Posttraumatic stress disorder and quality of life: Extension of findings to veterans of the wars in Iraq and Afghanistan

Sensitivity of the SF-36 to PTSD symptom change in veterans

The authors examined the relationship between changes in symptoms of posttraumatic stress disorder (PTSD) and functioning as measured by the Medical Outcomes Study Short Form-36 (SF-36) among 167 veterans in a primary care clinic. Those who reported at least moderate baseline symptoms were categorized as better, unchanged, or worse at reassessment. The SF-36 was used to examine concordance between change in functioning and symptoms. Veterans with reliable changes in symptoms of PTSD showed corresponding statistically significant changes in functioning across health domains. Moreover, these changes in functioning were clinically significant on several SF-36 subscales and on one summary scale.

Post-traumatic stress in Crohn's disease and its association with disease activity

OBJECTIVE

Violence, accidents and natural disasters are known to cause post-traumatic stress, which is typically accompanied by fear, suffering and impaired quality of life. Similar to chronic diseases, such events preoccupy the patient over longer periods. We hypothesised that post-traumatic stress could also be caused by Crohn's disease (CD), and that CD specific post-traumatic stress could be associated with an increased risk of disease exacerbation.

METHODS

A cohort of CD patients was observed over 18 months in various types of locations providing gastroenterological treatment in Switzerland. The cohort included 597 consecutively recruited adults. At inclusion, CD specific post-traumatic stress was assessed using the Post-traumatic Diagnostic Scale (range 0-51 points). During follow-up, clinical aggravation was assessed by combining important outcome measures. Patients with post-traumatic stress levels suggestive of a post-traumatic stress disorder (≥ 15 points) were compared with patients with lower post-traumatic stress levels as well as with patients without post-traumatic stress. Also, the continuous relation between post-traumatic stress severity and risk of disease exacerbation was assessed.

RESULTS

The 88 (19.1%) patients scoring ≥15 points had 4.3 times higher odds of exacerbation (95% CI 2.6 to 7.2) than the 372 (80.9%) patients scoring <15 points, and 13.0 times higher odds (95% CI 3.6 to 46.2) than the 45 (9.8%) patients scoring 0 points. The odds of exacerbation increased by 2.2 (95% CI 1.6 to 2.8) per standard deviation of post-traumatic stress.

CONCLUSIONS

CD specific post-traumatic stress is frequent and seems to be associated with exacerbation of CD. Thus gastroenterologists may want to ask about symptoms of post-traumatic stress and, where relevant, offer appropriate management according to current knowledge.

Bedouin wives on the home front: living with men serving in the Israel Defense Forces

This community-based study examined emotional and somatic symptoms of 129 Bedouin women whose husbands serve in the Israel Defense Forces. Wives of men diagnosed with posttraumatic stress disorder (PTSD) reported more symptoms than wives of men diagnosed with other disorders and wives of men with no diagnosis. Findings indicate that not only was PTSD in Bedouin servicemen positively associated with their wives' symptoms of posttraumatic stress and depression and somatic complaints, but that this relationship was fully mediated by husbands' aggression. Unraveling the special circumstances of women from traditional backgrounds faced with the devastating effects of husbands' combat-related posttraumatic pathology may inform an approach to the concept of vicarious trauma that is more specific to non-Western societies.

Multisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impairments

CONTEXT

Few large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI).

OBJECTIVES

To understand the risk of developing PTSD symptoms and to assess the impact of PTSD on the development of health and cognitive impairments across the full spectrum of TBI severity.

DESIGN

Multisite US prospective cohort study.

SETTING

Eighteen level I trauma centers and 51 non-trauma center hospitals.

PATIENTS

A total of 3047 (weighted n = 10 372) survivors of multiple traumatic injuries between the ages of 18 and 84 years.

MAIN OUTCOME MEASURES

Severity of TBI was categorized from chart-abstracted International Classification of Diseases, Ninth Revision, Clinical Modification codes. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist 12 months after injury. Self-reported outcome assessment included the 8 Medical Outcomes Study 36-Item Short Form Health Survey health status domains and a 4-item assessment of cognitive function at telephone interviews 3 and 12 months after injury.

RESULTS

At the time of injury hospitalization, 20.5% of patients had severe TBI, 11.7% moderate TBI, 12.9% mild TBI, and 54.9% no TBI. Patients with severe (relative risk, 0.72; 95% confidence interval, 0.58-0.90) and moderate (0.63; 0.44-0.89) TBI, but not mild TBI (0.83; 0.61-1.13), demonstrated a significantly diminished risk of PTSD symptoms relative to patients without TBI. Across TBI categories, in adjusted analyses patients with PTSD demonstrated an increased risk of health status and cognitive impairments when compared with patients without PTSD.

CONCLUSIONS

More severe TBI was associated with a diminished risk of PTSD. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in self-reported health and cognitive function. Treatment programs for patients with the full spectrum of TBI severity should integrate intervention approaches targeting PTSD.

Trends of elevated PTSD risk in firefighters exposed to the World Trade Center disaster: 2001-2005

OBJECTIVES

We identified trends in the prevalence of elevated posttraumatic stress disorder (PTSD) risk as determined by the Fire Department of the City of New York (FDNY)-modified PTSD Checklist in World Trade Center (WTC)-exposed firefighters. We also examined trends in relation to WTC exposure, social support, change in recreational activities, and functional health.

METHODS

We analyzed 16,826 questionnaires from 10,074 firefighters in yearly intervals, from September 12, 2001, to September 11, 2005.

RESULTS

The prevalence of elevated PTSD risk increased over time, from 9.8% in year 1 to 10.6% in year 4 (p < 0.0001). Earliest arrival at the WTC site (odds ratio [OR] = 6.0; 95% confidence interval [CI] 4.4, 8.3), prolonged work at the site (OR = 2.0; 95% CI 1.8, 2.3), providing supervision without previous supervisory experience (OR = 4.1; 95% CI 2.8, 6.1), and retirement due to a WTC-related disability (OR=1.3; 95% CI 1.1, 1.5) were associated with ever having elevated PTSD risk. Difficulty functioning at home was strongly associated with elevated PTSD risk (ORs ranged from 17.0 [95% CI 14.5, 20.0] in year 1 to 26.7 [95% CI 20.3, 35.2] in year 3), as was difficulty functioning at work (ORs ranged from 12.1 [95% CI 10.2, 14.2] in year 1 to 23.0 [95% CI 14.6, 36.3] in year 2).

CONCLUSIONS

Elevated PTSD risk was associated with exposure to the WTC site as well as functional impairment, and remained largely unabated during the first four years of the study. Screening for elevated PTSD risk may be useful in identifying those who could benefit from interventions during long-term follow-up, as well as in the immediate aftermath of disasters.

The impact of crime victimization on quality of life

The authors review the extant literature examining the functional impact of crime victimization on indices of quality of life. They present findings within a conceptual framework comprised of role functioning, life satisfaction, and well-being, and social-material conditions, including crime-related medical, mental health, and employer costs, and health care utilization. The review indicates that crime victimization impacts multiple domains, including parenting skills, impaired occupational functioning, higher rates of unemployment, and problematic intimate relationships. However, data on relationships between crime victimization and overall life satisfaction were mixed, suggesting the need for further investigation. The authors conclude with a brief discussion of directions for future research.