Predictors and outcomes of posttraumatic stress disorder in World War II veterans exposed to mustard gas

Current posttraumatic stress disorder (PTSD) associated with participation in secret military tests of mustard gas during World War II was assessed in 363 male military veterans who were randomly sampled from a registry developed by the Department of Veterans Affairs. Current prevalence was 32% for full PTSD and 10% for partial PTSD. Prevalence of PTSD varied as a function of risk and protective factors, including volunteering, physical symptoms during the tests, and prohibited disclosure. Prediction of partial PTSD was weaker than prediction of full PTSD. Veterans with full PTSD reported poorer physical health, a higher likelihood of several chronic illnesses and health-related disability, greater functional impairment, and higher likelihood of health care use than those with no PTSD. Veterans with partial PTSD also had poorer outcomes than did veterans with no PTSD in a subset of these domains. There is discussion of the traumatic elements of experimental mustard gas exposure, vulnerability to PTSD, and the relevance of these findings to understanding the broad range of outcomes associated with PTSD.

Risk factors for adolescent substance abuse and dependence: data from a national sample

A national household probability sample of 4,023 adolescents aged 12 to 17 years was interviewed by telephone about substance use, victimization experiences, familial substance use, and posttraumatic reactions to identify risk factors for Diagnostic and Statistical Manual of Mental Disorders--(4th ed.; American Psychiatric Association, 1994) defined substance abuse/dependence. Age and ethnicity data were available for 3,907 participants. Major findings were (a) adolescents who had been physically assaulted, who had been sexually assaulted, who had witnessed violence, or who had family members with alcohol or drug use problems had increased risk for current substance abuse/dependence; (b) posttraumatic stress disorder independently increased risk of marijuana and hard drug abuse/dependence; and (c) when effects of other variables were controlled, African Americans, but not Hispanics or Native Americans, were at approximately 1/3 the risk of substance abuse/dependence as Caucasians.

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

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

Physical health and post-traumatic stress disorder: review and synthesis

This article reviews the empirical evidence on post-traumatic stress disorder (PTSD) and physical health and considers this evidence in light of the physical health outcomes associated with other psychiatric disorders. The existing data show that PTSD is associated with poor self-reported health and increased utilization of medical services. To a lesser extent, the data also show an association between PTSD and increased morbidity. Possible psychological, behavioral, and biological mechanisms are discussed, and a model integrating these mechanisms is presented.

Combat exposure, posttraumatic stress disorder symptoms, and health behaviors as predictors of self-reported physical health in older veterans

We used path analysis to model the effects of combat exposure, posttraumatic stress disorder (PTSD) symptoms, and health behaviors on physical health. Participants were 921 male military veterans from the Normative Aging Study. Their mean age at time of study was 65. Measures of combat exposure, PTSD symptoms, smoking, and alcohol problems were used to predict subsequent self-reported physical health status. Both combat exposure and PTSD were correlated with poorer health. In path analysis, combat exposure had only an indirect effect on health status, through PTSD, whereas PTSD had a direct effect. Smoking had a small effect on health status but did not mediate the effects of PTSD, and alcohol was unrelated to health status. We conclude that PTSD is an important predictor of physical health and encourage further investigation of health behaviors and other possible mediators of this relationship.

Physical symptom trajectories following trauma exposure: longitudinal findings from the normative aging study

This study modeled physical symptom trajectories from ages 30 to 75 in 1079 older male military veterans who were assessed every 3 to 5 years since the 1960s. Combat exposure and noncombat trauma were used to define four groups: no trauma (N = 249), noncombat trauma only (N = 333), combat only (N = 152), and both combat and noncombat trauma (N = 345). Number of symptoms on the Cornell Medical Index physical symptom scale increased 29% per decade. Men who had experienced either combat or noncombat trauma did not differ from nonexposed men, but those who had experienced both combat and noncombat trauma had 16% more symptoms across all ages. There were no differences in age-related trajectories as a function of trauma history. In cross-sectional analysis, men with combat and noncombat trauma had more posttraumatic stress disorder symptoms, but not more depression symptoms, than men with either no trauma or noncombat trauma only. Discussion focuses on the importance of considering physical as well as psychological outcomes of exposure to traumatic events.

Post-traumatic stress disorder among World War II mustard gas test participants

Open-minded and structured interviews were conducted to assess post-traumatic stress disorder (PTSD) and other psychosocial outcomes among 24 men who had participated in the military's mustard gas testing program during World War II. Most men had volunteered (92%) and had participated in chamber tests (96%). During the tests, few (22%) understood the danger involved. The majority (67%) were ordered to refrain from discussing their participation with anyone. Most men (83%) experienced physical symptoms subsequent to the test. At present, the men were less psychologically and physically healthy than expected for men of similar age. The current prevalence of PTSD due to the mustard gas was 17%. The current prevalence of subdiagnostic mustard-gas-related PTSD was 25%. Lifetime estimates for full and subdiagnostic PTSD was 17 and 33%, respectively. The only mustard gas experience that predicted lifetime full or subdiagnostic PTSD was the number of exposures to the gas.

