Brain Function News

Post-Traumatic Stress Disorder and Service Utilization in a Sample of Service Members from Iraq and Afghanistan

Objective: The purpose of this study was to evaluate levels of post-traumatic stress disorder (), depression, alcohol abuse, quality of life, and mental health service utilization among returnees from Operation Enduring Freedom and . Methods: One hundred twenty returnees, enrolled for health care at a midwestern Veterans Affairs medical center, completed questionnaires approximately 6 months after their return from deployment. Results: levels (12%) were consistent with previous research while problematic drinking levels were also elevated (33%). and, to a lesser degree, alcohol abuse were associated with lower quality of life in multiple domains, even when controlling for the influence of depression. Of those screening positive for , 56% reported using mental health services. Only 18% of those screening positive for alcohol abuse reported using such services. Conclusions: and alcohol problems are prevalent in Operation Enduring Freedom/ returnees and associated with lower quality of life. Mental health service utilization is limited, even among returnees enrolled for Veterans Affairs health care.

A comparative study of

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.

assessment under standard conditions and in the field

Little is known about the performance of clinician-administered structured diagnostic interviews when given under variable levels of examiner training and monitoring. We sought to explore this question. We examined the performance of a self-report questionnaire and a structured clinical interview in the assessment of post-traumatic stress disorder () in two community samples of war veterans. One sample was interviewed under standard conditions (N = 372) and the other under unknown and less standardized conditions (N = 420), more closely approximating 'field conditions'. Interview results were used to predict questionnaire-based status. Kappas, sensitivities, specificities, and positive predictive powers were moderate and of similar magnitude in both samples. Our results suggest that even under uncertain ('field') conditions, clinician-administered structured interviews can produce results comparable to those produced under more tightly controlled conditions.

Sleep in a community sample of elderly war veterans with and without

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.

Background: Although sleep disturbances are commonly reported by individuals with , objective findings have been inconsistent, due in part to small sample sizes, comorbid psychiatric disorders, variations in the recentness of trauma exposure, and the use of subjects involved in psychiatric treatment.

Methods: A community sample of elderly males (n = 59) exposed to war trauma 28-50 years ago and free from sleep-affecting medications and disorders other than completed 3 nights of polysomnography. Of these participants, 30 met criteria for current ; three were receiving supportive outpatient psychotherapy.

Results: Two statistically significant differences were observed: Those with had a higher percentage of rapid eye movement (REM) sleep and fewer arousals from non-REM sleep. The perceptions of sleep quality among the participants with were lower than the perceptions of non- participants. Although participants with untreated obstructive sleep apnea and sleep movement disorders were not included in the sample, many cases were detected on initial screening. Treatment resulted in improved sleep and increased feelings of well being.

Conclusions: Alterations in REM and arousals characterized in this sample. When comorbid sleep disorders were ruled out, sleep was clinically similar across the groups. Trauma-related sleep disturbances that subjects reported as arising early in the course of the disorder appear to have declined over time.

Trauma exposure, resilience, social support, and

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.

construct validity among former prisoners of war

Background: The aim of this study was to investigate predictors of persistent symptoms of and to examine the construct validity of in a national sample of 270 World War II and Korean Conflict prisoners of war (POWs). Method: POWs were interviewed at two points in time (1965 and 1990). Predictors included symptomatology measured in 1965 by items from the Cornell Medical Index (CMI), severity of captivity trauma, resilience factors, and post-trauma social support. The criterion, symptomatology in the early 1990s, was evaluated with the module of the Structured Clinical Interview for DSM (SCID). Results: The CMI provided only partial coverage of criteria and appeared to provide only a general index of distress. Clustering of SCID items in two-dimensional space via multidimensional scaling analysis offers some construct validation for the DSM's differentiation of symptoms into criterion groups, although there was not a perfect match. Trauma severity is best related to symptomatology experienced in 1990, mitigated in part by greater education level and age at the time of trauma exposure. Surprisingly, 1965 distress added only a modest amount to the prediction of current distress, while post-trauma social support added none. Conclusions: These findings support previous work showing the severe psychological sequelae of POW status 40-50 years after captivity, and indicate that trauma severity during captivity is the best predictor of current symptomatology. Results also add to our understanding of the conceptual differentiation of symptoms into separate and distinct symptom clusters.

Polysomnographic sleep is not clinically impaired in vietnam combat veterans with chronic

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.

Background: Because sleep is typically disturbed in , this study was undertaken to evaluate a group of Vietnam combat veterans with the disorder using clinical polysomnographic techniques.

Methods: Eighteen Vietnam combat veterans with and 10 healthy non-combat-exposed Vietnam era veterans participated in 2 nights of polysomnographic study and a multiple sleep latency test.

Results: No significant differences between subjects and controls were noted except for greater sleep onset latency to stage 2 (p < .03), and lower arousals/hour from stages 3 & 4 (p < .04) on night 2, and lower subjectively estimated total sleep time on night 1 (p < .005) in the case of subjects. Otherwise, results from the second night served to replicate those from the first, and no significant differences appeared on 2 successive nights for any polysomnographic variable. No daytime hypersomnolence was detected.

