Association Of Posttraumatic Stress Disorder Research Articles

Association between posttraumatic stress disorder and inflammation: a twin study.

The association of posttraumatic stress disorder (PTSD) with cardiovascular disease risk may be mediated by inflammation. Our objective was to examine the association between PTSD and measures of inflammation and to determine whether these associations are due to shared familial or genetic factors. We measured lifetime history of PTSD using the Structured Clinical Interview for DSM-IV in 238 male middle-aged military veteran twin pairs (476 individuals), selected from the Vietnam Era Twins Registry, who were free of cardiovascular disease at baseline. We assessed inflammation using levels of high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), fibrinogen, white blood cells, vascular cell adhesion molecule-1, and intercellular adhesion molecule-1 (ICAM-1). Geometric mean levels and percent differences by PTSD were obtained from mixed-model linear regression analyses with adjustment for potential confounders. Within-pair analysis was conducted to adjust for shared family environment and genetics (monozygotic pairs). Overall, 12.4% of participants had a lifetime history of PTSD. Adjusted mean levels of hsCRP and ICAM-1 were significantly higher among those with vs. without PTSD [hsCRP: 1.75 vs. 1.31mg/l (33% difference); ICAM-1: 319 vs. 293ng/ml (9% difference)]. Adjustment for depression rendered the association of PTSD with hsCRP non-statistically significant. For IL-6, no consistent association was seen. Within-pair analysis produced associations that were similar in direction for all three markers but lesser in magnitude for hsCRP and IL-6. There was no evidence of interaction by zygosity. Elevated hsCRP and ICAM-1 are associated with PTSD, and these associations may be confounded by shared non-genetic, antecedent familial and environmental factors.

Relationship between posttraumatic stress disorder and Type 2 Diabetes in a population-based cross-sectional study with 2970 participants

ObjectivesTo evaluate the association of posttraumatic stress disorder (PTSD) with type 2 diabetes (T2D) or prediabetes in a large population-based sample. MethodsIn 2970 subjects (aged 32–81years) drawn from the population-based cross-sectional study KORA F4 from the Augsburg region (Southern Germany) a PTSD screening was performed employing the Posttraumatic Diagnostic Scale, the Impact of Event Scale, and interview data. The exposure variable PTSD was sub-classified into partial and full PTSD and additionally in subjects with traumatic event but no PTSD” to “The exposure variable PTSD was classified into (1) no traumatic event (2) traumatic event, but no PTSD, (3) partial PTSD, (4) full PTSD. A total of 50 (1.7%) subjects qualified for full PTSD, whereas 261 (8.8%) qualified for partial PTSD. A total of 333 subjects (11.2%) suffered from T2D and 498 (16.8%) from prediabetes as assessed by an oral glucose tolerance test and physicians’ validation. The associations of PTSD with T2D and prediabetes were estimated by multinomial logistic regression analyses with adjustments for sociodemographic characteristics, metabolic risk factors or psychopathological conditions. ResultsIn the model adjusted for sociodemographic characteristics and metabolic risk factors, full PTSD was significantly associated with T2D (OR: 3.90, 95% CI: 1.61–9.45, p=0.003) compared to subjects with no traumatic event. Significance remained after additional adjustment for other psychopathological conditions (OR: 3.56, 95% CI: 1.43–8.85, p=0.006). Regarding prediabetes, no significant associations were observed. ConclusionsSuffering from PTSD might activate chronic stress symptoms and trigger physiological mechanisms leading to T2D. Prospective studies are needed to investigate temporal and causal relationships between PTSD and T2D.

Concerns about medications mediate the association of posttraumatic stress disorder with adherence to medication in stroke survivors

