COMBAT PTSD

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COMBAT PTSD

• Milton Lasoski, PhD
• New Mexico Veterans Affairs
• Health Care System

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Various ReactionsPTSD is only a Possible Path

• Depression
• Anxiety
• Phobias
• Substance Abuse
• Aggression
• Adjustment

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Acknowledgements for use of Slides

• Gregory A. Leskin, Ph.D. National Center for PTSD
• APA Sub-Committee on Resiliency and Terrorism
• Jose Canive, MD New Mexico VAHCS
• Matthew Friedman PTSD 101 Course ncptsd_at_va.gov

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PTSD

• A. Traumatic event experienced with fear,
  helplessness, horror, extreme distress
• B. Re-experiencing (Intrusion)
• C. Avoidance
• D. Hyperarousal
• E. Symptoms present for 1 month or more
• F. Distress social/occupational function

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Acute Stress Disorder (ASD) Criterion

• Three dissociative symptoms
• Derealization
• Numbing or detachment
• Reduced awareness of surroundings
• Depersonalization
• Dissociative amnesia

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Acute Stress Disorder (ASD) How predictive is
it?

• Prospective studies find that a high proportion
  of those diagnosed with ASD develop PTSD.
• However, in terms of people who eventually
  developed PTSD, about half of those met criteria
  for ASD.

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B Re-experiencing SXS (1) needed

• Distressing intrusive recollections
• Distressing Dreams of the event
• Reliving the experience (flashbacks)
• Distress at exposure to reminders
• Physiological reactivity at exposure to trauma
  reminders

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C Avoidance/Numbing SXS (3) needed

• Avoid thoughts/feelings that remind
• Avoid activities/situations that remind
• Inability to recall aspects of the trauma
• Diminished interest in activities
• Detachment/Estrangement from others
• Restricted range of affect
• Sense of foreshortened future

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D Hyperarousal Symptoms (2) needed

• Difficulty falling/staying asleep
• Irritability or outbursts of anger
• Difficulty concentrating
• Hypervigilance
• Exaggerated startle

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Active Duty Self Report (Hoge,etal) PTSD/ GAD/
Depression

• Pre-Deployment
• OEF Post-Deployment
• OIF Post-Deployment

• 9
• 11
• 1517

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Active Duty Self Report (Hoge,etal) ETOH Abuse

• 17
• 24
• 35

• Pre-Deployment
• OEF Post-Deployment
• OIF Post-Deployment

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Active Duty Self Report (Hoge,etal) PTSD and
Reported Firefights

• 4.5
• 8.2-9.3
• 18.9-19.3

• NO firefights
• 1-2 firefights
• 5 or more firefights

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PD Health Assessment and MH Sxs Utilization
(Hoge, et al)

• Peace Keeping Deployment
• OEF Post-Deployment
• OIF Post-Deployment

• 8.5
• 11.3
• 19.1

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PD Health Assessment and MH Sxs Utilization
(Hoge, et al)

• Active Military
• National Guard
• Women
• Men

• 18.4
• 21
• 23.6
• 18.6

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PTSD SELF Report (Hoge, et al)

• Peace Keeping Deployment
• OEF Post-Deployment
• OIF Post-Deployment

• 2.1
• 4.7
• 9.8

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PTSD SELF Report (Hoge, et al)

• Screened Positive and witnessed Casualties
• Screened Negative and witnessed Casualties

• 80
• 48

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PTSD SELF Report (Hoge, et al)

• OIF Vets who accessed MH SVS at least one time
• Screened Positive for Mental Health Problems and
  accessed MH SVS

• 1/3
• 60

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Anxiety depression and PTSD four months after
trauma
PTSD37
16 (43.8)
5
12
4
MDD30
ANX31
3
11 (36.7)
19 (61)
None(n141)(67)
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PTSD Prevalence in US Adults

• National Comorbidity Survey NCS-Replication
  (2005)
• Large national probability samples (Ns gt 5000)
• Benchmark for prevalence of mental disorders in
  US
• Lifetime PTSD prevalence 6.8 (NCS-R)
• 9.7 women
• 3.6 men
• Current PTSD prevalence 3.6 (NCS-R)
• 5.2 women
• 1.8 men

