Aggression among combat veterans is of great concern. Although some studies have found an association between combat exposure and aggressive behavior following deployment, others conclude that aggression is more strongly associated with symptoms of posttraumatic stress disorder (PTSD), and that alcohol misuse may influence this association. Many of these studies have assessed aggression as a single construct, whereas the current study explored both nonphysical aggression only and physical aggression in a sample of Iraq and Afghanistan war veterans (N = 337; 91% male).
We found that alcohol problems interacted with PTSD symptom severity to predict nonphysical aggression only. At low levels of PTSD symptoms, veterans with alcohol problems were more likely to perpetrate nonphysical aggression only, as compared with no aggression, than veterans without an alcohol problem. There was no difference in the likelihood of nonphysical aggression only between those with and without alcohol problems at high levels of PTSD symptoms. The likelihood of nonphysical aggression only, as compared with no aggression, was also greater among younger veterans. Greater combat exposure and PTSD symptom severity were associated with an increased likelihood of perpetrating physical aggression, as compared with no aggression. Ethnic minority status and younger age were also associated with physical aggression, as compared with no aggression.
Findings suggest that a more detailed assessment of veterans' aggressive behavior, as well as their alcohol problems and PTSD symptoms, by researchers and clinicians is needed in order to determine how best to intervene.
Fischer, Ellen P.; Sherman, Michelle D.; Han, Xiaotong; & Owen Jr., Richard R..
Professional Psychology: Research and Practice, Mar 18 , 2013, No Pagination Specified.
Posttraumatic stress disorder (PTSD) is prevalent among users of the Veterans Affairs (VA) health care system. Effective approaches to involving family in care for PTSD are critical because family functioning both affects and is affected by treatment outcomes. Although multifamily group treatment is an evidence-based practice for schizophrenia and other serious mental illnesses, no data have been published on its effectiveness for those living with PTSD and their family members.
This study examined the impact of participation in REACH (Reaching out to Educate and Assist Caring, Healthy Families), an adaptation of the multifamily group psychoeducation program tailored for delivery to veterans with PTSD and their family members. Read more . . .
Wisco BE, Pineles SL, Shipherd JC, & Marx BP.
Cogn Emot. 2013 Mar 21; PMID: 23517445 [PubMed - as supplied by publisher]
Attentional interference by threat is associated with PTSD, but the mechanisms of this relationship remain unclear. Attentional interference might be related to increased use of maladaptive thought control strategies, such as suppressing unwanted thoughts (thought suppression) or replacing threatening thoughts with everyday concerns (worry), which increase PTSD risk. Conversely, attentional interference might be associated with reduced use of adaptive strategies, such as talking about threatening thoughts (social control), which decrease PTSD risk.
This study tested if thought control strategies mediate the relationship between attentional interference and PTSD. Sixty-one male Vietnam-era veterans completed measures of PTSD symptoms and thought control strategies. Participants also completed a Visual Search Task measuring attentional interference, which required participants to identify a target letter string among a group of threat or neutral words.
Attentional interference by threat was related to PTSD symptoms, and mediation analyses revealed significant indirect effects of attentional interference through thought suppression and worry. Attentional interference was related to re-experiencing and avoidance, but not hyperarousal, symptom clusters. Thought suppression was a unique mediator for re-experiencing, whereas thought suppression and worry both mediated the relationship with avoidance.
These results offer evidence for maladaptive thought control strategies as a mechanism linking attentional biases for threat to PTSD.
Jakupcak, Matthew; Blais, Rebecca K.; Grossbard, Joel; Garcia, Hector; & Okiishi, John.
Psychology of Men & Masculinity, Feb 18 , 2013
The association between endorsement of emotional “toughness” (i.e., extreme self-reliance and the suppression of outward displays of emotional distress) and likelihood for screening positive for mental health conditions was examined in a male sample of 198 Iraq and Afghanistan veterans presenting for postdeployment Veteran Affairs health care.
After accounting for relevant covariates, veterans endorsing higher levels of emotional toughness were more likely to screen positive for posttraumatic stress disorder and depression. There was also a nonsignificant trend (p = .08) associated with a positive relationship between toughness and likelihood of self-reported alcohol abuse.
Results are discussed in terms of identifying and addressing toughness norms among returning veterans to promote effective use of mental health services.
J Spec Oper Med. 2013;13(1):49-54 PMID: 23526322 [PubMed - as supplied by publisher]
This large case series reports the results of using a removable soft intraoral stabilization splint in the treatment of chronic headaches and chronic nightmares in 60 military post-traumatic stress disorder (PTSD) patients of the Vietnam, Desert Storm, Operation Iraqi Freedom, and Operation Enduring Freedom conflicts.
Patient treatment criteria included meeting all of the following requirements: minimum of three headaches per week; minimum of three nightmares per week; minimum of three sleep interruptions per week; minimum of three intraoral or extraoral (craniofacial) trigger points; and previous PTSD diagnosis by the U.S. Army or Veterans Administration with duration of this disorder for a minimum of three years.
Significant reduction (60%?90%) in headache and nightmare severity, intensity, and duration was obtained in 75% of the 44 patients who completed the three-month follow-up.
J Anxiety Disord. 2013 Mar 4;27(2):240-251 PMID: 23523947 [PubMed - as supplied by publisher]
This study examined the influence of trauma history and PTSD symptoms on the behavior of veterans and their intimate partners (287 couples; N=574) observed during conflict discussions and coded using the Rapid Marital Interaction Coding System (Heyman, 2004).
Dyadic structural equation modeling analyses showed that PTSD was associated with more frequent displays of hostility and psychological abuse and fewer expressions of acceptance and humor in both veterans and their partners.
Findings provide new insight into the social and emotional deficits associated with PTSD and emphasize the importance of addressing the trauma histories and PTSD of both partners when treating veteran couples with relationship disturbance.
Lewis VJ, Dell L, & Matthews LR.
Rehabil Med. 2013 Mar 28;45(4):403-9 PMID: 23546308 [PubMed - in process]
Objective: The increasing number of veterans with complex health conditions accessing rehabilitation leads to the need for an outcome measure that identifies success in areas beyond return to work. The current study was designed to assess the feasibility of Goal Attainment Scaling as a routine measure of outcomes of rehabilitation. Read more . . .
King MW, Street AE, Gradus JL, Vogt DS, & Resick PA.
J Trauma Stress. 2013 Mar 22; PMID: 23526678 [PubMed - as supplied by publisher
Establishing whether men and women tend to express different symptoms of posttraumatic stress in reaction to trauma is important for both etiological research and the design of assessment instruments. Use of item response theory (IRT) can reveal how symptom reporting varies by gender and help determine if estimates of symptom severity for men and women are equally reliable.
We analyzed responses to the PTSD Checklist (PCL) from 2,341 U.S. military veterans (51% female) who completed deployments in support of operations in Afghanistan and Iraq (Operation Enduring Freedom/Operation Iraqi Freedom [OEF/OIF]), and tested for differential item functioning by gender with an IRT-based approach.
Among men and women with the same overall posttraumatic stress severity, women tended to report more frequent concentration difficulties and distress from reminders whereas men tended to report more frequent nightmares, emotional numbing, and hypervigilance. These item-level gender differences were small (on average d = 0.05), however, and had little impact on PCL measurement precision or expected total scores. For practical purposes, men's and women's severity estimates had similar reliability.
This provides evidence that men and women veterans demonstrate largely similar profiles of posttraumatic stress symptoms following exposure to military-related stressors, and some theoretical perspectives suggest this may hold in other traumatized populations.
Bush, Nigel E.; Prins, Annabel; Laraway, Sean; O'Brien, Karen; Ruzek, Joséf; & Ciulla, Robert P.
Psychological Trauma: Theory, Research, Practice, and Policy, Mar 25 , 2013, No Pagination Specified.
This pilot study employed a nonconcurrent, multiple-baseline single-case design to examine the impact of an online self-management posttraumatic stress (PTS) workshop on self-reported symptoms of PTS, depression, and functional impairment.
Eleven student veterans with PTS first completed between three and five weekly baseline measures. Second, they took part in eight weekly online workshop sessions, each accompanied by symptom assessments. Third, they completed postintervention outcome measures. Read more . . .
Vella, Elizabeth Jane; Milligan, Briana; Bennett, & Jessie Lynn.
Military Medicine, Volume 178, Number 3, March 2013 , pp. 254-260(7)
Purpose: Evaluate the effectiveness of a 2-day, 3-night outdoor recreation intervention involving fly-fishing in reducing the psychological concomitants of stress among 74 veterans (M = 47.27, SD = 14.55 years) with post-traumatic stress disorder (PTSD).
Methods: Participants completed repeated assessments of attentiveness, mood, depression, anxiety, and somatic stress across 3 time periods, corresponding to 2 weeks before the trip (baseline), the last day of the trip, and a 6-week follow-up. Assessments of perceptual stress, PTSD symptoms, and sleep quality were also administered during the baseline and follow-up periods.
Results: Acute effects were observed for improvements in attentiveness and positive mood states, coupled with significant and sustained reductions in negative mood states, anxiety, depression, and somatic symptoms of stress. Comparisons between the baseline and follow-up periods revealed significant improvements in sleep quality and reductions in perceptual stress and PTSD symptoms.
Conclusions: The current findings suggest that combat veterans with PTSD may benefit from participation in group-based outdoor recreation as a means to improve psychosocial well-being.
James LM, Van Kampen E, Miller RD, & Engdahl BE.
Mil Med. 2013 Feb;178(2):159-65 PMID: 23495461 [PubMed - in process]
Military personnel returning from the conflicts in Iraq and Afghanistan commonly experience mental health problems and efforts are underway to determine risk and protective factors associated with postdeployment mental health concerns.
This study examined the contribution of trait neuroticism, predeployment life events, combat experience, perceptions of threat, and postdeployment social support on mental health symptoms at 6 months, 12 months, and 24 months postdeployment. Two hundred seventy-one veterans completed self-report measures.
Hierarchical regression analyses demonstrated that neuroticism predicted post-traumatic stress and depressive symptoms at all 3 time points; perceived threat predicted post-traumatic stress symptoms at time 1 and time 2 and depressive symptoms at time 2. Social support was a strong negative predictor of post-traumatic stress and depressive symptoms. Alcohol misuse was not significantly predicted by any of the variables.
The present study highlights the role of perceived threat and trait neuroticism on postdeployment mental health symptoms and indicates social support is a robust protective factor. Efforts aimed at increasing sustained postdeployment social support may help defend against significant mental health problems among veterans.
Jennifer Tawa & Susan Murphy.
Journal of the American Academy of Nurse Practitioners, Early View.
Purpose Posttraumatic stress disorder (PTSD) is a serious mental health disorder. The current first-line psychopharmacologic treatment for PTSD is selective serotonin reuptake inhibitors (SSRIs). Recently, the efficacy of SSRIs has been challenged in favor of propranolol use.
This article reviews the origins of PTSD, its impact within the veteran population, psychopharmacological treatment of PTSD, and current literature on the use of propranolol for PTSD treatment. Read more . . .
Boden, M. Babson, K. et al.
The American Journal on Addictions. 6 MAR 2013
The present study is the first to explore links between PTSD and cannabis use characteristics immediately prior to a cannabis quit attempt, including motives, use problems, withdrawal, and craving.
Methods: Measures of PTSD diagnosis, symptom severity, and cannabis use characteristics were administered to a sample of cannabis dependent military veterans (n = 94). Hypotheses were tested with a series of analyses of variance and covariance and hierarchical multiple regressions with Bonferroni corrections. Analyses were conducted with and without adjusting for variance shared with substance use (cannabis, alcohol, tobacco) in the previous 90 days, and co-occurring mood, anxiety, and substance use diagnoses.
Results and Conclusions: Compared to participants without PTSD, participants with PTSD reported significantly increased: (a) use of cannabis to cope, (b) severity of cannabis withdrawal, and (c) experiences of craving related to compulsivity, emotionality, and anticipation, with findings regarding coping and craving remaining significant after adjusting for covariates. Among the total sample, PTSD symptom severity was positively associated with (a) use of cannabis to cope, (b) cannabis use problems, (c) severity of cannabis withdrawal, and (d) experiences of craving related to compulsivity and emotionality, with findings regarding withdrawal and emotion-related craving remaining significant after adjusting for covariates.
Thus, links between PTSD and using cannabis to cope, severity of cannabis withdrawal, and especially craving appear robust across measures of PTSD and analytical method.
van Hoorn LA, Jones N, Busuttil W, Fear NT, Wessely S, Hunt E, & Greenberg N.
Occup Med (Lond). 2013 Mar 11; 23479566 [PubMed - as supplied by publisher]
Background: Recently, proposals have been made to improve mental health care for UK military veterans. Combat Stress (CS), a veteran's charity, has provided mental health services for veterans since 1919. Since 2003, service users have included veterans from the Iraq and Afghanistan conflicts; however, their pattern of help-seeking has not been evaluated.
Aims: To describe the characteristics of the veteran population of the recent Iraq or Afghanistan conflicts who sought help from CS between 2003 and May 2011.
Methods: CS Iraq and Afghanistan veteran clinical and welfare records were evaluated.ResultsNine hundred and eighty-eight records were evaluated. The median time for veterans of recent conflicts to seek help from CS since discharge from military service was ~2 years, considerably shorter than the mean time of 14 years previously estimated by CS. Approximately, three-quarters of the veterans receiving a full clinical assessment (n = 114), received a diagnosis of post traumatic stress disorder (PTSD) (n = 87). Approximately half of the clinically assessed veterans self-referred to CS (51%); their most frequent diagnosis was PTSD.
Conclusions: Veterans who have served in Iraq and Afghanistan are presenting to Combat Stress sooner, and at a younger age, than veterans of previous conflicts and operations.
Elbogen EB, Wagner HR, Johnson SC, Kinneer P, Kang H, Vasterling JJ, Timko C, & Beckham JC.
Psychiatr Serv. 2013 Feb 1;64(2):134-41 PMID: 23475498 [PubMed - in process]
OBJECTIVE: This study analyzed data from a national survey of Iraq and Afghanistan veterans to improve understanding of mental health services use and perceived barriers.
METHODS: The National Post-Deployment Adjustment Survey randomly sampled post-9/11 veterans separated from active duty or in the Reserves or National Guard. The corrected response rate was 56% (N=1,388). Read more . . .
Suzannah K. Creecha, & Brian Borsari.
Addictive Behaviors. Available online 26 February 2013.
Background: Little is known regarding alcohol use and its correlates in women Veterans. An understanding of these variables is of utility to providers in primary care at Veterans Affairs (VA) hospitals, who are among the first to identify and intervene for problem drinking.
Objective: The objective of this study was to describe and explore the associations between posttraumatic stress disorder symptoms, experience of military sexual trauma (MST), expectancies for alcohol use, and coping skills in predicting drinking behavior. Read more . . .
Stecker T, Shiner B, Watts BV, Jones M, & Conner KR.
Psychiatr Serv. 2013 Mar 1;64(3):280-3 PMID: 23450385 [PubMed - in process]
OBJECTIVES: Barriers associated with the decision not to seek treatment for symptoms of combat-related posttraumatic stress disorder (PTSD) were examined.
METHODS: Participants were 143 military men and women who served in Operation Enduring Freedom or Operation Iraqi Freedom (OEF/OIF) and who screened positive for posttraumatic stress disorder (PTSD), as assessed by the PTSD Checklist-Military Version, and who had not sought treatment for PTSD. During a cognitive-behavioral telephone intervention, participants were asked about their beliefs concerning seeking PTSD treatment.
RESULTS: Four categories of beliefs were associated with the decision to seek treatment, including concerns about treatment (40%), emotional readiness for treatment (35%), stigma (16%), and logistical issues (8%).
CONCLUSIONS: This work suggests areas for intervention efforts to minimize barriers to treatment for PTSD for OEF/OIF veterans.
April A. Gerlock, Jackie Grimesey, & George Sayre.
Journal of Marital and Family Therapy.
The protracted conflict in Iraq and Afghanistan and an all-volunteer military has resulted in multiple war zone deployments for many service members. While quick redeployment turnaround has left little time for readjustment for either the service member or family, dealing with the long-term sequelae of combat exposure often leaves families and intimate partners ill-prepared for years after deployments.
Using a modified grounded theory approach, digitally recorded couple interviews of 23 couples were purposefully selected from a larger sample of 441 couples to better understand the impact of war zone deployment on the couple. The veteran sample was recruited from a randomly selected cohort of men in treatment for posttraumatic stress disorder (PTSD).
Overall, it was found when veterans experiencing deployment-related PTSD reenter or start new intimate relationships they may bring with them a unique cluster of interrelated issues which include PTSD symptoms, physical impairment, high rates of alcohol and/or drug abuse, and psychological and physical aggression. These factors contributed to a dynamic of exacerbating conflict. How these couples approached relationship qualities of mutuality, balanced locus of control and weakness tolerance across six axes of caregiving, disability, responsibility, trauma, communication, and community impacted the couple's capacity to communicate and resolve conflict. This dyadic relationship model is used to help inform implications for clinical practice.
Thompson J, Hopman W, Sweet J, VanTil L, MacLean MB, VanDenKerkhof E, Sudom K, Poirier A, & Pedlar D.
2013;104(1):e15-e21 Not yet in PubMed
OBJECTIVES: Describe health-related quality of life (HRQoL) of former Canadian Forces (CF) men and women in uniform (Veterans) after transition to civilian life, and compare to age- and sex-adjusted Canadian norms. Read more . . .
Jones N, Jones M, Fear NT, Fertout M, Wessely S, & Greenberg N.
Occup Environ Med. 2013 Feb 26; PMID: 23444279 [PubMed - as supplied by publisher]
OBJECTIVE: Third Location Decompression (TLD) is an activity undertaken by UK Armed Forces (UK AF) personnel at the end of an operational deployment which aims to smooth the transition between operations and returning home. We assessed whether TLD impacted upon both mental health and postdeployment readjustment. Read more . . .
Washington DL, Davis TD, Der-Martirosian C, & Yano EM.
J Gen Intern Med. 2013 Feb 23; PMID: 23435765 [PubMed - as supplied by publisher]
BACKGROUND: Post-traumatic stress disorder (PTSD) is common in women veterans (WVs), and associated with significant co-morbidity. Effective treatment is available; however, PTSD is often unrecognized.
OBJECTIVES: Identify PTSD prevalence and mental healthcare (MHC) use in a representative national WV sample. Read more . . .
Outcalt SD, Yu Z, Hoen HM, Pennington TM, & Krebs EE.
Pain Med. 2013 Feb 22; PMID: 23432958 [PubMed - as supplied by publisher]
OBJECTIVE: To examine health care utilization among veterans with both chronic pain and posttraumatic stress symptoms.
METHODS: Retrospective cohort study of 40,716 veterans in a VA regional network from January 1, 2002 to January 1, 2007. Veterans were categorized into pain-only, posttraumatic stress disorder symptoms (PTSD)-only, and pain plus PTSD (pain+PTSD) comparison groups. Negative binomial models were used to compare adjusted rates of primary care, mental health, and specialty pain service use, as well as opioids, benzodiazepines, nonopioid analgesics, and antidepressant prescriptions. Rates of clinic visits were calculated by days per year, and rates of medication use were calculated by prescription months per year. Participants were followed for a mean duration of 47 months. Read more . . .
Davis JJ, Walter KH, Chard KM, Parkinson RB, & Houston WS.
Rehabil Psychol. 2013 Feb;58(1):36-42 PMID: 23437998 [PubMed - in process]
Objective: This retrospective study examined treatment adherence in Cognitive Processing Therapy (CPT) for combat-related posttraumatic stress disorder (PTSD) in Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) with and without history of mild traumatic brain injury (mTBI). Read more . . .
Alao A, Selvarajah J, & Razi S.
Int J Psychiatry Med. 2012;44(2):165-9 PMID: 23413663 [PubMed - in process]
OBJECTIVE: To describe the successful treatment of PTSD associated nightmares in two patients with PTSD.
CASE SUMMARIES: The report of the successful use of clonidine to treat PTSD associated nightmares among two Veterans following combat exposure.
DISCUSSION: Clonidine, a centrally acting alpha-agonist agent used to treat hypertension, stimulates alpha-adrenoreceptors in the brain stem. This action results in reduced sympathetic outflow from the central nervous system. We hypothesize that this central mechanism of action is why clonidine may be more effective in treating nightmares among patients with PTSD when compared with other agents.
CONCLUSION: Clonidine should be considered as an alternative in the treatment of nightmares among patients with PTSD.
van Liempt S, van Zuiden M, Westenberg H, Super A, & Vermetten E.
Depress Anxiety. 2013 Feb 6; PMID: 23389990 [PubMed - as supplied by publisher]
BACKGROUND: A significant proportion of soldiers return from deployment with symptoms of fatigue, sleep difficulties, and posttraumatic complaints. Disrupted sleep has been proposed as a contributing factor for the development of posttraumatic stress disorder (PTSD). This study investigates the impact of impaired sleep and nightmares before deployment on the development of PTSD symptoms. Read more . . .
Morasco BJ, Lovejoy TI, Lu M, Turk DC, Lewis L, & Dobscha SK.
Pain. 2013 Jan 11; PMID: 23398939 [PubMed - as supplied by publisher]
People with chronic pain and comorbid posttraumatic stress disorder (PTSD) report more severe pain and poorer quality of life than those with chronic pain alone. This study evaluated the extent to which associations between PTSD and chronic pain interference and severity are mediated by pain-related coping strategies and depressive symptoms. Read more . . .
Paulus EJ, Argo TR, & Egge JA.
J Trauma Stress. 2013 Jan 31; PMID: 23371434 [PubMed - as supplied by publisher]
Hyperarousal is a hallmark of posttraumatic stress disorder (PTSD). PTSD has been associated with increased blood pressure (BP) and heart rate (HR) in veteran populations. We retrospectively identified male patients consulted to outpatient psychiatry at the Iowa City Veterans Affairs Healthcare System. Patients were divided into PTSD (n = 88) and non-PTSD (n = 98) groups. All PTSD patients and a subset of non-PTSD patients had documented blast exposure during service. The study investigated whether patients with PTSD had higher systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) than patients without PTSD. The effect of trauma exposure on BP was also examined.
Mean SBP (133.8 vs. 122.3 mm Hg; p < .001), DBP (87.6 vs. 78.6 mm Hg; p < .001), and HR (78.9 vs. 73.1 bpm; p < .001) were all significantly higher in the PTSD group. Trauma-exposed patients without PTSD had significantly higher BP than nonexposed patients. The prevalence of hypertension (HTN) was 34.1% (diagnosed and undiagnosed) among PTSD patients. Patients with PTSD had higher BP and HR compared to patients without PTSD.
Trauma exposure may increase BP in this population. These findings will increase awareness about the cardiovascular implications of PTSD.
Collin L. Davidson, Kimberly A. Babson PhD, & Marcel O.
Suicide and Life-Threatening Behavior.
Suicide has a large public health impact. Although effective interventions exist, the many people at risk for suicide cannot access these interventions. Exercise interventions hold promise in terms of reducing suicide because of their ease of implementation. While exercise reduces depression, and reductions in depressive symptoms are linked to reduced suicidal ideation, no studies have directly linked exercise and suicide risk. The current study examined this association, including potential mediators (i.e., sleep disturbance, posttraumatic stress symptoms, and depression), in a sample of Veterans. SEM analyses revealed that exercise was directly and indirectly associated with suicide risk. Additionally, exercise was associated with fewer depressive symptoms and better sleep patterns, each of which was, in turn, related to lower suicide risk.
