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Li H, Zhang N, Zhang J, Xie T, He R, Jiang Y, Mao Y, Zhu B. The role of military service in preventing depression in China: evidence from a nationally representative longitudinal survey. BMC Public Health 2023; 23:2447. [PMID: 38062444 PMCID: PMC10702066 DOI: 10.1186/s12889-023-17317-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Despite recognition in the West that military veterans experience more mental health issues than the general population, little research has focused on this subject in China. This study examined the associations between male veterans' military experience and depression in China. METHODS A sample of 12,914 men including 669 veterans was included in the final analysis and propensity score matching, multivariable regressions and fixed effect model were used. RESULTS The military experience was associated with a lower likelihood of depression in male veterans. In the subgroup analysis, military experience was associated with a lower likelihood of depression among married and urban male veterans. Military experience was also associated with a lower likelihood of depression in both "junior college and above" and "below junior college" groups. In contrast, evidence was lacking regarding the associations between military experience and depression for unmarried and rural veterans. CONCLUSIONS Individual characteristics could influence the relationship between military experience and depression in male veterans, and the mental health of veterans should be paid more attention and guaranteed.
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Affiliation(s)
- Haoran Li
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
| | - Ning Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
| | - Jingya Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
| | - Tao Xie
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
| | - Rongxin He
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yufei Jiang
- Department of Pediatrics, Shenzhen Children's Hospital of China Medical University, Shenzhen, China
| | - Ying Mao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China.
| | - Bin Zhu
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
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2
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Sá M, Pereira PA, Castro-Vale I. General Practitioners' Own Traumatic Experiences and Their Skills in Addressing Patients' Past History of Adversities: A Cross-Sectional Study in Portugal. Healthcare (Basel) 2023; 11:2450. [PMID: 37685484 PMCID: PMC10487406 DOI: 10.3390/healthcare11172450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Addressing trauma has been found to be important for primary care patients, as it can improve their health-related outcomes. We aimed to assess how Portuguese general practitioners' (GPs) past history of traumatic events (TEs) and adverse childhood experiences (ACEs) influence their clinical communication skills when addressing their patients' past history of adversities. An online survey was circulated by email to GPs' associations and through GPs' social media groups. A sample of 143 GPs participated in this study. GPs' exposure to ACEs and TEs was assessed using the Childhood Trauma Questionnaire-Short Form and the Life Events Checklist for the DSM-5. To evaluate clinical communication skills, we adapted the Self-confidence Scale and used the Jefferson Scale of Physician Empathy. GPs identified barriers to addressing trauma routinely, including a lack of time (86.7%) and a fear of causing further patient suffering (56.6%). GPs' exposure to TEs and ACEs was positively correlated with scores in some dimensions of self-confidence and empathy (r values varying from 0.170 to 0.247). GPs exposed to traumatic experiences felt more confident when addressing their patients' adversities and were more empathic when conducting therapeutic relationships. This study shows that GPs with a history of traumatic experiences are able to address their patients' adversities; however, they lack proper training and better patient care conditions, such as more time and more resources available for patient guidance.
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Affiliation(s)
- Mariana Sá
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Unidade de Saúde Familiar Famílias, Agrupamento de Centros de Saúde Entre Douro e Vouga I—Feira/Arouca, 4535-086 Lourosa, Portugal
| | - Paulo Almeida Pereira
- Institute of Management and Health Organizations, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal;
| | - Ivone Castro-Vale
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- i3S-Institute of Research and Innovation in Health, University of Porto, 4200-135 Porto, Portugal
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3
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Qin Y, Sneddon DA, MacDermid Wadsworth S, Topp D, Sterrett RA, Newton JR, Eicher-Miller HA. Grit but Not Help-Seeking Was Associated with Food Insecurity among Low Income, At-Risk Rural Veterans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2500. [PMID: 36767870 PMCID: PMC9916015 DOI: 10.3390/ijerph20032500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/14/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Rural veterans have poorer health, use healthcare services less often than their urban counterparts, and have more prevalent food insecurity than average U.S. households. Food insecurity and resource use may be influenced by modifiable psychological attributes such as grit and help-seeking behaviors, which may be improved through interventions. Grit and help-seeking have not been previously evaluated among rural veterans. Thus, this cross-sectional study evaluated the hypothesis that grit and help-seeking were associated with food insecurity and the use of resources. Food security, resource use, grit, and help-seeking behavior were assessed among rural veterans (≥18 years) from five food pantries in southern Illinois counties (n = 177) from March 2021 to November 2021. Adjusted multiple regression was used to estimate the relationship between the odds of food insecurity and the use of resources with grit and help-seeking scores. Higher grit scores were significantly associated with lower odds of food insecurity (OR = 0.5, p = 0.009). No other associations were detected. The results provided evidence to inform the content of future educational interventions to improve food insecurity and address health disparities among rural veterans by addressing grit. The enhancement of psychological traits such as grit is related to food security and has the potential to benefit other aspects of well-being.
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Affiliation(s)
- Yue Qin
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
| | - Douglas A. Sneddon
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN 47907, USA
| | | | - Dave Topp
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN 47907, USA
| | - Rena A. Sterrett
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN 47907, USA
| | - Jake R. Newton
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN 47907, USA
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4
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Johnstone G, Joe A, Dickins M, Lowthian JA. Use of home care services by older Veterans and dependants in Melbourne, Australia, 2007-2016. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2022. [DOI: 10.3138/jmvfh-2021-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
LAY SUMMARY Military service has an impact on health and well-being across the life course. However, there is little research on older Veterans and dependants who use home care to enable them to remain living in the community. The authors analysed data from a Melbourne, Australia, home care organization’s electronic care records to explore the differences between clients supported by the Department of Veterans’ Affairs and clients in the general home nursing population. Results showed the greater needs of and complexity of care utilized by Veterans and dependants. Funding structures and support services need to account for these needs in older age.
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Affiliation(s)
- Georgina Johnstone
- Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Victoria, Australia
| | - Angela Joe
- Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Victoria, Australia
| | - Marissa Dickins
- Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Victoria, Australia
| | - Judy A. Lowthian
- Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Victoria, Australia
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5
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Cypel Y, Schnurr PP, Schneiderman AI, Culpepper WJ, Akhtar FZ, Morley SW, Fried DA, Ishii EK, Davey VJ. The mental health of Vietnam theater veterans-the lasting effects of the war: 2016-2017 Vietnam Era Health Retrospective Observational Study. J Trauma Stress 2022; 35:605-618. [PMID: 35290689 PMCID: PMC9310606 DOI: 10.1002/jts.22775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/11/2022]
Abstract
Mental health data from the 2016-2017 Vietnam Era Health Retrospective Observational Study (VE-HEROeS) were analyzed by cohort, represented by United States Vietnam theater veterans (VTs) who served in Vietnam, Cambodia, and Laos; nontheater veterans (NTs) without theater service; and age- and sex-matched nonveterans (NVs) without military service. The exposure of interest was Vietnam theater service. Surveys mailed to random samples of veterans (n = 42,393) and nonveterans (n = 6,885) resulted in response rates of 45.0% for veterans (n = 6,735 VTs, Mage = 70.09, SE = 0.04; n = 12,131 NTs) and 67.0% for NVs (n = 4,530). We examined self-report data on four mental health outcomes: probable posttraumatic stress disorder (PTSD), depression, psychological distress, and overall mental health functioning. Weighted adjusted odds ratios (aORs) between each outcome and cohort were estimated, controlling for covariates in four models: cohort plus sociodemographic variables (Model 1), Model 1 plus physical health variables (Model 2), Model 2 plus potentially traumatic events (PTEs; Model 3), and Model 3 plus other military service variables (Model 4). Mental health outcome prevalence was highest for VTs versus other cohorts, with the largest aOR, 2.88, for PTSD, 95% CI [2.46, 3.37], p < .001 (Model 4, VT:NT). Physical health and PTEs contributed most to observed effects; other service variables contributed least to aORs overall. Mental health dysfunction persists among VTs years after the war's end. The present results reaffirm previous findings and highlight the need for continued mental health surveillance in VTs.
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Affiliation(s)
- Yasmin Cypel
- Epidemiology Program, Health Outcomes of Military Exposures (12POP5)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - Paula P. Schnurr
- National Center for PTSDU.S. Department of Veterans AffairsWhite River JunctionVermontUSA,Department of PsychiatryGeisel School of Medicine at DartmouthHanoverNew HampshireUSA
| | - Aaron I. Schneiderman
- Epidemiology Program, Health Outcomes of Military Exposures (12POP5)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - William J. Culpepper
- Epidemiology Program, Health Outcomes of Military Exposures (12POP5)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - Fatema Z. Akhtar
- Epidemiology Program, Health Outcomes of Military Exposures (12POP5)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - Sybil W. Morley
- VISN 2 Center of Excellence for Suicide PreventionU.S. Department of Veterans AffairsCanandaiguaNew YorkUSA
| | - Dennis A. Fried
- War Related Injury & Illness Study CenterU.S. Department of Veterans AffairsEast OrangeNew JerseyUSA
| | - Erick K. Ishii
- Population Health Services (10P4V)U.S. Department of Veterans AffairsWashingtonD.C.USA
| | - Victoria J. Davey
- Office of Research & Development (14RD)U.S. Department of Veterans AffairsWashingtonD.C.USA
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6
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O'Toole BI. Intergenerational Transmission of Posttraumatic Stress Disorder in Australian Vietnam Veterans' Daughters and Sons: The Effect of Family Emotional Climate While Growing Up. J Trauma Stress 2022; 35:128-137. [PMID: 34121220 DOI: 10.1002/jts.22700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 11/11/2022]
Abstract
Posttraumatic stress disorder (PTSD) in military veterans increases the risk of PTSD in their offspring, a concept known as "intergenerational transmission;" however, the mechanism by which this transmission may occur is, as yet, undetermined. The present study included a nonclinical sample of 197 Australian Army veterans of the Vietnam War who were interviewed 17 years before in-person interviews of their adult daughters (n = 163) and sons (n = 120) were conducted. Veterans' PTSD symptoms were assessed using the Mississippi Scale for Combat-Related PTSD. Approximately 17 years later, offspring PTSD symptoms were assessed using the Clinician-Administered PTSD Scale for DSM-IV. In addition, offspring described the family emotional climate during their youth; responses were coded using the Family Affective Attitude Rating Scale (FAARS) to produce scale scores of veterans' negative, positive, and family relationship styles. A path analysis was conducted via structural equation modeling to test for significant path coefficients between veteran PTSD, family emotional climate, and offspring PTSD symptoms. For daughters, significant path coefficients were observed between veteran PTSD scores and FAARS scores, path coefficient = -.268; FAARS scores and offspring CAPS severity scores, path coefficient = -.223; and veteran PTSD scores and daughters' CAPS severity scores, path coefficient = .186. No satisfactory model could be found for sons. The results suggest that a positive emotional climate while growing up may be a significant protective factor against the development of PTSD in veterans' daughters, but other factors remain significant in veteran-to-offspring intergenerational transmission.