Post-traumatic stress disorder (PTSD) can be a consequence of acute medical events and has been associated with non-adherence to medications. We tested whether increased concerns about medications could explain the association between PTSD and non-adherence to medication in stroke survivors. We surveyed 535 participants aged 40 years or older who had at least one stroke or transient ischaemic attack in the previous 5 years. We assessed PTSD using the PTSD checklist-specific for stroke, medication adherence with the Morisky Medication Adherence Questionnaire, and beliefs about medications with the Beliefs about Medicines Questionnaire. We used logistic regression to test whether concerns about medications mediated the association between stroke-induced PTSD and non-adherence to medication. Covariates for adjusted analyses included age, sex, race, comorbid medical conditions, stroke-related disability, years since last stroke/TIA, and depression. Symptoms of PTSD were correlated with greater concerns about medications (r = 0.45; p < .001), and both were associated with medication non-adherence. Adjustment for concerns about medications attenuated the relationship between PTSD and non-adherence to medication, from an odds ratio [OR] of 1.04 (95% confidence interval [CI], 1.01-1.06; OR, 1.63 per 1 SD) to an OR of 1.02 (95% CI, 1.00-1.05; OR, 1.32 per 1 SD), and increased concerns about medications remained associated with increased odds of non-adherence to medication (OR, 1.17; 95% CI, 1.10-1.25; OR, 1.72 per 1 SD) in this fully adjusted model. A bootstrap mediation test suggested that the indirect effect was statistically significant and explained 38% of the association of PTSD to medication non-adherence, and the direct effect of PTSD symptoms on medication non-adherence was no longer significant. Increased concerns about medications explain a significant proportion of the association between PTSD symptoms and non-adherence to medication in stroke survivors.

Risk of Incarceration and Other Characteristics of Iraq and Afghanistan Era Veterans in State and Federal Prisons

The Health Care for Reentry Veterans (HCRV) program provides Veterans Health Administration outreach services to veterans incarcerated in state and federal prisons. This study used HCRV data to compare risk of incarceration of veterans of Operations Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND) and other veterans and to identify sociodemographic and clinical characteristics of incarcerated veterans of OEF/OIF/OND. Administrative national data were analyzed for 30,968 incarcerated veterans, including 1,201 OEF/OIF/OND veterans, contacted from October 2007 to April 2011. Odds ratios were calculated comparing the risk of incarceration among OEF/OIF/OND and other veterans in the HCRV sample and in a weighted sample of nonincarcerated veterans from the 2010 National Survey of Veterans. Stepwise logistic regressions of HCRV data examined characteristics of incarcerated veterans independently associated with OEF/OIF/OND service. Regardless of ethnicity or age, OEF/OIF/OND veterans were less than half as likely as other veterans to be incarcerated and constituted only 3.9% of the incarcerated veterans. Compared with other incarcerated veterans, OEF/OIF/OND veterans were younger, were more likely to be married, were more likely to report combat exposure, expected a shorter incarceration, were 26% less likely to have a diagnosis of drug abuse or dependence, and were three times more likely to have combat-related posttraumatic stress disorder (PTSD). OEF/OIF/OND veterans appeared to be at lower risk of incarceration than veterans of other service eras, but those who were incarcerated had higher rates of PTSD. Efforts to link these veterans to mental health services upon their release are warranted.

