of symptoms reported at onset, but the delayed-onset group differed in showing a gradual accumulation of symptoms that began earlier and continued throughout their military career. They were more likely to report major depressive disorder and alcohol abuse prior to PTSD onset. Both groups described similar amounts of trauma exposure, but those in the delayed-onset group reported significantly less peritraumatic dissociation, anger, and shame. Veterans with delayed onsets were more likely than veterans with no PTSD to report the presence of a severe life stressor in the year before onset. In conclusion, the results suggest that delayed onsets involve a more general stress sensitivity and a progressive failure to adapt to continued stress exposure. (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)     

Longitudinal analyses of family functioning in veterans and their partners across treatment.

Objective: This study evaluated the relations between posttraumatic stress disorder (PTSD) symptoms and poor family functioning in veterans and their partners. Method: Data were collected from Caucasian veterans with PTSD (N = 1,822) and their partners (N = 702); mean age = 53.9 years, SD = 7.36. Veterans completed the Posttraumatic Checklist Military Version (PCL-M) and, along with their partners, completed the McMaster Family Assessment Device (FAD-12). Assessments were conducted at intake into a treatment program at 3 months and 9 months posttreatment. Results: Structural equation models (SEMs) were developed for veterans as well as for veterans and their partners. Poor family functioning for veterans at intake predicted intrusion (β = .08), hyperarousal (β = .07), and avoidance (β = .09) at 3 months posttreatment. At 3 months posttreatment, family functioning predicted hyperarousal (β = .09) and avoidance (β = .10) at 9 months. For veterans and their partners, family functioning at intake predicted avoidance (β = .07) at 3 months, and poor family functioning at 3 months predicted intrusion (β = .09) and hyperarousal (β = .14) at 9 months. The reverse pathways, with PTSD symptoms predicting poor family functioning, were only evident with avoidance (β = .06). Conclusion: Family functioning may play a role in treatment for veterans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of posttraumatic stress disorder in veterans with and without spinal cord injury.

The authors assessed effects of paraplegic and quadriplegic spinal cord injuries (SCls) on posttraumatic stress disorder (PTSD) by comparing severity and prevalence of PTSD in these groups to a sample of controls who experienced traumatic injuries other than SCI. The authors found that veterans with quadriplegia reported significantly less severe current PTSD symptoms than controls who were not significantly different from veterans with paraplegia. These results suggest that sustaining a quadriplegic SCI decreases risk of current PTSD, whereas sustaining a paraplegic SCI is associated with greater risk of PTSD, although the risk is no greater than that incurred from experiencing the trauma itself. (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)     

A Longitudinal Study of Retirement in Older Male Veterans.

In this study, the authors examined the effect of retirement on psychological and physical symptoms in 404 older male veterans who were taking part in an ongoing longitudinal study. Hierarchical linear modeling was used to analyze symptom trajectories from preretirement, peri-retirement, and postretirement periods in veterans with either lifetime full or partial posttraumatic stress disorder (PTSD), trauma exposure only, or no traumatic exposure. As expected, the PTSD group experienced greater increases in psychological and physical symptoms during retirement, relative to the other groups. Retirement due to poor health in the PTSD group did not account for the findings regarding physical symptoms. Results indicate that clinicians should recognize and address the potential for older individuals with PTSD to experience difficulties during retirement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive processing therapy for veterans with military-related posttraumatic stress disorder.

Sixty veterans (54 men, 6 women) with chronic military-related posttraumatic stress disorder (PTSD) participated in a wait-list controlled trial of cognitive processing therapy (CPT). The overall dropout rate was 16.6% (20% from CPT, 13% from waiting list). Random regression analyses of the intention-to-treat sample revealed significant improvements in PTSD and comorbid symptoms in the CPT condition compared with the wait-list condition. Forty percent of the intention-to-treat sample receiving CPT did not meet criteria for a PTSD diagnosis, and 50% had a reliable change in their PTSD symptoms at posttreatment assessment. There was no relationship between PTSD disability status and outcomes. This trial provides some of the most encouraging results of PTSD treatment for veterans with chronic PTSD and supports increased use of cognitive- behavioral treatments in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of a wartime stressor scale for women.

Prior research has demonstrated the importance of stress measurement as a component of evaluating posttraumatic stress disorder (PTSD). Much of the work conducted in this area has focused on male combat veterans, resulting in the development of several combat exposure scales. The nature of war-zone exposure for women, however, has not been systematically addressed. This article describes the development and preliminary psychometric analyses of the Women's Wartime Stressor Scale, an instrument designed to measure the self-report of wartime stressors by both theater and era veterans as well as civilian women who served in Vietnam. Measurement of internal consistency, test-retest reliability, and construct validity points to the potential clinical and research utility of this type of instrument. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans.