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Affiliation(s)
- Brian I O'Toole
- Brain and Mind Centre, University of Sydney, Sydney, Australia
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7
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Zhang T. A Modeling and Machine Learning Pipeline to Rationally Design Treatments to Restore Neuroendocrine Disorders in Heterogeneous Individuals. Front Genet 2021; 12:656508. [PMID: 34567056 PMCID: PMC8458900 DOI: 10.3389/fgene.2021.656508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022] Open
Abstract
Heterogeneity among individual patients presents a fundamental challenge to effective treatment, since a treatment protocol working for a portion of the population often fails in others. We hypothesize that a computational pipeline integrating mathematical modeling and machine learning could be used to address this fundamental challenge and facilitate the optimization of individualized treatment protocols. We tested our hypothesis with the neuroendocrine systems controlled by the hypothalamic–pituitary–adrenal (HPA) axis. With a synergistic combination of mathematical modeling and machine learning (ML), this integrated computational pipeline could indeed efficiently reveal optimal treatment targets that significantly contribute to the effective treatment of heterogeneous individuals. What is more, the integrated pipeline also suggested quantitative information on how these key targets should be perturbed. Based on such ML revealed hints, mathematical modeling could be used to rationally design novel protocols and test their performances. We believe that this integrated computational pipeline, properly applied in combination with other computational, experimental and clinical research tools, can be used to design novel and improved treatment against a broad range of complex diseases.
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Affiliation(s)
- Tongli Zhang
- Department of Pharmacology and Systems Physiology, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
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8
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Molt F, Torres P, Flores V, Valladares C, Ibáñez JL, Cortés M. Trastornos del sueño en emergencias y desastres. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [PMCID: PMC8635449 DOI: 10.1016/j.rmclc.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Los trastornos del sueño son frecuentes en la población y una causa importante de morbilidad. El objetivo de esta revisión es evaluar las alteraciones del sueño en periodos de emergencia y desastres. A lo largo de la historia, la esfera biopsicosocial y el sueño de las personas ha sido abrumada por múltiples eventos a gran escala, tales como desastres naturales, tragedias provocadas por el hombre, conflictos bélicos, crisis sociales y pandemias, cuya experiencia puede derivar en problemas de salud a corto, mediano y/o largo plazo. En los estudios analizados, se ha observado el impacto negativo de las emergencias y desastres en el sueño, por lo que ha cobrado gran relevancia la difusión y promoción de medidas que incentiven el buen dormir. Debido a la llegada del COVID-19 y a la situación de confinamiento por periodos prolongados en el hogar para prevenir su propagación, han surgido importantes consecuencias a nivel social. Ciertos factores ocupacionales y características de los desastres se asocian a mayor comorbilidad, un alto riesgo de experimentar agotamiento físico, trastornos psicológicos e insomnio en grupos altamente vulnerables, como lo son los profesionales de la salud, rescatistas y socorristas. El insomnio es el trastorno de sueño más frecuente en la población general y su empeoramiento en el contexto de pandemia por COVID-19 representa un nuevo problema en salud pública. Es por ello, que es indispensable promover campañas de prevención de salud física y mental orientados a la pesquisa precoz y manejo de patologías de la esfera psicosocial, dentro de las posibilidades socioeconómicas.
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9
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Meng J, Tang C, Xiao X, Välimäki M, Wang H. Co-occurrence Pattern of Posttraumatic Stress Disorder and Depression in People Living With HIV: A Latent Profile Analysis. Front Psychol 2021; 12:666766. [PMID: 34025528 PMCID: PMC8131520 DOI: 10.3389/fpsyg.2021.666766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The comorbidity of posttraumatic stress disorder (PTSD) and depression is common among people living with the HIV (PLWH). Given the high prevalence and serious clinical consequences of the comorbidity of these two disorders, we conducted a latent profile analysis to examine the co-occurrence pattern of PTSD and depression in PLWH. Methods: The data for this cross-sectional study of PLWH were collected from 602 patients with HIV in China. A secondary analysis using latent profile analysis was conducted to examine HIV-related PTSD and depression symptoms. Results: A four-class solution fits the data best, with the four classes characterized as asymptomatic (42.9%), mild symptoms (33.9%), low to moderate symptoms (19.8%), and high to moderate symptoms (3.4%). The severity of PTSD and depression symptoms was comparable in this solution, and no group was dominated by PTSD or depression. Conclusion: The absence of a distinct subcluster of PLWH with only PTSD or depression symptoms supports that PTSD and depression in PLWH are psychopathological manifestations after traumatic exposures. Health care staff should pay more attention to the existence of comorbid symptoms of individuals, develop integrated interventions for the symptoms cluster, and evaluate their effectiveness in clinical practice.
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Affiliation(s)
- Jingjing Meng
- Xiangya Nursing School of Central South University, Changsha, China
| | - Chulei Tang
- Xiangya Nursing School of Central South University, Changsha, China
| | - Xueling Xiao
- Xiangya Nursing School of Central South University, Changsha, China
| | - Maritta Välimäki
- Xiangya Nursing School of Central South University, Changsha, China.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Honghong Wang
- Xiangya Nursing School of Central South University, Changsha, China
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10
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Wallace D, Lane J, Heffernan K, Nas Jones C. Australian military and veterans' mental health care: improving assessment of military personnel and veterans. Australas Psychiatry 2021; 29:153-156. [PMID: 32713189 DOI: 10.1177/1039856220943043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe key practical knowledge and skill components required for clinicians involved with the assessment of military personnel and veterans. CONCLUSIONS Assessment of military and veterans' mental health issues involves a tailored history-taking process that includes specific aspects of service, transition and reporting requirements. Recommendations for the detailed assessment of military personnel and veterans are provided. Comorbid conditions, chronic pain and the needs of both women and older veterans are also discussed.
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Affiliation(s)
- Duncan Wallace
- Australian Defence Force Centre for Mental Health, Australia.,School of Psychiatry, University of NSW, Australia
| | - Jonathan Lane
- Centre for Traumatic Stress Studies, University of Adelaide, Australia.,School of Medicine, University of Tasmania, Australia
| | - Kristi Heffernan
- Joint Health Command, Australian Defence Force, Australia.,Phoenix Australia - Centre for Posttraumatic Mental Health, Australia
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11
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Roughead EE, Ramsay EN, Kalisch Ellett LM, Khoo A, Moffatt A, Pratt NL. Variation in health service use by veterans with an accepted disability of post-traumatic stress disorder who had a service record post 1975: a cluster analysis. BMJ Mil Health 2021; 168:76-81. [PMID: 33547192 PMCID: PMC8788042 DOI: 10.1136/bmjmilitary-2020-001456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022]
Abstract
Background The use of health services is likely to vary among veterans with an accepted disability of post-traumatic stress disorder (PTSD), however, the extent of variation is not known. We aimed to determine the extent and type of health services used by veterans with an accepted disability of PTSD. Methods The cohort included veterans who served post 1975, were eligible for all Australian Government Department of Veterans’ Affairs funded health services, had PTSD as an accepted disability prior to July 2015 and were alive at the 30 June 2016. Veterans were assigned to groups based on their use of health services using K-means cluster analysis. Results The cohort comprised five clusters involving 2286 veterans. The largest cluster (43%) were a younger, general practitioner (GP) managed cluster who saw their GP quarterly and the psychiatrist twice a year. The second GP cluster (30%) had higher levels of physical comorbidity. The psychiatrist managed cluster (14%) had a mean of 12 psychiatrist visits and one PTSD hospitalisation in the year. The remaining two clusters involved GP and allied healthcare, but no psychologist care. High levels of antidepressant use occurred in all clusters, ranging from 44% up to 69%. The psychiatrist managed cluster had 47% on antipsychotics and 58% on anxiolytics. Conclusion Our study highlights the heterogeneity in health service use. These results identify the significant health utilisation required for up to one-sixth of veterans with PTSD and the significant role of primary care physicians in supporting veterans with PTSD.
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Affiliation(s)
- Elizabeth Ellen Roughead
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - E N Ramsay
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - L M Kalisch Ellett
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - A Khoo
- Toowong Private Hospital, Gallipoli Medical Research Foundation, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - A Moffatt
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - N L Pratt
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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12
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Liang Y, Zhou Y, Liu Z. Consistencies and differences in posttraumatic stress disorder and depression trajectories from the Wenchuan earthquake among children over a 4-year period. J Affect Disord 2021; 279:9-16. [PMID: 33035749 DOI: 10.1016/j.jad.2020.09.107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/03/2020] [Accepted: 09/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and depression are the most prevalent mental disorders following disasters, and they often co-occur. The current study investigated trajectories of PTSD and depression among children after exposure to the Wenchuan earthquake and identified factors associated with PTSD or depression trajectories. METHODS Three hundred children who were exposed to the Wenchuan earthquake reported PTSD and depression symptoms 4, 16, 29, 40 and 52 months after the disaster, and potential predictors (age, earthquake exposure, prequake trauma and parental relationship) were identified. The PTSD and depression trajectories were identified with latent growth mixture modeling (LGMM), and the predictors were explored with multinomial logistic regression. RESULTS Two depression trajectories emerged: resilient (66.2%) and chronic (33.8%). Three PTSD trajectories emerged: resilient (74.9%), recovery (7.5%) and relapsing (17.7%). Overall, 57.3% of the children had low depression and PTSD symptoms over four years. Depression trajectories were significantly predicted by age and parental relationship, while PTSD trajectories were significantly predicted by trauma exposure and prequake trauma experience. LIMITATIONS The children's prequake mental health statuses were unknown, and all assessments relied on self-report questionnaires. CONCLUSION The postdisaster developmental course of depression was more stable than that of PTSD, and PTSD and depression had different risk factors. Previous studies that focus only on PTSD or depression trajectories may overestimate children's resilient responses. Longer-term postdisaster intervention should pay more attention to depression than to PTSD.
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Affiliation(s)
- Yiming Liang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yueyue Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China.
