Comparing PTSD Among Returning War Veterans Now, PTSD is thoroughly documented and a whole array of treatments are available to veterans of the Iraqi and Afghan Wars. . Journal of the American Osteopathic Association. vol. POV: What is Post-Traumatic Stress Disorder (PTSD) and what are some of the that has been done on the relationship between killing in war and PTSD?. Aims: The aim of the study was to examine the relationship between war trauma, PTSD, depression, and anxiety among Palestinian children in the Gaza Strip.
The most frequently reported problems are increased anger or irritability and difficulty sleeping. Other arousal symptoms include constantly being on guard, having difficulty concentrating and feeling jumpy or easily startled. These symptoms cause difficulties in social relationships -- with family, dating and friendships -- and occupational functioning in work or school.
Is it common for soldiers returning from war to experience symptoms of PTSD? In addition to military personnel that meet full criteria for a PTSD diagnosis, many others display some combination of PTSD symptoms as they readjust to the challenges of civilian life after functioning under the constant life-threat they experienced during deployment.
It is common to have some PTSD symptoms at first, especially hypervigilance, insomnia and nightmares as veterans try to integrate and process their war zone experiences. These symptoms are likely to be more intense for those who have returned recently, and many of these symptoms are likely to decrease over time as they adjust to civilian life. One way to conceptualize many of these PTSD symptoms is to think of them as part of a stress-response continuum.
Comparing PTSD Among Returning War Veterans
At one end are individuals who are burdened by stressors at home at the same time that they are reminded of traumatic events that happened in the war zone, yet are coping well with few mental health symptoms and little functional impairment. These people are often able to reintegrate into their previous jobs with little disruption and return to their relationships, in which they can communicate about areas of difficulty. In the middle may be those who have a variety of PTSD symptoms, yet do not evidence clinically significant impairment in functioning.
At the other end of the spectrum are veterans who are plagued with a host of PTSD symptoms and have difficulty functioning in their daily lives.
Can you tell us about the research that has been done on the relationship between killing in war and PTSD?
Despite this country's involvement in wars for hundreds of years, there has been little clinical research on the mental health impact of taking another life in combat among veterans, compared to the amount of research that exists about other potentially traumatic events that military personnel may experience in the context of war. A few studies have detailed the elements of war-zone exposure that are necessary, but not sufficient, to create risk for chronic PTSD.
In one study of Vietnam veterans, King and colleagues found that instances of traditional combat e. In another study that examined killing in the context of committing atrocities during war within a larger model, Fontana and Rosenheck found a strong relationship between killing and PTSD.
After taking killing into account, the atrocities variable no longer predicted PTSD symptoms, suggesting that killing could be the potent ingredient in predicting PTSD. Our preliminary results from a current study of Vietnam veterans have demonstrated that in addition to PTSD, killing is also associated with a number of mental health and functioning problems, even after taking exposure to general combat into account. Finally, we are currently in the process of conducting a study about the impact of killing on veterans returning from deployments to Iraq and Afghanistan.
We are not aware of any other studies that document this relationship in newly returning veterans. Why is killing in war a potentially traumatic event that would lead to PTSD? War-zone stressors in Vietnam, whose U. Fortunately, the clinical examinations for the diagnosis of PTSD in a subsample of veterans from the NVVRS were conducted so that all PTSD symptoms were rated for all veterans regardless of whether the clinician judged that the veteran had experienced a Criterion A stressor in Vietnam.
In doing so, we will take into account involvement in harm to civilians and prisoners in a type of war that was new for this generation of Americans. We will ask and seek answers to three main questions: Were Criterion A combat stressors, i. Alternatively, was it possible for a veteran to experience PSS onset based on his general experience in Vietnam without having experienced one or more Criterion A combat stressors?
Are there specific types or severities of Criterion A combat stressors that were sufficient for the onset of war-related PSS? What were the effects of pre-Vietnam vulnerability factors and harming civilians or prisoners during service in Vietnam on the onset and adverse course of war-related PSS?
This last question is the most complex and bears directly on the relative importance of exposure and personal vulnerability in the development of PTSD. First, exposure will contribute more if its effect on war-related PSS with vulnerability controlled is greater than the effect of vulnerability with exposure controlled.
In other words, we would expect a negative interaction between combat exposure and vulnerability. Finally, if as suggested by previous research e. If so, this would be another indication of the greater importance of exposure compared with vulnerability in the development of the disorder. Vietnam veterans Kulka et al. Our focus is on veterans subsampled from the 1, member NVVRS sample of males who served in the Vietnam theater of operations Theater veterans during the period of the war from to The tours were typically for one year.
Suitably weighted, the demographic distribution of subsample veterans is very similar to that in the full 1, member sample, except that it does not include veterans from rural areas Dohrenwend et al, Five veterans from minority backgrounds other than Black and Hispanic are removed as too few to analyze. Relevant data on PTSD status or information about sampling weights was missing for three more, and they are also omitted.
