The Prevalence of PTSD across War Eras and the Effect of Deployment on PTSD:a Systematic Review and Meta-analysis

Abstract

<p>The recent conflicts in Iraq and Afghanistan have rekindled interest in war-related posttraumatic stress disorder (PTSD). Sparked by experiences of returning Vietnam veterans, PTSD was codified in the <CITE>Diagnostic and Statistical Manual of Mental Disorders</CITE>, third edition (DSM-III) in 19801 and became the “signature” illness of this war era. The explicit diagnostic criteria outlined in DSM-III made it possible to conduct large-scale epidemiologic studies of PTSD prevalence. Since then, a number of studies have been conducted, which compare the prevalence of PTSD in military veterans of various war eras who have served in war zones versus those who have not; however, these studies often vary greatly in terms of methodology (eg, criteria for caseness, sample selection, response rates, and exposure assessment) and results. This has made it difficult to compare results both within and between war eras. Our goal was to conduct a systematic review of studies of PTSD prevalence related to deployment status and conduct a meta-analysis to estimate the impact of military deployment by war era on the odds of PTSD among military veterans.</p> <H4>ABOUT THE AUTHORS</H4> <P>Kathryn M. Magruder, MPH, PhD; and Derik E. Yeager, MBS, are with the Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, and the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.</P> <P>Address correspondence to: Kathryn Magruder, MPH, PhD, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston SC 29425; fax 843.805.5782; or e-mail <A HREF="mailto:magrudkm@musc.edu">magrudkm@musc.edu</A>.</p> <P>Dr. Magruder and Dr. Yeager have disclosed no relevant financial relationships.</P> <P>doi: 10.3928/00485713-20090728-04</P> <H4>EDUCATIONAL OBJECTIVES</H4><OL> <P><LI>Summarize the risk of posttraumatic stress disorder (PTSD) that is associated with deployment.</P></LI> <P><LI>Assess how this risk may differ by war era.</P></LI> <P><LI>Evaluate the impact of study methods on PTSD prevalence.</P></LI>