Conclusions: Polysomnographically recorded sleep was notably better than expected in the presence of clinically significant with typical histories of disrupted sleep. In these subjects, there is no clinically significant sleep disorder or typical pattern of sleep disturbance detectable by standard polysomnography.

Assessment of

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.

in World War II Veterans

Four scales were compared in a community sample of 330 American former prisoners of war and combat veterans of World War II. The Mississippi Scale for Combat-Related (M-), the Minnesota Multiphasic Personality Inventory-2 Pk scale, and the Impact of Event Scale (IES) all demonstrated moderate relationships with as defined by the Structured Clinical Interview for DSM-III-R. Comparative validities were similar to those observed in Vietnam veteran samples. Confirmatory factor analysis indicated that the 3 scales loaded significantly on 1 factor. The impact of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria changes was examined and found to be minimal. Implications for the use of the M-, Pk, and IES in combat-related assessment are discussed.

Prevalence and Correlates of Depressive Symptoms among Former Prisoners of War

Studies of former prisoners of war (POWs) provide valuable insights into posttraumatic adaptation because they gather information from a large population who survived the traumatic experiences of military captivity. Previous studies of POWs have shown elevated rates of psychiatric symptoms and disorders. This report presents evidence from a longitudinal study of three large, representative, national samples of former POWs. The study finds that depressive symptomatology, as measured by the Center for Epidemiologic Studies Depression Scale, is elevated in World War II POWs from the Pacific and European theaters and in Korean conflict POWs. Decades later, depressive symptomatology is found to be strongly associated with prior treatment in captivity. Differences in depressive symptomatology among the three POW groups can be attributed to captivity-related factors and to buffering factors, such as age at capture and education.

Prevalence of Somatic and Psychiatric Disorders Among Former Prisoners of War

American former prisoners of war (POWs) are an aging group who seek health care with increasing frequency. To examine the prevalence of long-term physical and emotional consequences of captivity in this population, the authors analyzed medical and psychiatric examination data for 426 former POWs. Detailed psychiatric diagnostic criteria were used to assess the POWs' mental health. Compared with general population groups, POWs had moderately elevated lifetime prevalence rates of depressive disorders and greatly elevated rates of , although their rates of hypertension, diabetes, myocardial infarction, bipolar disorder, schizophrenia, and alcoholism were not elevated. POWs who lost more than 35 percent of their body weight during captivity had higher rates of anxiety disorder, depressive disorders, , and schizophrenia, compared with other POWs.

An adaptational view of trauma response as illustrated by the prisoner of war experience

We propose a model of Post-Traumatic Stress Disorder () symptoms in which they have positive evolutionary adaptational value in traumatic environments. The persistence of symptoms following return to more benign environments may result from biological changes within the organism, reflected by a primary response of increased levels of underlying traits such as Negative Affectivity. Secondary symptoms such as social withdrawal and substance abuse are conceptualized as subsequent coping with the primary trauma response. This model was tested using data on 413 former World War II Prisoners of War (POWs). The results were consistent with the model, indicating an enduring high level of Negative Affectivity as measured by scales on the MMPI. Captivity severity scores, developed using a factor analysis of POW experience variables, were related to lifetime and current diagnoses of , generalized anxiety disorder, and major or minor depression. They were not related to schizophrenia, alcohol abuse/dependence, bipolar I and II disorders, or organic mental disorders. Elevated Negative Affectivity indicators were proportional to the captivity severity scores.

Comorbidity of psychiatric disorders and personality profiles of American World War II prisoners of war

Examined the psychiatric comorbidity and personality characteristics of 62 World War II prisoners of war (POWs). This study extends the previous findings of N. Speed et al (see record 1989-26181-001). Each former POW completed the Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L), a symptom severity scale based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and the Minnesota Multiphasic Personality Inventory (MMPI). The Ss displayed a remarkable frequency of comorbid psychiatric disorders and a current adjustment characterized by traits of depression, anxiety, and somatization. Only 19% were free from all SADS-L lifetime psychiatric diagnoses, and only 9 had MMPI profiles within "normal limits." The amount of comorbidity of and depression 40 yrs after captivity was also remarkable. Findings support the hypothesis that depression is a late manifestation of being chronically ill with .

Age, education, maltreatment, and social support as predictors of chronic depression in former prisoners of war

This study examined the relationships of prisoner of war captivity trauma variables and individual protective variables to current depressive symptoms as indexed by the CES-D and its components. The sample consisted of 989 U.S. former POWs of World War II and the Korean War, who have been followed since the mid 1950s. Depressive symptoms persisted over 40 years later. Age, education, medical symptoms during captivity, and level of social support were related to later levels of adjustment. Theoretical and methodological implications of the findings were discussed.