Exposure-Based PTSD Therapy Doesn’t Worsen Drug Abuse

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessExposure-Based PTSD Therapy Doesn’t Worsen Drug AbuseAaron LevinAaron LevinSearch for more papers by this authorPublished Online:21 Sep 2012https://doi.org/10.1176/pn.47.18.psychnews_47_18_20-aAbstractThe association of posttraumatic stress disorder (PTSD) with substance dependence is no random pairing.As many as 65 percent of patients with PTSD have a comorbid substance use disorder, and up to 62 percent of people with substance dependence have PTSD, according to sources cited by Katherine Mills, Ph.D., in a new study of combined PTSD/substance dependence therapy. Mills is a senior lecturer in the National Drug and Alcohol Research Centre at the University of New South Wales in Sydney, Australia.“Substance abuse may follow PTSD as a way of coping with stress or as an avoidance strategy,” noted Paula Schnurr, Ph.D. “Or it can predate and lead to PTSD by encouraging risky behavior that results in trauma.”However, many clinicians have worried that exposure-based therapy could increase those stresses and cause patients to revert to primary coping strategies such as substance abuse, said Schnurr, deputy executive director of the Department of Veterans Affairs’ National Center for PTSD in White River Junction, Vt., and a research professor of psychiatry at Dartmouth Medical School, in an interview with Psychiatric News.Nevertheless, exposure-based therapies are the standard for treating PTSD, and conventional wisdom has held that prolonged exposure should be used only with patients who have been off substances for some time.The truth of that belief was unknown, however, since substance-dependent subjects have usually been excluded from other than pilot studies of combined therapies.Now Mills and colleagues have presented evidence indicating that such fears may be misplaced.The researchers randomized 103 patients to receive either “usual treatment” for substance dependence—that is, anything available in the community, or usual treatment plus a modified version of COPE—Concurrent Treatment of PTSD and Cocaine Dependence.The participants were 34 years old on average; 62 percent were women and 80 percent had a history of injection drug use. Most had experienced noncombat trauma exposure, such as sexual or physical assault, or accidents or disasters.The COPE protocol included 13 individual sessions with a therapist, cognitive-behavioral therapy for substance use, psychoeducation, and in-vivo and imaginal exposure.After nine months of treatment, symptom severity had decreased in both groups. “However, the treatment group demonstrated a significantly greater reduction in PTSD symptom severity,” said the researchers in the August 15 Journal of the American Medical Association.There was also no significant difference in changes in substance use or in depression, or anxiety symptoms, but those symptoms did not worsen either.“The complex trauma, substance use, and psychiatric presentations commonly found among individuals with PTSD and substance dependence should not be a deterrent to providing trauma-focused treatment,” concluded Mills and colleagues.“This study may minimize potential benefits of combined therapy,” said Schnurr. “It provides evidence that such treatment doesn’t create other problems, although I’m surprised and a little disappointed that the treatment didn’t help with substance dependence symptoms.”While the COPE treatment protocol called for 13 sessions, participants attended a median number of only five sessions. Perhaps a greater number of therapy sessions attended or a different type of treatment might have made a difference, she said.However, the fact that the study report appears in a journal of wide general circulation will help communicate the importance of the topic, said Schnurr.“My hope is that people pay attention to this study,” she said. “Opinions have changed over time about whether people who have PTSD and substance abuse can engage in PTSD care. Many people still believe that these people were fragile and that treating PTSD would increase substance abuse. I hope that this paper changes some minds in that regard, because I worry that people have not received the treatment that they need and that they could benefit from.” “Integrated Exposure-Based Therapy for Co-occurring Posttraumatic Stress Disorder and Substance Dependence” is posted at http://jama.jamanetwork.com/article.aspx?articleid=1346186#Abstract. ISSUES NewArchived

Association of posttraumatic stress disorder with increased prevalence of autoimmune disorders in Iraq and Afghanistan veterans

Association of posttraumatic stress disorder with increased prevalence of autoimmune disorders in Iraq and Afghanistan veterans

Trauma Exposure and PTSD Symptoms among Homeless Mothers: Predicting Coping and Mental Health Outcomes

This longitudinal study investigated associations of posttraumatic stress disorder (PTSD) symptoms from prior trauma with coping with a subsequent stressor and with psychological symptoms. Seventy homeless mothers provided information about previous trauma history and posttraumatic stress symptoms at baseline; coping and psychological symptoms were assessed 15 months later. Results revealed moderately high levels of PTSD in this sample. PTSD symptomatology was related to increased avoidant coping, which mediated the relationship between previous trauma and subsequent psychological symptom severity. implications for future research and interventions to reduce the negative impact of trauma in homelesswomen are discussed.

The Association of Posttraumatic Stress Disorder with Fast Food and Soda Consumption and Unhealthy Weight Loss Behaviors Among Young Women

This study examines the association of posttraumatic stress disorder (PTSD) symptoms with fast food and soda consumption, unhealthy dieting behaviors, and body mass index (BMI) in a group of young women. This study was conducted on cross-sectional data gathered from 3181 females 16-24 years of age attending five publicly funded clinics in Texas. The associations among PTSD, fast food consumption frequency, soda consumption frequency, unhealthy dieting behaviors, and BMI were examined using binary and ordinal logistic regression. PTSD symptoms were associated with an increased frequency of consumption of fast food and soda as well as unhealthy dieting behaviors but not with increased body mass index (BMI). PTSD symptoms adversely affect both eating and dieting behaviors of young women. These behaviors may have negative long-term consequences for the health of females with PTSD symptoms.

Potential Association of Posttraumatic Stress Disorder and Decreased Bone Mineral Density in Repatriated Prisoners of War

We conducted a retrospective evaluation of bone mineral density data collected during routine medical follow-up evaluations of 241 Vietnam-era male repatriated prisoners of war, with and without the lifetime diagnosis of posttraumatic stress disorder (PTSD), and 79 subjects in a comparison group. Dual-energy X-ray absorptiometry scans evaluated total hip and lumbar spine T-scores. A multivariate analysis of covariance was performed on the data using age, body mass index, ethnicity, and reported alcohol consumption as covariates. There was a significant effect of group on total hip, but not lumbar spine, T-scores. Pairwise comparisons revealed statistically lower total hip T-scores in repatriates with a lifetime history of PTSD in comparison to both the comparison group and repatriates without a lifetime history of PTSD. In this study of elderly repatriated prisoners of war, we noted an association between a lifelong history of PTSD and decreased bone mineral density at the hip.