Laska KM, Smith TL, Wislocki AP, Minami T, & Wampold BE.
J Couns Psychol. 2013 Jan;60(1):31-41 PMID: 23356465 [PubMed - in process]
Objective: Various factors contribute to the effective implementation of evidence-based treatments (EBTs). In this study, cognitive processing therapy (CPT) was administered in a Veterans Affairs (VA) posttraumatic stress disorder (PTSD) specialty clinic in which training and supervision were provided following VA implementation guidelines. The aim was to (a) estimate the proportion of variability in outcome attributable to therapists and (b) identify characteristics of those therapists who produced better outcomes. Read more . . .
Lande RG, & Williams LB.
Mil Med. 2013 Jan;178(1):50-4 PMID: 23356119 [PubMed - in process]
The authors' principle objective was determining the prevalence and characteristics of medical malingering in the military. The authors accessed an electronic database used by the Department of Defense to monitor and manage military health care activities worldwide. The authors searched the database from 2006 to 2011 in the Northern Regional Medical Command for all instances where a health care provider, consequent to an outpatient medical visit, diagnosed malingering, factitious disorder with psychological symptoms, or factitious disorder with physical symptoms.
During the time period studied, the Northern Regional Medical Command reported 28,065,568 health care visits. During the same time period, clinicians diagnosed 1,074 individuals with malingering, factitious disorder with predominantly psychological signs and symptoms, or factitious disorder with predominantly physical signs and symptoms. The typical subject diagnosed with one of these disorders was young, male, nonmarried, and enlisted. Although most diagnoses came from a mental health clinic, other medical specialties also contributed to the total tally.
These diagnoses are extremely rare based on the findings from this study of outpatient medical care visits.
Church D, Hawk C, Brooks AJ, Toukolehto O, Wren M, Dinter I, & Stein P.
J Nerv Ment Dis. 2013 Feb;201(2):153-60 PMID: 23364126 [PubMed - in process]
This study examined the effect of Emotional Freedom Techniques (EFT), a brief exposure therapy combining cognitive and somatic elements, on posttraumatic stress disorder (PTSD) and psychological distress symptoms in veterans receiving mental health services.
Veterans meeting the clinical criteria for PTSD were randomized to EFT (n = 30) or standard of care wait list (SOC/WL; n = 29). The EFT intervention consisted of 6-hour-long EFT coaching sessions concurrent with standard care. The SOC/WL and EFT groups were compared before and after the intervention (at 1 month for the SOC/WL group and after six sessions for the EFT group). The EFT subjects had significantly reduced psychological distress (p < 0.0012) and PTSD symptom levels (p < 0.0001) after the test. In addition, 90% of the EFT group no longer met PTSD clinical criteria, compared with 4% in the SOC/WL group. After the wait period, the SOC/WL subjects received EFT.
In a within-subjects longitudinal analysis, 60% no longer met the PTSD clinical criteria after three sessions. This increased to 86% after six sessions for the 49 subjects who ultimately received EFT and remained at 86% at 3 months and at 80% at 6 months. The results are consistent with that of other published reports showing EFT's efficacy in treating PTSD and comorbid symptoms and its long-term effects.
Brooks E, Novins DK, Thomas D, Jiang L, Nagamoto HT, Dailey N, Bair B, & Shore JH.
Psychiatr Serv. 2012 Sep 1;63(9):862-7 PMID: 22707088 [PubMed - indexed for MEDLINE]
OBJECTIVE: Posttraumatic stress disorder (PTSD) is widespread among veterans, but many veterans with PTSD use few health services. This study examined how individual characteristics influenced use of outpatient visits by veterans with PTSD. Read more . .
Abrams TE, Vaughan-Sarrazin M, Richardson K, Cram P, & Rosenthal GE.
Radiology. 2013 Jan 29; PMID: 23360739 [PubMed - as supplied by publisher]
Purpose: To examine the relationship between posttraumatic stress disorder (PTSD) and computed tomography (CT) utilization and to determine whether there were patterns of comorbid illness that could explain the relationship. Read more . . .
Naylor JC, Dolber TR, Strauss JL, Kilts JD, Strauman TJ, Bradford DW, Szabo ST, Youssef NA, Connor KM, Davidson JR, & Marx CE.
Psychiatry Res. 2012 Dec 28; 23276723 [PubMed - as supplied by publisher]
Subthreshold posttraumatic stress disorder (PTSD) is associated with increased risk for suicidality, depression, and functional impairment. We thus conducted a small (N=12) pilot randomized controlled trial (RCT) with paroxetine for subthreshold PTSD in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) era veterans.
Hospital Anxiety and Depression Scale (HADS) scores improved by 30.4% in the paroxetine group. Paroxetine may have promise for subthreshold PTSD.
Babson KA, Boden MT, Woodward S, Alvarez J, & Bonn-Miller M.
J Nerv Ment Dis. 2013 Jan;201(1):48-51 PMID: 23274295 [PubMed - in process]
A cardinal feature of posttraumatic stress disorder (PTSD) is decreased sleep quality. Anxiety sensitivity (AS) is one factor that has shown early theoretical and empirical promise in better understanding the relation between sleep quality and PTSD outcomes. The current study is the first to test the independent and interactive effects of sleep quality and AS on PTSD symptoms.
Consistent with hypotheses, AS and sleep quality were found to be independent and interactive predictors of PTSD symptom severity in our sample of male military veterans seeking treatment for PTSD. Slope analyses revealed that AS was differentially related to PTSD symptom severity as a function of quality of sleep. The veterans with good sleep quality and relatively lower levels of AS had the lowest level of PTSD symptoms, whereas the veterans with poor sleep quality and low AS evidenced severity of PTSD symptoms similar to those with high AS.
Blum K, Giordano J, Oscar-Berman M, Bowirrat A, Simpatico T, & Barh D.
J Genet Syndr Gene Ther. 2012 May 31;3(3): PMID: 23264885 [PubMed - as supplied by publisher]
There is a need for understanding and treating post-traumatic stress disorder (PTSD), in soldiers returning to the United States of America after combat. Likewise, it would be beneficial to finding a way to reduce violence committed by soldiers, here and abroad, who are suspected of having post-traumatic stress disorder (PTSD). We hypothesize that even before combat, soldiers with a childhood background of violence (or with a familial susceptibility risk) would benefit from being genotyped for high-risk alleles. Such a process could help to identify candidates who would be less suited for combat than those without high-risk alleles.
Of secondary importance is finding safe methods to treat individuals already exposed to combat and known to have PTSD. Since hypodopaminergic function in the brain's reward circuitry due to gene polymorphisms is known to increase substance use disorder in individuals with PTSD, it might be parsimonious to administer dopaminergic agonists to affect gene expression (mRNA) to overcome this deficiency.
Jacobson IG, Horton JL, Leardmann CA, Ryan MA, Boyko EJ, Wells TS, Smith B, & Smith TC.
J Trauma Stress. 2012 Nov 26; PMID: 23184886 [PubMed - as supplied by publisher]
Limited prospective studies exist that evaluate the mental health status of military health care professionals who have deployed. This study used prospective data from the Millennium Cohort Study with longitudinal analysis techniques to examine whether health care professionals deployed in support of the operations in Iraq and Afghanistan were more likely to screen positive for new-onset posttraumatic stress disorder (PTSD) or depression after deployment than individuals from other occupations.
California Institute of Integral Studies, 2012, 240 pages.
An integrative literature review and online survey examined the significance of military cultural competence in civilian clinicians treating U.S. combat veterans diagnosed with posttraumatic stress disorder (PTSD), where the U.S. military was understood as an unrecognized "cultural minority." Combat trauma's development as a diagnostic construct since the American Civil War was reviewed in the clinical literature, and cultural factors distinguishing combat PTSD from civilian trauma were identified. These factors include: (a) parallels between disseminated military values and behaviors inculcated into military personnel and the DSM-IV-TR criteria for PTSD; (b) the multi-faceted nature of trauma occurring in combat; and (c) retraumatization upon civilian reentry. Read more . . .
The current study examined the longitudinal effects of clinical and treatment utilization factors on aggressive behavior among 376 help-seeking U.S. veterans recently diagnosed with posttraumatic stress disorder (PTSD) who were followed for 5-12 months. Participants were sampled from 4 strata: male Iraq/Afghanistan veterans, female Iraq/Afghanistan veterans, male prior-era veterans, and female prior-era veterans. Read more . . .
MacEachron A & Gustavsson N.
ADVANCES IN SOCIAL WORK, Fall 2012, 13(3)
Abstract: The incidence of PTSD and other combat-related trauma symptoms among more than 2 million veterans returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) in Afghanistan suggests that many will experience psychological challenges in adjusting to civilian life. However, the literature is sparse about this new group of veterans.
This study examined the relationships between peer support, self-efficacy, and PTSD symptoms among 216 OIF/OEF veterans who had attended 1 of 17 Vets4Vets peer support weekend retreats. Vets4Vets is a national grassroots program whose mission is to improve the psychological well-being of returning OIF/OEF veterans. Analysis of posttest changes indicate the generalizability of previous research findings, based on other groups of trauma-affected groups, to OIF/OEF veterans.
As predicted, increased perceived peer support and self-efficacy reduced PTSD symptoms. From a theoretical perspective, we found that both models of self-efficacy, situation-specific (Bandura, 1997; Benight & Bandura, 2004) and general self-efficacy (Schwarzer & Fuchs, 1996), mediated or explained the relationship between peer support and PTSD symptoms. Implications for social work are discussed.
Collen JF, Lettieri CJ, & Hoffman M.
J Clin Sleep Med. 2012;8(6):667-72 PMID: 23243400 [PubMed - in process]
INTRODUCTION: Obstructive sleep apnea (OSA) is a common comorbid condition in patients with posttraumatic stress disorder (PTSD); insufficiently treated OSA may adversely impact outcomes. Sleep fragmentation and insomnia are common in PTSD and may impair CPAP adherence. We sought to determine the impact of combat-related PTSD on CPAP adherence in soldiers. Read more . . .
Schoenfeld FB, Deviva JC, & Manber R.
J Rehabil Res Dev. 2012;49(5):729-52 PMID: 23015583 [PubMed - indexed for MEDLINE]
Sleep disturbances are among the most commonly reported posttraumatic stress disorder (PTSD) symptoms. It is essential to conduct a careful assessment of the presenting sleep disturbance to select the optimal available treatment. Cognitive-behavioral therapies (CBTs) are at least as effective as pharmacologic treatment in the short-term and more enduring in their beneficial effects.
Cognitive-behavioral treatment for insomnia and imagery rehearsal therapy have been developed to specifically treat insomnia and nightmares and offer promise for more effective relief of these very distressing symptoms.
Pharmacotherapy continues to be an important treatment choice for PTSD sleep disturbances as an adjunct to CBT, when CBT is ineffective or not available, or when the patient declines CBT. Great need exists for more investigation into the effectiveness of specific pharmacologic agents for PTSD sleep disturbances and the dissemination of the findings to prescribers. The studies of prazosin and the findings of its effectiveness for PTSD sleep disturbance are examples of studies of pharmacologic agents needed in this area. Despite the progress made in developing more specific treatments for sleep disturbances in PTSD, insomnia and nightmares may not fully resolve.
Tansey CM, Rain P, & Wolfson C.
Epidemiol Rev (2012)
How individuals age is affected by life experiences. What we know today about aging has been largely shaped by a generation who experienced the special circumstances of wartime in their formative years. In this review, we investigate the research question, “What is known about the physical health of Canadian veterans?” In answering this question, we summarize the literature on Canadian Veterans but also include international literature on the physical health of American and Australian Veterans, along with some information from reports from Great Britain and other parts of Europe. Areas in which veterans perhaps fare worse than civilians of similar age include general health, hearing loss, musculoskeletal disorders, infections, cirrhosis, skin conditions, stomach conditions, neurologic conditions, and cardiovascular disease. The differing effects of combat on female veterans are also summarized. The healthy warrior effect is discussed along with its impact on research findings and the importance of choosing an appropriate control group.
Hughes J, Jouldjian S, Washington DL, Alessi CA, & Martin JL.
Behav Sleep Med. 2012 May 11; PMID: 23205531 [PubMed - as supplied by publisher]
Women will account for 10% of the Veteran population by 2020, yet there has been little focus on sleep issues among women Veterans. In a descriptive study of 107 women Veterans with insomnia (mean age = 49 years, 44% non-Hispanic white), 55% had probable post traumatic stress disorder (PTSD) (total score ?33). Probable PTSD was related to more severe self-reported sleep disruption and greater psychological distress. In a regression model, higher PTSD Checklist-Civilian (PCL-C) total score was a significant independent predictor of worse insomnia severity index score while other factors were not. Women Veterans preferred behavioral treatments over pharmacotherapy in general, and efforts to increase the availability of such treatments should be undertaken. Further research is needed to better understand the complex relationship between insomnia and PTSD among women Veterans.
In 2010, the Department of Veterans Affairs (VA) and Department of Defense (DOD) jointly published the revised VA/DOD Clinical Practice Guideline for Management of Posttraumatic Stress. The Clinical Practice Guideline (CPG) provides evidence-based recommendations for diagnosing and treating a spectrum of stress-related disorders. Included in the CPG were recommendations for assessing posttraumatic stress disorder (PTSD) and other stress disorder-related functional impairment.
This article complements those CPG recommendations by providing information that may further guide clinicians in the assessment of functional impairment related to PTSD and other stress-related disorders. We briefly review some of the empirical literature on the association between PTSD and functional impairment and some of the more frequently used methods and measures for assessing functional impairment and introduce a new measure currently being developed by our group. We suggest that information obtained via patient self-report and/or clinician rating be supplemented whenever possible with collateral data from friends, family members, coworkers, or supervisors to provide a complete picture of current and premorbid functional status. Finally, we explore several important issues that we encourage clinicians to keep in mind when assessing functional impairment among Veterans and Active Duty servicemembers.
Garber BG, Zamorski MA, & Jetly R.
Can J Psychiatry. 2012 Dec;57(12):736-44 PMID: 23228232 [PubMed - in process]
Abstract Objective: The deployed environment poses special challenges to the delivery of effective in-theatre mental health care. Our study sought to identify the prevalence and impact of symptoms of mental health problems in Canadian Forces (CF) personnel serving in Task Force Afghanistan; and, to determine the use of, and perceived need for, mental health services in CF personnel while deployed. Read more . . .
Abstract: Poor sleep quality among individuals with posttraumatic stress disorder (PTSD) is associated with poorer prognosis and outcomes. The factor structure of the most commonly employed measure of self-reported sleep quality, the Pittsburgh Sleep Quality Index (PSQI), has yet to be evaluated among individuals with PTSD. The current study sought to fill this gap among a sample of 226 U.S. military veterans with PTSD (90% with co-occurring mood disorders, 73.5% with substance use disorders).
We evaluated the factor structure of the PSQI by conducting an exploratory factor analysis (EFA) in approximately half of the sample (n = 111). We then conducted a second EFA in the other split half (n = 115). Lastly, we conducted a path analysis to investigate the relations between sleep factors and PTSD symptom severity, after accounting for the relation with depression.
Results suggested sleep quality can best be conceptualized, among those with PTSD, as a multidimensional construct consisting of 2 factors, Perceived Sleep Quality and Efficiency/Duration. After accounting for the association between both factors and depression, only the Perceived Sleep Quality factor was associated with PTSD (? = .51). The results provide a recommended structure that improves precision in measuring sleep quality among veterans with PTSD.
BACKGROUND: The efficacy of psychosocial therapies for common mental health disorders in veterans is unclear and requires further examination.
METHOD: Systematic review and meta-analyses of randomised controlled trials (RCTs). Twenty databases were searched. Studies were included if they reported a psychosocial intervention designed to treat or reduce common mental health symptoms in veterans identified as being symptomatic at the time they entered the study. Studies of substance dependency disorders and psychosis were excluded. Eligible studies were assessed against methodological quality criteria and data were extracted and analysed. Read more . . .
Jones M, Sundin J, Goodwin L, Hull L, Fear NT, Wessely S, & Rona RJ.
Psychol Med. 2012 Nov 13;:1-10 PMID: 23199850 [PubMed - as supplied by publisher]
BACKGROUND: In previous studies an association between deployment to Iraq or Afghanistan and an overall increased risk for post-traumatic stress disorder (PTSD) in UK armed forces has not been found. The lack of a deployment effect might be explained by including, in the comparison group, personnel deployed on other operations or who have experienced traumatic stressors unrelated to deployment. Read more . . .
Wood MD, Foran HM, Britt TW & Wright KM.
Military Psychology Volume 24, Issue 6, 2012
Benefit finding and unit leadership have been identified as buffers against the negative effects of combat exposure on posttraumatic stress disorder (PTSD) symptoms. However, little is known about how these different buffers work together to protect military personnel from the negative effects of combat. We examined benefit finding and leadership as buffers of the combat-PTSD symptoms link in a sample of recently returned combat veterans (N = 583). Results revealed that when higher levels of noncommissioned officer (NCO) leadership and benefit finding (BF) were reported, fewer PTSD symptoms were endorsed. Additionally, BF buffered the relationship between combat stress and PTSD symptoms, but only under conditions of supportive officer leadership. Implications of these findings for military settings are discussed.
Hollowaya KM, & Regera GM.
International Journal of Human-Computer Interaction , posted online 08 Nov 2012.
Deploying Active Duty Service Members face multiple psychological health risks, including post-traumatic stress disorder (PTSD). Despite a significant proportion of Service Members with psychological health needs, a number of barriers prevent access to education and treatment services available to them. These barriers include perceived stigma, physical access barriers, and psychological barriers.
Web resources provide important information regarding psychological health issues and available resources, but have limitations in the learning experience they can provide. Virtual worlds platforms, such as Second Life, offer unique affordances that may reduce some barriers to accessing psychological health education and care. They may allow for a unique immersive and interactive learning experience augmenting current web resources. One such virtual world environment, the T2 Virtual PTSD Experience, is described.
The T2 Virtual PTSD Experience aims to educate military Service Members, Veterans, family, and peers about the causes, symptoms, and help available for combat-related PTSD. Reactions from visitors have been positive, with many reporting improved understanding of PTSD and motivation to seek care. Future directions for leveraging virtual worlds in the service of psychological health care are discussed.
Canadian Military Journal Vol. 12, No. 4, Autumn 2012
Today, the care provided for members of the Canadian Forces (CF) and veterans who experience mental health problems as a result of military service is arguably as good as it has ever been in our history. This enviable situation came about because of many improvements to the ways the Department of National Defence (DND) and Veterans Affairs Canada (VAC) treat those with mental health problems, based upon lessons learned from the ‘Decade of Darkness’ - a time in the 1990s when the CF’s reputation in this area was at a historic low. Read more . . .
Rizzo AA, John B, Williams J, Newman B, Koenig ST, Lange BS & Buckwalter JG.
Proc. 9th Intl Conf. Disability, Virtual Reality & Associated Technologies Laval, France, 10–-12 Sept. 2012.
The incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel has created a significant behavioral healthcare challenge. This has served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. One emerging form of treatment for combat-related PTSD that has shown promise involves the delivery of exposure therapy using immersive Virtual Reality (VR). Initial outcomes from open clinical trials have been positive and fully randomized controlled trials are currently in progress to further investigate the efficacy of this approach. Read more . . .
Bourne C, Mackay CE, & Holmes EA.
Psychol Med. 2012 Oct 18;:1-12 PMID: 23171530 [PubMed - as supplied by publisher]
BACKGROUND: Psychological traumatic events, such as war or road traffic accidents, are widespread. A small but significant proportion of survivors develop post-traumatic stress disorder (PTSD). Distressing, sensory-based involuntary memories of trauma (henceforth 'flashbacks') are the hallmark symptom of PTSD. Understanding the development of flashbacks may aid their prevention. This work is the first to combine the trauma film paradigm (as an experimental analogue for flashback development) with neuroimaging to investigate the neural basis of flashback aetiology. We investigated the hypothesis that involuntary recall of trauma (flashback) is determined during the original event encoding. Read more . . .
Libby DJ, Reddy F, Pilver CE, & Desai RA.
Int J Yoga Therap. 2012;(22):79-88 PMID: 23070675 [PubMed - in process]
Abstract: Background: Posttraumatic stress disorder (PTSD) is a chronic, debilitating anxiety disorder that is highly prevalent among U.S. military veterans. Yoga, defined to include physical postures (asana) and mindfulness and meditation, is being increasingly used as an adjunctive treatment for PTSD and other psychological disorders. No research or administrative data have detailed the use of these services in Department of Veterans Affairs' (VA) 170 PTSD treatment programs.
Methods: One hundred twenty-five program coordinators or designated staff completed an 81-item survey of their program's use of complementary and alternative medicine modalities in the past year. This report describes data from a subset of 30 questions used to assess the prevalence, nature, and context of the use of yoga, mindfulness, and meditation other than mindfulness practices.
Results: Results revealed that these practices are widely offered in VA specialized PTSD treatment programs and that there is great variability in the context and nature of how they are delivered. Conclusions: Understanding how yoga is used by these programs may inform ongoing efforts to define and distinguish yoga therapy as a respected therapeutic discipline and to create patient-centered care models that mindfully fulfill the unmet needs of individuals with mental health issues, including veterans with PTSD.
Taft CT, Creech SK, & Kachadourian L.
J Rehabil Res Dev. 2012 Jul;49(5):777-88 PMID: 23015585 [PubMed - in process]
Abstract: The Department of Veterans Affairs (VA) and Department of Defense's (DOD) recently published and updated Department of Veterans Affairs/Department of Defense VA/ DOD Clinical Practice Guideline for Management of PostTraumatic Stress includes irritability, severe agitation, and anger as specific symptoms that frequently co-occur with PTSD.
For the first time, the guideline includes nine specific recommendations for the assessment and treatment of PTSD-related anger, irritability, and agitation. This article will review the literature on PTSD and its association with anger and aggression. We highlight explanatory models for these associations, factors that contribute to the occurrence of anger and aggression in PTSD, assessment of anger and aggression, and effective anger management interventions and strategies.
Monson C, Macdonald A, Vorstenbosch V, Shnaider P, Goldstein E, Ferrier-Auerbach A, & Mocciola K.
Journal of Traumatic Stress, vol 25 (5) p 519-526
Abstract: The current study sought to determine if different spheres of social adjustment, social and leisure, family, and work and income improved immediately following a course of cognitive processing therapy (CPT) when compared with those on a waiting list in a sample of 46 U.S. veterans diagnosed with posttraumatic stress disorder (PTSD). We also sought to determine whether changes in different PTSD symptom clusters were associated with changes in these spheres of social adjustment. Overall social adjustment, extended family relationships, and housework completion significantly improved in the CPT versus waiting-list condition, ?2 = .08 to .11.
Hierarchical multiple regression analyses revealed that improvements in total clinician-rated PTSD symptoms were associated with improvements in overall social and housework adjustment. When changes in reexperiencing, avoidance, emotional numbing, and hyperarousal were all in the model accounting for changes in total social adjustment, improvements in emotional numbing symptoms were associated with improvements in overall social, extended family, and housework adjustment (? = .38 to .55). In addition, improvements in avoidance symptoms were associated with improvements in housework adjustment (? = .30), but associated with declines in extended family adjustment (? = ?.34).
Results suggest that it is important to consider the extent to which PTSD treatments effectively reduce specific types of symptoms, particularly emotional numbing and avoidance, to generally improve social adjustment.
Carter AC, Capone C, & Short EE.