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13
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Kwon A, Lee HS, Lee SH. The Mediation Effect of Hyperarousal Symptoms on the Relationship Between Childhood Physical Abuse and Suicidal Ideation of Patients With PTSD. Front Psychiatry 2021; 12:613735. [PMID: 33841200 PMCID: PMC8032896 DOI: 10.3389/fpsyt.2021.613735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/03/2021] [Indexed: 12/11/2022] Open
Abstract
Objective: This study examined the relationship of childhood physical abuse, posttraumatic stress disorder (PTSD), depression, and suicide in patients with PTSD through path analysis. Materials and Methods: A total of 114 patients with PTSD (36 men and 78 women) were recruited and completed psychological assessments including the Childhood Trauma Questionnaire, the scale for suicidal ideation, the clinician-administered PTSD scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the PTSD checklist, and the Hospital Anxiety and Depression Scale. Structural equation modeling was used to evaluate the results. We developed a model including childhood physical abuse experience as the causal variable, suicidal ideation as a result variable, and PTSD and depression as mediation variables. PTSD symptoms were divided into four clusters [intrusion, avoidance, negative cognition and mood, and altered arousal and reactivity (hyperarousal)] to determine predictive power for suicide. Results: PTSD symptoms fully mediated the relationship between childhood physical abuse and suicidal ideation. Furthermore, PTSD symptoms fully mediated the relationship between childhood physical abuse and depression. Among the PTSD symptoms, hyperarousal was the only symptom cluster that mediated the relationship between childhood physical abuse and suicidal ideation. The symptom clusters of negative cognition and mood as well as hyperarousal mediated the relationship between childhood physical abuse and depression. Conclusions: This study presents a link between childhood physical abuse and current symptoms in patients with PTSD, and highlights specific PTSD symptom clusters (i.e., hyperarousal, negative cognition and mood) that may increase the risk for psychopathology later in life.
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Affiliation(s)
- Aeran Kwon
- Department of Social Welfare and Counseling, Chodang University, Muan, South Korea
| | - Hyun Seo Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea.,Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, South Korea
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14
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O'Toole BI, Gorman P, Catts SV. Military Combat, Posttraumatic Stress Disorder, and the Course of Alcohol Use Disorders in a Cohort of Australian Vietnam War Veterans. J Trauma Stress 2020; 33:709-719. [PMID: 32939901 DOI: 10.1002/jts.22588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 01/19/2023]
Abstract
The present study examined the course of diagnosed alcohol use disorders (AUDs) in a cohort of Australian veterans of the Vietnam War (N = 388) who were assessed 22 and 36 years after returning home. Standardized interviews provided data on AUDs, posttraumatic stress disorder (PTSD), other psychiatric diagnoses, and combat exposure. Overall, 148 veterans (38.1%) had no history of alcohol-related diagnoses, 151 veterans (38.9%) had a past AUD diagnosis that was not current at the second assessment point, and 89 veterans (22.9%) had a current AUD diagnosis at the second assessment. Less education, lower intelligence test scores, and misconduct were individual risk factors for AUDs, as were first-interview diagnoses of PTSD, antisocial personality disorder, generalized anxiety, and dysthymia, but not depression; these variables were all nonsignificant after controlling for combat exposure and PTSD. Multinomial regression was used to assess the relative contributions of combat exposure and PTSD to the course of AUDs. Combat exposure and PTSD had different patterns of association with AUDs whereby combat exposure, but not PTSD, was associated with a history of AUDs, odds ratio (OR) = 1.02, but not with current AUDs, whereas PTSD, but not combat exposure, was associated with current AUDs, OR = 3.37. Current numbing and avoidance symptoms were associated with current AUDs, OR = 4.48. The results do not support a mutual maintenance model of PTSD and AUDs but are consistent with a self-medication model, which suggests treatment for PTSD may have beneficial effects on AUDs.
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Affiliation(s)
- Brian I O'Toole
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Patrick Gorman
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Stanley V Catts
- Brain and Mind Centre, University of Sydney, Sydney, Australia.,Department of Psychiatry, University of Queensland, Brisbane, Australia
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Trauma-Informed Care in Primary Health Settings-Which Is Even More Needed in Times of COVID-19. Healthcare (Basel) 2020; 8:healthcare8030340. [PMID: 32937966 PMCID: PMC7551418 DOI: 10.3390/healthcare8030340] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 12/01/2022] Open
Abstract
Included in the general practitioner’s (GP) core competencies is the ability to adopt a person-centered approach, and the use of the biopsychosocial model in their clinical work. Traumatic events (TEs) are frequently experienced within the population and are known to dysregulate the stress response system and to be associated with psychiatric and physical disorders. GPs may feel reluctant to confront TEs for a variety of reasons, such as a lack of sufficient training in trauma-informed care or a fear of causing harm when discussing a patient’s more complicated issues, among others. This perspective paper aims to review the existing studies that support the practice of trauma-informed healthcare and to summarise best practices. Studies have shown that patients appreciate the questions that clinicians ask them about trauma-related issues and that they understand that this can be important for their healthcare. Furthermore, asking about trauma-related issues in a patient-centered and empathic way can result in better doctor–patient relationships, which improves the levels of satisfaction of both the patient and the doctor with the consultation, as well as improved health-related outcomes. As past traumatic experiences increase the risk of developing post-traumatic stress disorder on exposure to a new TE, the onset of the COVID-19 pandemic has led to trauma-informed care becoming even more important if the strategy is to continue to invest in preventive medicine.
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Hall AL, Sweet J, Tweel M, MacLean MB. Comparing negative health indicators in male and female veterans with the Canadian general population. BMJ Mil Health 2020; 168:82-87. [PMID: 32868291 PMCID: PMC8788043 DOI: 10.1136/bmjmilitary-2020-001526] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 11/22/2022]
Abstract
Introduction Sex-based information on differences between Canadian veterans and the general population is important to understand veterans’ unique health needs and identify areas requiring further research. This study compared various health indicators in male and female veterans with their Canadian counterparts. Methods Health indicators for recent-era Regular Force veterans (released between 1998 and 2015) were obtained from the 2016 Life After Service Survey and compared with the general population in the 2015–16 Canadian Community Health Survey using a cross-sectional approach. Age-adjusted rates and 95% CIs were calculated for males and females separately. Results Compared with Canadians, veterans (both sexes) reported higher prevalence of fair or poor health and mental health, needing help with one or more activity of daily living, lifetime suicidal ideation and being diagnosed with mood and anxiety disorders, post-traumatic stress disorder, migraines, back problems, chronic pain, arthritis, ever having cancer, hearing problems, chronic pain and gastrointestinal problems. A higher prevalence of cardiovascular disease (all types) and high blood pressure was observed in male veterans compared with their Canadian counterparts. Within veterans only, males reported a higher prevalence of diagnosed hearing problems and cardiovascular disease compared with females; conversely females reported a higher prevalence of diagnosed migraines, mood, anxiety and gastrointestinal disorders, and needing help with activities of daily living. These sex differences are similar to the Canadian general population. Some similarities in reporting prevalence between male and female veterans (eg, fair or poor mental health, lifetime suicidal ideation, arthritis, asthma, lifetime cancer incidence, chronic pain and diabetes) were not observed in other Canadians. Conclusion Male and female veterans differed from comparable Canadians, and from each other, in various areas of health. Further research is needed to explore these findings, and veteran-based policies and services should consider sex differences.
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Affiliation(s)
- Amy L Hall
- Veterans Affairs Canada, Government of Canada, Charlottetown, Prince Edward Island, Canada
| | - J Sweet
- Veterans Affairs Canada, Government of Canada, Charlottetown, Prince Edward Island, Canada
| | - M Tweel
- Veterans Affairs Canada, Government of Canada, Charlottetown, Prince Edward Island, Canada
| | - M B MacLean
- Veterans Affairs Canada, Government of Canada, Charlottetown, Prince Edward Island, Canada.,School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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Rzeszutek M, Lis-Turlejska M, Krajewska A, Zawadzka A, Lewandowski M, Szumiał S. Long-Term Psychological Consequences of World War II Trauma Among Polish Survivors: A Mixed-Methods Study on the Role of Social Acknowledgment. Front Psychol 2020; 11:210. [PMID: 32174863 PMCID: PMC7055398 DOI: 10.3389/fpsyg.2020.00210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/30/2020] [Indexed: 12/21/2022] Open
Abstract
Background The research on the psychological consequences of World War II (WWII) trauma has predominantly focused on concentration camp and Holocaust survivors. Only a few studies have been undertaken among civilian survivors of WWII. Objectives The purpose of this study was to examine the association between perceived social acknowledgment of WWII trauma and the level of post-traumatic stress disorder (PTSD) and depressive symptoms among Polish survivors of WWII by employing a mixed-methods design (i.e., a quantitative analysis supported by qualitative interviews). Method In the quantitative part, 123 participants filled out: the list of WWII-related traumatic events, the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5), the shortened version of the Geriatric Depression Scale (GDS), and the Social Acknowledgment Questionnaire (SAQ). In the qualitative part, an interpretative phenomenological analysis (IPA) of participants’ reminiscences of WWII was examined. Results Although we observed a direct positive association between the number of WWII-related traumatic events and the intensity of PTSD and depressive symptoms, these relationships changed when we entered the social acknowledgment construct into the model. Specifically, we found that perceived social acknowledgment (general disapproval) was a mediator of the relationship between the number of WWII traumatic events and the intensity of PTSD symptoms only, and not of depressive symptoms. In the qualitative part, three themes relating to traumatic reminiscences emerged among the participants: parental efficacy, parental betrayal, and support from the invader. Conclusion Our study showed the significance of the general social acknowledgment in the long-term mental consequences of the WWII trauma in Poland. In addition, the results of our study may be an adjunct to the discussion on the long-term impact of WWII trauma in Poland and the factors that hindered its social recognition.
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Affiliation(s)
| | - Maja Lis-Turlejska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | | | | | | | - Szymon Szumiał
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
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Mallonee S, Tate L, De Oliveira F, Ruiz A. Development and Trial Implementation of a 30-Day Outpatient Program for Subthreshold PTSD. Mil Med 2020; 185:e38-e42. [PMID: 31287892 DOI: 10.1093/milmed/usz165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/10/2019] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Posttraumatic stress disorder (PTSD) negatively impacts service members at high rates, causing considerable physical and psychological consequences. Additionally, many service members experience subthreshold PTSD (i.e., experiencing PTSD symptoms that do not meet full diagnostic criteria), which has also been shown to cause significant functional impairment and can be a precursor to the development of full PTSD. Typically, treatment for PTSD at Walter Reed National Military Center facility includes weekly outpatient individual therapy over a three-month period or referral to an intensive outpatient program (IOP), which emphasizes group treatment. Inclusion in these programs is dependent on the severity of symptoms. Service members with subthreshold symptoms do not typically qualify for an IOP, and weekly outpatient therapy does not meet the needs of some service members or their commands. METHODS As a result, we developed an alternative program with the intention of allowing service members with subthreshold PTSD to receive treatment and return to full-duty status more rapidly. The program emphasized bi-weekly evidenced-based PTSD therapies treatment adjusted to meet the needs of each service member along with the option of adjunct individual and group treatments. RESULTS While this program is ongoing and we have not yet conducted outcome data analyses, the structure and pace of this program have the potential to produce quicker functional improvements, prevent the development of full PTSD symptoms, and reduce long-term or recurring healthcare utilization. CONCLUSION Although more research is needed, there exists preliminary empirical evidence of efficacy for an accelerated protocol of biweekly evidence-based therapy for service members with subthreshold PTSD. DISCLAIMER The opinions expressed in this abstract are those of the authors and do not necessarily represent the opinions of the Uniformed Services University of the Health Sciences, the Department of Defense, or the United States Government. Additionally, the authors have no conflicts of interests to report.