Chronic social defeat stress disrupts regulation of lipid synthesis

Several psychiatric disorders increase the risk of cardiovascular disease, including posttraumatic stress disorder and major depression. While the precise mechanism for this association has not yet been established, it has been shown that certain disorders promote an unfavorable lipid profile. To study the interaction of stress and lipid dysregulation, we utilized chronic social defeat stress (CSDS), a mouse model of chronic stress with features of posttraumatic stress disorder and major depression. Following exposure to CSDS, mice were given access to either regular chow or a Western-style diet high in fat and cholesterol (HFD). The combination of social stress and HFD resulted in significant perturbations in lipid regulation, including two key features of the metabolic syndrome: increased plasma levels of non-HDL cholesterol and intrahepatic accumulation of triglycerides. These effects were accompanied by a number of changes in the expression of hepatic genes involved in lipid regulation. Transcriptional activity of LXR, SREBP1c, and ChREBP were significantly affected by exposure to HFD and CSDS. We present CSDS as a model of social stress induced lipid dysregulation and propose that social stress alters lipid metabolism by increasing transcriptional activity of genes involved in lipid synthesis.

Posttraumatic Stress Disorder and Pain Impact Functioning and Disability After Major Burn Injury

This study sought to clarify the prospective and concurrent associations of posttraumatic stress disorder (PTSD) and pain with functioning and disability after burn injury. The sample was composed of consecutive patients admitted to a regional burn center with major burn injuries (N = 171) who were followed at 1, 6, 12, and 24 months postdischarge. The predictor measures were the McGill Pain Questionnaire and Davidson Trauma Scale, and the outcome measures were Short Form-36 Health Survey subscales administered at 6, 12, and 24 months after discharge. Linear mixed-effects analyses were conducted to evaluate pain and PTSD as predictors of functional outcomes. Higher PTSD symptom severity soon after hospital discharge was prospectively related to poorer physical and social functioning and greater psychosocial disability (P < .001). However, significant PTSD-by-time interactions also predicted future physical functioning and disability, indicating that the deleterious effects of early PTSD were ameliorated by time. In addition, at each follow-up, PTSD symptoms were concurrently related to greater physical and psychosocial disability, poorer social functioning, and less vitality (P < .001). More severe pain at each follow-up, but not PTSD, was correlated with poorer concurrent physical functioning (P < .002). Significant interaction terms indicated that the concurrent effect of PTSD on psychosocial disability, social functioning, and vitality attenuated during the 24-month recovery period. These findings suggest that assessing PTSD and pain following burn injury may aid in predicting future functioning. Future work should confirm this and evaluate whether aggressively treating both PTSD and pain helps improve functioning after major burn injury.

TCT-177: Association of Post-traumatic Stress Disorder and the Severity of Coronary Artery Disease Diagnosed by Computed Tomography Angiography

TCT-177: Association of Post-traumatic Stress Disorder and the Severity of Coronary Artery Disease Diagnosed by Computed Tomography Angiography

Association of posttraumatic stress disorder with low-grade elevation of C-reactive protein: Evidence from the general population

Background Posttraumatic stress disorder (PTSD) has been associated with several somatic diseases, and low-grade inflammation may be one psychobiological mechanism mediating this relationship. We assessed the association between PTSD and elevated serum levels of C-reactive protein (CRP; >3 mg/L) in a large general population sample. Methods About 3049 adults living in the community were included in the present study. CRP, lipoproteins and triglycerides were determined. Participants were also examined with regard to blood pressure, body mass index (BMI), physical activity, comorbid somatic diseases, medication, daily alcohol intake, and depression. Results PTSD was diagnosed in 55 participants (1.8%), and low-grade inflammation (i.e. CRP >3 mg/L) was found in 701 subjects (23.0%). PTSD positive participants had significantly higher odds for elevated CRP values than those without PTSD (OR = 2.27; 95% CI: 1.32–3.93). Even after adjusting for sex, age, other sociodemographic factors, BMI, blood pressure, lipoproteins and triglycerides, physical activity, comorbid somatic diseases, daily alcohol intake, and trauma exposure, there were almost twofold higher odds for elevated CRP levels in participants with PTSD compared to those without PTSD (OR = 1.87; 95% CI: 1.05–3.35). Conclusions Our findings suggest a close relationship between PTSD and low-grade inflammation possibly representing one psychobiological pathway from PTSD to poor physical health, particularly with respect to cardiovascular and pulmonary disease as well as diabetes.