J Dual Diagn. 2011 10;7(4):285-299 PMID: 23087599 [PubMed - as supplied by publisher]
Abstract: Co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorders have become increasingly prevalent in military populations. Over the past decade, PTSD has emerged as one of the most common forms of psychopathology among the 1.7 million American military personnel deployed to Iraq and Afghanistan in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND). Among veterans from all eras, symptoms of PTSD have been highly correlated with hazardous drinking, leading to greater decreases in overall health and greater difficulties readjusting to civilian life. In fact, a diagnosis of co-occurring PTSD and alcohol use disorder has proven more detrimental than a diagnosis of PTSD or alcohol use disorder alone. In order to effectively address co-occurring PTSD and alcohol use disorder, both the clinical and research communities have focused on better understanding this comorbidity, as well as increasing treatment outcomes among the veteran population.
The purpose of the present article is threefold: (1) present a case study that highlights the manner in which PTSD and alcohol use disorder co-develop after trauma exposure; (2) present scientific theories on co - occurrence of PTSD and alcohol use disorder; and (3) present current treatment options for addressing this common comorbidity.
Bryan CJ, Hernandez AM, Allison S, & Clemans T.
J Clin Psychol. 2012 Oct 15; PMID: 23070894 [PubMed - as supplied by publisher]
Abstract: OBJECTIVE: In light of increased suicidal behaviors among military personnel and veterans since the initiation of combat operations in Afghanistan and Iraq, questions have been raised about the potential causal role of combat. The objective of the current study was to identify any direct or indirect effects of combat exposure on suicide risk through depression symptom severity, posttraumatic stress disorder (PTSD) symptom severity, thwarted belongingness, perceived burdensomeness, and fearlessness about death, consistent with the interpersonal-psychological theory of suicide (Joiner, 2005). Read more . . .
Gerlinde C. Harb, Richard Thompson, Richard J. Ross, & Joan M. Cook.
Journal of Traumatic Stress, Vol 25 (5). p 511-518
Abstract: The characteristics of nightmares of 48 male U.S. Vietnam war veterans with combat-related posttraumatic stress disorder (PTSD), as well as revised dream scripts developed in the course of Imagery Rehearsal therapy, were examined in relation to pretreatment symptomatology and treatment outcome.
Features, content, and themes of nightmares and rescripted dreams were coded by 2 independent raters. Nightmares were replete with scenes of death and violence and were predominantly replays of actual combat events in which the veteran was under attack and feared for his life. Although addressing or resolving the nightmare theme with rescripting was associated with a reduction in sleep disturbance, references to violence in the rescripted dream were related to poorer treatment outcome in nightmare frequency; B = 5.69 (SE = 1.14). The experience of olfactory sensations in nightmares, a possible index of nightmare intensity, was also related to poorer treatment response; B = 2.95 (SE = 1.06).
Imagery rehearsal for individuals with severe, chronic PTSD and fairly replicative nightmares may be most effective when the rescripted dream incorporates a resolution of the nightmare theme and excludes violent details.
Monson CM, Macdonald A, & Brown-Bowers A.
J Rehabil Res Dev. 2012 Jul;49(5):717-28 PMID: 23015582 [PubMed - in process]
Abstract: A well-documented association exists among Veterans' posttraumatic stress disorder (PTSD) symptoms, family relationship problems, and mental health problems in partners and children of Veterans. This article reviews the recommendations regarding couple/family therapy offered in the newest version of the Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress.
We then provide a heuristic for clinicians, researchers, and policy makers to consider when incorporating couple/family interventions into Veterans' mental health services. The range of research that has been conducted on couple/family therapy for Veterans with PTSD is reviewed using this heuristic, and suggestions for clinical practice are offered.
Chard KM, Ricksecker EG, Healy ET, Karlin BE, & Resick PA.
J Rehabil Res Dev. 2012 Jul;49(5):667-78 PMID: 23015578 [PubMed - in process]
Abstract: Clinical practice guidelines suggest that cognitive behavioral therapies are recommended for the treatment of posttraumatic stress disorder (PTSD). One of these treatments, cognitive processing therapy (CPT), is an evidence-based treatment that has been shown to be effective at treating combat, assault, and interpersonal violence trauma in randomized controlled trials. The Department of Veterans Affairs (VA) Office of Mental Health Services has implemented an initiative to disseminate CPT as part of a broad effort to make evidence-based psychotherapies widely available throughout the VA healthcare system.
This article provides an overview of CPT and reviews the efficacy and program evaluation data supporting its use in a variety of settings. In addition, we report on survey data from individuals who have participated in the VA initiative and on outcome data from patients treated by rollout-trained therapists.
Our data suggest that many clinicians trained in the rollout show good adoption of the CPT model and demonstrate solid improvements in their patients' PTSD and depressive symptomotology. Finally, we offer recommendations for using CPT in clinical settings.
Rebekah J. Nelson.
Traumatology. Oct 15 2012, online.
Abstract: Exposure therapy has been identified as an effective treatment for anxiety disorders, including posttraumatic stress disorder (PTSD). The use of virtual reality exposure therapy (VRET) in the past decade has increased due to improvements in virtual reality technology. VRET has been used to treat active duty service members and veterans experiencing posttraumatic stress symptoms by exposing them to a virtual environment patterned after the real-world environment in which the trauma occurred. This article is a systematic review of the effectiveness of using VRET with these two populations. Read more . . .
Julianne C. Hellmuth, Cynthia A. Stappenbeck, Katherine D. Hoerster, & Matthew Jakupcak.
Journal of Traumatic Stress. Vol 25(5). p 527-534. October 2012.
Abstract: Suicidal ideation and aggression are common correlates of posttraumatic stress disorder (PTSD) among U.S. Iraq and Afghanistan war veterans. The existing literature has established a strong link between these factors, but a more nuanced understanding of how PTSD influences them is needed. The current study examined the direct and indirect relationships between PTSD symptom clusters and suicidal ideation in general aggression (without a specified target) regarding depression, alcohol misuse, and trait anger.
Participants were 359 (92% male) U.S. Iraq/Afghanistan war veterans. Path analysis results suggested that the PTSD numbing cluster was directly (? = .28, p < .01) and indirectly (? = .17, p = .001) related through depression. The PTSD hyperarousal cluster was indirectly related to suicidal ideation through depression (? = .13, p < .001). The PTSD reexperiencing cluster was directly related to aggression (? = .17, p < .05), whereas the PTSD numbing and hyperarousal clusters were indirectly related to aggression through trait anger (? = .05, p < .05; ? = .20, p < .001).
These findings indicate that adjunct treatments aimed at stabilizing anger, depression, and alcohol misuse may help clinicians ameliorate the maladaptive patterns often observed in veterans. These results also point to specific manifestations of PTSD and co-occurring conditions that may inform clinicians in their attempts to identify at risk veterans and facilitate preventative interventions.
Mott, Juliette M.; Sutherland, Roy John; Williams, Wright; Lanier, Stacey Holmes; Ready, David J.; & Teng, Ellen J.
Psychological Trauma: Theory, Research, Practice, and Policy, Oct 8 , 2012
Abstract: Although an extensive body of empirical literature supports the efficacy of individual exposure therapy for posttraumatic stress disorder (PTSD), there is substantial debate about the suitability of exposure-based techniques in group treatment settings. Whereas some clinicians and researchers have predicted that these techniques may vicariously traumatize patients, others have argued that the group setting may facilitate exposure work by offering opportunities for normalization and social support. Few studies, however, have explored patients' opinions on group exposure.
This study examined veterans' perspectives on the effectiveness and tolerability of a 12-week model of group-based exposure therapy (GBET) for PTSD. Analysis of qualitative and quantitative self-report data from 20 combat veterans indicated that participants were highly satisfied with GBET and experienced it as both helpful and acceptable. Eighty-five percent of the sample (n = 16) evidenced reliable reductions in PTSD symptoms from pre- to posttreatment, without experiencing symptom exacerbation over the course of treatment. The observed dropout rate was low (5%, n = 1), and treatment completers reported that commitment to the group was instrumental in their decision to remain in treatment.
Veterans described that hearing other group members' in-session imaginal exposures had a normalizing effect, and they indicated that feedback from fellow veterans on their own imaginal exposures was the most helpful aspect of GBET.
Osório C, Jones N, Fertout M, & Greenberg N.
Anxiety Stress Coping. 2012 Sep 26; PMID: 23009368 [PubMed - as supplied by publisher]
Abstract: Perceived stigma and organizational barriers to care (stigma/BTC) can influence the decision to seek help for military personnel when they are suffering from mental health problems. We examined the relationship between stigmatizing beliefs, perceived BTC, and probable post-traumatic stress disorder (PTSD) in 23,101 UK military personnel deployed to Afghanistan and Iraq both during and after deployment; and in a smaller group some six months later.
Overall, our results suggest that stigma/BTC perceptions were significantly, and substantially higher during deployment than when personnel are returning home; however, within the smaller follow-up group, the rates climbed significantly over the first six-months post-deployment although they still remained lower than during-deployment levels. Male personnel, those who reported higher levels of PTSD symptoms and/or greater combat exposure were significantly more likely to endorse more stigma/BTC at both sampling points. Rates of stigma/BTC on deployment are substantially higher than rates measured when personnel are in less threatening environments.
We suggest that the considerable efforts that military forces make to encourage effective help seeking should take account of the fluctuating levels of stigma/BTC. Commanders should be aware that encouraging help seeking may be more difficult in operational environments than when personnel have returned home.
Jeffreys M, Capehart B, & Friedman MJ.
J Rehabil Res Dev. 2012 Jul;49(5):703-16 PMID: 23015581 [PubMed - in process]
Abstract: Posttraumatic stress disorder (PTSD) is a prevalent psychiatric diagnosis among veterans and has high comorbidity with other medical and psychiatric conditions. This article reviews the pharmacotherapy recommendations from the 2010 revised Department of Veterans Affairs/Department of Defense Clinical Practice Guideline (CPG) for PTSD and provides practical PTSD treatment recommendations for clinicians.
While evidence-based, trauma-focused psychotherapy is the preferred treatment for PTSD, pharmacotherapy is also an important treatment option. First-line pharmacotherapy agents include selective serotonin reuptake inhibitors and the selective serotonin-norepinephrine reuptake inhibitor venlafaxine. Second-line agents have less evidence for their usefulness in PTSD and carry a potentially greater side effect burden. They include nefazodone, mirtazapine, tricyclic antidepressants, and monoamine oxidase inhibitors. Prazosin is beneficial for nightmares. Benzodiazepines and antipsychotics, either as monotherapy or used adjunctively, are not recommended in the treatment of PTSD.
Treating co-occurring disorders, such as major depressive disorder, substance use disorders, and traumatic brain injury, is essential in maximizing treatment outcomes in PTSD. The CPG provides evidence-based treatment recommendations for treating PTSD with and without such co-occurring disorders.
Booth BM, Davis TD, Cheney AM, Mengeling MA, Torner JC, & Sadler AG.
Psychosom Med. 2012 Oct 15; PMID: 23071345 [PubMed - as supplied by publisher]
Abstract: Objective: The aim of this study was to determine whether current physical health status in female veterans is associated with rape during military service and same-sex partnership. Read more . . .
Klari M, Franiškovi T, Obrdalj EC, Petri D, Britvi D, & Zovko N.
Psychiatr Danub. 2012 Sep;24(3):280-6 PMID: 23013633 [PubMed - in process]
Abstract: BACKGROUND: Along with primary traumatization, wives of PTSD-diagnosed war veterans often become victims of the altered and dysfunctional state of their partners, which adds to the severity of symptoms of primary traumatization and furthers the development of other mental disorders. The aim of this study was to compare the effects of primary and secondary traumatization in wives of PTSD-diagnosed war veterans and wives of war veterans without PTSD. Read more . . .
Rauch SA, Eftekhari A, & Ruzek JI.
J Rehabil Res Dev. 2012 Jul;49(5):679-88 PMID: 23015579 [PubMed - in process]
Abstract: Prolonged exposure (PE) is an effective first-line treatment for posttraumatic stress disorder (PTSD), regardless of the type of trauma, for Veterans and military personnel. Extensive research and clinical practice guidelines from various organizations support this conclusion. PE is effective in reducing PTSD symptoms and has also demonstrated efficacy in reducing comorbid issues such as anger, guilt, negative health perceptions, and depression. PE has demonstrated efficacy in diagnostically complex populations and survivors of single- and multiple-incident traumas.
The PE protocol includes four main therapeutic components (i.e., psychoeducation, in vivo exposure, imaginal exposure, and emotional processing). In light of PE's efficacy, the Veterans Health Administration designed and supported a PE training program for mental health professionals that has trained over 1,300 providers.
Research examining the mechanisms involved in PE and working to improve its acceptability, efficacy, and efficiency is underway with promising results.
J Rehabil Res Dev. 2012 Jul;49(5):753-76 PMID: 23015584 [PubMed - in process]
Abstract: With the large number of Veterans experiencing posttraumatic stress disorder (PTSD) and chronic pain, the purpose of this article is to review the prevalence of PTSD and chronic pain, the theoretical models that explain the maintenance of both conditions, and the challenges faced by providers and families who care for these patients. The Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress with special attention to chronic pain is presented.
Limited scientific evidence supports specific care and treatment of PTSD and chronic pain, and this challenges providers to investigate and research potential treatment options. Integrated care models designed for working with these patients are reviewed, including a focus on the techniques and strategies to address not only PTSD and chronic pain, but other conditions, including substance dependence and depression. A specific focus on headaches, back pain, and neuropathic pain follows, including treatment recommendations such as pharmacological, psychotherapeutic, and complementary approaches, given the high rates of these pain complaints for Veterans in PTSD clinical programs. Integrated care is presented as a viable solution and approach that challenges clinicians and researchers to develop innovative, scientifically based therapeutics and treatments to enhance the recovery and quality of life for Veterans with PTSD and chronic pain.
Capehart B & Bass D.
J Rehabil Res Dev. 2012 Jul;49(5):789-812 PMID: 23015586 [PubMed - in process]
Abstract: Military deployments to Afghanistan and Iraq have been associated with elevated prevalence of both posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) among combat veterans. The diagnosis and management of PTSD when a comorbid TBI may also exist presents a challenge to interdisciplinary care teams at Department of Veterans Affairs (VA) and civilian medical facilities, particularly when the patient reports a history of blast exposure. Treatment recommendations from VA and Department of Defense's (DOD) recently updated VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress are considered from the perspective of simultaneously managing comorbid TBI.
Borders A, McAndrew L, Quigley K, & Chandler H.
Journal of Traumatic Stress. Vol 25(5) p 583-586. October 2012
Abstract: Risky behaviors, including unsafe sex, aggression, rule breaking, self-injury, and dangerous substance use have become a growing issue for U.S. veterans returning from combat deployments. Evidence in nonveteran samples suggests that risky behaviors reflect efforts to cope with and alleviate depressive and/or anxious symptoms, particularly for individuals with poor emotion-regulation skills. These associations have not been studied in veterans.
Rumination, or repeated thoughts about negative feelings and past events, is a coping strategy that is associated with several psychopathologies common in veterans. In this cross-sectional study, 91 recently returned veterans completed measures of trait rumination, self-reported risky behaviors, and symptoms of posttraumatic stress disorder (PTSD) and depression.
Analyses revealed that veterans with more depressive and PTSD symptoms reported more risky behaviors. Moreover, rumination significantly interacted with PTSD symptoms and depressive symptoms (both ? = .21, p < .05), such that psychiatric symptoms were associated with risky behaviors only for veterans with moderate to high levels of rumination.
Although cross-sectional, these findings support theory that individuals with poor coping skills may be particularly likely to respond to negative mood states by engaging in risky behaviors. Implications include using rumination-focused interventions with veterans in order to prevent engagement in risky behaviors.
van Liempt S.
Eur J Psychotraumatol. 2012;3 PMID: 23050070 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: Sleep facilitates the consolidation of fear extinction memory. Nightmares and insomnia are hallmark symptoms of posttraumatic stress disorder (PTSD), possibly interfering with fear extinction and compromising recovery. A perpetual circle may develop when sleep disturbances increase the risk for PTSD and vice versa. To date, therapeutic options for alleviating sleep disturbances in PTSD are limited. Read more . . .
Abstract: The Beck Depression Inventory II (BDI-II) has been suspected of overestimating the level of depression in individuals that endure chronic pain. Using a sample (N = 345) of male military veterans with chronic pain enrolled in an outpatient treatment program, a factor analysis on the BDI-II revealed a "Somatic Complaints" factor along with 2 other factors we labeled "Negative Rumination" and "Mood." Standardized scores were provided for each BDI-II factor score, Total score, and Total minus Somatic score.
The internal consistency reliabilities (Gilmer-Feldt and alpha coefficients) for all scores were found to be clinically acceptable. Item-Total score correlations found that all of the BDI-II items were good discriminators (r > .30). We conclude that the normative data provided in this study should help control for somatic responding by male chronic pain veterans on the BDI-II. We highly recommend that clinicians and researchers use the norm-referenced method when interpreting BDI-II scores from individuals suffering from chronic pain. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Lee C, Crawford C, Wallerstedt D, York A, Duncan A, Smith J, Sprengel M, Welton R, & Jonas W.
Syst Rev. 2012 Oct 15;1(1):46 PMID: 23067573 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: Co-morbid symptoms (for example, chronic pain, depression, anxiety, and fatigue) are particularly common in military fighters returning from the current conflicts, who have experienced physical and/or psychological trauma. These overlapping conditions cut across the boundaries of mind, brain and body, resulting in a common symptomatic and functional spectrum of physical, cognitive, psychological and behavioral effects referred to as the 'Trauma Spectrum Response' (TSR).While acupuncture has been shown to treat some of these components effectively, the current literature is often difficult to interpret, inconsistent or of variable quality. Thus, to gauge comprehensively the effectiveness of acupuncture across TSR components, a systematic review of reviews was conducted using the Samueli Institute's Rapid Evidence Assessment of the Literature (REAL(C)) methodology. Read more . . .
J Rehabil Res Dev. 2012 Jul;49(5):753-76 PMID: 23015584 [PubMed - in process]
Abstract With the large number of Veterans experiencing posttraumatic stress disorder (PTSD) and chronic pain, the purpose of this article is to review the prevalence of PTSD and chronic pain, the theoretical models that explain the maintenance of both conditions, and the challenges faced by providers and families who care for these patients. The Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress with special attention to chronic pain is presented.
Limited scientific evidence supports specific care and treatment of PTSD and chronic pain, and this challenges providers to investigate and research potential treatment options. Integrated care models designed for working with these patients are reviewed, including a focus on the techniques and strategies to address not only PTSD and chronic pain, but other conditions, including substance dependence and depression. A specific focus on headaches, back pain, and neuropathic pain follows, including treatment recommendations such as pharmacological, psychotherapeutic, and complementary approaches, given the high rates of these pain complaints for Veterans in PTSD clinical programs.
Integrated care is presented as a viable solution and approach that challenges clinicians and researchers to develop innovative, scientifically based therapeutics and treatments to enhance the recovery and quality of life for Veterans with PTSD and chronic pain.
Nash WP, & Watson PJ.
J Rehabil Res Dev. 2012 Jul;49(5):637-48 PMID: 23015576 [PubMed - in process]
Abstract: This article summarizes the recommendations of the Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress that pertain to acute stress and the prevention of posttraumatic stress disorder, including screening and early interventions for acute stress states in various settings.
Recommended interventions during the first 4 days after a potentially traumatic event include attending to safety and basic needs and providing access to physical, emotional, and social resources. Psychological first aid is recommended for management of acute stress, while psychological debriefing is discouraged. Further medical and psychiatric assessment and provision of brief, trauma-focused cognitive-behavioral therapy are warranted if clinically significant distress or functional impairment persists or worsens after 2 days or if the criteria for a diagnosis of acute stress disorder are met.
Follow-up monitoring and rescreening are endorsed for at least 6 months for everyone who experiences significant acute posttraumatic stress. Four interventions that illustrate early intervention principles contained in the VA/DOD Clinical Practice Guideline are described.
Jain S, Greenbaum MA, & Rosen CS.
Prim Care Companion CNS Disord. 2012;14(2) PMID: 22943028 [PubMed - in process]
Abstract: Objective: Guidelines addressing the treatment of veterans with posttraumatic stress disorder (PTSD) strongly recommend a therapeutic trial of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). This study examined veteran characteristics associated with receiving such first-line pharmacotherapy, as well as how being a veteran of the recent conflicts in Afghanistan and Iraq impact receipt of pharmacotherapy for PTSD. Read more . . .
Kearney DJ, McDermott K, Malte C, Martinez M, & Simpson TL.
J Clin Psychol. 2012 Aug 28; PMID: 22930491 [PubMed - as supplied by publisher]
Abstract OBJECTIVE: To assess outcomes associated with Mindfulness-Based Stress Reduction (MBSR) for veterans with PTSD.
METHODS: Forty-seven veterans with posttraumatic stress disorder (PTSD; 37 male, 32 Caucasian) were randomized to treatment as usual (TAU; n = 22), or MBSR plus TAU (n = 25). PTSD, depression, and mental health-related quality of life (HRQOL) were assessed at baseline, posttreatment, and 4-month follow-up. Standardized effect sizes and the proportion with clinically meaningful changes in outcomes were calculated.
RESULTS: Intention-to-treat analyses found no reliable effects of MBSR on PTSD or depression. Mental HRQOL improved posttreatment but there was no reliable effect at 4 months. At 4-month follow-up, more veterans randomized to MBSR had clinically meaningful change in mental HRQOL, and in both mental HRQOL and PTSD symptoms. Completer analyses (? 4 classes attended) showed medium to large between group effect sizes for depression, mental HRQOL, and mindfulness skills.
CONCLUSIONS: Additional studies are warranted to assess MBSR for veterans with PTSD.
Foote FO & Schwartz L.
Explore (NY). 2012 Sep;8(5):282-90 MID: 22938747 [PubMed - in process]
Abstract: Traumatic brain injury and posttraumatic stress disorder are the signature injuries of the Iraq and Afghanistan wars. Holistic medicine (comprising multispecialty care integration, patient/family-centered care, wellness interventions, and the construction of architectural "healing environments") has much to offer these patients. In this work we describe the architecture and holistic medicine programming of the National Intrepid Center of Excellence (NICoE), a new clinical research center for traumatic brain injury and posttraumatic stress disorder in the Military Health System.
Architecture and clinical process are united in a "design/care continuum" for optimal healing. A groundbreaking institution, the NICoE foreshadows many trends in national healthcare for the 21st century.
Lambert JE, Engh R, Hasbun A, & Holzer J.
J Fam Psychol. 2012 Aug 27; PMID: 22924422 [PubMed - as supplied by publisher]
Abstract The authors conducted a meta-analysis of the literature on associations between trauma survivors' PTSD symptoms and the (a) relationship quality and (b) psychological distress of intimate partners.
Results yielded a small combined effect size (r = -.24) for the association between PTSD and partners' perceived relationship quality. Gender and military status moderated this association with a larger effect size for female partners of male trauma survivors than for male partners of female trauma survivors and a larger effect size for military samples than for civilians. The effect size of the association between PTSD and partners' psychological distress was moderate in magnitude (r = .30). Analysis of hypothesized moderators indicated this association was stronger among military than civilian samples. The association was also stronger among samples of survivors who experienced traumatic events in the more distant past compared with those who experienced more recent events.
Results support the systemic impact of one family member's PTSD symptoms and highlight areas for future research.
Levi O, Liechtentritt R, & Savaya R.