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Affiliation(s)
- Sybil Mallonee
- Uniformed Services University, 4301 Jones Bridge Rd., Bethesda, MD 20814
| | - Larissa Tate
- Uniformed Services University, 4301 Jones Bridge Rd., Bethesda, MD 20814
| | | | - Augusto Ruiz
- Center for Deployment Psychology, 4301 Jones Bridge Rd., Bethesda MD, 20814, & Walter Reed Military National Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
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O'Toole BI, Kirk R, Bittoun R, Catts SV. Combat, Posttraumatic Stress Disorder, and Smoking Trajectory in a Cohort of Male Australian Army Vietnam Veterans. Nicotine Tob Res 2019; 20:1198-1205. [PMID: 29161451 DOI: 10.1093/ntr/ntx257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/16/2017] [Indexed: 12/12/2022]
Abstract
Background Whether trauma exposure itself or consequent posttraumatic stress disorder (PTSD) is primarily responsible for smoking and failure to quit remains unclear. Methods A cohort of male Australian Vietnam veterans (N = 388) was interviewed twice, 22 and 36 years after their return to Australia using standardized psychiatric diagnostic and health interviews and assessment of combat exposure. The smoking trajectory over time revealed a spectrum of outcomes (never smoked, early quitters, late quitters, and continuing smokers). Analysis used multivariate statistics to assess the relative contributions of combat trauma exposure and PTSD while controlling for potential confounders. Results The trajectory of smoking over time revealed that 21.9% of veterans had never smoked, 45.1% had quit smoking by the time of wave 1, 16.2% were current smokers at wave 1 who had quit by the time of wave 2, 2.8% were late adopters who were current smokers, and 13.9% were continuing smokers. Smoking was associated in single-predictor models with demographics, intelligence, combat exposure, PTSD symptom clusters and diagnosis, and alcohol disorders. Multivariate analysis revealed that PTSD, combat, and intelligence were related to the smoking spectrum but, after adding demographics and other Axis I psychiatric diagnoses, only combat remained significant. No PTSD symptom cluster uniquely predicted smoking status. Conclusions The results suggest that trauma exposure in the form of military combat may be a more robust predictor of smoking status over time than PTSD. It may be stress itself, rather than poststress disorder, that is more germane to smoking and failure to quit. Implications Exposure to traumatic stress and development of PTSD have been implicated separately in the maintenance of smoking. This longitudinal cohort study of smoking in war veterans up to three decades postwar enabled evaluation of traumatic stress exposure in combat and the course of PTSD in smoking and quitting while controlling for intelligence, background disadvantage, and other psychiatric conditions. Combat rather than PTSD emerged as more significant to smoking status, suggesting that it may be the traumatic stress itself rather than the development of a poststress disorder that is more germane to smoking in war veterans.
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Affiliation(s)
- Brian I O'Toole
- Brain & Mind Centre, University of Sydney, Sydney, Australia
| | - Robyn Kirk
- Brain & Mind Centre, University of Sydney, Sydney, Australia
| | - Renée Bittoun
- Brain & Mind Centre, University of Sydney, Sydney, Australia
| | - Stanley V Catts
- Brain & Mind Centre, University of Sydney, Sydney, Australia.,School of Psychiatry, University of Queensland, Brisbane, Australia
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20
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Spirometric Pulmonary Restriction in Herbicide-Exposed U.S. Vietnam War Veterans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173131. [PMID: 31466319 PMCID: PMC6747381 DOI: 10.3390/ijerph16173131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 11/24/2022]
Abstract
Spirometric restriction in herbicide-exposed U.S. Army Chemical Corps Vietnam War veterans was examined because no published research on this topic in Vietnam War veterans exists. Spirometry was conducted on 468 veterans who served in chemical operations in a 2013 study assessing the association between chronic obstructive pulmonary disease (COPD) and herbicide exposure. Exposure was verified based on blood serum values of 2,3,7,8-tetrachlorodibenzo-p-dioxin. Further, the association between herbicide exposure and spirometry restriction (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ≥ lower limit of normal (LLN) and FVC < LLN) was tested after adjustment for military characteristics, selected anthropometrics, and other predictors using multivariable regression. Spirometric restriction in herbicide sprayers (15.7%, 95% CI: 10.6, 20.9) was almost twice that of nonsprayers (9.91%, 95% CI: 5.9, 13.9) (p = 0.081). While spirometric restriction was not significantly associated with herbicide exposure (adjusted odds ratio (aOR) = 1.64, 95% CI: 0.82, 3.29) despite the greater prevalence of restriction in sprayers versus nonsprayers, spirometric restriction was significantly associated with race/ethnicity (aOR = 3.04, 95% CI: 1.36, 6.79) and waist circumference (aOR = 2.46, 95% CI: 1.25, 4.85). Because restrictive pulmonary disease may result from chemically-induced inflammation or sensitivity, research on chemical exposures and restriction in veterans should continue. Future study should include full pulmonary function testing, targeted research designs, and a wider set of explanatory variables in analysis, such as other determinants of health.
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Graham K, Searle A, Van Hooff M, Lawrence-Wood E, McFarlane A. The Value of Physical Symptoms in Screening For Posttraumatic Stress Disorder in the Military. Assessment 2019; 27:1139-1150. [PMID: 31328529 DOI: 10.1177/1073191119864662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physical symptoms are highly comorbid with posttraumatic stress disorder (PTSD). As PTSD is underdiagnosed, this study explored the value of self-reported physical symptoms in screening for 30-day PTSD in military personnel. Two physical symptom scales were constructed using items from a 67-item health symptom checklist, clinical interviews were used as the diagnostic reference standard, and diagnostic utility of physical symptoms was compared with the current gold standard screen, the PTSD checklist (PCL). Receiver operating characteristic analyses showed that both a 9-item and a 10-item physical symptom scale were of value in predicting PTSD (areas under the curve 0.81 and 0.85). Importantly, two thirds of PTSD positive personnel missed by the PCL were captured with physical symptoms scales, and when physical symptoms were added to the PCL, prediction was improved (areas under the curve 0.90 to 0.92). Our findings highlight the value of including assessing physical symptoms in PTSD screening.
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Affiliation(s)
- Kristin Graham
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Amelia Searle
- The University of Adelaide, Adelaide, South Australia, Australia
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22
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Abstract
Objectives: We provide a review of the literature on posttraumatic stress disorder (PTSD) in older adults, focusing largely on older U.S. military veterans in two primary areas: 1) assessment and diagnosis and 2) non-pharmacological treatment of PTSD in late life. Methods: We performed a search using PubMed and Academic Search Premier (EBSCO) databases and reviewed reference sections of selected papers. We also drew on our own clinical perspectives and reflections of seven expert mental health practitioners. Results: Rates of PTSD are lower in older compared with younger adults. The presence of sub-syndromal/partial PTSD is important and may impact patient functioning. Assessment requires awareness and adaptation for potential differences in PTSD experience and expression in older adults. Psychotherapies for late-life PTSD appear safe, acceptable and efficacious with cognitively intact older adults, although there are relatively few controlled studies. Treatment adaptations are likely warranted for older adults with PTSD and co-morbidities (e.g., chronic illness, pain, sensory, or cognitive changes). Conclusions: PTSD is an important clinical consideration in older adults, although the empirical database, particularly regarding psychotherapy, is limited. Clinical Implications: Assessment for trauma history and PTSD symptoms in older adults is essential, and may lead to increased recognition and treatment.
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Affiliation(s)
- Anica Pless Kaiser
- National Center for PTSD at VA Boston Healthcare System, Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Joan M. Cook
- Department of Psychiatry, Yale School of Medicine and National Center for PTSD, West Haven, CT, USA
| | | | - Jennifer Moye
- New England Geriatric Research Education and Clinical Center and Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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O'Toole BI, Dadds M, Outram S, Catts SV. The mental health of sons and daughters of Australian Vietnam veterans. Int J Epidemiol 2019; 47:1051-1059. [PMID: 29425292 DOI: 10.1093/ije/dyy010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 01/16/2023] Open
Abstract
Background War service increases the risk of post-traumatic stress disorder (PTSD) to combatants, and has been shown to increase the risk of PTSD in their offspring. The extent to which there is an excess compared with the general population is not yet established, nor whether PTSD increases the risk of other psychiatric problems. Methods A national sample of 133 sons and 182 daughters of a cohort of 179 Australian Vietnam veterans' families were assessed in person, using structured psychiatric interviews. The prevalence of trauma exposures, DSM-IV (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition) diagnoses and suicidality were compared with the Australian Bureau of Statistics' 2007 National Survey of Mental Health and Wellbeing data matched for age and sex. The risk of mental health problems potentially attributable to PTSD was also assessed. Results Sons and daughters were more likely than population expectations to report exposures to natural disasters, fire or explosions and transport accidents, and sons more likely to report exposure to toxic chemicals whereas daughters were more likely to report sexual assault. Sons and daughters had higher prevalences of alcohol and other substance dependence, depression and anxiety, and PTSD, and children's PTSD was associated with substance dependence, depression and suicidal ideation. There were strong associations between children's PTSD and comorbid conditions of substance use disorders, depression and anxiety. Conclusions Higher rates of mental health problems in veterans' families, together with comorbidity with PTSD and the link between veterans' and children's PTSD, suggest that the effects of trauma may continue into subsequent generations.