Association of posttraumatic stress disorder with increased prevalence of metabolic syndrome.

Few studies have compared prevalence rates of metabolic abnormalities in antipsychotic-treated patients with different psychiatric disorders, including posttraumatic stress disorder (PTSD). In this study, we examined components of metabolic syndrome among middle-aged and older patients with psychiatric disorders. In the study, 203 outpatients older than 40 years and with psychotic symptoms that needed antipsychotic treatment were enrolled. Among them, 65 had a diagnosis of schizophrenia, 56 had dementia, 49 had mood disorder, and 33 had PTSD. Clinical evaluations included medical history, use of psychotropic and other medications, adverse effects, physical examination, and clinical laboratory tests for metabolic profiles. Overall, the prevalence rates of metabolic syndrome were 72% in patients with PTSD, 60% in those with schizophrenia, 58% in those with mood disorder, and 56% in those with dementia. There were significant differences in body mass index, diastolic blood pressure, waist circumference, and high-density lipoprotein cholesterol among the 4 diagnostic groups. Posttraumatic stress disorder, schizophrenia, and mood disorder groups had significantly higher body mass indexes compared with the dementia group. The PTSD group also had significantly higher diastolic blood pressure compared with the dementia and mood disorder groups. Posttraumatic stress disorder may be associated with worsened metabolic profile. The overall frequency of metabolic syndrome and its components in patients with PTSD taking antipsychotics seemed to be at least equivalent, if not slightly worse, compared with that in patients with schizophrenia, dementia, or a mood disorder.

The association of posttraumatic stress disorder and metabolic syndrome: a study of increased health risk in veterans

BackgroundThere is accumulating evidence for a link between trauma exposure, posttraumatic stress disorder (PTSD) and diminished health status. To assess PTSD-related biological burden, we measured biological factors that comprise metabolic syndrome, an important established predictor of morbidity and mortality, as a correlate of long-term health risk in PTSD.MethodsWe analyzed clinical data from 253 male and female veterans, corresponding to five factors linked to metabolic syndrome (systolic and diastolic blood pressure, waist-to-hip ratio and fasting measures of high-density lipoprotein (HDL) cholesterol, serum triglycerides and plasma glucose concentration). Clinical cut-offs were defined for each biological parameter based on recommendations from the World Health Organization and the National Cholesterol Education Program. Controlling for relevant variables including sociodemographic variables, alcohol/substance/nicotine use and depression, we examined the impact of PTSD on metabolic syndrome using a logistic regression model.ResultsTwo-fifths (40%) of the sample met criteria for metabolic syndrome. Of those with PTSD (n = 139), 43% met criteria for metabolic syndrome. The model predicted metabolic syndrome well (-2 log likelihood = 316.650, chi-squared = 23.731, p = 0.005). Veterans with higher severity of PTSD were more likely to meet diagnostic criteria for metabolic syndrome (Wald = 4.76, p = 0.03).ConclusionThese findings provide preliminary evidence linking higher severity of PTSD with risk factors for diminished health and increased morbidity, as represented by metabolic syndrome.