Qual Health Res. 2012 Aug 24; PMID: 22923386 [PubMed - as supplied by publisher]
Abstract: In this qualitative study we examined the experience and perception of hope of 10 Israeli soldiers with chronic posttraumatic stress disorder (PTSD), with the goal of achieving an understanding of the manners in which hope intertwines with trauma. The results indicate that hope is an integrative, changing, multidimensional phenomenon which plays a unique role in the individual's life. Viewing hope as a crucial aspect of human life was further evident when participants referred to the traumatic event. Hope and trauma are interconnected phenomena. The form of hope a person possesses thus shapes the manner in which the traumatic event is perceived, whereas the trauma clearly reshapes the individual's form of hope. We discuss practical implications for treatment of chronic PTSD, based on the important role of hope at times of trauma, as well as on the interrelation between hope and trauma.
Cohen BE, Maguen S, Bertenthal D, Shi Y, Jacoby V, & Seal KH.
Womens Health Issues. 2012 Sep;22(5):e461-71 PMID: 22944901 [PubMed - in process]
Abstract BACKGROUND: An increasing number of women serve in the military and are exposed to trauma during service that can lead to mental health problems. Understanding how these mental health problems affect reproductive and physical health outcomes will inform interventions to improve care for women veterans. Read more . . .
Suicide Life Threat Behav. 2012 Aug;42(4):453-69 PMID: 22924892 [PubMed - in process]
Abstract: The mediating effects of posttraumatic stress disorder (PTSD) symptoms, negative mood, and social support on the relationship of war experiences to suicidality were examined.
The research literature suggested a sequence among study scales representing these constructs, which was then tested on survey data obtained from a sample of National Guard soldiers (N = 4,546). Results from structural equation modeling suggested that war experiences may precipitate a sequence of psychological consequences leading to suicidality. However, suicidality may be an enduring behavioral health condition.
War experiences showed no direct effects on postdeployment suicidality, rather its effect was indirect through PTSD symptoms and negative mood. War experiences were, however, predictive of PTSD symptoms, as would be expected. PSTD symptoms showed no direct effect on postdeployment suicidality, but showed indirect effects through negative mood. Results also suggested that suicidality is relatively persistent, at least during deployment and postdeployment. The percentage of those at risk for suicide was low both during and after deployment, with little association between suicidality and time since returning from deployment. Additionally, few soldiers were initially nonsuicidal and then reported such symptoms at postdeployment.
Implications of relationships of both negative mood and combat trauma to suicidality are discussed, as well as possible mediating effects of both personal dispositions and social support on relationships of war experiences to PTSD, negative mood, and suicidality.
Committee on the Assessment of Ongoing Effects in the Treatment of Posttraumatic Stress Disorder; Institute of Medicine.2012.
Prior to the military conflicts in Iraq and Afghanistan, wars and conflicts have been characterized by such injuries as infectious diseases and catastrophic gunshot wounds. However, the signature injuries sustained by United States military personnel in these most recent conflicts are blast wounds and the psychiatric consequences to combat, particularly posttraumatic stress disorder (PTSD), which affects an estimated 13 to 20 percent of U.S. service members who have fought in Iraq or Afghanistan since 2001. PTSD is triggered by a specific traumatic event - including combat - which leads to symptoms such as persistent re-experiencing of the event; emotional numbing or avoidance of thoughts, feelings, conversations, or places associated with the trauma; and hyperarousal, such as exaggerated startle responses or difficulty concentrating.
As the U.S. reduces its military involvement in the Middle East, the Departments of Defense (DoD) and Veterans Affairs (VA) anticipate that increasing numbers of returning veterans will need PTSD services. As a result, Congress asked the DoD, in consultation with the VA, to sponsor an IOM study to assess both departments' PTSD treatment programs and services. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment is the first of two mandated reports examines some of the available programs to prevent, diagnose, treat, and rehabilitate those who have PTSD and encourages further research that can help to improve PTSD care.
Full text: http://www.nap.edu/catalog.php?record_id=13364#toc
Greenberg JB, Ameringer KJ, Trujillo MA, Sun P, Sussman S, Brightman M, Pitts SR, & Leventhal AM.
Psychol Addict Behav. 2012 Mar;26(1):89-98 PMID: 21688875 [PubMed - indexed for MEDLINE]
Abstract: Understanding the relationship between Posttraumatic stress disorder (PTSD) and cigarette smoking has been difficult because of PTSD's symptomatic heterogeneity. This study examined common and unique lifetime cross-sectional relationships between PTSD symptom clusters [Re-experiencing (intrusive thoughts and nightmares about the trauma), Avoidance (avoidance of trauma-associated memories or stimuli), Emotional Numbing (loss of interest, interpersonal detachment, restricted positive affect), and Hyperarousal (irritability, difficulty concentrating, hypervigilance, insomnia)] and three indicators of smoking behavior: (1) smoking status; (2) cigarettes per day; and (3) nicotine dependence. Read more . . .
Williams JL, McDevitt-Murphy ME, Murphy JG, & Crouse EM.
Mil Med. 2012 Jul;177(7):789-96 PMID: 22808885 [PubMed - in process]
Abstract: Along with post-traumatic stress disorder (PTSD), mild traumatic brain injury (mTBI) is considered one of the "signature wounds" of combat operations in Iraq (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]), but the role of mTBI in the clinical profiles of Veterans with other comorbid forms of post-deployment psychopathology is poorly understood.
The current study explored the deployment risk and postdeployment health profiles of heavy drinking OIF and OEF Veterans as a function of mTBI. Sixty-nine heavy-drinking OIF/OEF Veterans were recruited through a Veterans' Affairs Medical Center and completed questionnaires and structured interviews assessing war-zone experiences, postdeployment drinking patterns, and PTSD symptoms.
Veterans with positive mTBI screens and confirmed mTBI diagnoses endorsed higher rates of combat experiences, including direct and indirect killing, and met criteria for PTSD at a higher rate than Veterans without a history of mTBI. Both PTSD and combat experiences independently predicted screening positive for mTBI, whereas only combat experiences predicted receiving a confirmed mTBI diagnosis. mTBI was not associated with any dimension of alcohol use. These results support a growing body of literature linking mTBI with PTSD.
Naragon-Gainey K, Hoerster KD, Malte CA, & Jakupcak M.
Psychiatr Serv. 2012 Jul 15; PMID: 22810211 [PubMed - as supplied by publisher]
Abstract: OBJECTIVE: Distress symptoms and high-risk behaviors among Iraq and Afghanistan veterans were examined as predictors of treatment utilization.
METHODS: Veterans (N=618) completed self-report measures upon treatment enrollment (2005-2008). Two-year utilization data were obtained for five settings: primary care, mental health within primary care, outpatient mental health, emergency room, and inpatient psychiatric. Read more . . .
Lenhardt JM, Howard JM, Taft CT, Kaloupek DG, & Keane TM.
J Trauma Stress. 2012 Jul 11; PMID: 22786658 [PubMed - as supplied by publisher]
Abstract: We examined the relationship between trauma exposure and the perpetration of aggression by male Vietnam veterans (N = 1,328) using archival data from a multisite study conducted by the Cooperative Studies Program of the Department of Veteran Affairs (CSP-334) in the early 1990s. Both traumatic events in civilian life and combat exposure were examined as correlates of aggression.
Results indicated that pre- and postmilitary traumatic events and combat exposure were all related to perpetration of aggression at the bivariate level; r = .07, r = .20, and r = .13, respectively. When these variables were examined simultaneously, only combat exposure (? = .14, p < .001) and postmilitary traumatic events (? = .20, p < .001) were associated with aggression. No interaction effects were found for civilian traumatic events and combat in relation to aggression. Results highlight the importance of attending to the psychological aftermath of exposure to traumatic events experienced during and following deployment before aggressive patterns develop.
Richardson JD, St Cyr KC, McIntyre-Smith AM, Haslam D, Elhai JD, & Sareen J.
Can J Psychiatry. 2012 Aug;57(8):496-504 PMID: 22854032 [PubMed - in process]
Abstract: Objective: Our study examines the association between suicidal ideation and and self-reported symptoms of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and alcohol use disorder (AUD) in a sample of treatment-seeking Canadian combat and peacekeeping veterans; and identifies potential predictors of suicidal ideation. Read more . . .
Armed Forces Health Surveillance Center (AFHSC).
MSMR. 2012 Jul;19(7):2-10 PMID: 22876800 [PubMed - in process]
Abstract: Women account for approximately 10 percent of all U.S. military deployers to Afghanistan and Iraq. This analysis estimates the percentages of female deployers (n=154,548) who were affected by selected illnesses and injuries after first through third deployments to Iraq/Afghanistan in relation to age group, service branch, military occupation, marital status, pre-deployment medical history, "dwell time" prior to 2nd and 3rd deployments, and length of deployment.
Of these factors, diagnosis of a condition before deployment was by far the strongest predictor of diagnosis of the condition after deployment. Durations of dwell times before repeat deployments were not strong predictors of post-deployment diagnoses of any of the conditions considered. For several conditions (e.g., PTSD, disorders of joints, peripheral enthesopathies, infertility), the percentages of deployers diagnosed with the conditions sharply increased with deployment length. Post-deployment morbidity moderately increased with increasing numbers of deployments in the case of some conditions (e.g., PTSD, migraine, musculoskeletal disorders), but not others.
The findings suggest that limiting wartime deployments to nine months may have broad beneficial effects on the post-deployment health of female service members. However, limiting the number of wartime deployments and lengthening "dwell times" before repeat deployments would likely not have strong and broad beneficial effects on the health of female veterans. Further research to mitigate the effects of heavy loads and repetitive stresses on the musculoskeletal systems of combat deployed females is indicated.
Kronish IM, Edmondson D, Li Y, & Cohen BE.
J Psychiatr Res. 2012 Jul 16; PMID: 22809686 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: Patients with post-traumatic stress disorder (PTSD) are at increased risk for adverse outcomes from comorbid medical conditions. Medication non-adherence is a potential mechanism explaining this increased risk. METHODS: We examined the association between PTSD and medication adherence in a cross-sectional study of 724 patients recruited from two Department of Veterans Affairs Medical Centers between 2008 and 2010. PTSD was assessed using the Clinician Administered PTSD Scale. Medication adherence was assessed using a standardized questionnaire. Ordinal logistic regression models were used to calculate the odds ratios (ORs) for medication non-adherence in patients with versus without PTSD, adjusting for potential confounders. Read more. . .
ABSTRACT:: Introduction Risk for post-traumatic stress disorder (PTSD) varies in part due to the nature of the traumatic event involved. Both injury and return from combat pose high risk of PTSD symptoms. How different injuries may predispose towards PTSD is less well understood.
METHODS: A retrospective record review was conducted from 1402 service members who had returned to Naval Medical Center San Diego from Iraq or Afghanistan and who had completed the PTSD Checklist as part of their post-deployment screening. Rates of PTSD were examined in relation to mechanism of injury. Read more . . .
Aversa LH, Stoddard JA, Doran NM, Au S, Chow B, McFall M, Saxon A, & Baker DG.
J Psychosom Res. 2012 Sep;73(3):185-90 PMID: 22850258 [PubMed - in process]
Abstract: OBJECTIVE: Smoking, depression and PTSD are related to poor physical health outcomes and health-related quality of life (HRQoL). Previous studies examining the effects of quitting smoking on HRQoL have been mixed. This study aimed to examine the effects of PTSD, depressive symptoms and smoking cessation on HRQoL in a sample receiving treatment for PTSD. Read more . . .
Schnurr PP, Friedman MJ, Oxman TE, Dietrich AJ, Smith MW, Shiner B, Forshay E, Gui J, & Thurston V.
J Gen Intern Med. 2012 Aug 3; PMID: 22865017 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: Although collaborative care is effective for treating depression and other mental disorders in primary care, there have been no randomized trials of collaborative care specifically for patients with Posttraumatic stress disorder (PTSD).
OBJECTIVE: To compare a collaborative approach, the Three Component Model (3CM), with usual care for treating PTSD in primary care. Read more . . .
Rozanov V, & Carli V.
Int J Environ Res Public Health. 2012 Jul;9(7):2504-19 PMID: 22851956 [PubMed - in process]
Abstract: Studies aiming to identify if war veterans are at higher risk of suicide have often produced inconsistent results; this could be due to the complexity of comparisons and different methodological approaches. It should be noted that this contingent has many risk factors, such as stressful exposures, wounds, brain trauma and pain syndrome.
Most recent observations confirm that veterans are really more likely to die of suicide as compared to the general population; they are also more likely to experience suicidal ideation and suffer from mental health problems. Suicides are more frequent in those who develop PTSD, depression and comorbid states due to war exposure. Combat stress and its' frequency may be an important factor leading to suicide within the frame of the stress-vulnerability model. According to this model, the effects of stress may interact with social factors, interpersonal relations and psychological variables producing suicidal tendencies.
Modern understanding of stress-vulnerability mechanisms based on genetic predispositions, early life development, level of exposure to stress and stress-reactivity together with interpersonal aspects may help to build more effective suicide prevention programs based on universal/selective/indicated prevention principles.
Pietrzak RH, Tsai J, Harpaz-Rotem I, Whealin JM, & Southwick SM.
J Psychiatr Res. 2012 Mar;46(3):317-22 PMID: 22154134 [PubMed - indexed for MEDLINE]
Abstract: BACKGROUND: A large body of confirmatory factor analytic studies of posttraumatic stress disorder (PTSD) symptoms has demonstrated the superiority of 4-factor dysphoria and emotional numbing models over the DSM-IV model. Recently, a novel 5-factor model, which separates the DSM-IV hyperarousal symptom cluster into distinct dysphoric and anxious arousal clusters, has been identified. However, little research has evaluated the best-fitting representation of PTSD symptoms in veterans of the Iraq and Afghanistan wars. Read more . . .
Wang SJ, Rushiti F, Sejdiu X, Pacolli S, Gashi B, Salihu F, & Modvig J.
Confl Health. 2012 Jul 30;6(1):4 PMID: 22846511 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: The management of chronic debilitating health conditions after trauma remains a challenge in post-conflict settings. The study aimed to expand current understanding of the diagnostic overlap of pain and PTSD and explore their independent and interactive effect on career change, sleep disorder and suicide ideation. The role of anger and hatred as contributing factors to the persistence of pain and PTSD were also examined. Read more . . .
Marx BP, Jackson JC, Schnurr PP, Murdoch M, Sayer NA, Keane TM, Friedman MJ, Greevy RA, Owen RR, Sinnott PL, & Speroff T.
J Trauma Stress. 2012 Jul 13; PMID: 22807212 [PubMed - as supplied by publisher]
Abstract: In this reply to McNally and Frueh (2012), we offer some additional insight into the studies they use to support their argument that we should be worried about malingering among veterans. We also describe other research on the disability system of the Department of Veterans Affairs and compensation-seeking behavior that challenges their conclusions.
Kashdan TB, Young KC, & McKnight PE.
J Anxiety Disord. 2012 Jul 25;26(7):762-768 PMID: 22885656 [PubMed - as supplied by publisher]
Abstract: Prior research suggests that rumination and chronic negative emotions serve to maintain emotional disorders. However, some evidence suggests that pondering the nature and meaning of negative experiences can be adaptive. To better understand the function of this dimension of rumination, we studied the use of this strategy in response to negative emotions as they unfold from day to day in veterans with (n=27) and without (n=27) post traumatic stress disorder (PTSD).
For two weeks, veterans completed daily questions about when they experienced a bad mood and how often they used rumination to feel differently. It was hypothesized that rumination would attenuate negative emotional reactions in veterans without PTSD, but that rigid, intense negative emotions would persist in veterans with PTSD. Using multilevel modeling, we found that on the same day, rumination was positively associated with negative affect. Because covariation fails to address directionality, we also examined lagged effects from one occasion to the next. For veterans without PTSD, more frequent use of rumination predicted less intense negative affect the next day; there was no support for a model with negative affect predicting rumination the next day.
For veterans with PTSD, the prior day's intensity of negative affect was the only predictor of intensity of negative affect the next day. Results support the value of distinguishing within-day and across day effects, and the presence of PTSD, to clarify contexts when rumination is adaptive.
Castro CA, Adler AB, McGurk D, & Bliese PD.
J Trauma Stress. 2012 Jul 25; PMID: 22833447 [PubMed - as supplied by publisher]
Abstract: Military personnel report significant and increasing mental health problems in the months following return from combat. Nevertheless, studies have not assessed the impact of mental health training with this at-risk population. The present study evaluated the efficacy of a prototype mental health training module designed for U.S. soldiers 3-6 months after returning from combat; the module was a component of the Battlemind Training system.
Soldiers (N = 1,645) were randomly assigned by platoon to 1 hour of training or a survey-only control group. Baseline surveys were conducted immediately before training; a training satisfaction survey was administered immediately after training, and a follow-up survey was administered 6 months later. Immediate postsession surveys were conducted with 681 subjects, and follow-up surveys were conducted with 542 soldiers.
The Battlemind Training module received positive ratings from participants, and those who received it reported significantly better adjustment in terms of posttraumatic stress disorder symptoms, depression, and life satisfaction at follow-up compared to those in the survey-only control group. Changes in attitudes about the stigma of seeking mental health care were found immediately posttraining, but not at follow-up. The findings demonstrate that brief mental health training can be effective in reducing mental health systems with at-risk occupational groups.
Fetzner MG, McMillan KA, & Asmundson GJ.
Depress Anxiety. 2012 Jul 16; PMID: 22807208 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: The link between posttraumatic stress disorder (PTSD) and deleterious physical health consequences among previously deployed military veterans has been well documented. Research has focused primarily on investigating prevalence rates of physical health disorders among individuals with PTSD. Far less research has compared prevalence rates of specific physical health disorders among individuals with full and subsyndromal PTSD. The current study investigated differences in the prevalence of seven specific categories of physical health disorders (i.e. musculoskeletal, circulatory, endocrine, respiratory, gastrointestinal, neurological, and other physical health disorders) among individuals with full PTSD, subsyndromal PTSD, and no PTSD (i.e. controls). Read more . . .
Escolas SM, Arata-Maiers R, Hildebrandt EJ, Maiers AJ, Mason ST, & Baker MT.
US Army Med Dep J. 2012 Jul-Sep;:54-61 PMID: 22815166 [PubMed - in process]
Abstract: This study examined the effects of attachment style on self-reported posttraumatic stress disorder (PTSD) symptoms in a population of service members (N=561). Active duty, postdeployment service members completed anonymous questionnaires including 2 measures of adult attachment and the PTSD checklist-military as a measure of PTSD symptoms.
Results confirmed the central hypothesis that attachment style was related to reported PTSD symptoms. Secure attachment style was associated with less reported PTSD symptoms and therefore may be involved in mechanisms associated with protection from developing PTSD after experiencing wartime trauma. Results were consistent when tested across continuous and dichotomous assessments that captured diagnostic criteria. This study demonstrates a significant relationship between attachment style and PTSD symptoms within a military population, potentially providing the basis for future research in this area.
Gallaway MS, Fink DS, Millikan AM, & Bell MR.
Aggress Behav. 2012 Sep;38(5):357-67 PMID: 22898873 [PubMed - in process]
Abstract: There are a growing number of studies that have approximated levels of aggression and associated outcomes among combat veterans returning from Iraq and Afghanistan using brief screening assessments. However, further research to evaluate the relative role of combat exposures and overt physical behaviors is required to further elucidate potential associations between military service, combat deployment, and overt physical aggression. Read more . . .
Jovanovic T, Sakoman AJ, Kozari?-Kova?i? D, Meštrovi? AH, Duncan EJ, Davis M, & Norrholm SD.
Depress Anxiety. 2012 Aug 20;1-8. PMID: 22907890 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: Previous work has shown that inhibition of fear is impaired in posttraumatic stress disorder (PTSD) resulting from both civilian and combat trauma. The purpose of the present study was to investigate the inhibition of learned fear in traumatized individuals diagnosed with either acute stress disorder (ASD) or PTSD. This is the first study to use a conditioned inhibition paradigm with traumatized individuals within a month of trauma exposure. We hypothesized that impaired fear inhibition would be evident in PTSD, but not ASD. Read more . . .
Dedert EA, Elbogen EB, Hauser MA, Hertzberg JS, Wilson SM, Dennis MF, Calhoun PS, Kirby AC, & Beckham JC.
Genet Test Mol Biomarkers. 2012 Aug 14; PMID: 22891755 [PubMed - as supplied by publisher]
Abstract: The perspectives of patients with posttraumatic stress disorder (PTSD) on genetic research have not yet been investigated in the genetics research literature. To provide a basis for research on attitudes toward genetic research in PTSD, we surveyed the U.S. Military Afghanistan/Iraq-era veterans with PTSD and their social support companions to investigate the attitudes and knowledge about genetics and genetic testing. Read more . . .
Lu MW, Carlson KF, Duckart JP, & Dobscha SK.
Gen Hosp Psychiatry. 2012 Aug 13; PMID: 22898446 [PubMed - as supplied by publisher]
Abstract: OBJECTIVE: The objective was to examine differences by age in mental health treatment initiation in Veterans Health Administration (VA) primary care patients after positive posttraumatic stress disorder (PTSD) screens. Read more . . .
Correa R, Parry B.
J Affect Disord. 2012 Aug 10; PMID: 22889523 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: Due to specific gender predispositions to present certain illnesses, increasing incorporation of women in the U.S. military system represents an important challenge to both medical and mental health providers. The aim of this report is to describe the main characteristics of the population attended in a mental health women's clinic at the San Diego Veterans Administration (VA) health care system. Read more . . .
Resnick EM, Mallampalli M, & Carter CL.
J Womens Health (Larchmt). 2012 Aug 9; PMID: 22876756 [PubMed - as supplied by publisher]
Abstract: Women in the U.S. military are technically barred from serving in combat specialties, positions, or units; however, since Operation Desert Storm, women have served in forward positions in greater numbers. This increased involvement in combat zones has resulted in exposures to trauma, injury, and a myriad of environmental hazards associated with modern war. Some of these hazards present new health risks specifically relevant to women who have been deployed to or recently returned from Iraq or Afghanistan or both. To address this evolving public health concern, the Society for Women's Health Research (SWHR) convened a 1-day interdisciplinary scientific conference, with speakers and attendees from civilian, military, and veteran settings.
The purpose of the conference was to reveal the state-of-the-science on the health of the female veteran and to focus attention on recent advances in biomedical research related to female veterans' health. The following topics were discussed: mental health (posttraumatic stress disorder [PTSD] and depression), urogenital health, musculoskeletal health, and traumatic brain injury (TBI).
Armed Forces Health Surveillance Center (AFHSC).
MSMR. 2012 Jul;19(7):2-10 PMID: 22876800 [PubMed - in process]
Abstract: Women account for approximately 10 percent of all U.S. military deployers to Afghanistan and Iraq. This analysis estimates the percentages of female deployers (n=154,548) who were affected by selected illnesses and injuries after first through third deployments to Iraq/Afghanistan in relation to age group, service branch, military occupation, marital status, pre-deployment medical history, "dwell time" prior to 2nd and 3rd deployments, and length of deployment.
Of these factors, diagnosis of a condition before deployment was by far the strongest predictor of diagnosis of the condition after deployment.
Durations of dwell times before repeat deployments were not strong predictors of post-deployment diagnoses of any of the conditions considered. For several conditions (e.g., PTSD, disorders of joints, peripheral enthesopathies, infertility), the percentages of deployers diagnosed with the conditions sharply increased with deployment length.
Post-deployment morbidity moderately increased with increasing numbers of deployments in the case of some conditions (e.g., PTSD, migraine, musculoskeletal disorders), but not others. The findings suggest that limiting wartime deployments to nine months may have broad beneficial effects on the post-deployment health of female service members.