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Prevalence Of Trauma And PTSD
More Than 60 Experience A Traumatic Event In
Their LifeMore Than 25 Experience Multiple
Traumatic Events
Kessler et al., 1999
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Combat Exposure in the NCS

• Lifetime prevalence of PTSD 39 among combat
  veterans
• Male combat vs. all other male trauma
• Higher lifetime PTSD prevalence
• Greater likelihood of delayed onset
• Greater likelihood of unresolved symptoms

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Lifetime prevalence rates of trauma and their
association with PTSD ()
Men Women Event PTSD Event
PTSD Natural Disaster 18.9 3.7 15.2 5.4 C
riminal Assault 11.1 1.8 6.9 21.3 Combat 6.4 38
.8 0.0 - Rape 0.7 65.0 9.2 49.5 Any
trauma 60.7 8.1 51.2 20.4 Kessler et al
(1995)
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PTSD Prevalence in Vietnam Veterans

• National Vietnam Veterans Readjustment Study
• Large, nationally-representative sample of
  theater and era veterans and civilians (N gt3000)
• Lifetime prevalence
• 31 men, 26 women
• Current prevalence (1986-87)
• 15 men, 8 women

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Lifetime PrevalenceVietnam Veterans

• SW American Indian 45
• NP American Indian 57
• Hispanic 34
• African American 35
• White 20

NVVRS and Matsunaga 8-year difference
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Prevalence of PTSD from Other Wars

• Gulf War veterans1
• Population sample of over 11,000 Gulf War
  veterans
• Current PTSD prevalence 10
• Afghanistan2
• Army (N1962)
• Current PTSD prevalence 6-11.5
• Iraq2
• Army (N894), current PTSD prevalence 13-18
• Marine (N815), current PTSD prevalence 12-20

1 Khan, Natelson, Mahan, Kyung, Frances (2003).
Amer. J. of Epidemiology 2 Hoge, et al. (2004).
New England Journal of Medicine
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Military studies

• Risk Factors Effect Size
• Adverse Childhood .27
• Trauma Severity .26
• Lack of social support .43

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PTSD Course in Veterans

• 214 Israeli combat veterans
• Assessed 1, 2, 3 20 years post-war
• Delayed onset of PTSD at Yr 20
• No PTSD at Yr 1 34.5
• No PTSD at Yr 3 31.6
• No PTSD Yrs 1-3 8.6

Shalev Yehuda, 1999.
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Longitudinal Course Of PTSD
94
Most People Who Develop PTSD Recover From It
47
w/PTSD symptoms
42
25-15
?
3m
W
9m
Years
Shalev Yehuda, 1999.
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PTSD and Comorbidity in the NCS
PTSD elevated the odds of comorbidity in men
women
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Social Support IssuesTo disclose or not to
disclose? (Bolton et al., 2003)

• Self-disclosure about events to significant
  others/ military personnel was related to lower
  levels of PTSD severity.  
• The reactions to self-disclosure by
  partner/spouse, family, friends, and other
  military personnel were significantly associated
  with PTSD symptoms severity. In each instance,
  more positive reactions were related to lower
  levels of PTSD symptoms severity.

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Social Support IssuesTo disclose or not to
disclose? (Bolton et al., 2003), Cont.

• No differences were detected in PTSD symptoms
  between veterans whose disclosures were met with
  an overall negative or nonvalidating response and
  those who did not disclose at all.
• This later finding suggests that negative or
  nonvalidating responses by other to
  self-disclosure may negate the potentially
  beneficial effects of discussing the experience.
• However, it may also indicate that there are
  equally negative effects of not disclosing when
  the alternative is disclosure followed by a
  negative response.

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Longitudinal Course Of PTSD
94
Most People Who Develop PTSD Recover From It
47
w/PTSD symptoms
42
25-15
?
3m
W
9m
Years
Shalev Yehuda, 1999.