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Affiliation(s)
- Brian I O'Toole
- Brain & Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Mark Dadds
- Brain & Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Sue Outram
- Health Behaviour Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Stanley V Catts
- Brain & Mind Centre, University of Sydney, Sydney, NSW, Australia.,Department of Psychiatry, University of Queensland, Royal Brisbane Hospital, Brisbane, QLD, Australia
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24
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Murphy D, Busuttil W. Understanding the needs of veterans seeking support for mental health difficulties. J ROY ARMY MED CORPS 2019; 166:211-213. [DOI: 10.1136/jramc-2019-001204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/04/2022]
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Forbes D, Pedlar D, Adler AB, Bennett C, Bryant R, Busuttil W, Cooper J, Creamer MC, Fear NT, Greenberg N, Heber A, Hinton M, Hopwood M, Jetly R, Lawrence-Wood E, McFarlane A, Metcalf O, O'Donnell M, Phelps A, Richardson JD, Sadler N, Schnurr PP, Sharp ML, Thompson JM, Ursano RJ, Hooff MV, Wade D, Wessely S. Treatment of military-related post-traumatic stress disorder: challenges, innovations, and the way forward. Int Rev Psychiatry 2019; 31:95-110. [PMID: 31043106 DOI: 10.1080/09540261.2019.1595545] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Post-traumatic stress disorder (PTSD) is one of the common mental disorders in military and veteran populations. Considerable research and clinical opinion has been focused on understanding the relationship between PTSD and military service and the implications for prevention, treatment, and management. This paper examines factors associated with the development of PTSD in this population, considers issues relating to engagement in treatment, and discusses the empirical support for best practice evidence-based treatment. The paper goes on to explore the challenges in those areas, with particular reference to treatment engagement and barriers to care, as well as treatment non-response. The final section addresses innovative solutions to these challenges through improvements in agreed terminology and definitions, strategies to increase engagement, early identification approaches, understanding predictors of treatment outcome, and innovations in treatment. Treatment innovations include enhancing existing treatments, emerging non-trauma-focused interventions, novel pharmacotherapy, personalized medicine approaches, advancing functional outcomes, family intervention and support, and attention to physical health.
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Affiliation(s)
- David Forbes
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - David Pedlar
- b Canadian Institute for Military and Veteran Health Research , Kingston , ON, Canada
| | - Amy B Adler
- c Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research , Silver Spring , MD , USA
| | - Clare Bennett
- d New Zealand Defence Force , Wellington , New Zealand
| | - Richard Bryant
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia.,e School of Psychology , University of New South Wales , Sydney , Australia
| | | | - John Cooper
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Mark C Creamer
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Nicola T Fear
- g King's Centre for Military Health Research, King's College London , London , UK.,h Academic Centre for Military Mental Health Research , London , UK
| | - Neil Greenberg
- g King's Centre for Military Health Research, King's College London , London , UK
| | - Alexandra Heber
- i Veterans Affairs Canada , Charlottetown , Canada.,j Department of Psychiatry , University of Ottawa , Ottawa , Canada
| | - Mark Hinton
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Mal Hopwood
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Rakesh Jetly
- k Directorate of Mental Health , Canadian Armed Forces , Ottawa , Canada
| | - Ellie Lawrence-Wood
- l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Alexander McFarlane
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia.,l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Olivia Metcalf
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Meaghan O'Donnell
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Andrea Phelps
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - J Don Richardson
- m Department of Psychiatry , Western University , London , Canada.,n McDonald/Franklin OSI Research Centre , London , Canada
| | - Nicole Sadler
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Paula P Schnurr
- o National Center for PTSD , White River Junction , VT , USA.,p Department of Psychiatry , Geisel School of Medicine , Hanover , NH , USA
| | - Marie-Louise Sharp
- g King's Centre for Military Health Research, King's College London , London , UK
| | - James M Thompson
- i Veterans Affairs Canada , Charlottetown , Canada.,q Department of Public Health Sciences , Queen's University , Kingston , ON , Canada
| | - Robert J Ursano
- r Center for the Study of Traumatic Stress, Department of Psychiatry , Uniformed Services University School of Medicine , Bethesda , MD , USA
| | - Miranda Van Hooff
- l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Darryl Wade
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Simon Wessely
- g King's Centre for Military Health Research, King's College London , London , UK
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Abstract
Posttraumatic stress disorder (PTSD) differs from other anxiety disorders in that experience of a traumatic event is necessary for the onset of the disorder. The condition runs a longitudinal course, involving a series of transitional states, with progressive modification occurring with time. Notably, only a small percentage of people that experience trauma will develop PTSD. Risk factors, such as prior trauma, prior psychiatric history, family psychiatric history, peritraumatic dissociation, acute stress symptoms, the nature of the biological response, and autonomic hyperarousal, need to be considered when setting up models to predict the course of the condition. These risk factors influence vulnerability to the onset of PTSD and its spontaneous remission. In the majority of cases, PTSD is accompanied by another condition, such as major depression, an anxiety disorder, or substance abuse. This comorbidity can also complicate the course of the disorder and raises questions about the role of PTSD in other psychiatric conditions. This article reviews what is known about the emergence of PTSD following exposure to a traumatic event using data from clinical studies.
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Affiliation(s)
- A C McFarlane
- Department of Psychiatry, University of Adelaide, Queen Elizabeth Hospital, Woodville, South Australia, Australia.
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27
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Cohn E, Lurie I, Yang YX, Bilker WB, Haynes K, Mamtani R, Shacham-Shmueli E, Margalit O, Boursi B. Posttraumatic Stress Disorder and Cancer Risk: A Nested Case-Control Study. J Trauma Stress 2018; 31:919-926. [PMID: 30520529 DOI: 10.1002/jts.22345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 08/19/2018] [Accepted: 08/20/2018] [Indexed: 11/08/2022]
Abstract
Data regarding cancer risk for individuals who were exposed to traumatic and stressful life events are conflicting. We sought to evaluate the association between posttraumatic stress disorder (PTSD) and the risk of the four most common solid tumors: lung, breast, prostate, and colorectal cancers. We conducted four nested case-control studies using a large UK population-based database. Cases were defined as individuals with any medical code for the specific malignancy. For every case, we used incidence-density sampling to match four controls by age, sex, practice site, and both duration and calendar time of follow-up. Exposure of interest was any diagnosis of PTSD prior to cancer diagnosis. The odds ratios (ORs) and 95% confidence intervals (CIs) for cancer risk associated with PTSD were estimated using multivariable conditional logistic regression and were adjusted for smoking status, obesity, and antidepressant use. The study population included four case groups according to cancer type. There were 19,143 cases with lung cancer (74,473 matched controls), 22,163 cases with colorectal cancer (86,538 matched controls), 31,352 cases with breast cancer (123,285 matched controls), and 27,212 cases with prostate cancer (105,940 matched controls). There was no statistically significant association between PTSD and cancer risk among any of the cancer types: lung, OR = 0.73, 95% CI [0.43, 1.23]; breast, OR = 0.73, 95% CI [0.52, 1.01]; prostate, OR = 1.24, 95% CI [0.87, 1.77]; and colorectal, OR = 1.05, 95% CI [0.68, 1.62]. Our findings indicated that participants in our study with PTSD were not at increased risk of lung, breast, prostate, and colorectal cancers.
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Affiliation(s)
- Elana Cohn
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Lurie
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Yu-Xiao Yang
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Haynes
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ronac Mamtani
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Einat Shacham-Shmueli
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ofer Margalit
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ben Boursi
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Oncology, Sheba Medical Center, Tel Hashomer, Israel
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O'Toole BI, Dadds M, Burton MJ, Rothwell A, Catts SV. Growing up with a father with PTSD: The family emotional climate of the children of Australian Vietnam veterans. Psychiatry Res 2018; 268:175-183. [PMID: 30031270 DOI: 10.1016/j.psychres.2018.06.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/08/2018] [Accepted: 06/24/2018] [Indexed: 12/21/2022]
Abstract
A non-clinical sample of male Australian Vietnam veterans, their wives, and adult offspring were interviewed in-person in a national epidemiological study to assess the relationship between the mental ill-health of veterans and the emotional climate of the family while the children were growing up. Veterans were assessed 17 years before their children using standardised psychiatric diagnostic interviews. Family emotional climate was assessed using offspring ratings of parental attachment, and codings of positive and negative family relationship styles based on five minute speech samples provided by the offspring. Sons and daughters had different views of their mothers and fathers, and were less positive towards their fathers particularly if he had posttraumatic stress disorder (PTSD). Veteran PTSD and depression significantly negatively impacted the family emotional climate, while mothers' mental health was not related. Veteran PTSD symptoms were lowest in secure attachment to the veteran and highest in inconsistent attachment for both sons and daughters, but were not related to attachment to the mother. Veteran PTSD was related to daughters' but not sons' perceptions of family emotional climate. The impact of veterans' PTSD on their families' emotional climate is more marked for daughters than sons.
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Affiliation(s)
- Brian I O'Toole
- Brain and Mind Centre, University of Sydney, Sydney, Australia.
| | - Mark Dadds
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | | | - Alice Rothwell
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Stanley V Catts
- Brain and Mind Centre, University of Sydney, Sydney, Australia; School of Psychiatry, Queensland University, Brisbane, Australia
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29
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Cypel YS, Hines SE, Davey VJ, Eber SM, Schneiderman AI. Self-reported physician-diagnosed chronic obstructive pulmonary disease and spirometry patterns in Vietnam Era US Army Chemical Corps veterans: A retrospective cohort study. Am J Ind Med 2018; 61:802-814. [PMID: 30159906 DOI: 10.1002/ajim.22900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Research on chronic obstructive pulmonary disease (COPD) and herbicide exposure in Vietnam War veterans is limited. METHODS Survey data were collected from 3193 US Army Chemical Corps veterans on herbicide exposure and self-reported physician-diagnosed COPD. Three spirometric patterns were used to define airflow obstruction (AFO): (i) FEV1 /FVC < 70% ("fixed ratio"); (ii) FEV1 /FVC < lower limit of normal ("LLN"); and (iii) (FEV1 /FVC < LLN and FVC ≥ LLN and FEV1 <LLN) or (FEV1 /FVC<LLN and FEV1 ≥ LLN) ("specific obstruction"). Associations between herbicide exposure and self-reported COPD and spirometric-AFO were determined using regression. RESULTS COPD prevalence varied (self-reports: 20.1%; spirometry: 29.8%, 12.9%, 8.4% by fixed ratio, LLN, and specific obstruction definitions, respectively). Spirometric parameters did not differ by exposure. Self-reported COPD and herbicide exposure were significantly associated (adjusted odds ratio [aOR] = 1.82, 95% confidence intervaI: 1.48,2.24). No association was found between spirometric-AFO and herbicide exposure. CONCLUSIONS A significant association was found between herbicide exposure and self-reported physician-diagnosed COPD but not when COPD diagnosis was based on spirometry.