This study examined (a) the relationships between posttraumatic stress disorder (PTSD) symptom clusters and marital intimacy among Israeli war veterans and (b) the role of self-disclosure and verbal violence in mediating the effects of PTSD avoidance and hyperarousal symptoms on marital intimacy. The sample consisted of 219 participants divided into 2 groups: ex-prisoners of war (ex-POWs; N = 125) and a comparison group of veterans who fought in the same war but were not held in captivity (N = 94). Ex-POWs displayed higher levels of PTSD symptoms and verbal violence and lower levels of self-disclosure than did controls. Although ex-POWs and controls did not differ in level of marital intimacy, they did, however, present a different pattern of relationships between PTSD clusters and intimacy. In ex-POWs, self-disclosure mediated the relations between PTSD avoidance and marital intimacy. Verbal aggression was also found via indirect effect of hyperarousal on marital intimacy. The results point to the importance of self-disclosure and verbal violence as interpersonal mechanisms for the relations between posttraumatic symptoms on marital intimacy of ex-POWs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive symptoms of psychosis in posttraumatic stress disorder

The possible presence of hallucinations and delusional thoughts in posttraumatic stress disorder (PTSD) was investigated. Other symptom clusters were also assessed in order to further clarify the nature of PTSD. Twenty combat veterans with PTSD were compared to 18 combat veterans without PTSD on symptom rating scales. The subjects with PTSD exhibited a greater degree of depression, anxiety, agitation, anhedonia, and positive symptoms of psychosis than the comparison group. Specifically, the PTSD group manifested increased hallucinations, delusions, and bizarre behavior. Some of these positive symptoms did not appear to be due to reexperiencing of the trauma. The groups were not significantly different on indices of mania, thought disorder, or inertia. The clinical and diagnostic implications of the results are discussed. A diagnosis of PTSD should be considered with patients who have positive symptoms in the absence of thought disorder.     

Posttraumatic stress disorder, anger, and partner abuse among Vietnam combat veterans.

The authors examined interrelationships among posttraumatic stress disorder (PTSD) symptomatology, anger, and partner abuse perpetration among a sample of 60 combat veterans. Compared with PTSD-negative participants, PTSD-positive participants reported higher state anger across time and neutral and trauma prime conditions and higher anger reactivity during the trauma prime condition. PTSD-positive participants also exhibited more anger reactivity during the trauma prime than during the neutral condition. The same pattern of results was not found for anxiety reactivity during trauma memory activation. PTSD symptoms were associated with physical assault and psychological aggression perpetration, and trait anger mediated these relationships. Findings indicate a heightened anger response among PTSD-positive veterans and suggest the salience of dispositional components of anger in abuse perpetration in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning predicts outcomes for veterans in treatment for chronic posttraumatic stress disorder.

A longitudinal framework was used to examine the competing hypotheses of (a) whether family functioning predicts changes in posttraumatic stress disorder (PTSD) symptoms or (b) whether PTSD symptoms predict changes in family functioning. Veterans (N = 311) admitted to a treatment program completed a series of questionnaires at 3 time points: at intake, from intake to completion of a treatment program, and at the 6-month follow-up. Alcohol use and general mental health symptoms were also measured at intake. A cross-lagged panel model using structural equation modeling analyses indicated that family functioning was a moderate predictor of PTSD symptoms at posttreatment and at the 6-month follow-up. PTSD was not a significant predictor of family functioning across time and alcohol use, and general mental health symptoms did not affect the overall findings. Further analyses of PTSD symptom clusters indicated that the avoidance symptom cluster was most strongly related to family functioning. Targeting family relationships for treatment may be important in the future for veterans with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early childhood trauma and disorders of extreme stress as predictors of treatment outcome with chronic posttraumatic stress disorder

History of early childhood trauma was prevalent and highly correlated with Disorders of Extreme Stress Not Otherwise Specified (DESNOS) in a sample of veterans in inpatient treatment for chronic posttraumatic stress disorder (PTSD). DESNOS predicted reliable change on a variety of measures of psychiatric symptomatology (including PTSD) and psychosocial functioning independently of the effects of PTSD diagnosis and early childhood trauma history. DESNOS also predicted treatment outcome on PTSD and quality of life measures after controlling for the effects of ethnicity, war zone trauma exposure severity, initial level of symptomatic severity or quality of life, Axis I (PTSD and major depression) and Axis II (personality disorder) diagnostic status, and early childhood trauma history. Early childhood trauma was not predictive of outcome. DESNOS appears to play an important role in assessment and treatment planning for psychotherapeutic rehabilitation of chronic PTSD.     

The effects of initial trauma exposure on the symptomatic response to a subsequent trauma.

The effect of initial trauma on the symptomatic response to a subsequent trauma was investigated in a cross-sectional study of urban bus drivers. Comparisons were made among 175 drivers (mean age 42.2 yrs) who had developed either high or low symptoms of posttraumatic stress disorder (PTSD) as a result of the initial trauma, and a third group exposed to only a single trauma. The group with high levels Of PTSD symptoms after the initial trauma reported high PTSD symptoms for a subsequent trauma (75%) significantly more often than the other two groups who did not differ from each other (Low PTSD symptoms group 49%, No prior trauma group 41 %). These results suggest that unless trauma exposure leads to significant PTSD symptoms, it is not a risk factor for high PTSD symptoms after exposure to a subsequent traumatic event. (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)     

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.