However, limiting the number of wartime deployments and lengthening "dwell times" before repeat deployments would likely not have strong and broad beneficial effects on the health of female veterans. Further research to mitigate the effects of heavy loads and repetitive stresses on the musculoskeletal systems of combat deployed females is indicated.
Kashdan TB, Young KC, & McKnight PE.
J Anxiety Disord. 2012 Jul 25;26(7):762-768 PMID: 22885656 [PubMed - as supplied by publisher]
Abstract: Prior research suggests that rumination and chronic negative emotions serve to maintain emotional disorders. However, some evidence suggests that pondering the nature and meaning of negative experiences can be adaptive.
To better understand the function of this dimension of rumination, we studied the use of this strategy in response to negative emotions as they unfold from day to day in veterans with (n=27) and without (n=27) post traumatic stress disorder (PTSD). For two weeks, veterans completed daily questions about when they experienced a bad mood and how often they used rumination to feel differently. It was hypothesized that rumination would attenuate negative emotional reactions in veterans without PTSD, but that rigid, intense negative emotions would persist in veterans with PTSD.
Using multilevel modeling, we found that on the same day, rumination was positively associated with negative affect. Because covariation fails to address directionality, we also examined lagged effects from one occasion to the next. For veterans without PTSD, more frequent use of rumination predicted less intense negative affect the next day; there was no support for a model with negative affect predicting rumination the next day. For veterans with PTSD, the prior day's intensity of negative affect was the only predictor of intensity of negative affect the next day. Results support the value of distinguishing within-day and across day effects, and the presence of PTSD, to clarify contexts when rumination is adaptive.
Scott JC, Pietrzak RH, Mattocks K, Southwick SM, Brandt C, Haskell S.
Drug Alcohol Depend. 2012 Jul 2; PMID: 22770463 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: Despite increasing numbers of women veterans from the Iraq and Afghanistan conflicts, few studies have examined hazardous drinking in this group. The present study examined the prevalence of and risk and protective factors for hazardous drinking in a community-based sample of men and women veterans of Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND). Read more . . .
Hourani LL, Williams J, Forman-Hoffman V, Lane ME, Weimer B, & Bray RM.
Depress Res Treat. 2012;2012:425463 PMID: 22778931 [PubMed - as supplied by publisher]
Abstract: Understanding the role of spirituality as a potential coping mechanism for military personnel is important given growing concern about the mental health issues of personnel returning from war. This study seeks to determine the extent to which spirituality is associated with selected mental health problems among active duty military personnel and whether it moderates the relationship between combat exposure/deployment and (a) depression, (b) posttraumatic stress disorder (PTSD), and (c) suicidality in active duty military personnel.
Data were drawn from the 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel. Over 24,000 randomly selected active duty personnel worldwide completed an anonymous self-report questionnaire. High spirituality had a significant protective effect only for depression symptoms. Medium, as opposed to high or low, levels of spirituality buffered each of the mental health outcomes to some degree. Medium and low spirituality levels predicted depression symptoms but only among those with moderate combat exposure. Medium spirituality levels also predicted PTSD symptoms among those with moderate levels of combat exposure and predicted self-reported suicidal ideation/attempt among those never deployed. These results point to the complex relationship between spirituality and mental health, particularly among military personnel and the need for further research.
Telles S, Singh N, & Balkrishna A.
Depress Res Treat. 2012;2012:401513 PMID: 22778930 [PubMed - as supplied by publisher]
Abstract: There are many and varied types of trauma. The extent to which trauma influences the mental health of an individual depends on the nature of trauma, as well as on the individual's coping capabilities. Often trauma is followed by depression, anxiety, and PTSD. As the pharmacological remedies for these conditions often have undesirable side-effects, nonpharmacological remedies are thought of as a possible add-on treatment. Yoga is one such mind-body intervention.
This paper covers eleven studies indexed in PubMed, in which mental health disorders resulting from trauma were managed through yoga including meditation. The aim was to evaluate the use of yoga in managing trauma-related depression, anxiety, PTSD and physiological stress following exposure to natural calamities, war, interpersonal violence, and incarceration in a correctional facility. An attempt has also been made to explore possible mechanisms underlying benefits seen. As most of these studies were not done on persons exposed to trauma thathad practiced yoga, this is a definite area for further research.
van Liempt S, Arends J, Cluitmans PJ, Westenberg HG, Kahn RS, & Vermetten E.
Psychoneuroendocrinology. 2012 Jul 7; PMID: 22776420 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: Nightmares and insomnia in PTSD are hallmark symptoms, yet poorly understood in comparison to the advances toward a biological framework for the disorder. According to polysomnography (PSG), only minor changes in sleep architecture were described. This warrants alternative methods for assessing sleep regulation in PTSD. Read more . . .
Wolf EJ, Miller MW, Reardon AF, Ryabchenko KA, Castillo D, & Freund R.
Arch Gen Psychiatry. 2012 Jul 1;69(7):698-705 PMID: 22752235 [PubMed - in process]
Abstract: CONTEXT The nature of the relationship of dissociation to posttraumatic stress disorder (PTSD) is controversial and of considerable clinical and nosologic importance. OBJECTIVES To examine evidence for a dissociative subtype of PTSD and to examine its association with different types of trauma. Read more . . .
Mikuls TR, Padala PR, Sayles HR, Yu F, Michaud K, Caplan L, Kerr GS, Reimold A, Cannon GW, Richards JS, Lazaro D, Thiele GM, & Boscarino JA.
Arthritis Care Res (Hoboken). 2012 Jun 27; PMID: 22740431 [PubMed - as supplied by publisher]
Abstract: OBJECTIVE: To examine the relationship between posttraumatic stress disorder (PTSD) and disease activity in U.S. veterans with rheumatoid arthritis (RA). METHODS: U.S. veterans with RA were enrolled in a longitudinal observational study and were categorized as having 1) PTSD, 2) other anxiety/depression disorders, or 3) neither of these psychiatric diagnoses using administrative codes. Generalized linear mixed effects models were used to examine the associations of diagnostic groups with outcomes measured over a mean follow-up period of 3.0 years. Read more . . .
Baumann SL, & Smith DG.
Nurs Sci Q. 2012 Jul;25(3):267-71 PMID: 22753576 [PubMed - in process]
Abstract: The war in Iraq and Afghanistan has involved the deployment of hundreds of thousands of American soldiers, many of whom are married and have children. The experience of one military family living through a deployment in Iraq in 2011 is discussed and interpreted in light of Parse's humanbecoming family model. The model provides a useful way for nurses, and others, to understand families, in a way that honors their values and struggles in an everchanging and unpredictable world. Included is a brief discussion on how communication technologies are changing the experience of military deployment for families.
Zerach G, Solomon Z, Horesh D, & Ein-Dor T.
Soc Psychiatry Psychiatr Epidemiol. 2012 Jul 3; PMID: 22752110 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: The bi-directional relationships between combat-induced posttraumatic symptoms and family relations are yet to be understood. The present study assesses the longitudinal interrelationship of posttraumatic intrusion and avoidance and family cohesion among 208 Israeli combat veterans from the 1982 Lebanon War.
METHODS: Two groups of veterans were assessed with self-report questionnaires 1, 3 and 20‚ years after the war: a combat stress reaction (CSR) group and a matched non-CSR control group. Read more . . .
Litz BT, Salters-Pedneault K, Steenkamp MM, Hermos JA, Bryant RA, Otto MW, & Hofmann SG.
J Psychiatr Res. 2012 Jun 11; PMID: 22694905 [PubMed - as supplied by publisher]
Abstract: d-Cycloserine (DCS) is a partial NMDA receptor agonist that has been shown to enhance therapeutic response to exposure-based treatments for anxiety disorders, but has not been tested in the treatment of combat-related posttraumatic stress disorder (PTSD). The aim of this randomized, double-blind, placebo-controlled trial was to determine whether DCS augments exposure therapy for PTSD in veterans returning from Iraq and Afghanistan and to test whether a brief six-session course of exposure therapy could effectively reduce PTSD symptoms in returning veterans. In contrast to previous trials using DCS to enhance exposure therapy, results indicated that veterans in the exposure therapy plus DCS condition experienced significantly less symptom reduction than those in the exposure therapy plus placebo condition over the course of the treatment. Possible reasons for why DCS was associated with poorer outcome are discussed.
Sherman MD, Perlick DA, & Straits-Tröster K.
Psychol Serv. 2012 Jun 25. [epub ahead of print] PMID:22731838[PubMed - as supplied by publisher]
Abstract: The Department of Veterans Affairs (VA) health care system's leadership has endorsed family involvement in veterans' mental health care as an important component of treatment.
Both veterans and families describe family participation as highly desirable, and research has documented that having healthy social support is a strong protective factor for posttraumatic stress disorder (PTSD). Family psychoeducation has been shown to be effective in preventing relapse among severely mentally ill, and preliminary evidence suggests that family interventions for PTSD may improve veteran and family outcomes. The multifamily group (MFG) treatment model incorporates psychoeducation, communication training, and problem-solving skill building, and it increases social support through its group format.
This article describes the rationale for further adaptation of the MFG model for PTSD, and it reviews issues related to its implementation as a promising adjunctive treatment as part of the continuum of PTSD services available in VA.
Wood MD, Britt TW, Wright KM, Thomas JL, & Bliese PD.
J Trauma Stress. 2012 Jun;25(3):307-14 PMID: 22729980 [PubMed - in process]
Abstract: Benefit finding, described as one's ability to find benefits from stressful situations, has been hypothesized as a buffer against the negative effects of stress on mental health outcomes. Nonetheless, many have questioned the buffering potential of benefit finding in the face of prolonged and excessive stress such as is found in the combat environment. This study suggests that the length of a combat deployment and benefit finding may impact the relationship between combat exposure and posttraumatic stress disorder (PTSD) symptoms.
Surveys were distributed to U.S. enlisted soldiers (n = 1,917), officers, and warrant officers (n = 163) of various combat and combat support units deployed to Iraq. A significant 3-way interaction (sr(2) = .004, p < .05) revealed that benefit finding buffered soldiers from increased PTSD symptoms under high levels of combat exposure early in the deployment, but not in later months. These results indicate that although benefit finding may be a useful coping approach during the early phases of deployment, prolonged exposure to stress may diminish a soldier's ability to use benefit finding as a method for coping.
McLay RN, Graap K, Spira J, Perlman K, Johnston S, Rothbaum BO, Difede J, Deal W, Oliver D, Baird A, Bordnick PS, Spitalnick J, Pyne JM, & Rizzo A.
Mil Med. 2012 Jun;177(6):635-42 PMID: 22730837 [PubMed - in process]
Abstract: This study was an open-label, single-group, treatment-development project aimed at developing and testing a method for applying virtual reality exposure therapy (VRET) to active duty service members diagnosed with combat post-traumatic stress disorder (PTSD). Forty-two service members with PTSD were enrolled, and 20 participants completed treatment.
The PTSD Checklist-Military version, Patient Health Questionnaire-9 for depression, and the Beck Anxiety Inventory were used as outcome measures. Of those who completed post-treatment assessment, 75% had experienced at least a 50% reduction in PTSD symptoms and no longer met DSM-IV criteria for PTSD at post treatment. Average PSTD scores decreased by 50.4%, depression scores by 46.6%, and anxiety scores by 36%. Intention-to-treat analyses showed that statistically significant improvements in PTSD, depression, and anxiety occurred over the course of treatment and were maintained at follow up. There were no adverse events associated with VRET treatment.
This study provides preliminary support for the use of VRET in combat-related PTSD. Further study will be needed to determine the wider utility of the method and to determine if it offers advantages over other established PTSD treatment modalities.
Garber BG, & Zamorski MA.
Mil Med. 2012 Apr;177(4):397-403 PMID: 22594129 [PubMed - indexed for MEDLINE]
Abstract: BACKGROUND: Service members returning from combat can experience difficulty adapting to home life. To help ease this transition, the Canadian Forces provides a Third-location Decompression (TLD) program in Cyprus to members returning from deployment to Afghanistan.
METHODS: The 5-day program consists of individual free time, structured recreational activities, and educational programming. Its perceived value and impact were measured immediately afterward and 4 to 6 months later.
RESULTS: Respondents overwhelmingly supported the TLD concept, with 95% agreeing that "some form of TLD is a good idea." Eighty-one percent of participants found the program valuable, and 83% recommended it for future deployments to Afghanistan. Perceived value persisted 4 to 6 months after return, and 74% felt that it helped to make reintegration easier for them.
CONCLUSION: Canadian Forces members saw value in the TLD program, and most members believed that the program had its intended effect of making the reintegration process easier for them.
Brooks E, Novins DK, Thomas D, Jiang L, Nagamoto HT, Dailey N, Bair B, & Shore JH.
Psychiatr Serv. 2012 Jun 15; PMID: 22707088 [PubMed - as supplied by publisher]
Abstract: OBJECTIVE: Posttraumatic stress disorder (PTSD) is widespread among veterans, but many veterans with PTSD use few health services. This study examined how individual characteristics influenced use of outpatient visits by veterans with PTSD. Read more . . .
Searcy CP, Bobadilla L, Gordon WA, Jacques S, & Elliott L.
Mil Med. 2012 Jun;177(6):649-54 PMID: 22730839 [PubMed - in process]
Abstract: Preventing posttraumatic stress disorder (PTSD) could have a significant positive impact on military readiness and quality of life. Few studies have examined whether pharmacological agents may prevent PTSD, and there has not been a systematic and critical review of these studies in order to guide future research efforts. We performed a literature review of articles examining the use of pharmacological agents for the prevention of PTSD. A total of 27 articles met inclusion criteria for the review and their results are summarized.
The review points to corticosteroids and propranolol as the most promising agents for future research. Gamma-Amino butyric acid mimetic drugs received the least support. Complementary approaches using psychotherapy and pharmacological agents could also yield good results. Research aimed at determining the potential efficacy of these agents could start being carried out in the field with smaller numbers of personnel that has not been personally injured but have witnessed traumatic events. In addition, psychological interventions immediately after postdeployment could be used in large numbers of soldiers. Preliminary studies regarding the use of pharmacologic agents for the secondary prevention of PTSD are promising. However, much larger studies are needed before implementation in generalized practice.
Vanderploeg RD, Belanger HG, Horner RD, Spehard AM, Powell-Cope G, Luther SL, & Scott SG.
Arch Phys Med Rehabil. 2012 Jun 13; PMID: 22705240 [PubMed - as supplied by publisher]
Abstract: OBJECTIVE: To determine the association between specific military deployment experiences and immediate and longer- term physical and mental health effects, as well as examine the effects of multiple deployment-related traumatic brain injuries on health outcomes. These relationships have important implications for post-deployment monitoring and treatment, but have yet to be fully delineated. Read more . . .
Interian A, Kline A, Callahan L, & Losonczy M.
Psychiatr Serv. 2012 Jun 15; PMID: 22706956 [PubMed - as supplied by publisher]
Abstract: OBJECTIVE: Readjustment stressors are commonly encountered by veterans returning from combat operations and may help motivate treatment seeking for posttraumatic stress disorder (PTSD). The study examined rates of readjustment stressors (marital, family, and employment) and their relationship to early mental health treatment seeking among returning National Guard soldiers with PTSD. Read more . . .
Alschuler KN, & Otis JD.
Eur J Pain. 2012 Jun 20; PMID: 22718501 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: Pain and post-traumatic stress disorder (PTSD) are two of the most common health complaints among US veterans. Studies suggest that the co-morbidity of these disorders exacerbates veterans' experiences of chronic pain. Although a limited number of papers have reviewed reasons for this exacerbation, no studies have explored the potential contribution of significant others' responses to veterans' experience of pain in the context of PTSD symptomatology. The purpose of this study was to explore whether significant others' responses to chronic pain differed for veterans with and without clinical levels of PTSD symptoms. It was hypothesized that veterans who presented with higher levels of PTSD symptomatology would report higher levels of 'punishing' responses to their pain from significant others. Read more . . .
Koffel E, Polusny MA, Arbisi PA, & Erbes CR.
Depress Anxiety. 2012 Jun 11; PMID: 22689256 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: Research has shown that posttraumatic stress disorder (PTSD) is highly comorbid with other mental disorders. The DSM-5 marks an opportunity to increase the differential diagnosis of PTSD by emphasizing symptoms that are specific to PTSD and deemphasizing symptoms that are common to many mental disorders. This study analyzes the new and revised PTSD symptom criteria proposed for DSM-5 by examining their relations with diagnoses and measures of PTSD. In addition, we report the specificity of DSM-5 symptoms with PTSD compared to depressive disorders and substance use. Read more . . .
Jones MD, Etherage JR, Harmon SC, & Okiishi JC.
Psychol Serv. 2012 May;9(2):132-43 PMID: 22662728 [PubMed - in process]
Abstract: Telehealth has been touted as one solution to the shortage of mental health providers within the military. Despite developing evidence for the equivalence of telehealth mental health care, there is no research that covers the use of telehealth for population mental health screening, a standard component of postdeployment medical screening. This paper summarizes soldier perceptions of three separate screening events in which telehealth was used and the cost-effectiveness of telehealth versus in-person implementations of the same screening.
Soldiers who have not been through telehealth screening report a strong preference for in-person screening. Soldiers who have been through telehealth screening still report preference for in-person screening, but they express more ambivalence about the screening method. Using telehealth-only mental health screening for large numbers of soldiers within a compressed time frame is more expensive than in-person screening. Telehealth resulted in higher referral rates than in-person screening. Government and military leaders should use care when making decisions about telehealth implementation. Although telehealth for small numbers may be sufficiently equivalent and economical, there is no evidence of cost savings or improved acceptability for telehealth mental health post-deployment screening.
Gros DF, Price M, Strachan M, Yuen EK, Milanak ME, & Acierno R.
Behav Modif. 2012 Jun 7; PMID: 22679240 [PubMed - as supplied by publisher]
Abstract: Effectiveness of exposure therapy for posttraumatic stress disorder (PTSD) may be adversely influenced by comorbid disorders. The present study investigated behavioral activation and therapeutic exposure (BA-TE), a new integrated treatment designed specifically for comorbid symptoms of PTSD and depression.
Combat veterans with PTSD (N = 117) completed eight sessions of BA-TE that included two phases of treatment: (a) behavioral activation (BA) in which some activities involved situational exposures and (b) BA and situational exposures with imaginal exposures.
Findings supported improvements in symptoms of PTSD, and overlapping symptoms of PTSD and depression, but not in nonoverlapping symptoms of depression. The findings also demonstrated a relatively consistent rate of change in PTSD and depression symptoms during BA-TE, despite the addition of imaginal exposures midway through the treatment. Together, these findings provide preliminary support for BA-TE as a treatment for PTSD and depression, and highlight the utility of transdiagnostic treatments in addressing comorbidity and symptom overlap.
Vermetten E, & Lanius RA.
Handb Clin Neurol. 2012;106:291-342 PMID: 22608629 [PubMed - in process]
Abstract: Three decades of posttraumatic stress disorder (PTSD) research have placed it well on the map. PTSD is a young disorder that started being properly understood only from 1980 with incorporation in DSM-III, in which it was acknowledged that exposure to traumatic events can lead to long-term psychopathology. This chapter reviews the history and nosology of the disorder, epidemiology, and etiology, as well as the clinical features. It lists the diagnostic assessments and provides an overview of the biological framework of the disorder by addressing brain, neurohormonal, and transmitter alterations. Exposure to traumatic events is commonplace. Read more . . .
Britvi? D, Glu?ina D, Anti?evi? V, Kekez V, Lapenda B, Dogaš V, Dodig G, Urli? I, Moro I, & Fran?iškovi? T.
Int J Group Psychother. 2012 Jul;62(3):418-35 PMID: 22676788 [PubMed - in process]
Abstract: Due to the long-lasting and resistant symptoms characteristic of chronic combat posttraumatic stress disorder (PTSD), its treatment is complex and often requires a tailored therapeutic approach incorporating both psychotherapy and pharmacotherapy. A multimodal approach of psychoeducative, sociotherapeutic, and dynamically oriented trauma-focused groups is described. We assessed the short- and long-term effectiveness of this therapeutic program by monitoring its impact on PTSD symptoms, depression, neurotic symptoms, coping skills, and quality of life for three years.
The findings revealed short-term reduction in the symptoms of PTSD and depression, while the long-term results were manifested as the increased use of all coping mechanisms and a greater level of obsession.
Wolf EJ, Lunney CA, Miller MW, Resick PA, Friedman MJ, & Schnurr PP.
Depress Anxiety. 2012 May 25; PMID: 22639402 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: The nature of the relationship between dissociation and posttraumatic stress disorder (PTSD) has clinical and nosological importance. The aim of this study was to evaluate the evidence for a dissociative subtype of PTSD in two independent samples and to examine the pattern of personality disorder (PD) comorbidity associated with the dissociative subtype of PTSD. Read more . . .
Science. 2012 May 18;336(6083):872-4 PMID: 22605766 [PubMed - indexed for MEDLINE]
Abstract: The most methodologically rigorous epidemiological study on American military personnel deployed to Iraq and Afghanistan found that 4.3% of troops developed posttraumatic stress disorder (PTSD). Among deployed combatants, 7.6% developed PTSD, whereas 1.4% of deployed noncombatants did so.
The U.S. Department of Veterans Affairs has launched a program ensuring that all veterans with PTSD will receive evidence-based cognitive-behavioral therapy, and the Army has developed Battlemind postdeployment early interventions that reduce risk for the disorder.
Shiner B, Bateman D, Young-Xu Y, Zayed M, Harmon AL, Pomerantz A, & Watts BV.
J Nerv Ment Dis. 2012 Jun;200(6):520-5 PMID: 22652617 [PubMed - in process]
Abstract: We studied differences in diagnostic stability between patients with full and patients with partial posttraumatic stress disorder (PTSD). We collected self-reported symptoms of PTSD, anxiety, depression, and functioning at a Veterans Affairs mental health clinic (n = 1962). We classified patients as meeting full or partial PTSD based upon their initial assessment.
We performed Kaplan-Meier survival analysis to compare stability of diagnosis over time and Cox proportional hazards models to understand how comorbid symptoms and level of functioning confounded the relationship. We performed a chart review to examine differences in treatment received by the two groups.
Patients in the partial PTSD group lost their diagnosis significantly faster and at significantly higher rates than did patients with full PTSD. Comorbid symptoms contributed significantly to this difference.
Mental health treatments delivered to the two groups were similar. These diagnoses appear to be different, suggesting that people with partial PTSD may benefit from a different clinical approach.
Abstract: Military personnel deployed in support of combat operations are at significantly higher risk for mental health problems. However, much of what we know about combat-related mental health comes from postdeployment assessments. This study describes the mental health of 1,336 treatment-seeking deployed U.S. military personnel and interventions recommended by military mental health providers in Iraq from January 2006 to January 2007. Cases were primarily young enlisted men, most of whom were on their first combat deployment. Marines made up the majority of the cases (60%), but there were also large numbers of Army and Navy personnel.
The most common psychiatric diagnoses were anxiety disorders (31%, including 11% with posttraumatic stress disorder), followed by adjustment (27%) and mood disorders (25%, including 22% with depression). Medication was the most commonly prescribed treatment for patients with psychiatric diagnoses but was often combined with recommendations for psychotherapy/counseling and/or behavioral modifications.
The findings illustrate the distribution of mental health conditions seen among treatment-seeking troops while actively serving in a combat environment and the interventions recommended for them. Further examination of postdeployment health outcomes may help to facilitate the development of more effective acute intervention strategies in theater.
Bazarian JJ, Donnelly K, Peterson DR, Warner GC, Zhu T, & Zhong J.