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Affiliation(s)
- Yasmin S. Cypel
- Epidemiology Program; Post Deployment Health Services (10P4Q); Office of Patient Care Services; Department of Veterans Affairs; Washington District of Columbia
| | - Stella E. Hines
- Division of Occupational and Environmental Medicine and Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of Maryland-Baltimore; Baltimore Veterans Affairs Medical Center; Baltimore Maryland
| | - Victoria J. Davey
- Office of Research and Development, Veterans Health Administration; Department of Veterans Affairs; Washington District of Columbia
| | - Stephanie M. Eber
- Epidemiology Program; Post Deployment Health Services (10P4Q); Office of Patient Care Services; Department of Veterans Affairs; Washington District of Columbia
| | - Aaron I. Schneiderman
- Epidemiology Program; Post Deployment Health Services (10P4Q); Office of Patient Care Services; Department of Veterans Affairs; Washington District of Columbia
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30
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Evaluation of an equine-assisted therapy program for veterans who identify as 'wounded, injured or ill' and their partners. PLoS One 2018; 13:e0203943. [PMID: 30260975 PMCID: PMC6160012 DOI: 10.1371/journal.pone.0203943] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/10/2018] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to evaluate outcomes of an equine-assisted therapy program for Defence Force veterans and their partners across the psychological domains of depression, anxiety, stress, posttraumatic stress, happiness, and quality of life, as well as compare the outcomes of an Individual and Couples program. A non-controlled, within-subjects longitudinal design was utilized with assessment at three time points (pre-intervention, post-intervention, and three months follow-up). Between-subjects analysis with two groups was also conducted to compare the outcomes of the Individual and Couples programs. Participants were recruited from ten programs in 2016 with a total of 47 veterans and partners from both an Individual program (n = 25; veterans only) and a Couples program (n = 22). Outcome measures included the Depression Anxiety Stress Scale-21, Posttraumatic Stress Disorder Checklist for DSM-5, Oxford Happiness Questionnaire, and Quality-of-Life Enjoyment and Satisfaction Questionnaire-Short Form. Paired samples t-tests revealed that within both the Individual and Couples programs, there were significantly fewer psychological symptoms and significantly greater levels of happiness and quality of life at post-intervention compared to pre-intervention. Reduced psychological symptoms were maintained at the three months follow-up for participants of the Couples program only. Independent samples t-tests revealed participants in the Couples program reported significantly less symptoms of depression, stress, and posttraumatic stress disorder (PTSD) at follow-up compared to participants in the Individual program. These results indicate there may only be meaningful benefits for equine-assisted therapy in the reduction of depression, stress, and PTSD symptoms for veterans, if partners are integrated into the intervention.
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31
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Cha JM, Kim JE, Kim MA, Shim B, Cha MJ, Lee JJ, Han DH, Chung US. Five Months Follow-up Study of School-based Crisis Intervention for Korean High School Students Who Experienced a Peer Suicide. J Korean Med Sci 2018; 33:e192. [PMID: 29983694 PMCID: PMC6033103 DOI: 10.3346/jkms.2018.33.e192] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/10/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The purpose of this study was to examine post-traumatic stress, depression, anxiety, and complicated grief in Korean high school students who experienced a peer suicide. METHODS A total of 956 students were included in the statistical analysis. One week after a peer suicide, a school-based crisis intervention program was conducted. The cohort was followed-up at one week and five months after a peer suicide. The program consists of screening tests, educational sessions, and further interview with psychiatric specialists for the selected group. Screening tests were conducted for all students to measure the Child Report of Post-traumatic Symptoms (CROPS), the post-traumatic stress symptoms (The University of California at Los Angeles post-traumatic stress disorder [PTSD] reaction index; UCLA-PTSD-RI), the anxiety symptoms (The Korean-Beck Anxiety Inventory; K-BAI), the depressive symptoms (The Korean-Beck Depression Inventory-II; K-BDI-II), and the complicated grief reaction (The Inventory of Complicated Grief; ICG). For statistical analysis, the SPSS Statistics 21.0 program was used. RESULTS At baseline and five months follow-ups, 8.6% and 2.9% of the students showed post-traumatic stress symptoms. At five months follow-up, there was a statistically significant decline in the post-traumatic stress symptoms, anxiety, depression, and complicated grief among the 'trauma group.' A higher proportion of the female students showed post-traumatic stress symptoms after the incident of peer suicide than the male students. CONCLUSION School-based crisis intervention helps improvement of trauma-related symptoms. It might be an effective way to prevent suicide spreading among students by alleviating trauma-related symptoms.
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Affiliation(s)
- Ji Min Cha
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji Eun Kim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Min A Kim
- Student Mental Health Resource & Research Center, Daegu, Korea
| | - Boyoung Shim
- Student Mental Health Resource & Research Center, Daegu, Korea
| | - Myeong Jin Cha
- Student Mental Health Resource & Research Center, Daegu, Korea
| | - Jung Jae Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Korea
| | - Un Sun Chung
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
- Student Mental Health Resource & Research Center, Daegu, Korea
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32
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Armenta RF, Rush T, LeardMann CA, Millegan J, Cooper A, Hoge CW. Factors associated with persistent posttraumatic stress disorder among U.S. military service members and veterans. BMC Psychiatry 2018; 18:48. [PMID: 29452590 PMCID: PMC5816529 DOI: 10.1186/s12888-018-1590-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 01/04/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) can have long-term and far-reaching impacts on health and social and occupational functioning. This study examined factors associated with persistent PTSD among U.S. service members and veterans. METHODS Using baseline and follow-up (2001-2013) questionnaire data collected approximately every 3 years from the Millennium Cohort Study, multivariable logistic regression was conducted to determine factors associated with persistent PTSD. Participants included those who screened positive for PTSD using the PTSD Checklist-Civilian Version at baseline (N = 2409). Participants were classified as having remitted or persistent PTSD based on screening negative or positive, respectively, at follow-up. RESULTS Almost half of participants (N = 1132; 47%) met criteria for persistent PTSD at the first follow-up; of those, 804 (71%) also screened positive for PTSD at the second follow-up. Multiple factors were independently associated with persistent PTSD in an adjusted model at the first follow-up, including older age, deployment with high combat exposure, enlisted rank, initial PTSD severity, depression, history of physical assault, disabling injury/illness, and somatic symptoms. Among those with persistent PTSD at the first follow-up, additional factors of less sleep, separation from the military, and lack of social support were associated with persistent PTSD at the second follow-up. CONCLUSIONS Combat experiences and PTSD severity were the most salient risk factors for persistent PTSD. Comorbid conditions, including injury/illness, somatic symptoms, and sleep problems, also played a significant role and should be addressed during treatment. The high percentage of participants with persistent PTSD supports the need for more comprehensive and accessible treatment, especially after separation from the military.
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Affiliation(s)
- Richard F. Armenta
- 0000 0004 0587 8664grid.415913.bDeployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521 USA ,0000 0004 0614 9826grid.201075.1The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD USA
| | - Toni Rush
- 0000 0001 2107 4242grid.266100.3Department of Family Medicine and Public Health, La Jolla, University of California, San Diego, School of Medicine, San Diego, CA USA
| | - Cynthia A. LeardMann
- 0000 0004 0587 8664grid.415913.bDeployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521 USA ,0000 0004 0614 9826grid.201075.1The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD USA
| | - Jeffrey Millegan
- 0000 0001 0639 7318grid.415879.6Directorate of Mental Health, Naval Medical Center San Diego, San Diego, CA USA
| | - Adam Cooper
- 0000 0004 0587 8664grid.415913.bDeployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521 USA
| | - Charles W. Hoge
- 0000 0001 0036 4726grid.420210.5Walter Reed Army Institute of Research, Silver Spring, MD USA
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33
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Brailey K, Mills MA, Marx BP, Proctor SP, Seal KH, Spiro A, Ulloa EW, Vasterling JJ. Prospective Examination of Early Associations of Iraq War Zone Deployment, Combat Severity, and Posttraumatic Stress Disorder with New Incident Medical Diagnoses. J Trauma Stress 2018. [PMID: 29513919 DOI: 10.1002/jts.22264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
War zone deployment and posttraumatic stress disorder (PTSD) have been associated with morbidity and mortality decades later. Less is known about the associations between these variables and the early emergence of medical disorders in war zone veterans. This prospective study of 862 U.S. Army soldiers (n = 569 deployed; n = 293 nondeployed) examined: (a) associations between Iraq War deployment status (deployed vs. nondeployed) and new medical diagnoses that emerged within six months after return from Iraq among all participants; and (b) associations between combat severity and PTSD symptoms, and new postdeployment medical diagnoses that emerged within 12 months after return from Iraq within deployed participants. New medical diagnoses were abstracted from diagnostic codes associated with clinical outpatient visits recorded within the Department of Defense Standard Ambulatory Data Record database. Combat severity was measured with the Combat Experiences module of the Deployment Risk and Resilience Inventory, and postdeployment posttraumatic stress disorder symptom severity was measured using the PTSD Checklist-Civilian. Neither deployment nor combat severity was associated with new medical diagnoses. However, among deployed soldiers, more severe PTSD symptoms were associated with increased risk for a new medical disorder diagnosis; every 10-point increase in PTSD symptoms increased odds of a new diagnosis by nearly 20% (odds ratio = 1.20). Results suggest that PTSD symptoms are associated with early morbidity in Iraq War veterans.
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Affiliation(s)
- Kevin Brailey
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Mary Alice Mills
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Brian P Marx
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Susan P Proctor
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA.,Research Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Karen H Seal
- San Francisco VA Health Care System, San Francisco, California, USA.,Departments of Medicine and Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Avron Spiro
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Erin W Ulloa
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer J Vasterling
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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Abstract
Australia has deployed over 25 000 personnel to recent conflicts in the Middle East and has been involved in peacekeeping missions. Australian veterans report elevated rates of mental health problems such as post-traumatic stress disorder, anxiety disorders, affective disorders and substance use disorders. Veteran healthcare is delivered through publicly funded services, as well as through private services, at primary, secondary and tertiary levels. Some of the challenges involve coordination of services for veterans transitioning from Defence to Veterans' Affairs, service delivery across a large continent and stigma inhibiting service-seeking. Initiatives have been introduced in screening and delivery of evidence-based treatments. While challenges remain, Australia has come a long way towards an integrated and comprehensive approach to veteran mental healthcare.