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

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

Combat-related posttraumatic stress disorder symptoms in older men

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

Combat-related posttraumatic stress disorder symptoms in older men

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

Language content and schizophrenia in acute phase Turkish patients

The purpose of this study was to replicate and extend, in a Turkish sample, previous investigations of speech content in English-speaking schizophrenics. Computer content analytic procedures, which quantify thematic emphases in the subjects' free speech, have been shown to differentiate schizophrenic patients from other acutely ill psychiatric patients and from normal controls. We repeated the speech sampling procedure with hospitalized psychiatric patients in Turkey, and analyzed their responses using content analysis procedures with a translation of the dictionary or language classification system used in the original studies of English-speaking patients in the United States. Eighty subjects were included in the study: 20 schizophrenics, 20 depressives, 20 manics and 20 healthy controls. There were ten females and ten males in each group. After being diagnosed separately by two clinicians using the Turkish version of the Structured Clinical Interview for DSM-III-R (SCID), each subject's free speech was tape-recorded in a standardized session. The speech content of Turkish patients with schizophrenia exhibited considerable similarity to that previously observed in American subjects, but there were certain dissimilarities that appeared to reflect the impact of culture on the manifestations of the schizophrenic disorder. The phenomenological differences between the three psychiatric syndromes compared were also reflected in the results of the content analysis. The most dissimilar syndromes were mania and depression whereas the most similar were mania and schizophrenia. The particular word categories emphasized by specific groups also appeared to be consistent with the effects of their psychiatric disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

Issues in the Comparison of Techniques for Eliciting Source Material in Computerized Content Analysis

Zeldow and McAdams (1993) recently presented artifactual explanations for our data showing dissimilarity between the content of speech elicited by the Thematic Apperception Test (Murray, 1943) and free speech tasks (Schnurr, Rosenberg, & Oxman, 1992). In particular, they alleged that our findings resulted from a lack of psychological meaning in our content categories and in the free speech task. We cite empirical and theoretical support to refute this allegation and provide additional analyses of our data that are consistent with our earlier suggestion that text samples elicited under different conditions may not be interchangeable.

Change in MMPI scores from college to adulthood as a function of military service

We examined changes in Minnesota Multiphasic Personality Inventory scores from adolescence to adulthood in a longitudinal study of 540 men who attended college during the Vietnam War. Using change scores that were adjusted for initial values, we compared civilians to veterans who were grouped according to combat exposure: none, peripheral, or direct. In cross-sectional analyses, the groups differed only as adults. Groups were similar in relative stability but differed by multivariate analysis in absolute change on the clinical scales. Only veterans with peripheral exposure differed from civilians in multivariate contrasts, even after controlling for premilitary variables. Effect sizes were small. Results suggest that combat exposure does not produce uniformly negative outcomes and may have positive effects in select populations.

Change in MMPI scores from college to adulthood as a function of military service

We examined changes in Minnesota Multiphasic Personality Inventory scores from adolescence to adulthood in a longitudinal study of 540 men who attended college during the Vietnam War. Using change scores that were adjusted for initial values, we compared civilians to veterans who were grouped according to combat exposure: none, peripheral, or direct. In cross-sectional analyses, the groups differed only as adults. Groups were similar in relative stability but differed by multivariate analysis in absolute change on the clinical scales. Only veterans with peripheral exposure differed from civilians in multivariate contrasts, even after controlling for premilitary variables. Effect sizes were small. Results suggest that combat exposure does not produce uniformly negative outcomes and may have positive effects in select populations.

Premilitary MMPI scores as predictors of combat-related PTSD symptoms

OBJECTIVE

The authors used data collected before military service to assess predictors of combat-related lifetime symptoms of posttraumatic stress disorder (PTSD).

METHOD

The subjects were 131 male Vietnam and Vietnam-era veterans who had taken the MMPI in college and who were interviewed as adults with the Structured Clinical Interview for DSM-III-R. Scores on the basic MMPI scales were used to predict combat exposure, lifetime history of any PTSD symptoms given exposure, and lifetime PTSD classification (symptoms only, subthreshold PTSD, or full PTSD).

RESULTS

Group means on the MMPI scales were within the normal range. No scale predicted combat exposure. Hypochondriasis, psychopathic deviate, masculinity-femininity, and paranoia scales predicted PTSD symptoms. Depression, hypomania, and social introversion predicted diagnostic classification among subjects with PTSD symptoms. The effects persisted when amount of combat exposure was controlled for.

CONCLUSIONS

Pre-military personality can affect vulnerability to lifetime PTSD symptoms in men exposed to combat.