J Head Trauma Rehabil. 2012 May 28; PMID: 22647965 [PubMed - as supplied by publisher]
Abstract: OBJECTIVE: To understand the relations of mild traumatic brain injury (TBI), blast exposure, and brain white matter structure to severity of posttraumatic stress disorder (PTSD). Read more . . .
Tsai J, Harpaz-Rotem I, Pietrzak RH, & Southwick SM.
Psychiatry. 2012;75(2):135-49 PMID: 22642433 [PubMed - in process]
Abstract: Posttraumatic stress disorder (PTSD) is one of the most common psychiatric disorders among veterans returning tfrom Iraq and Afghanistan. Little research has examined variables that may mediate the relation between PTSD and aspects of social functioning, such as relationship satisfaction and family functioning. Read more . . .
Wright KM, Foran HM, Wood MD, Eckford RD, & McGurk D.
J Clin Psychol. 2012 May 9; [epub ahead of print] PMID: 22573513 [PubMed - as supplied by publisher]
Abstract: OBJECTIVES: The study examined whether elevated rates of externalizing behaviors following deployment could be explained by internalizing symptoms (depression, anxiety, and PTSD symptoms), and health of the social environment (unit leadership, organizational support, and stigma/barriers to care).
DESIGN: A model of combat exposure, social environment, internalizing symptoms, and externalizing behaviors was tested in a military unit following a fifteen-month deployment to Iraq. The sample included 1,397 soldiers assessed four month post-deployment; 589 of these soldiers were assessed again nine months post-deployment.
RESULTS: Externalizing behaviors were highly stable over the five-month post-deployment period. Both social environment and internalizing symptoms were significantly associated with level of externalizing behaviors at four months and nine months post-deployment, but combat exposure alone significantly predicted change in externalizing behaviors over the follow-up period.
CONCLUSIONS: Results suggest the need to broaden the scope of interventions targeted to combat veterans and have implications for care providers and military leaders.
Wahbeh H, Lu M, & Oken B.
Mindfulness (N Y). 2011 Dec 1;2(4):219-227 PMID: 22582091 [PubMed - as supplied by publisher]
Abstract: The objective of this cross-sectional study was to assess group differences between veterans with and without posttraumatic stress disorder (PTSD) in mindful awareness and mindful non-judging. The relationships between mindfulness and PTSD symptom clusters were also evaluated. Read more . . .
Ruzek JI, Rosen RC, Marceau L, Larson MJ, Garvert DW, Smith L, & Stoddard A.
Implement Sci. 2012 May 14;7(1):43 PMID: 22583520 [PubMed - as supplied by publisher]
Abstract: This paper presents the rationale and methods for a randomized controlled evaluation of webbased training in motivational interviewing, goal setting, and behavioral task assignment.
Web-based training may be a practical and cost-effective way to address the need for largescale mental health training in evidence-based practice; however, there is a dearth of wellcontrolled outcome studies of these approaches. For the current trial, 168 mental health providers treating post-traumatic stress disorder (PTSD) were assigned to web-based training plus supervision, web-based training, or training-as-usual (control). A novel standardized patient (SP) assessment was developed and implemented for objective measurement of changes in clinical skills, while on-line self-report measures were used for assessing changes in knowledge, perceived self-efficacy, and practice related to cognitive behavioral therapy (CBT) techniques. Eligible participants were all actively involved in mental health treatment of veterans with PTSD.
Study methodology illustrates ways of developing training content, recruiting participants, and assessing knowledge, perceived self-efficacy, and competencybased outcomes, and demonstrates the feasibility of conducting prospective studies of training efficacy or effectiveness in large healthcare systems.
Abstract: The Marine Resiliency Study (MRS) is a prospective study of factors predictive of posttraumatic stress disorder (PTSD) among approximately 2,600 Marines in 4 battalions deployed to Iraq or Afghanistan. We describe the MRS design and predeployment participant characteristics.
Starting in 2008, our research team conducted structured clinical interviews on Marine bases and collected data 4 times: at predeployment and at 1 week, 3 months, and 6 months postdeployment. Integrated with these data are medical and career histories from the Career History Archival Medical and Personnel System (CHAMPS) database.
The CHAMPS database showed that 7.4% of the Marines enrolled in MRS had at least 1 mental health diagnosis. Of enrolled Marines, approximately half (51.3%) had prior deployments. We found a moderate positive relationship between deployment history and PTSD prevalence in these baseline data. Full Text: http://www.cdc.gov/Pcd/issues/2012/pdf/11_0134.pdf
Wright KM, Foran HM, Wood MD, Eckford RD, & McGurk D.
J Clin Psychol. 2012 May 9; [epub ahead of print] PMID: 22573513 [PubMed - as supplied by publisher]
Abstract: OBJECTIVES: The study examined whether elevated rates of externalizing behaviors following deployment could be explained by internalizing symptoms (depression, anxiety, and PTSD symptoms), and health of the social environment (unit leadership, organizational support, and stigma/barriers to care). Read more . . .
Kok BC, Herrell RK, Thomas JL, & Hoge CW.
J Nerv Ment Dis. 2012 May;200(5):444-50 PMID: 22551799 [PubMed - in process]
Abstract: Studies of posttraumatic stress disorder (PTSD) prevalence associated with deployment to Iraq or Afghanistan report wide variability, making interpretation and projection for research and public health purposes difficult. This article placed this literature within a military context. Studies were categorized according to deployment time-frame, screening case definition, and study group (operational infantry units exposed to direct combat versus population samples with a high proportion of support personnel).
Precision weighted averages were calculated using a fixed-effects meta-analysis. Using a specific case definition, the weighted postdeployment PTSD prevalence was 5.5% (95% CI, 5.4-5.6) in population samples and 13.2% (12.8-13.7) in operational infantry units. Both population-level and unit-specific studies provided valuable and unique information for public health purposes; understanding the military context is essential for interpreting prevalence studies.
Goodwin L, Jones M, Rona RJ, Sundin J, Wessely S, & Fear NT.
J Nerv Ment Dis. 2012 May;200(5):429-37 PMID: 22551797 [PubMed - in process]
ABSTRACT: Delayed-onset posttraumatic stress disorder (PTSD) is defined as onset at least 6 months after a traumatic event. This study investigates the prevalence of delayed-onset PTSD in 1397 participants from a two-phase prospective cohort study of UK military personnel. Delayed-onset PTSD was categorized as participants who did not meet the criteria for probable PTSD (assessed using the PTSD Checklist Civilian version) at phase 1 but met the criteria by phase 2. Of the participants, 3.5% met the criteria for delayed-onset PTSD.
Subthreshold PTSD, common mental disorder (CMD), poor/fair self-reported health, and multiple physical symptoms at phase 1 and the onset of alcohol misuse or CMD between phases 1 and 2 were associated with delayed-onset PTSD. Delayed-onset PTSD exists in this UK military sample. Military personnel who developed delayed-onset PTSD were more likely to have psychological ill-health at an earlier assessment, and clinicians should be aware of the potential comorbidity in these individuals, including alcohol misuse. Leaving the military or experiencing relationship breakdown was not associated.
Lane ME, Hourani LL, Bray RM, & Williams J.
Am J Public Health. 2012 Jun;102(6):1213-20 PMID: 22571709 [PubMed - in process]
Abstract: Objectives. We examined stress levels and other indicators of mental health in reservists and active-duty military personnel by deployment status.
Methods: We used data from the Department of Defense Health-Related Behaviors surveys, which collect comprehensive, population-based data for reserve and active-duty forces. Data were collected from 18 342 reservists and 16 146 active-duty personnel. Read more . . .
Rizzo A, Buckwalter JG, John B, Newman B, Parsons T, Kenny P, & Williams J.
Stud Health Technol Inform. 2012;173:379-85 PMID: 22357022 [PubMed - indexed for MEDLINE]
Abstract: The incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel is creating a significant healthcare challenge. This has served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. One emerging form of treatment for combat-related PTSD that has shown promise involves the delivery of exposure therapy using immersive Virtual Reality (VR). Read more . . .
Mulligan K, Jones N, Davies M, McAllister P, Fear NT, Wessely S, & Greenberg N.
Br J Psychiatry. 2012 Apr 26; [epub ahead of print] PMID: 22539778 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: Most studies of the mental health of UK armed forces focus on retrospective accounts of deployment and few sample personnel while they are deployed.
AIMS: This study reports the results of a survey of deployed personnel, examining the perceived impact of
events at home and military support for the family on current mental health during the deployment. Read more . . .
Arbisi PA, Kaler ME, Kehle-Forbes SM, Erbes CR, Polusny MA, & Thuras P.
Psychol Assess. 2012 Apr 30;[epub ahead of print] PMID: 22545697 [PubMed - as supplied by publisher]
Abstract: After returning from an extended combat deployment to Iraq, 348 National Guard soldiers were administered the PTSD Checklist (PCL-M), and the Beck Depression Inventory II (BDI-II) followed, on
average, 3 months later by structured diagnostic interviews including the Clinician-Administered PTSD Scale (CAPS) for the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). There were 6.5% of the soldiers who met diagnostic criteria for posttraumatic stress disorder (PTSD) based on structured interview. The predictive validity of the PCL was examined and contrasted with the predictive validity of the BDI-II in identifying soldiers meeting CAPS diagnosis for PTSD.
The best identified PCL cut scores produced between 65% and 76% false positive
errors when used as the sole source for identification of enduring PTSD.
Comparison of prediction between the PCL and the BDI-II in identifying
PTSD suggested that both instruments may be operating through tapping
generalized distress rather than specific aspects of the disorder.
(PsycINFO Database Record (c) 2012 APA, all rights reserved).
Sutherland RJ, Mott JM, Lanier SH, Williams W, Ready DJ, & Teng EJ.
J Trauma Stress. 2012 Apr;25(2):150-6 PMID: 22522728 [PubMed - in process]
Abstract: Group-based exposure therapy (GBET) is an intensive group treatment that targets posttraumatic stress disorder (PTSD) symptoms through repeated imaginal and in vivo exposure. The purpose of the present study was to assess the feasibility and acceptability of a modified 12-week course of GBET (modified from the standard 16 weeks) and to examine its effectiveness in reducing veterans' PTSD symptoms.
Participants were 10 male Operation Iraqi Freedom and Vietnam-era veterans recruited from a PTSD specialty clinic at a large Veterans Affairs Medical Center. All participants were retained and demonstrated clinically significant reductions in PTSD symptoms comparable to the standard protocol. The findings from this small sample indicate that the abbreviated 12-week GBET protocol is a potentially effective treatment for PTSD.
Perspect Psychiatr Care. 2012 Apr;48(2):108-15 PMID: 22458724 [PubMed - in process]
Abstract: PURPOSE: The purpose of this case study is to present the complex contribution of combatrelated post-traumatic stress disorder (PTSD) to suicide and international standards of treatment among veterans deployed to the Middle East.
CONCLUSIONS: PTSD carries increased physical and psychological health risk in combat soldiers. Internationally, guidelines for PTSD promote cognitive behavior therapies, specifically exposure therapy, as first line treatment; however, implementation varies among countries.
PRACTICE IMPLICATIONS: Evidence supports the benefit of exposure-based psychotherapy for combat-related PTSD. Commonly prescribed antidepressants and other psychotherapy treatments may not be as beneficial.
Chao LL, Lenoci M, & Neylan TC.
Neuroreport. 2012 Mar 26; [epub ahead of print] PMID: 22453299 [PubMed - as supplied by publisher]
Abstract: Although there is evidence for strong connectivity between the amygdala and the visual cortex and some evidence for reduced occipital lobe gray matter volume in patients with post-traumatic stress disorder (PTSD), few studies have directly examined the effects of PTSD on occipital function. The current study used functional and structural MRI to examine occipital cortex function and structure in male combat veterans with and without PTSD. Left occipital gray matter volume was reduced in PTSD patients relative to the controls and correlated negatively with the severity of PTSD symptoms. Functional activity in the lateral occipital complex to aversive and nonaversive pictures presented in novel and repeated presentations was not altered by PTSD.
These findings suggest that PTSD adversely affects occipital lobe volume but not the reactivity of the lateral occipital complex to generally aversive, trauma nonspecific stimuli.
Klemanski DH, Mennin DS, Borelli JL, Morrissey PM, & Aikins DE.
Depress Anxiety. 2012 Mar 27; [epub ahead of print] PMID: 22461455 [PubMed - as supplied by publisher]
Abstract: Data suggest military personnel involved in U.S. military initiatives in Iraq and Afghanistan are returning from deployment with elevated rates of mental health diagnoses, including posttraumatic stress disorder (PTSD).
The aim of this study was to examine difficulties with emotion regulation as a potential contributory mechanism by which soldiers have poorer psychological outcomes, such as depression, dissociation, alcohol abuse, and interpersonal difficulties. Participants were 44 active-duty male service members who comprised three groups, including those deployed with and without diagnosed PTSD and those prior to deployment.
Participants in the PTSD group scored significantly higher on measures of selfreported depression, trauma-related dissociation, alcohol misuse, and social adjustment difficulties than did comparison groups. Importantly, difficulties with emotion regulation were found to partially mediate the relationship between PTSD and depression, poor social adjustment, and trauma-related depersonalization but not alcohol misuse. Emotion-regulation difficulties are important to consider in the relationship between PTSD and additional psychological outcomes in recently deployed personnel. Implications for treatment are briefly discussed.
Hassija CM, Jakupcak M, Maguen S, & Shipherd JC.
J Trauma Stress. 2012 Apr;25(2):216-9 PMID: 22522738 [PubMed - in process]
Abstract: The present study evaluated the impact of combat and interpersonal trauma exposure in a sample of 115 U.S. women veterans from Gulf War I and the Iraq and Afghanistan wars on 3 postdeployment trauma-related mental health outcomes: posttraumatic stress disorder symptoms (PSS), depressive symptom severity (DSS), and alcohol misuse.
Patients presenting for healthcare services at a Veterans Affairs postdeployment health specialty clinic completed screening questionnaires that assessed combat exposure, lifetime interpersonal trauma history of childhood neglect, physical, or sexual abuse, and adult sexual and physical assault. In a regression model, combat exposure was the only significant independent variable associated with PSS, DSS, and alcohol misuse (? = .42, .27 and B = 1.58, respectively) even after adding lifetime interpersonal assault exposure to the model.
Results highlight the negative effects of combat exposure on treatment-seeking women veterans' postdeployment mental health. Incorporating combat exposure into routine screening procedures for Gulf War and Iraq and Afghanistan war women veterans can aid in mental health treatment planning.
DeVoe ER & Ross A.
Mil Med. 2012 Feb;177(2):184-90 PMID: 22360065 [PubMed - indexed for MEDLINE]
Abstract: Parents of dependent children comprise approximately 42% of Active Duty and National Guard/Reserve military members serving in Operation Iraqi Freedom/Operation Enduring Freedom. Recent estimates indicate that more than two million children have experienced parental deployment since the terrorist attacks on September 11, 2001.
This article seeks to characterize the impact of the deployment life cycle on parenting roles among service members and at-home partners/caregivers of dependent children. Specifically, a new conceptual framework is presented for considering the ways in which parenting and co-parenting processes are affected by the demands and transitions inherent in contemporary deployment to a war zone.
Although the phase-based emotional cycle of deployment continues to offer an instructive description of the broad challenges faced by military couples, a parenting cycle of deployment model shifts the perspective to the critical and largely ignored processes of parenting in the context of deployment and war, and to the realities faced by parents serving in the U.S. military. Implications for prevention, intervention, and future research related to military families are addressed.
Hundt NE & Holohan DR.
J Trauma Stress. 2012 Apr;25(2):191-7 PMID: 22522734 [PubMed – in process]
Abstract: Increasing attention is being paid to the fact that exposure to traumatic stressors in military combat may lead to perpetration of intimate partner violence (IPV). Because shame has been identified as a factor in posttraumatic stress disorder (PTSD), the current cross-sectional study examined the relationship in U.S. veterans between IPV and PTSD, depression, guilt, and shame. We hypothesized that shame would be the strongest correlate of perpetration of IPV and that shame would mediate the relationship between PTSD and IPV.
Participants were 264 primarily male and Caucasian mixed-era veterans presenting for psychological treatment at a Veterans Affairs hospital. They completed standard measures of depression, PTSD symptoms, shame, and guilt and a local checklist was used to dichotomize the sample regarding IPV.
Discriminant analysis indicated that shame contributed most (standardized canonical discriminant function coefficient = .44) to distinguishing perpetrators of IPV. In addition, the results were consistent with shame as a mediator of the relationship between PTSD and IPV. These results are in line with studies indicating that shame is linked to IPV perpetration in nonveteran samples (Harmon, 2002; Rand, 2004; Schibik, 2002) and suggests that shame may be an important aspect of the relationship between PTSD and IPV.
van Zuiden M, Heijnen CJ, Maas M, Amarouchi K, Vermetten E, Geuze E, & Kavelaars A.
Psychoneuroendocrinology. 2012 Apr 11.
Abstract: AIM: Posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and severe fatigue may develop in response to severe stress and trauma. These conditions have all been shown to be associated with altered sensitivity of leukocytes for regulation by glucocorticoids (GCs). However, it remains unknown whether sensitivity of leukocytes for GCs is a pre-existing vulnerability factor, or whether GC-sensitivity of leukocytes alters as a consequence of stress and stress-related conditions. Our aim was to investigate whether sensitivity of T-cells and monocytes for regulation by GCs (i.e. dexamethasone: DEX) assessed before military deployment predicts high levels of PTSD, depressive, and/or fatigue symptoms 6 months after return from deployment. Read more . . .
Renshaw KD & Caska CM.
Behav Ther. 2012 Jun;43(2):416-426 PMID: 22440076 [PubMed - as supplied by publisher]
Abstract: Partners of combat veterans with posttraumatic stress disorder report elevated relationship and psychological distress, but little is known about the mechanisms by which such distress develops. In two separate samples, we examined partners' perceptions of veterans' PTSD symptoms, with a specific focus on the simultaneous associations of partners' distress with their perceptions of veterans' reexperiencing, withdrawal/numbing, and hyperarousal symptom clusters.
The first sample consisted of 258 partners of Operation Enduring- and Iraqi Freedom-era veterans who completed questionnaires. The second sample consisted of 465 partners of Vietnam-era veterans who completed interviews as part of the National Vietnam Veterans Readjustment Study.
In both samples, path analyses revealed that, when examined simultaneously, partners'perceptions of withdrawal/numbing symptoms were associated with greater distress, but perceptions of reexperiencing symptoms were unrelated to psychological distress and significantly associated with lower levels of relationship distress.
Given the cross-sectional nature of the data in both samples, there are multiple plausible interpretations of the results. However, the pattern is consistent with an attributional model of partner distress, whereby partners are less distressed when symptoms are more overtly related to an uncontrollable mental illness. Potential clinical implications are discussed.
Gray MJ, Schorr Y, Nash W, Lebowitz L, Amidon A, Lansing A, Maglione M, Lang AJ, & Litz BT.
Behav Ther. 2012 Jun;43(2):407-415 PMID: 22440075 [PubMed - as supplied by publisher]
Abstract: We evaluated the preliminary effectiveness of a novel intervention that was developed to address combat stress injuries in active-duty military personnel. Adaptive disclosure (AD) is relatively brief to accommodate the busy schedules of active-duty service members while training for future deployments.
Further, AD takes into account unique aspects of the phenomenology of military service in war in order to address difficulties such as moral injury and traumatic loss that may not receive adequate and explicit attention by conventional treatments that primarily address fear-inducing life-threatening experiences and sequelae. In this program development and evaluation open trial, 44 marines received AD while in garrison.
It was well tolerated and, despite the brief treatment duration, promoted significant reductions in PTSD, depression, negative posttraumatic appraisals, and was also associated with increases in posttraumatic growth.
J Hist Med Allied Sci. 2012 Jan;67(1):94-119 PMID: 20713494 [PubMed - indexed for MEDLINE]
Abstract: During the First World War, thousands of soldiers were treated for "shell shock," a condition which encompassed a range of physical and psychological symptoms. Shell shock has most often been located within a "genealogy of trauma," and identified as an important marker in the gradual recognition of the psychological afflictions caused by combat. In recent years, shell shock has increasingly been viewed as a powerful emblem of the suffering of war.
This article, which focuses on Britain, extends scholarly analyses which questions characterizations of shell shock as an early form of post-traumatic stress disorder. It also considers some of the methodological problems raised by recasting shell shock as a wartime medical construction rather than an essentially timeless manifestation of trauma.
It argues that shell shock must be analyzed as a diagnosis shaped by a specific set of contemporary concerns, knowledges, and practices. Such an analysis challenges accepted understandings of what shell shock "meant" in the First World War, and also offers new perspectives on the role of shell shock in shaping the emergence of psychology and psychiatry in the early part of the twentieth century. The article also considers what relation, if any, might exist between intellectual and other histories, literary approaches, and perceptions of trauma as timeless and unchanging.
Doherty ME & Scannell-Desch E.
J Midwifery Womens Health. 2012 Mar;57(2):172-7 PMID: 22432490 [PubMed - in process]
Abstract: Introduction: The purpose of this study was to describe women's health and hygiene experiences during their deployment to Iraq and Afghanistan during the war years, 2003 through 2010. Read more . . .
Myers CE, Vanmeenen KM, & Servatius RJ.
Psychiatry Res. 2012 Mar 5; [epub ahead of print] PMID: 22397911 [PubMed - as supplied by publisher]
Abstract: Behavioral inhibition (BI), a temperamental bias to respond to novel stimuli with avoidance behaviors, is a risk factor for posttraumatic stress disorder (PTSD). It is unclear whether BI accounts for additional variance in PTSD symptom severity beyond that accounted for by general anxiety. Here, 109 veterans (mean age 50.4years, 9.2% female) provided self-assessment of PTSD symptoms, state and trait anxiety, combat exposure, and current (adult) and retrospective (childhood) BI.
Adult BI was correlated with anxiety and PTSD symptom severity, especially cluster C (avoidance) symptoms, but not with combat exposure. A regression model including adult BI, state and trait anxiety, and combat exposure was able to correctly classify over 80% of participants according to presence or absence of severe PTSD symptoms.
Because avoidance behaviors are a core component of PTSD, self-assessments of BI may be an important tool in understanding PTSD and potentially assessing vulnerability to the disorder.
Uhac I, Tariba P, Kovac Z, Simoni?-Kocijan S, Lajnert V, Mesi? VF, Kuis D, & Braut V.
Coll Antropol. 2011 Dec;35(4):1161-6 PMID: 22397254 [PubMed - in process]
Abstract: The aim of this study was to investigate the prevalence and intensity of masticatory muscle and temporomandibular joint (TMJ) pain in Croatian war veterans with posttraumatic stress disorder (PTSD). The examined group consisted of 100 Croatian war veterans, in whom PTSD had previously been diagnosed. Patients were compared with 92 subjects who had not taken part in the war and in whom PTSD was excluded by psychiatric examination. Read more . . .
Forbes D, Lloyd D, Nixon RD, Elliott P, Varker T, Perry D, Bryant RA, & Creamer M.
J Anxiety Disord. 2012 Jan 24;26(3):442-452 PMID: 22366446 [PubMed - as supplied by publisher]
Abstract: Cognitive processing therapy (CPT) is currently applied in military veteran mental health services in many countries. This study tests the effectiveness of community-administered CPT for military-related PTSD under randomized controlled conditions. Fifty-nine treatment-seeking veterans with military-related PTSD were randomly allocated to receive 12 twice-weekly 60min sessions of CPT or an equivalent period of usual treatment at veterans' community based counseling services.