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Pitts BL, Safer MA, Russell DW, Castro-Chapman PL. Effects of Hardiness and Years of Military Service on Posttraumatic Stress Symptoms in U.S. Army Medics. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Dale W. Russell
- Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
| | - Paula L. Castro-Chapman
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida, and Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida
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36
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Murphy D, Busuttil W. Focusing on the mental health of treatment-seeking veterans. J ROY ARMY MED CORPS 2017; 164:3-4. [PMID: 28993485 DOI: 10.1136/jramc-2017-000844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Dominic Murphy
- Research Department, Combat Stress, Leatherhead, UK.,Department of Psychological Medicine, King's Centre for Military Health Research, King's College London, London, UK
| | - W Busuttil
- Research Department, Combat Stress, Leatherhead, UK
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Fares J, Gebeily S, Saad M, Harati H, Nabha S, Said N, Kanso M, Abdel Rassoul R, Fares Y. Post-traumatic stress disorder in adult victims of cluster munitions in Lebanon: a 10-year longitudinal study. BMJ Open 2017; 7:e017214. [PMID: 28821528 PMCID: PMC5724068 DOI: 10.1136/bmjopen-2017-017214] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/24/2017] [Accepted: 05/30/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study aims to explore the short-term and long-term prevalence and effects of post-traumatic stress disorder (PTSD) among victims of cluster munitions. DESIGN AND SETTING A prospective 10-year longitudinal study that took place in Lebanon. PARTICIPANTS Two-hundred-and-forty-four Lebanese civilian victims of submunition blasts, who were injured in 2006 and were over 18 years old, were interviewed. Included were participants who had been diagnosed with PTSD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and the PTSD Checklist - Civilian Version in 2006. Interviewees were present for the 10-year follow-up. MAIN OUTCOME MEASURES PTSD prevalence rates of participants in 2006 and 2016 were compared. Analysis of the demographical data pertaining to the association of long-term PTSD with other variables was performed. p Values <0.05 were considered statistically significant for all analyses (95% CI). RESULTS All the 244 civilians injured by cluster munitions in 2006 responded, and were present for long-term follow-up in 2016. The prevalence of PTSD decreased significantly from 98% to 43% after 10 years (p<0.001). A lower long-term prevalence was significantly associated with male sex (p<0.001), family support (p<0.001) and religion (p<0.001). Hospitalisation (p=0.005) and severe functional impairment (p<0.001) post-trauma were significantly associated with increased prevalence of long-term PTSD. Symptoms of negative cognition and mood were more common in the long run. In addition, job instability was the most frequent socioeconomic repercussion among the participants (88%). CONCLUSIONS Psychological symptoms, especially PTSD, remain high in war-affected populations many years after the war; this is particularly evident for Lebanese civilians who were victimised by cluster munitions. Screening programmes and psychological interventions need to be implemented in vulnerable populations exposed to war traumas. Officials and public health advocates should consider the socioeconomic implications, and help raise awareness against the harm induced by cluster munitions and similar weaponry.
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Affiliation(s)
- Jawad Fares
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Souheil Gebeily
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Department of Neurology, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Mohamad Saad
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Division of Statistical Genetics, Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Hayat Harati
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Sanaa Nabha
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Najwane Said
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Mohamad Kanso
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ronza Abdel Rassoul
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- UMR 1141, Hôpital Robert Debré, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Youssef Fares
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Department of Neurosurgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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38
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Wade D, Mewton L, Varker T, Phelps A, Forbes D. The impact of potentially traumatic events on the mental health of males who have served in the military: Findings from the Australian National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2017; 51:693-702. [PMID: 27694637 DOI: 10.1177/0004867416671413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The study investigated the impact of potentially traumatic events on mental health outcomes among males who had ever served in the Australian Defence Force. METHOD Data from a nationally representative household survey of Australian residents, the 2007 National Survey of Mental Health and Wellbeing, were used for this study. RESULTS Compared with community members, Australian Defence Force males were significantly more likely to have experienced not only deployment and other war-like events but also accidents or other unexpected events, and trauma to someone close. For non-deployed males, Australian Defence Force members were at increased risk of accidents or other unexpected events compared to community members. After controlling for the effect of potentially traumatic events that were more prevalent among all Australian Defence Force members, the increased risk of mental disorders among Australian Defence Force members was no longer evident. For non-deployed males, Australian Defence Force and community members were at comparable risk of poor mental health outcomes. A significant minority of Australian Defence Force members had onset of a mental disorder prior to their first deployment. CONCLUSIONS Deployment and other potentially traumatic events among Australian Defence Force members can help to explain their increased vulnerability to mental disorders compared with community members. Providers should routinely enquire about a range of potentially traumatic events among serving and ex-serving military personnel.
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Affiliation(s)
- Darryl Wade
- 1 Phoenix Australia and Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
| | - Louise Mewton
- 2 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Tracey Varker
- 1 Phoenix Australia and Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
| | - Andrea Phelps
- 1 Phoenix Australia and Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
| | - David Forbes
- 1 Phoenix Australia and Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
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39
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O'Toole BI, Burton MJ, Rothwell A, Outram S, Dadds M, Catts SV. Intergenerational transmission of post-traumatic stress disorder in Australian Vietnam veterans' families. Acta Psychiatr Scand 2017; 135:363-372. [PMID: 28032331 DOI: 10.1111/acps.12685] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the association between parental post-traumatic stress disorder (PTSD) and offspring PTSD and its specificity for other disorders in a non-clinical epidemiological cohort of Australian Vietnam veterans, their partners and their sons and daughters. METHOD Veterans were interviewed twice, in 1992-1994 and 2005-2006; partners were interviewed in 2006-2007, and their offspring in 2012-2014. A total of 125 sons and 168 daughters were interviewed from 197 families, 137 of which also included partners who were the mothers of the children. Statistical analysis used multi-level modelling to compute odds ratios and 95% confidence intervals while controlling for clustering effects within families. Parent PTSD diagnoses were examined for associations with offspring trauma exposure, PTSD and other psychiatric diagnoses. RESULTS Veteran PTSD increased the risk of PTSD and no other disorder in both sons and daughters; partner PTSD did not. Veteran depression was also a risk factor for sons' PTSD, and alcohol disorder was linked to alcohol dependence in sons and PTSD in daughters, but not when controlling for veteran PTSD. CONCLUSION We conclude that PTSD in a Vietnam veteran father increases the risk specifically for PTSD in his sons and daughters.
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Affiliation(s)
- B I O'Toole
- Brain & Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - M J Burton
- Brain & Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - A Rothwell
- Brain & Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - S Outram
- Health Behaviour Sciences, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - M Dadds
- Brain & Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - S V Catts
- Brain & Mind Centre, University of Sydney, Sydney, NSW, Australia.,Department of Psychiatry, Royal Brisbane Hospital, University of Queensland, Brisbane, QLD, Australia
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O'Toole BI, Catts SV. The Course and Correlates of Combat-Related PTSD in Australian Vietnam Veterans in the Three Decades After the War. J Trauma Stress 2017; 30:27-35. [PMID: 28103407 DOI: 10.1002/jts.22160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 10/26/2016] [Accepted: 11/03/2016] [Indexed: 11/06/2022]
Abstract
Australian male Vietnam veterans (N = 388) were assessed 22 and 36 years after their return to Australia using standardized diagnostic interviews, with added data from Army records and self-report questionnaires. Among veterans who ever had posttraumatic stress disorder (PTSD), 50.3% had a current diagnosis at the second assessment; of those who had a current diagnosis at Wave 1, 46.9% were also current at Wave 2. Late onset occurred for 19.0% of veterans, of whom 60.8% were current at Wave 2. Multivariate analysis compared veterans with no history of PTSD (n = 231) with veterans who had ever had PTSD (n = 157) to assess risk factors for PTSD incidence; and veterans with a history, but not current PTSD (n = 78) with veterans who had current PTSD at the second assessment (n = 79) to assess risk factors for failure to remit. Incidence was associated with lower education, shorter Army training predeployment, higher combat, excess drinking, and help-seeking after return to Australia. Prevalence was associated with having a father who saw combat in World War II, being injured in battle, having a lower intelligence test score, experiencing higher combat, and having a diagnosis of phobia at the first assessment. Only combat was common to incidence and prevalence.
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Affiliation(s)
- Brian I O'Toole
- Brain & Mind Centre, University of Sydney, Sydney, Australia.,ANZAC Research Institute, University of Sydney, Sydney, Australia
| | - Stanley V Catts
- Brain & Mind Centre, University of Sydney, Sydney, Australia.,School of Psychiatry, University of Queensland, Brisbane, Australia
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Horswill SC, Desgagné G, Parkerson HA, Carleton RN, Asmundson GJG. A psychometric evaluation of hierarchical and oblique versions of five variants of the Posttraumatic Growth Inventory. Psychiatry Res 2016; 246:438-446. [PMID: 27788466 DOI: 10.1016/j.psychres.2016.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 10/12/2016] [Accepted: 10/17/2016] [Indexed: 12/27/2022]
Abstract
The Posttraumatic Growth Inventory (PTGI; Tedeschi and Calhoun, 1996) is the most commonly used measure of posttraumatic growth. Although the original five factor structure has extensive psychometric support, evidence exists for alternate PTGI models. The current study assessed the validity of oblique and hierarchical factor structures of five PTGI models. Confirmatory factor analyses were performed among a heterogeneous community sample with a diverse trauma history. The oblique models provided a better fit to the data compared with their respective hierarchical models. Three oblique variants provided good fit to the data on two fit indices and all five oblique variants met the recommended criteria for at least one fit index. The 10-item model demonstrated the lowest Expected Cross-Validation Index (ECVI) values and is a brief and useful measure when examining PTGI total scores; however, current results suggest that consideration of the specific subscales may be more meaningful than total scores. Researchers and clinicians interested in subscale scores should consider using the 18- or 21-item variants due to a higher number of items per factor and, therefore, greater factor stability. Future directions in refining and measuring posttraumatic growth are discussed.
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42
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Herbicide Exposure, Vietnam Service, and Hypertension Risk in Army Chemical Corps Veterans. J Occup Environ Med 2016; 58:1127-1136. [DOI: 10.1097/jom.0000000000000876] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Bonde JP, Utzon-Frank N, Bertelsen M, Borritz M, Eller NH, Nordentoft M, Olesen K, Rod NH, Rugulies R. Risk of depressive disorder following disasters and military deployment: systematic review with meta-analysis. Br J Psychiatry 2016; 208:330-6. [PMID: 26892850 DOI: 10.1192/bjp.bp.114.157859] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 05/28/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Numerous studies describe the occurrence of post-traumatic stress disorder following disasters, but less is known about the risk of major depression. AIMS To review the risk of depressive disorder in people surviving disasters and in soldiers returning from military deployment. METHOD A systematic literature search combined with reference screening identified 23 controlled epidemiological studies. We used random effects models to compute pooled odds ratios (ORs). RESULTS The average OR was significantly elevated following all types of exposures: natural disaster OR = 2.28 (95% CI 1.30-3.98), technological disaster OR = 1.44 (95% CI 1.21-1.70), terrorist acts OR = 1.80 (95% CI 1.38-2.34) and military combat OR = 1.60 (95% CI 1.09-2.35). In a subset of ten high-quality studies OR was 1.41 (95% CI 1.06-1.87). CONCLUSIONS Disasters and combat experience substantially increase the risk of depression. Whether psychological trauma per se or bereavement is on the causal path is unresolved.