Comparison of TAT and Free Speech Techniques for Eliciting Source Material in Computerized Content Analysis

We compared the free speech samples and Thematic Apperception Test (TAT) responses of 95 community-residing volunteers by using the General Inquirer content analysis computer program and the Harvard III Psychosociological Dictionary (Stone, Dunphy, Smith, & Ogitvie, 1966). Comparability was assessed by computing mean differences and correlations among techniques. The techniques were evaluated by assessing the ability of data derived from each to predict individual differences in developmental level, gender, depressive symptomatology, and personality. Results show highly discriminable profiles and low reliability among techniques. TAT data were superior in predicting individual, differences. We suggest that structured techniques like the TAT are preferable to standard free speech instructions for eliciting data in content analytic studies and discuss the possibility of computerized content analysis as a method of scoring the TAT.

Late luteal phase dysphoric disorder in 670 women evaluated for premenstrual complaints

OBJECTIVE

The American Psychiatric Association's DSM-IV Work Group on Late Luteal Phase Dysphoric Disorder (LLPDD) reanalyzed existing data from prospective, daily symptom ratings to evaluate the DSM-III-R criteria for LLPDD. The objectives were to 1) evaluate the individual symptoms presently required for the diagnosis and other symptoms, 2) determine the proportion of treatment-seeking women who meet the LLPDD criteria, and 3) explore the association between LLPDD and other mental disorders.

METHOD

Data from over 1,000 women seeking evaluation for premenstrual complaints at five U.S. sites were examined. The data from 670 of these women were sufficiently complete to warrant evaluation by four different methods of assessing symptom change.

RESULTS

Depending on the assessment method used, 14% to 45% of the women met the criteria for LLPDD. The current DSM-III-R symptoms were classified as positive for 7% to 54% of the women. Each of these symptoms was significantly more common among women with LLPDD regardless of the assessment method used. Five symptoms not presently included were also significantly more common. Women who had had mental disorders in the past, but not present, showed a significantly greater, but very small, relative risk of LLPDD.

CONCLUSIONS

The variability in the frequency of LLPDD diagnosis according to method of assessing symptom change underscores the need for a uniform assessment method. The five additional symptoms with frequencies comparable to those of the DSM-III-R symptoms should be studied further for possible inclusion in the criteria.

A prospective study of the effects of cigarette smoking and alcohol abuse on mortality

OBJECTIVE

To compare the relative risks of alcohol abuse and cigarette smoking.

DESIGN

Cohort studies utilizing a 12-to-16-year follow-up of 47-to-52-year old men.

PARTICIPANTS AND SETTING

237 Caucasian college sophomores (COLLEGE sample) and 366 socially disadvantaged junior high school students (CORE-CITY sample) selected in 1940-43 for relative mental health and for interdisciplinary study.

MAIN RESULTS

The presence of many risk factors for death, including alcohol abuse and smoking, had been assessed prior to age 47 (CORE-CITY sample) and age 52 (COLLEGE sample). Over the next 12 years (CORE-CITY sample) and the next 16 years (COLLEGE sample), the men's mortality was monitored. Heavy use of cigarettes and alcohol abuse were highly correlated. When the effect of alcohol abuse was controlled, heavy smoking was associated with elevated mortality risks in both samples, although this was not statistically significant in the CORE-CITY sample. When smoking was controlled, the odds ratios for mortality from alcohol abuse were substantial in both samples.

CONCLUSIONS

These results and a literature review suggest that insufficient alcohol abuse histories may lead clinicians to underestimate the mortality risk of alcohol abuse.

Predicting exercise in late midlife from young adult personality characteristics

This study explored the relationship between personality and exercise over the life span by using young adult personality characteristics to predict current exercise behavior in late middle-aged male graduates from the Harvard University classes of 1942 to 1944. After controlling for prior exercise behavior, body build, and fitness in young adulthood, we found that personality variables improved classification accuracy in discriminant analysis, and especially improved identification of frequent exercisers. Personality variables positively associated with frequent exercise include affective vitality, integration, lack of anxiety, and lack of shyness. Results are interpreted as supporting a psychobiological account of exercise behavior. Caution is suggested in generalizing the results to other populations, such as less privileged socio-economic classes or females.

The language of altered states

To compare the subjective experience of different forms of altered states of consciousness, computerized content analysis was applied to 66 autobiographical accounts of schizophrenia, hallucinogenic drug states, or mystical ecstasy and to 28 autobiographical control accounts of important personal experiences. The patterns of lexical choice used by the four groups were significantly different in word frequencies from 49 of 83 lexical categories measured. When data from the 13 most statistically significant categories were used in discriminant and classification analyses, 84% of the samples were correctly identified by their word frequencies. These findings suggest that the subjective experiences of schizophrenia, hallucinogenic drug-induced states, and mystical ecstasy are more different from one another than alike.