Intent to treat analyses found significantly greater improvement for participants receiving CPT over usual treatment at post-treatment and 3 month follow-up. CPT also produced greater improvements in anxiety, depression, social and dyadic relationships than usual treatment. No CPT related adverse events occurred during the trial.
This trial reports the first randomized controlled trial evidence that CPT is an effective treatment for military PTSD and co-morbid conditions when compared to usual treatment and delivered in community settings by clinicians from diverse disciplines, preferred treatment orientation and levels of experience.
Villarreal G, Cañive JM, Calais LA, Toney G, & Smith AK.
Psychopharmacol Bull. 2010;43(3):26-34 PMID: 21150844 [PubMed - indexed for MEDLINE]
Abstract: The objective of this prospective study was to assess the efficacy and tolerability of duloxetine in the treatment of in military veterans with posttraumatic stress disorder (PTSD).Twenty subjects were enrolled in this 12-week, open-label trial. Diagnosis and symptom severity were assessed with the Clinician Administered PTSD Scale (CAPS). Depressive symptoms were assessed the Hamilton Depression Rating Scale. All subjects had a CAPS score of at least 60 at baseline. Subjects with lifetime history of psychotic disorders or bipolar illness were excluded. Read more . . .
Taft CT, Kachadourian LK, Suvak MK, Pinto LA, Miller MM, Knight JA, & Marx BP.
J Fam Psychol. 2012 Feb 27; [epub ahead of print] PMID: 22369461 [PubMed - as supplied by publisher]
Abstract: We examined correlates of intimate partner violence (IPV) in a military Veteran sample (N = 129) using Finkel's (2007) framework for understanding the interactions between impelling and disinhibiting risk factors. Correlates investigated included head contact events (HCEs), posttraumatic stress disorder (PTSD) symptoms, and antisocial features.
Results indicated that antisocial features were significantly associated with IPV at the bivariate level. PTSD symptoms also were associated with IPV, but this association was marginally significant. Tests of moderation provided support for the expectation that HCEs would potentiate associations between antisocial features and IPV. HCEs also moderated the association between PTSD symptoms and IPV. However, contrary to expectations, the opposite pattern emerged such that PTSD symptoms were associated with a higher rate of IPV for those without a history of HCEs.
Study findings have potentially important implications for furthering our understanding of the complex etiology of IPV in this population. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Hinojosa R, Hinojosa MS, & Högnäs RS.
Mil Med. 2012 Feb;177(2):191-7 PMID: 22360066 [PubMed - in process]
Abstract: Twenty Reserve component (Army and Marines) and Army National Guard male veterans of Operational Enduring Freedom/Operation Iraqi Freedom discuss their deployment and postdeployment family reintegration experiences. A Grounded Theory approach is used to highlight some of the ways in which family miscommunication during deployment can occur.
Communication with civilian family members is affected by the needs of operational security, technical problems with communication tools, miscommunication between family members, or because veterans have "nothing new to say" to family back home. These communication difficulties may lead to an initial gulf of understanding between veterans and family members that can cause family strain during postdeployment family reintegration. We end with a discussion of veteran family reintegration difficulties.
Bonanno GA, Mancini AD, Horton JL, Powell TM, Leardmann CA, Boyko EJ, Wells TS, Hooper TI, Gackstetter GD, & Smith TC.
Br J Psychiatry. 2012 Feb 23; [epub ahead of print] PMID: 22361018 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: Most previous attempts to determine the psychological cost of military deployment have been limited by reliance on convenience samples, lack of pre-deployment data or confidentiality and cross-sectional designs. Read more . . .
Pigeon WR, Britton PC, Ilgen MA, Chapman B, & Conner KR.
Am J Public Health. 2012 Mar;102(S1):S93-S97 PMID: 22390611 [PubMed – as supplied by publisher]
Abstract: Objectives. We examined the role of sleep disturbance in time to suicide since the last treatment visit among veterans receiving Veterans Health Administration (VHA) services. Read more . . .
Seal KH, Shi Y, Cohen G, Cohen BE, Maguen S, Krebs EE, & Neylan TC.
JAMA. 2012 Mar 7;307(9):940-7 PMID: 22396516 [PubMed - in process]
Abstract: CONTEXT: Record numbers of Iraq and Afghanistan veterans survive their war injuries and yet continue to experience pain and mental health problems, particularly posttraumatic stress disorder (PTSD). Little is known about the association of mental health disorders and prescription opioid use. OBJECTIVE: To investigate the effect of mental health disorders, particularly PTSD, on risks and adverse clinical outcomes associated with prescription opioid use. Read more . . .
Barnes SM, Walter KH, & Chard KM.
Rehabil Psychol. 2012 Feb;57(1):18-26 PMID: 22369114 [PubMed – in process]
Abstract: Objective: Research shows that posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) independently increase suicide risk; however, scant research has investigated whether mTBI increases suicide risk above and beyond the risk associated with PTSD alone. Read more . . .
Macgregor AJ, Han PP, Dougherty AL, & Galarneau MR.
Am J Public Health. 2012 Mar;102 Suppl 1:S55-9 PMID: 22390601 [PubMed - in process]
Abstract: Objective: We investigated the association of the length of time spent at home between deployments, or dwell time, with posttraumatic stress disorder (PTSD) and other mental health disorders. Read more . . .
Abstract: OBJECTIVE: We examined the effects of sensory-enhanced hatha yoga on symptoms of combat stress in deployed military personnel, compared their anxiety and sensory processing with that of stateside civilians, and identified any correlations between the State-Trait Anxiety Inventory scales and the Adolescent/Adult Sensory Profile quadrants. Read more . . .
Jones N, Seddon R, Fear NT, McAllister P, Wessely S, & Greenberg N.
Psychiatry. 2012;75(1):49-59 PMID: 22397541 [PubMed - in process]
Abstract: Abstract UK Armed Forces (AF) personnel deployed to Afghanistan are frequently exposed to intense combat and yet little is known about the short-term mental health consequences of this exposure and the potential mitigating effects of military factors such as cohesion, morale, and leadership. Read more . . .
Eisen SV, Schultz MR, Vogt D, Glickman ME, Elwy AR, Drainoni ML, Osei-Bonsu PE, & Martin J.
Am J Public Health. 2012 Mar;102(S1):S66-S73 PMID: 22390605 [PubMed – as supplied by publisher]
Abstract: Objectives: We examined (1) mental and physical health symptoms and functioning in US veterans within 1 year of returning from deployment, and (2) differences by gender, service component (Active, National Guard, other Reserve), service branch (Army, Navy, Air Force, Marines), and deployment operation (Operation Enduring Freedom/Operation Iraqi Freedom [OEF/OIF]). Read more . . .
Yount RA, Olmert MD, & Lee MR.
US Army Med Dep J. 2012 Apr-Jun;:63-9 PMID: 22388685 [PubMed - in process]
Abstract: In July 2008, social worker and certified service dog trainer Rick Yount created the first Warrior dog-training program designed to be a safe, effective, nonpharmaceutical intervention to treat the symptoms of posttraumatic stress disorder (PTSD) and traumatic brain injury in Veterans and service members undergoing treatment at a large Veterans Administration residential treatment facility.
In 2009, Yount was asked to establish the program at a prominent Department of Defense medical center. In October 2010, Yount was invited to create a service dog training program to support the research and treatment mission at the new National Intrepid Center of Excellence (NICoE), in Bethesda, Maryland.
This program, now being offered through the nonprofit foundation Warrior Canine Connection, continues to produce anecdotal evidence that training service dogs reduces the PTSD symptoms of Warrior-trainers and that the presence of the dogs enhances the sense of wellness in the NICoE staff and the families of our Wounded Warriors. Under the research leadership of the NICoE, the Warrior Canine Connection research team plans to systematically investigate the physiological, psychological, and behavioral benefits of this program.
Beck CE, Gonzales F, Haertlein Sells C, Jones C, Reer T, & Zhu YY.
US Army Med Dep J. 2012 Apr-Jun;:38-45 PMID: 22388679 [PubMed - in process]
Abstract: Animal-assisted therapy (AAT) has gained much attention in civilian and military health care. Evidence supports its benefits with varied populations with diseases and disabilities, but no research has been done with injured or ill service members. This pretest, posttest nonrandomized control group study evaluated the effects of AAT on Warriors in transition (N=24) attending an Occupational Therapy Life Skills program with the long-term goal of improving their successful reintegration.
Although significant differences were not found between the groups on most measures, anecdotal reports by participants and observers indicate that participants eagerly anticipated being with the therapy dogs, expressed pleasure and satisfaction with the experience, and regretted seeing it end. There were significant correlations between mood, stress, resilience, fatigue, and function at various measurement points. This is the first study to formally assess the benefits of AAT with wounded service members in garrison. Suggestions for future research are provided.
US Army Med Dep J. 2012 Apr-Jun;:46-50 PMID: 22388680 [PubMed - in process]
Abstract: Combat and operational stress control (COSC) dogs represent a new category of military working dog. America's VetDogs, a nongovernmental, not-for-profit organization, trains and provides therapy dogs to work with the US Army's combat and operational stress control teams deployed to Afghanistan or Iraq.
By taking the therapy/service dog concept to the next level, these dogs have become an important modality in the Army's initiative to safeguard Soldiers' behavioral health while deployed, allowing COSC unit members to break down stigmas that are still present when dealing with behavioral health issues. The training process begins by choosing a pool of dogs, exposing them to different sensory experiences over several months, and training the primary and secondary handlers who will be responsible for the dogs while deployed in theater. After their deployment ends, the dogs are retrained by America's VetDogs to further serve in military or Veterans Administration medical centers as physical, occupational, or behavioral therapy dogs.
Abstract: A major focus of the mission of the US Department of Veterans Affairs (VA) is to respond to the needs of military personnel returning from war. Given the broad spectrum of the potential effects of combat deployment on the health and well being of service members, VA is increasingly oriented toward comprehensive postcombat support, health promotion, disease prevention, and proactive approaches to caring for combat veterans.
This article briefly summarizes the health care needs of service members returning from Afghanistan and Iraq, describes VA's approaches to addressing their needs, and outlines VA's evolving vision for how to apply principles of population health management to ensure prompt and effective response to the postdeployment needs of veterans returning from future conflicts. At the heart of postcombat care will be population-based approaches oriented to health recovery using interdisciplinary, team-based platforms.
Davis LL, Leon AC, Toscano R, Drebing CE, Ward LC, Parker PE, Kashner TM, & Drake RE.
Psychiatr Serv. 2012 Feb 1; [epub ahead of print] PMID: 22307881 [PubMed - as supplied by publisher]
Abstract: OBJECTIVE: Posttraumatic stress disorder (PTSD) is a potentially disabling mental illness that can cause occupational dysfunction. Although vocational rehabilitation is often prescribed for patients with PTSD, standard vocational services are far from adequate in helping them obtain and maintain competitive employment. This study is the first to examine the outcome of evidence-based supported employment for veterans with PTSD. Read more . . .
Harrington KM, Miller MW, Wolf EJ, Reardon AF, Ryabchenko KA, & Ofrat S.
Compr Psychiatry. 2012 Feb 1; [epub ahead of print] PMID: 22305866 [PubMed - as supplied by publisher]
Abstract: This study examined attention-deficit/hyperactivity disorder (ADHD) comorbidity in military veterans with a high prevalence of posttraumatic stress disorder (PTSD) and evaluated the relationships between the 2 disorders and exposure to traumatic events.
The sample included 222 male and female military veterans who were administered structured clinical interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Results show that 54.5% met the criteria for current PTSD, 11.5% of whom also met the criteria for current adult ADHD.
Level of trauma exposure and ADHD severity were significant predictors of current PTSD severity. Evaluation of the underlying structure of symptoms of PTSD and ADHD using confirmatory factor analysis yielded a best-fitting measurement model that comprised 4 PTSD factors and 3 ADHD factors.
Standardized estimates of the correlations among PTSD and ADHD factors suggested that the largest proportion of shared variance underlying PTSD-ADHD comorbidity is related to problems with modulating arousal levels that are common to both disorders (ie, hyperarousal and hypoarousal).
Shore JH, Brooks E, Anderson H, Bair B, Dailey N, Kaufmann LJ, & Manson S.
Psychiatr Serv. 2012 Feb 1;63(2):179-81 PMID: 22302338 [PubMed - in process]
Abstract: OBJECTIVE: This study examined use by American Indian and Alaska Native veterans of services provided by specialty telemental health clinics focused on posttraumatic stress disorder. These clinics offer services via videoconferencing to address challenges faced by rural veterans in accessing care. Read more . . .
Hall BJ, Elhai JD, Grubaugh A, Tuerk P, & Magruder K.
J Anxiety Disord. 2012 Jan 12;26(3):409-415 PMID: 22306134 [PubMed - as supplied by publisher]
Abstract: The present study assessed potential gender differences between the two prevailing PTSD models - the emotional numbing (King, Leskin, King, & Weathers, 1998) and dysphoria (Simms, Watson, & Doebbelling, 2002) models - in order to establish whether one model is superior with regard to its cross-gender generalizability.
The sample included 188 female and 690 male trauma-exposed United States Veterans presenting to Veterans Affairs primary care medical clinics. Multigroup confirmatory factor analyses with covariates (MIMIC models) were conducted using the PTSD Checklist. The covariates included were socio-demographic variables and the type of traumatic event experienced.
The emotional numbing model was statistically superior for men, but no difference between models was noted for females. After controlling for model covariates, men reported higher item-level severity and women had larger residual error variances and larger factor variances and covariances in the emotional numbing model. These results suggest partial generalizability of the emotional numbing model across gender.
Currier JM, & Holland JM.
J Trauma Stress. 2012 Feb 10; [epub ahead of print] PMID: 22328290 [PubMed - as supplied by publisher]
Abstract: Military combat often presents service members with a dual burden of coping with traumas of various types while also grappling with the deaths of close personal friends. At present, much less is known about the effects of bereavement in the context of war compared to other combat-related stressors.
Studying a sample of combat veterans from the National Vietnam Veterans Readjustment Study (NVVRS), we examined the contribution of combat loss in psychological functioning and posttraumatic stress disorder (PTSD). When controlling for gender, age, ethnicity, educational background, exposure to nonbereavement combat stressors, and recent bereavement experiences, combat loss was uniquely associated with past and current functional impairments among the veterans, ?s = .07 and .06, respectively, but was not related to the severity of PTSD.
These findings highlight that combat loss might act as a uniquely challenging stressor among many service members and more empirical research is needed on this topic.
Morgan M, Lockwood A, Steinke D, Schleenbaker R, & Botts S.
Psychiatr Serv. 2012 Feb 1;63(2):182-5 PMID: 22302339 [PubMed - in process]
Abstract: OBJECTIVE: The purpose of this study was to determine if veterans with posttraumatic stress disorder (PTSD) and mild traumatic brain injury (TBI) are treated differently pharmacologically than patients with PTSD alone. Read more . . .
Sher L, Braquehais MD, & Casas M.
Cleve Clin J Med. 2012 Feb;79(2):92-7 PMID: 22301558 [PubMed - in process]
Abstract: Suicidal behavior is a critical problem in war veterans. Combat veterans are not only more likely to have suicidal ideation, often associated with posttraumatic stress disorder (PTSD) and depression, but they are more likely to act on a suicidal plan.
Especially since veterans may be less likely to seek help from a mental health professional, non-mental-health physicians are in a key position to screen for PTSD, depression, and suicidal ideation in these patients. The authors discuss the association of PTSD, depression, and suicide in veterans, keys to assessment of suicide risk, and interventions.
Kelley AM, Athy JR, Cho TH, Erickson B, King M, & Cruz P.
J Psychiatr Res. 2012 Feb 3; [epub ahead of print] PMID: 22305118 [PubMed - as supplied by publisher]
Abstract: Anecdotal and preliminary evidence suggests that Soldiers returning from a combat deployment engage in an increased number of health risk behaviors. Three potential factors driving this change were examined in this study; posttraumatic stress disorder (PTSD), concussion and traumatic brain injury (TBI), and perceived invincibility.
We studied members of a combat arms brigade one month prior to a deployment to Iraq and approximately one month after their return (N = 319). Participants anonymously completed surveys characterizing attitudes about risk, risk propensity, invincibility, engagement in health risk behaviors, and personality. Using standardized screening instruments, participants were categorized with respect to PTSD and probable TBI.
Results suggest that Soldiers engage in more alcohol use and reckless driving behaviors post-deployment. These changes were exaggerated in those who screened positive for PTSD. Perception of one's invincibility and survival skills increased post-deployment thus suggesting that participants felt less susceptible to adverse consequences and more adept at surviving dangerous situations.
This study provides documentation of the pattern of health behavior in Soldiers engaged in the deployment cycle. Our findings suggest increases in the number of risks Soldiers' engage in post-deployment are not limited to those with PTSD symptomtotology. This study has implications for not only adjustment to life post-deployment at the individual level but also operational readiness.
Joseph AM, McFall M, Saxon AJ, Chow BK, Leskela J, Dieperink ME, Carmody TP, & Beckham JC.
J Trauma Stress. 2012 Feb 10; [epub ahead of print] PMID: 22328334 [PubMed - as supplied by publisher]
Abstract: Smoking prevalence among patients with posttraumatic stress disorder (PTSD) is over 40%.
Baseline data from the VA Cooperative Studies Program trial of integrated versus usual care for smoking cessation in veterans with PTSD (N = 863) were used in multivariate analyses of PTSD and depression severity, and 4 measures of smoking intensity: cigarettes per day (CPD), Fagerström Test for Nicotine Dependence (FTND), time to first cigarette, and expired carbon monoxide.
Multivariate regression analysis showed the following significant associations: CPD with race (B = -7.16), age (B = 0.11), and emotional numbing (B =0 .16); FTND with race (B = -0.94), education (B = -0.34), emotional numbing (B = 0.04), significant distress (B = -0.12), and PHQ-9 (B = 0.04); time to first cigarette with education (B = 0.41), emotional numbing (B = -0.03), significant distress (B = 0.09), and PHQ-9 (B = -0.03); and expired carbon monoxide with race (B = -9.40).
Findings suggest that among veterans with PTSD, White race and emotional numbing were most consistently related to increased smoking intensity and had more explanatory power than total PTSD symptom score. Results suggest specific PTSD symptom clusters are important to understanding smoking behavior in patients with PTSD.
Sripada RK, King AP, Garfinkel SN, Wang X, Sripada CS, Welsh RC, & Liberzon I.
J Psychiatry Neurosci. 2012 Feb 7;37(2):110069 PMID: 22313617 [PubMed - as supplied by publisher]
Abstract: Background: Converging neuroimaging research suggests altered emotion neurocircuitry in individuals with posttraumatic stress disorder (PTSD). Emotion activation studies in these individuals have shown hyperactivation in emotion-related regions, including the amygdala and insula, and hypoactivation in emotion-regulation regions, including the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC). However, few studies have examined patterns of connectivity at rest in individuals with PTSD, a potentially powerful method for illuminating brain network structure. Read more . . .
Xue Y, Taub PR, Iqbal N, Fard A, Wentworth B, Redwine L, Clopton P, Stein M, & Maisel A.
Am J Cardiol. 2012 Feb 2; [epub ahead of print] PMID: 22305506 [PubMed - as supplied by publisher]
Abstract: Post-traumatic stress disorder (PTSD) is gaining increasing recognition as a risk factor for morbidity and mortality. The aim of this study was to examine the impact of PTSD and abnormal cardiovascular biomarkers on mortality in military veterans.
Eight hundred ninety-one patients presenting for routine echocardiography were enrolled. Baseline clinical data and serum samples for biomarker measurement were obtained and echocardiography was performed at the time of enrollment.
Patients were followed for up to 7.5 years for the end point of all-cause mortality. Ninety-one patients had PTSD at the time of enrollment. There were 33 deaths in patients with PTSD and 221 deaths in those without PTSD. Patients with PTSD had a trend toward worse survival on Kaplan-Meier analysis (p = 0.057). Among patients with elevated B-type natriuretic peptide (>60 pg/ml), those with PTSD had significantly increased mortality (p = 0.024). Among patients with PTSD, midregional proadrenomedullin (MR-proADM), creatinine, and C-terminal
proendothelin-1 were significant univariate predictors of mortality (p = 0.006, p = 0.024, and p = 0.003, respectively). In a multivariate model, PTSD, B-type natriuretic peptide, and MR-proADM were independent predictors of mortality. In patients with PTSD, MR-proADM was a significant independent predictor of mortality after adjusting for B-type natriuretic peptide, cardiovascular risk factors, cancer, and sleep apnea. Adding MR-proADM to clinical predictors of mortality increased the C-statistic from 0.572 to 0.697 (p = 0.007). In conclusion, this study demonstrates an association among PTSD, abnormal cardiac biomarker levels, and increased mortality.
Hawkins EJ, Malte CA, Imel ZE, Saxon AJ, & Kivlahan DR.
Drug Alcohol Depend. 2012 Feb 2; [epub ahead of print] PMID: 22305658 [PubMed - as supplied by publisher]
Abstract: BACKGROUND: Although the Veterans Affairs and Department of Defense (VA/DoD) clinical guidelines for management of posttraumatic stress disorder (PTSD) recommend against routine benzodiazepine use, little is known about the trends and clinical and prescription profiles of benzodiazepine use since these guidelines were released in 2004. Read more . . .
Abstract: The present investigation prospectively evaluated whether treatment changes in PTSD symptom severity, among military Veterans in residential PTSD treatment, were related to cannabis use 4 months after discharge from residential rehabilitation. The sample was comprised of 432 male military Veteran patients (Mage = 51.06 years, SD = 4.17), who had a primary diagnosis of PTSD and were admitted to a VA residential rehabilitation program for PTSD.
Results demonstrated that lower levels of change in PCL-M scores between treatment intake and discharge were significantly predictive of greater frequency of cannabis use at 4-month follow-up (p < .05), even after accounting for the effects of length of treatment stay and frequency of cannabis use during the 2 months before treatment intake.
Germain A, Richardson R, Moul DE, Mammen O, Haas G, Forman SD, Rode N, Begley A, & Nofzinger EA.
J Psychosom Res. 2012 Feb;72(2):89-96 PMID: 22281448 [PubMed- in process]
Abstract: Objective: Pharmacological and cognitive-behavioral treatments targeting insomnia and nightmares have been shown to be effective in the treatment of military veterans with sleep complaints comorbid with symptoms of stress-related disorders, including Post-Traumatic Stress Disorder (PTSD), but the two approaches have not been directly compared. This randomized controlled trial compared the effects of prazosin vs. a behavioral sleep intervention (BSI), targeting nightmares and insomnia against a placebo pill control condition on sleep and daytime symptoms. Read more . . .
Brown JJ, & Weisler RH.
Prim Care Companion CNS Disord. 2011;13(5) PMID: 22295271 [PubMed - in process]
Abstract: Objective: Posttraumatic stress disorder (PTSD) is a signature injury of war among returning soldiers and US National Guard and Reserve members, with symptoms even more likely on rescreening. Studies that examine health care provider screening and referral practices outside the military for these patients are needed. The objective of this study was to assess health care provider PTSD practices and barriers to care. Read more . . .
Bottalico B, & Bruni T. Int J Law Psychiatry. 2012 Jan 17; [epub ahead of print] PMID: 22261320 [PubMed - as supplied by publisher]
Abstract: Post-Traumatic Stress Disorder (PTSD) is a complex psychiatric condition, the effects of which can be seriously debilitating. As it originates from a specific traumatic event, it often impacts soldiers and victims of violent crime. It is currently one of the most frequently litigated mental diseases. Neuroscience is slowly discovering the neural bases of PTSD and other psychiatric ailments and is building tests to distinguish actual patients from non-suffering individuals.