Only four of the remaining subsample veterans had first onsets of PTSD that occurred prior to their service in Vietnam. These are too few to provide a basis for evaluating whether pre-war PTSD increased vulnerability to war-related PTSD, and these four veterans are, therefore, also omitted from the analyses. The subsample for the analyses consequently consists of the remaining male veterans of the Vietnam War who did or did not have first onsets of PTSD that were war-related. As in the larger sample, Blacks and Hispanics were oversampled.
Onset requires establishing the presence of the PTSD symptom syndrome PSS for at least a month; adverse course requires the assessment of the persistence or recurrence of the syndrome over much longer periods of time after onset. Fortunately, the detailed diagnostic histories that were obtained from the intensively studied subsample of veterans in the NVVRS make it possible to differentiate between onset of war-related PTSD and, broadly, its subsequent course.
The SCID interviews were conducted by 28 doctoral level clinicians 11 to 12 years after the end of the war in The diagnostic examinations were tape-recorded, and staff psychiatrists and psychologists on the RTI study team reviewed every interview to check the adequacy of the data elicited on PTSD. The clinicians also conducted an independent reliability check of the diagnoses of current and lifetime PTSD on a subsample of 30 of the taped clinical interviews.
These checks found the quality of the data on PTSD to be excellent and inter-rater reliability for the diagnoses of current and lifetime PTSD as measured by kappa to be. The clinician then ascertained whether the symptoms recorded occurred together for at least a month in sufficient numbers and types to meet criteria for current syndrome present for one month or more of the last six months or lifetime but not current syndrome not present in the last six months, but present in criteria-meeting combination for at least one month before then Schlenger, We used additional information to establish whether a PTSD diagnosis was war-related.
If there were subsequent traumatic events, these and the course of PTSD symptoms that coincided with them were also diagrammed. For the present research, all of this information was used to establish whether the first onset of PTSD for the subsample respondents was related to their service in Vietnam, and to determine for whom in this group war-related PTSD was current and for whom it had remitted.
Only four veterans in the subsample had first onsets of PTSD that occurred prior to their service in Vietnam. As noted above, these are omitted from the present investigation. As noted earlier, all veterans in this subsample were asked about PTSD symptoms related to Vietnam regardless of whether the clinician believed that Criterion A was met.
This information enabled us to test whether Criterion A stressors were necessary for the occurrence of the symptom syndrome PSS. For example, the MHM does not describe his involvement in injuring or killing enemy combatants, whether he was wounded, or his possible experiences with harm to prisoners or civilians, any of which may have contributed to the development of PTSD symptoms e.
It makes sense, therefore, to use measures carefully constructed on the basis of self reports in combination with the MHM to develop comprehensive measures of stressful war-zone experiences. The following is an account of the record-based measures including the MHM and the self-report measures of combat exposure. Foremost among these is the MHM mentioned above, which has been described in detail elsewhere Dohrenwend et al. In brief summary, the composite military historical measure MHM consists of four categories ranging from probable very high to probable low severity of exposure.
Sociodemographic characteristic questionnaire This questionnaire includes sex, age, place of residence, parental information, and family income. Gaza traumatic events checklist Thabet et al. This checklist covers three domains of trauma.
The first domain covers witnessing acts of violence such as the killing of relatives, home demolition, bombardment, and injury of others. The second domain covers hearing experiences such as hearing of the killing or injury of friends or relatives.
The third domain covers personal traumatic events such being shot, injured, or beaten. This includes all 8 items of the original Impact of Events Scale [ 17 ].
A total score was provided, as well as subscale scores for intrusion, arousal and avoidance PTSD symptoms.
A cut-off total score of 19 has been found to predict the presence of anxiety disorder [ 19 ]. This has been developed for children and young people aged The total score ranges betweenand a score of 19 and higher has been found to indicate the likelihood of a depressive disorder. The CDI has been adapted for use with Arab children [ 21 ].
We held a meeting with supervisors of the summer camps to explain the aims of the study. A cover letter was sent to each parent to obtain written permission from them to interview their children in the study and for permission to participate in the study.
Sociodemographic information for the study population was collected from parents. The data was collected by 6 social workers and psychologists who were trained for 4 hours prior to interviewing children inside the summer camps.
Comparing PTSD Among Returning War Veterans
Children were given the self-report instruments to complete, interviewers gathered children into groups of 10 children they read the questions a loud to the children, Children were informed by data collectors that there was no right or wrong answers and that they were free to withdraw from the study at any time.
Children were also informed that if they had questions when completing the scales, they could raise their hands and ask any questions. The data was collected during summer Frequencies and percentages of trauma, PTSD, anxiety, and depression items were calculated.
Independent t test was conduced to find differences between two groups. Linear regression investigated the association between independent traumatic events and PTSD, anxiety, and depression as dependent variable was conducted to find the predictor factors of psychopathology in children.
Results Sociodemographic characteristics of the sample The sample consisted of children, were boys