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Affiliation(s)
- J P Bonde
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - N Utzon-Frank
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - M Bertelsen
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - M Borritz
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - N H Eller
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - M Nordentoft
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - K Olesen
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - N H Rod
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - R Rugulies
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
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McFarlane A. Accountability for the Psychological Costs of Military Service: A Benchmark Set by the Canadian Armed Forces. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:7S-9S. [PMID: 27270745 PMCID: PMC4800471 DOI: 10.1177/0706743715625423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sloan DM, Unger W, Gayle Beck J. Cognitive-behavioral group treatment for veterans diagnosed with PTSD: Design of a hybrid efficacy-effectiveness clinical trial. Contemp Clin Trials 2016; 47:123-30. [PMID: 26718094 PMCID: PMC4838993 DOI: 10.1016/j.cct.2015.12.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/17/2015] [Accepted: 12/19/2015] [Indexed: 01/18/2023]
Abstract
Despite significant advances in individual treatment approaches for PTSD, knowledge of group approaches has lagged behind. Much of the reason knowledge about group treatment for PTSD has been limited is due to the complexity of conducting randomized controlled trials in the group treatment context. This limited empirical knowledge is unfortunate given the frequency with which group treatment for PTSD is used in clinical settings, including the Department of Veteran Affairs. The goal of this study is to examine the efficacy of a group cognitive-behavioral treatment (GCBT) for PTSD relative to group supportive counseling approach (i.e. group present centered treatment; GPCT). The sample consists of 196 veterans diagnosed with PTSD who are randomly assigned to either GCBT (n=98) or GPCT (n=98). Both treatments are administered by two therapists over the course of 14 sessions. Assessments take place at baseline, mid-treatment, post-treatment and 3-, 6-, and 12-month follow-up. The primary outcome measure is the PTSD symptom severity assessed with a semi-structured diagnostic instrument. Given the substantial rise of veterans presenting for PTSD treatment services, identifying an efficacious group treatment approach is invaluable.
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Affiliation(s)
- Denise M Sloan
- VA Boston Healthcare System, United States; VA National Center for PTSD, United States; Boston University School of Medicine, United States.
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46
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Johnston DW, Shields MA, Siminski P. Long-term health effects of Vietnam-era military service: A quasi-experiment using Australian conscription lotteries. JOURNAL OF HEALTH ECONOMICS 2016; 45:12-26. [PMID: 26705967 DOI: 10.1016/j.jhealeco.2015.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 06/05/2023]
Abstract
This paper estimates the long-term health effects of Vietnam-era military service using Australia's National conscription lotteries for identification. Our primary contribution is the quality and breadth of our health outcomes. We use several administrative sources, containing a near-universe of records on mortality (1994-2011), cancer diagnoses (1982-2008), and emergency hospital presentations (2005-2010). We also analyse a range of self-reported morbidity indicators (2006-2009). We find no significant long-term effects on mortality, cancer or emergency hospital visits. In contrast, we find significant detrimental effects on a number of morbidity measures. Hearing and mental health appear to be particularly affected.
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Affiliation(s)
- David W Johnston
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Michael A Shields
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Peter Siminski
- School of Accounting, Economics and Finance, University of Wollongong, Wollongong, Australia; IZA, Bonn, Germany.
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Forbes D, O’Donnell M, Brand RM, Korn S, Creamer M, McFarlane AC, Sim MR, Forbes AB, Hawthorne G. The long-term mental health impact of peacekeeping: prevalence and predictors of psychiatric disorder. BJPsych Open 2016; 2:32-37. [PMID: 27703751 PMCID: PMC4995565 DOI: 10.1192/bjpo.bp.115.001321] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 10/25/2015] [Accepted: 10/26/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The mental health outcomes of military personnel deployed on peacekeeping missions have been relatively neglected in the military mental health literature. AIMS To assess the mental health impacts of peacekeeping deployments. METHOD In total, 1025 Australian peacekeepers were assessed for current and lifetime psychiatric diagnoses, service history and exposure to potentially traumatic events (PTEs). A matched Australian community sample was used as a comparator. Univariate and regression analyses were conducted to explore predictors of psychiatric diagnosis. RESULTS Peacekeepers had significantly higher 12-month prevalence of post-traumatic stress disorder (16.8%), major depressive episode (7%), generalised anxiety disorder (4.7%), alcohol misuse (12%), alcohol dependence (11.3%) and suicidal ideation (10.7%) when compared with the civilian comparator. The presence of these psychiatric disorders was most strongly and consistently associated with exposure to PTEs. CONCLUSIONS Veteran peacekeepers had significant levels of psychiatric morbidity. Their needs, alongside those of combat veterans, should be recognised within military mental health initiatives. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.
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Affiliation(s)
| | | | - Rachel M. Brand
- Rachel M. Brand, DClinPsy, Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Sam Korn
- Sam Korn, PhD, Mental Health Evaluation Unit, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Creamer
- Mark Creamer, PhD, Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander C. McFarlane
- Alexander C. McFarlane, AO, MD, FRANZCP, Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | | | - Andrew B. Forbes
- Andrew B. Forbes, PhD, Monash Centre for Occupational & Environmental Health, Department of Epidemiology & Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Graeme Hawthorne
- Graeme Hawthorne (deceased), PhD, Mental Health Evaluation Unit, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
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Cox B, McBride D, Broughton J, Tong D. Health conditions in a cohort of New Zealand Vietnam veterans: hospital admissions between 1988 and 2009. BMJ Open 2015; 5:e008409. [PMID: 26656012 PMCID: PMC4679881 DOI: 10.1136/bmjopen-2015-008409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To inform the provision of support to veterans by analysing hospital discharge data, thereby identifying which conditions show an excess risk, require specific management strategies and deserve further investigation. SETTING Tertiary level care, including all public and private New Zealand hospitals. PARTICIPANTS All New Zealand Vietnam veterans with service between 1964 and 1972. PRIMARY OUTCOME MEASURES Standardised hospitalisation ratios (SHRs) were calculated based on the number of first observed hospital admissions for a condition, those expected being based on New Zealand national hospitalisation rates. RESULTS The SHR for all causes of hospitalisation was 1.18, 95% CI 1.15 to 1.21, with modest increases for the major common causes, cardio and cerebrovascular disease. Admission rates for chronic renal failure and chronic obstructive pulmonary disease were highest in the 2006-2009 time period. The highest statistically significant hospitalisation risk was for alcohol-related mental disorder, SHR 1.91, 99% CI 1.39 to 2.43. CONCLUSIONS Chronic renal failure has limited attribution to veteran service but along with chronic obstructive pulmonary disease has the potential to have high costs both to the individual and the health system. We suggest that routine surveillance of veterans by way of a 'flag' in national and primary care databases would facilitate the recognition of service-related conditions and the appropriate provision of healthcare.
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Affiliation(s)
- Brian Cox
- Hugh Adam Cancer Epidemiology Unit, University of Otago, Dunedin, New Zealand
| | - David McBride
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - John Broughton
- Ngai Tahu Māori Health Research Unit, University of Otago, Dunedin, New Zealand
| | - Darryl Tong
- Department of Oral Diagnostic and Surgical Sciences, University of Otago, Dunedin, New Zealand
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Doron-LaMarca S, Niles BL, King DW, King LA, Kaiser AP, Lyons MJ. Temporal Associations Among Chronic PTSD Symptoms in U.S. Combat Veterans. J Trauma Stress 2015; 28:410-7. [PMID: 26367017 PMCID: PMC6785199 DOI: 10.1002/jts.22039] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The present study examined fluctuation over time in symptoms of posttraumatic stress disorder (PTSD) among 34 combat veterans (28 with diagnosed PTSD, 6 with subclinical symptoms) assessed every 2 weeks for up to 2 years (range of assessments = 13-52). Temporal relationships were examined among four PTSD symptom clusters (reexperiencing, avoidance, emotional numbing, and hyperarousal) with particular attention to the influence of hyperarousal. Multilevel cross-lagged random coefficients autoregression for intensive time series data analyses were used to model symptom fluctuation decades after combat experiences. As anticipated, hyperarousal predicted subsequent fluctuations in the 3 other PTSD symptom clusters (reexperiencing, avoidance, emotional numbing) at subsequent 2-week intervals (rs = .45, .36, and .40, respectively). Additionally, emotional numbing influenced later reexperiencing and avoidance, and reexperiencing influenced later hyperarousal (rs = .44, .40, and .34, respectively). These findings underscore the important influence of hyperarousal. Furthermore, results indicate a bidirectional relationship between hyperarousal and reexperiencing as well as a possible chaining of symptoms (hyperarousal → emotional numbing → reexperiencing → hyperarousal) and establish potential internal, intrapersonal mechanisms for the maintenance of persistent PTSD symptoms. Results suggested that clinical interventions targeting hyperarousal and emotional numbing symptoms may hold promise for PTSD of long duration.
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Affiliation(s)
- Susan Doron-LaMarca
- Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine, Boston, Massachusetts, USA
| | - Barbara L. Niles
- Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine, Boston, Massachusetts, USA
| | - Daniel W. King
- National Center for PTSD, VA Boston Healthcare System, Department of Psychology, Boston University, and Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lynda A. King
- National Center for PTSD, VA Boston Healthcare System, Department of Psychology, Boston University, and Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Anica Pless Kaiser
- Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michael J. Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
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McGuire A, Dobson A, Mewton L, Varker T, Forbes D, Wade D. Mental health service use: comparing people who served in the military or received Veterans' Affairs benefits and the general population. Aust N Z J Public Health 2015; 39:524-9. [DOI: 10.1111/1753-6405.12431] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/01/2015] [Accepted: 04/01/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Annabel McGuire
- Centre for Australian Military and Veterans' Health, School of Public Health; University of Queensland
| | | | - Louise Mewton
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital; University of New South Wales
| | - Tracey Varker
- Australian Centre for Posttraumatic Mental Health, Department of Psychiatry; University of Melbourne; Victoria
| | - David Forbes
- Australian Centre for Posttraumatic Mental Health, Department of Psychiatry; University of Melbourne; Victoria
| | - Darryl Wade
- Australian Centre for Posttraumatic Mental Health, Department of Psychiatry; University of Melbourne; Victoria
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