We examine the current state of neuroscientific research on PTSD and its biomarkers, focusing on a recent experiment by Apostolos Georgopoulos and coworkers. Then we analyze the legal consequences of these scientific advances, both in civil and criminal law, from a comparative perspective.
Neuro-technology is likely to provide courts with a new kind of evidence, which will not replace but add to older behavioral evidence. Furthermore, it will weaken the so far standing distinction between physical and emotional harm. However, even extremely sensitive tests (>95%) can have insufficient accuracy if the prevalence of a condition in the tested population is low. Therefore, the law ought to take into account the prevalence of PTSD and other psychiatric conditions when the decision whether to admit neuro-evidence in courts or not is made.
Bandelow B, Koch M, Zimmermann P, Biesold KH, Wedekind D, & Falkai P.
Eur Arch Psychiatry Clin Neurosci. 2012 Jan 25; [epub ahead of print] PMID: 22274736 [PubMed - as supplied by publisher]
Abstract: In 2006 and 2007, around 0.4 and 0.7% of all German soldiers involved in missions abroad were registered as suffering from PTSD. The frequency of PTSD in the German Armed Forces was assessed from army records. All soldiers admitted to the German Military Hospital in Hamburg, Germany, with PTSD (n = 117) in the years 2006 and 2007 were assessed by using questionnaires and structure interviews. Risk factors associated with PTSD were identified.
Of the 117 soldiers with PTSD, 39.3% were in missions abroad, and 18.0% had participated in combat situations. Five (4.3%) were wounded in combat, and 4 of them had a serious irreversible injury. In total, 53.8% of the PTSD cases were related to injuries or physical/sexual abuse, while 46.2% were due to psychological traumatization. Among soldiers with PTSD who were not abroad, sexual or physical abuse were the most common traumas. In 35.9% of the patients, there was evidence for psychiatric disorders existing before the traumatic event. The percentage of women among sufferers from PTSD was significantly higher than the proportion of women in the armed forces (30.8% vs. 5.17%).
A careful psychiatric screening before recruitment might help to identify persons at risk of PTSD.
Thorp SR, Stein MB, Jeste DV, Patterson TL, & Wetherell JL.
Am J Geriatr Psychiatry. 2012 Jan 23; [epub ahead of print] PMID: 22273763 [PubMed - as supplied by publisher]
Abstract: OBJECTIVES: The purpose of this pilot study was to assess the feasibility and preliminary efficacy of prolonged exposure psychotherapy in older Veterans with posttraumatic stress disorder (PTSD). Exposure therapy has broad empirical support for PTSD, but it has not been studied systematically in older adults, partly due to published concerns that older adults would not tolerate the treatment. Read more . . .
Dordevi? V, Bras M, Milunovi? V, Brajkovi? L, Boban M, Bicani? I, Jasaragi? M, Gregurek R, Milici? D, & Laco M.
Acta Clin Croat. 2011 Jun;50(2):177-84. PMID: 22263380 [PubMed - in process]
Abstract: The goal of this study was to evaluate the association between self-perceived social support and chronic combat-related posttraumatic stress disorder (PTSD). The study included 262 male war veterans suffering from chronic PTSD. Their diagnosis was confirmed according to DSM-IV-TR. They were given self-reported measures Trauma Symptom Inventory-A and Multidimensional Scale of Perceived Social Support.
No significant correlation was found between peer and family support and PTSD. The authors hypothesize this might be the result of secondary victimization, traumatization, and enduring personality changes during the course of PTSD. The items evaluating satisfaction with health care and state institutional support were correlated with most of the PTSD symptoms indicating the possible importance of improving institutional policies toward this population.
Novaco RW, Swanson RD, Gonzalez OI, Gahm GA, & Reger MD.
Psychol Assess. 2012 Jan 16; [epub ahead of print] PMID: 22250593 [PubMed - as supplied by publisher]
Abstract: The involvement of anger in the psychological adjustment of current war veterans, particularly in conjunction with combat-related posttraumatic stress disorder (PTSD), warrants greater research focus than it has received. The present study concerns a brief anger measure, Dimensions of Anger Reactions (DAR), intended for use in large sample studies and as a screening tool. Read more . . .
Woodhead C, Wessely S, Jones N, Fear NT, & Hatch SL.
Psychol Med. 2012 Jan 11;:1-12 PMID: 22234270 [PubMed - as supplied by publisher]
Abstract: Background:: Interest in the mental health of women deployed to modern military campaigns is increasing, although research examining gender differences is limited. Little is known about experiences women have had on these deployments, or whether men and women respond differently to combat exposure. Read more . . .
Abstract: Occupational functioning represents both an important outcome for military service members returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom and a predictor for long-term mental health functioning.
We investigated the role of mental health diagnoses, determined by structured clinical interviews, on occupational functioning in a group of 262 National Guard/Reserve servicemembers within 1 year of returning from a 16-month OIF combat deployment. We assessed occupational functioning at the time of diagnostic interviews and 1 year later. We hypothesized that servicemembers with diagnoses of posttraumatic stress disorder (PTSD), depression, and/or alcohol abuse or dependence would exhibit lower rates of employment at both time points and lower rates of reported work and/or school role functioning.
Servicemembers with a diagnosis of PTSD (5%, n = 13), subthreshold PTSD (6%, n = 15), a major depressive disorder (11%, n = 29), or alcohol abuse or dependence (11%, n = 28) did not differ on employment status from servicemembers without a diagnosis at either time point. However, those with a diagnosis of PTSD, depression, and/or alcohol abuse or dependence reported lower levels of work role functioning. In addition, servicemembers with a diagnosis of PTSD reported greater rates of deterioration in work role functioning over time.
Abstract: Among U.S. veterans who have been exposed to combat-related trauma, significantly elevated rates of posttraumatic stress disorder (PTSD) are reported. Veterans with PTSD are treated for the disorder at Veterans Affairs (VA) hospitals through a variety of psychotherapeutic interventions.
Given the significant impairment associated with PTSD, it is imperative to assess the typical treatment response associated with these interventions. 24 studies with a total sample size of 1742 participants were quantitatively reviewed.
Overall, analyses showed a medium between-groups effect size for active treatments compared to control conditions. Thus, the average VA-treated patient fared better than 66% of patients in control conditions. VA treatments incorporating exposure-based interventions showed the highest within-group effect size. Effect sizes were not moderated by treatment dose, sample size, or publication year. Findings are encouraging for treatment seekers for combat-related PTSD in VA settings.
Pietrzak RH, Russo AR, Ling Q, & Southwick SM.
J Psychiatr Res. 2011 Jun;45(6):720-6
Abstract: BACKGROUND: Recent epidemiologic studies have found an increased risk of suicide among Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF-OIF) with psychiatric disorders. However, little is known about whether variables other than psychiatric conditions, such as coping strategies, resilience, and social support, may be related to suicidality in this population. Read more . . .
Carlson K, & Hall JM.
J Holist Nurs. 2011 Sep;29(3):189-97; quiz 198-200
Abstract: The concept of manliness related to the phenomenon of crying can be better understood by tracing the roots of the language of manliness through history. A Bourdieusian theoretical approach is used, incorporating the analytics of habitus, bodily hexis, and symbolic violence.
This less-studied phenomenon of crying is investigated from a holistic, biopsychosocial framework. Manliness is a social construct that has remained surprisingly consistent throughout history. The importance of this concept to physical, psychological, and social health and well-being is addressed from a holistic nursing perspective.
This is a timely issue for men's mental health, for example, that of returning combat veterans experiencing loss, grief, and posttraumatic stress. This exploration provides insight for nursing by analyzing the concept of manliness, which stems largely from militaristic roots, and might present obstacles to emotional release. PMID: 21262775 [PubMed - indexed for MEDLINE]
Abstract: BACKGROUND: The underlying mechanisms of delayed-onset PTSD are yet to be understood. This study examines the role of stressful life events throughout the life cycle in delayed-onset PTSD following combat. Read more . . .
Abstract: OBJECTIVE: Military veterans experience a high prevalence of psychopathologies such as posttraumatic stress disorder (PTSD). Relationships between physical and psychological health are increasingly recognised. This study investigated associations between PTSD and hypertension in male Australian Gulf War veterans. Read more . . .
Lund BC, Bernardy NC, Alexander B, & Friedman MJ.
J Clin Psychiatry. 2011 Nov 29; [epub ahead of print] PMID: 22152399 [PubMed - as supplied by publisher]
Abstract: OBJECTIVE: Clinical practice guidelines issued by the US Department of Veterans Affairs (VA) and the Department of Defense caution against benzodiazepine use among veterans with posttraumatic stress disorder (PTSD) because of insufficient evidence for efficacy and emerging safety concerns. We examined recent trends in benzodiazepine prescribing among veterans with PTSD in terms of frequency of use, duration of use, and dose. Read more . . .
Campbell SB, & Renshaw KD.
J Fam Psychol. 2011 Dec 19; [epub ahead of print] PMID: 22182339 [PubMed - as supplied by publisher]
Abstract: Emerging literature shows a consistent pattern of relationship and psychological distress in spouses or partners of combat veterans with symptoms of posttraumatic stress disorder (PTSD). One possible mechanism of partners' distress posited in clinical literature is that excessive discussion of traumatic events from deployment may have negative effects on partners. At the extreme, some partners are suggested to develop PTSD-like symptoms, or secondary traumatic stress. Read more . . .
Maguen S, Luxton DD, Skopp NA, & Madden E.
J Psychiatr Res. 2011 Dec 13; [epub ahead of print] PMID: 22172997 [PubMed - as supplied by publisher]
Abstract: The purpose of this study was to examine gender differences in combat exposure, military sexual trauma (MST), and their associations with mental health screen results among military personnel deployed in support of the wars in Afghanistan and Iraq. Data were collected as part of a pre- and post-deployment screening program at a large Army medical treatment facility. Cases included 7251 active duty soldiers (6697 men and 554 women) who presented for their pre- and post-deployment screening from March 2006 to July 2009. Read more . . .
Bush NE, Skopp NA, McCann R, & Luxton DD.
Mil Med. 2011 Nov;176(11):1215-22 PMID: 22165648 [PubMed - in process]
Abstract: An upward trend of suicides has emerged in the U.S. military, and record high suicide rates have been reported. There is abundant evidence of the negative consequences of trauma, especially posttraumatic stress disorder, as risk factors for suicide. However, stressful events and trauma sometimes can have positive psychological consequences, commonly labeled posttraumatic growth (PTG).
Little formal research has examined the role of PTG in moderating suicide in the military. We examined the relationship between PTG and suicidal ideation in data reported by 5302 service members with war zone or combat experience completing the Army's Automated Behavioral Health Clinic electronic screening.
Controlling for other known risk factors for suicide, we found that the more PTG service members reported, the less suicidal ideation they subsequently espoused. Our results suggest the need for further research to determine the potential clinical value of PTG as a therapeutic component of suicide prevention.
Auxéméry Y, & Fidelle G.
Encephale. 2011 Dec;37(6):433-8 PMID: 22137215 [PubMed - in process ]
Abstract: INTRODUCTION: The co-occurrence between post-traumatic symptoms and psychotic symptoms is well described in the immediate suites of a trauma but can also be chronic. This symptomatic co-occurrence, rarely studied in the literature, is often approached under the sole angle of a primary post-traumatic stress disorder (PTSD) or of a primary psychosis, without federative will to unify the psychotic and post-traumatic symptoms within the same nosological framework. Individuals with schizophrenia or schizoaffective disorder report higher rates of trauma and assault than the general population. Read more . . .
Detweiler MB, Khachiyants N, Detweiler JG, Ali R, & Kim KY.
Consult Pharm. 2011 Dec;26(12):920-8 PMID: 22155575 [PubMed - in process]
Abstract: OBJECTIVE: To report the response to low-dose risperidone in individuals with combat-related post-traumatic stress disorder (PTSD) combat nightmares.
DESIGN: Case series. SETTING: Veterans Affairs Medical Center Mental Health Clinic and collaborative VA-U.S. Army Fort Bragg Warrior Transition Telepsychiatry Clinic. PRACTICE DESCRIPTION: Veterans at the VA; soldiers that have severe medical and mental health problems in the Warrior Transition Telepsychiatry Clinic.
MAIN OUTCOME MEASURE(S): No response: no change in frequency and/or severity of nightmares; partial response: decrease in frequency and/or severity of nightmares; full response: total cessation of recall of nightmares.
RESULTS: The four individuals included one active duty soldier and three veterans, ranging from 40 to 76 years of age. All served in the infantry, each in a different combat theater. Two participants had a reduction in the frequency and severity of nightmares at risperidone 1 mg at night. One veteran with blood alcohol levels greater than 300 mg/mL had a partial response with risperidone 3 mg at night. Without active substance abuse, the four individuals had a total cessation of nightmares the first night at a risperidone dose of 2 mg at night. The total cessation of nightmares with risperidone continued despite changes in concurrent antidepressants, anxiolytics, and hypnotics. No medication side effects were reported.
CONCLUSION: The use of low-dose risperidone (1-3 mg) at night can reduce the severity and frequency or stop the recall of PTSD combat nightmares in some veterans and active duty soldiers. Risperidone may be an effective medication for combat nightmares of PTSD and merits additional exploration.
Boden MT, Bonn-Miller MO, Kashdan TB, Alvarez J, & Gross JJ.
J Anxiety Disord. 2011 Nov 28; [epub ahead of print] PMID: 22169054 [PubMed - as supplied by publisher]
Abstract: The goal of this investigation was to examine how emotional clarity and a specific emotion regulation strategy, cognitive reappraisal, interact to predict Posttraumatic Stress Disorder (PTSD) symptom severity and positive affect among treatment seeking military Veterans (N=75, 93% male) diagnosed with PTSD.
PTSD is a highly relevant context because PTSD features include heightened stress reactivity, diminished ability to differentiate and understand emotions, and reliance on maladaptive forms of emotion regulation.
We found that the combination of high levels of emotional clarity and frequent use of cognitive reappraisal were associated with (a) lesser total PTSD severity after accounting for shared variance with positive affect and the extent to which emotions are attended to (attention to emotions), and (b) greater positive affect after accounting for shared variance with total PTSD severity and attention to emotions. This is the first study to demonstrate interactive effects of emotional clarity and cognitive reappraisal.
Caska CM, & Renshaw KD.
Anxiety Stress Coping. 2011 Nov 9; [epub ahead of print] PMID: 22129461 [PubMed - as supplied by publisher]
Abstract: This investigation examined traits from the five-factor model of personality as moderators of the associations of combat and aftermath of battle experiences with symptoms of posttraumatic stress disorder (PTSD) in 214 National Guard/Reserve service members deployed to operations enduring and Iraqi freedom. Read more . . .
Hourani LL, Council CL, Hubal RC, & Strange LB.
Mil Med. 2011 Jul;176(7):721-30 PMID: 22128712 [PubMed - in process]
Abstract: Numerous studies are underway, using data collected from clinical studiesand data collected from surveys of combat troops, to determine the most efficacious treatment options for those diagnosed with posttraumatic stress disorder (PTSD). In contrast, little is known about the effectiveness of predeployment training in preventing or mitigating the impact of combat-related stressors on the development of PTSD.
We conducted a comprehensive review of literature pertaining to primary prevention efforts to stem the advent of PTSD and other combat and operational stress injuries in military populations using databases from the peer-reviewed literature as well as online searches and colleague referrals. Results show that, as with treatment for PTSD, the most promising preventive approaches appear to utilize exposure strategies, especially those in conjunction with education and stress reduction skills training.
Kearney DJ, McDermott K, Malte C, Martinez M, & Simpson TL.
J Clin Psychol. 2011 Nov 28; [epub ahead of print] PMID: 22125187 [PubMed - as supplied by publisher]
Abstract: Objectives: To assess outcomes of veterans who participated in mindfulness-based stress reduction (MBSR).
Design: Posttraumatic stress disorder (PTSD) symptoms, depression, functional status, behavioral activation, experiential avoidance, and mindfulness were assessed at baseline, and 2 and 6 months after enrollment. Read more . . .
Buchanan C, Kemppainen J, Smith S, MacKain S, Cox CW.
Mil Med. 2011 Jul;176(7):743-51 PMID: 22128714 [PubMed - in process]
Abstract: The purpose of this qualitative study was to identify perspectives of female spouses/intimate partners regarding posttraumatic stress disorder (PTSD) in returning Iraq and Afghanistan combat Veterans. Through the use of a self-administered questionnaire based on Flanagan's critical incident technique, reports were obtained from a purposive sample of 34 spouses/intimate partners of Veterans recruited through a social group for military spouses and a university in southeastern North Carolina.
Two-thirds of the participants reported not having received formal education about PTSD. The main perceived barriers to PTSD treatment seeking were denial of symptoms, fear, and stigma about disclosing PTSD symptoms. Spouses/intimate partners observed Veterans for changes in behavior and routines, disturbed sleep patterns, and nightmares. In the event of PTSD treatment resistance, spouses/intimate partners reported they would suggest the need for treatment, issue an ultimatum, take action, or offer patience and support without taking any action.
Held P, Owens GP, Schumm JA, Chard KM, & Hansel JE.
J Trauma Stress. 2011 Nov 30; [epub ahead of print] PMID: 22131291 [PubMed - as supplied by publisher]
Abstract: This study examined disengagement coping as a partial mediator between trauma-related guilt and severity of posttraumatic stress disorder (PTSD) in a sample of veterans (N = 175) entering residential PTSD treatment with either PTSD or subthreshold PTSD.
Disengagement coping partially mediated the relationship between guilt and self-reported PTSD severity (b = .07; 95% CI = [-.003, .13]; p = .06), but did not mediate the relationship when PTSD severity was based on clinicians' ratings. These findings bolster Street, Gibson, and Holohan's (2005) contention that higher guilt-related cognitions are related to increases in the use of disengagement coping strategies, which can interfere with PTSD recovery. The findings support the importance of PTSD treatments that target reductions in guilt-related cognitions and disengagement coping strategies.
Fikretoglu D, & Liu A.
Soc Psychiatry Psychiatr Epidemiol. 2011 Nov 29; [epub ahead of print] PMID: 22124662 [PubMed - as supplied by publisher]
Abstract: Purpose: Since its inclusion in the Diagnostic and Statistical Manual of Mental Disorders, there has been skepticism over the validity of delayed-onset posttraumatic stress disorder (PTSD). Paucity of research on the correlates and the clinical consequences of delayed-onset PTSD have historically added to this skepticism. The objective of this study was to address an important gap in the literature by examining the prevalence, the correlates, and the clinical consequences of delayed-onset PTSD using data from a large epidemiological survey. Read more . . .
Can J Surg. 2011 Dec;54(6):S142-4 PMID: 22099328 [PubMed - in process ]
Abstract: Not since the Korean War have the Canadian Forces engaged in combat missions like those in Afghanistan. Combat, asymmetric warfare, violent insurgency and the constant threat of improvised explosive devices all contribute to the psychological stressors experienced by Canadian soldiers.
Mental health teams deployed with the soldiers and provided assessment, treatment and education.
Lessons learned included refuting the myth that all psychological disorders would be related to trauma; confirming that most patients do well after exposure to trauma; confirming that treating disorders in a war zone requires flexible and creative adaptation of civilian treatment guidelines; and confirming that in a combat mission mental health practice is not limited to the clinical setting.
Wright KM, Britt TW, Bliese PD, Adler AB, Picchioni D, & Moore D.
J Clin Psychol. 2011 Nov 7; [epub ahead of print] PMID: 22065464 [PubMed - as supplied by publisher]
Abstract: Objectives: The study conducted a longitudinal assessment of insomnia as an antecedent versus consequence of posttraumatic stress disorder (PTSD) and depression symptoms among combat veterans. Read more . . .
Bourne C, Mackay CE, & Holmes EA.
Psychol Med. 2012 Oct 18;:1-12 PMID: 23171530 [PubMed - as supplied by publisher]
BACKGROUND: Psychological traumatic events, such as war or road traffic accidents, are widespread. A small but significant proportion of survivors develop post-traumatic stress disorder (PTSD). Distressing, sensory-based involuntary memories of trauma (henceforth 'flashbacks') are the hallmark symptom of PTSD. Understanding the development of flashbacks may aid their prevention. This work is the first to combine the trauma film paradigm (as an experimental analogue for flashback development) with neuroimaging to investigate the neural basis of flashback aetiology. We investigated the hypothesis that involuntary recall of trauma (flashback) is determined during the original event encoding. Read more . . .
Fontana A, Rosenheck R, & Desai R.
J Psychiatr Res. 2012 Jun 26; PMID: 22743092 [PubMed - as supplied by publisher]
Abstract: Most of the attention to the treatment of patients who have comorbid Substance Use/Dependence Disorder (SUD) and Posttraumatic Stress Disorder (PTSD) has focused on SUD outcomes. This study focuses on the PTSD outcomes of comorbid patients as compared to those with PTSD only. Altogether 8599 Veterans admitted to VA specialized inpatient/residential PTSD programs were assessed for PTSD and SUD symptoms at admission and four months following discharge. Two samples were drawn sequentially in separate phases due to unexpected results in the first sample: 4966 in the first sample and 3633 in the second sample. In the first sample, dually diagnosed Veterans had significantly better PTSD outcomes than Veterans diagnosed with PTSD only. The differences could be attributed primarily to improvement in comorbid SUD symptoms. These results were replicated in the second sample. The results suggest that there may be a synergistic effect operating in the treatment of the two comorbid disorders.
Wieland DM, Haley JL, & Bouder M.
Pa Nurse. 2011 Dec;66(4):17-9, 21 PMID: 22359967 [PubMed - in process]
Abstract: Nurses' awareness of MST as a specific type of sexual assault within the military culture and sensitivity to the physical and psychological symptoms are important aspects of care. Nurses must treat the physical and emotional components of sexual assault in all settings; however, referral to the veterans administration programs and resources is key for the woman veteran to receive the specialized care developed by the healthcare system.
Women veterans who have PTSD from MST and combat exposure are prone to depression, suicide and substance use/abuse. Nurses must not fear asking the woman if she is having suicidal thoughts or has a plan and intent to follow through with the plan. MST and PTSD may result in internalized anger, shame, self-blame, helplessness, hopelessness and powerlessness. Patient safety is of utmost importance. Assessing Patients for Sexual Violence, A Guide for Health Care Providers (2009) is a useful resource for nurses. The National Center for PTSD (2009) newsletter on the topic of MST includes a list of research studies. The work of Benedict (2007) and Corbett (2007) provide additional personal accounts of women soldiers who were in the Middle East conflicts. The nurse's referral to specialized services to treat MST and PTSD with evidence-based therapies is a crucial first step in the resiliency and well-being of these brave women who have served in all branches of the U.S. military.
Brown AD, Root JC, Romano TA, Chang LJ, Bryant RA, & Hirst W.
J Behav Ther Exp Psychiatry. 2011 Dec 7
Abstract: BACKGROUND: Studies show that individuals with Posttraumatic Stress Disorder (PTSD) tend to recall autobiographical memories with decreased episodic specificity. A growing body of research has demonstrated that the mechanisms involved in recalling autobiographical memories overlap considerably with those involved in imagining the future. Although shared autobiographical deficits in remembering the past and imagining the future have been observed in other clinical populations, this has yet to be examined in PTSD. This study examined whether, compared to combat trauma-exposed individuals without PTSD, those with combat-related PTSD would be more likely to generate overgeneralized autobiographical memories and imagined future events. Read more . . .