Screening for Sexual Trauma Improves Access to Care

Back to table of contents Previous article Next article Professional NewsFull AccessScreening for Sexual Trauma Improves Access to CareAaron LevinAaron LevinSearch for more papers by this authorPublished Online:18 Jan 2008https://doi.org/10.1176/pn.43.2.0002Routine screening of veterans for a history of sexual trauma that occurred while in military service is an efficient way to identify affected individuals and increase their access to care, according to an analysis of Veterans Health Administration records.The Department of Veterans Affairs (VA) mandated universal screening for military sexual trauma (MST) for both men and women beginning in 1999. Screening was backed by an offer of “all appropriate care and services” to treat sexual trauma occurring during military service.“It was important to evaluate this system to see if universal screening was appropriate and if the use of mental health services increased afterward,” said Rachel Kimerling, Ph.D., of the Veterans Administration Health Care System in Palo Alto, Calif., at the International Society for Traumatic Stress Studies meeting in Baltimore last November.An article by Kimerling and colleagues on the same research appeared in the December 2007 American Journal of Public Health.The definition of military sexual trauma includes sexual assault and sexual harassment, coercion, and unwanted sexual attention. Sexual trauma in the armed forces may involve complicating factors that lack parallels in the civilian world. Such events, or the fear of reporting them, may disrupt the victim's career path, since perpetrators may be peers or supervisors. Reporting sexual trauma may also be seen as a form of betrayal of unit solidarity, one of the highest values in military organizations.“This means that victims must continue to live and work closely with their perpetrators, often leading to an increased sense of feeling helpless, powerless, and at risk for additional victimization,” wrote Amy Street, Ph.D., and Jane Stafford, Ph.D., in the “Iraq War Clinician Guide” published by the VA's National Center for Posttraumatic Stress Disorder.Kimerling and colleagues used the Veterans Health Administration (VHA) Out-patients Events File to identify more than 4 million men and 185,000 women who made at least one visit to a VHA medical facility in 2003. The VHA uses a computerized medical record with a pop-up reminder that prompts clinicians to screen for sexual trauma. The reminder stays on the screen until the clinician enters a response.The sexual-trauma screening includes just two questions: “While you were in the military: (a) Did you receive uninvited and unwanted sexual attention, such as touching, cornering, pressure for sexual favors, or verbal remarks? (b) Did someone ever use force or threat of force to have sexual contact with you against your will?”Data from 2003 were available for 134,894 women and 2,900,106 men. Although the screening is called “universal,” only about 70 percent of patients were screened. That rate is not far below rates of screening for alcohol abuse (80 percent) or cervical cancer (90 percent) in the VA.Both men and women with positive screens were more likely to be white, younger, never married, and have a service-connected disability than those who screened negative. Men who screened positive were likely to be separated or divorced, as well.The rates of positive responses to the MST screen were much higher for women than for men, but the preponderance of men in the VA system meant that absolute numbers were similar. About 22 percent of women (29,418) screened positive, compared with 1 percent of men (31,797).“This highlights the issue of military sexual trauma in males,” said Kimerling.Women were three times and men twice as likely to have a psychiatric diagnosis if they also screened positive for MST.The association of posttraumatic stress disorder, alcohol use, and anxiety disorders with MST was stronger among women. The relationship of adjustment disorder, bipolar disorder, and schizophrenia or other psychoses to MST was stronger among men.Only a few nonpsychiatric medical conditions were associated with MST, including weight loss, obesity, and hypothyroidism among women; AIDS among men; and chronic lung or liver disease among both. Risky health behaviors that may lead to these conditions are more frequent among patients exposed to trauma than others.On average, screening 5.5 women and 7.2 men moved one person into treatment, said Kimerling. “Universal screening is efficient and increases access to care.”The study marks just the beginning of bringing to light the“ significant burden” of morbidity related to military sexual trauma, she emphasized.An abstract of “The Veterans Health Administration and Military Sexual Trauma” is posted at<www.ajph.org/cgi/content/abstract/97/12/2160>.▪ ISSUES NewArchived

Association of Trauma and PTSD Symptoms With Openness to Reconciliation and Feelings of Revenge Among Former Ugandan and Congolese Child Soldiers

Tens of thousands of the estimated 250,000 child soldiers worldwide are abused or have been abused during the last decade in Africa's Great Lakes Region. In the process of rebuilding the war-torn societies, it is important to understand how psychological trauma may shape the former child soldiers' ability to reconcile. To investigate the association of posttraumatic stress disorder (PTSD) symptoms and openness to reconciliation and feelings of revenge in former Ugandan and Congolese child soldiers. Cross-sectional field study of 169 former child soldiers (aged 11-18 years) in rehabilitation centers in Uganda and the Democratic Republic of the Congo, conducted in 2005. Potentially traumatic war-related experiences assessed via a sample-specific events scale; PTSD symptoms assessed using the Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI), with a score of 35 or higher indicating clinically important PTSD symptoms; and openness to reconciliation and feelings of revenge assessed via structured questionnaires. Children participating in this study were a mean of 15.3 years old. These former child soldiers reported that they had been (violently) recruited by armed forces at a young age (mean [SD], 12.1 [2] years), had served a mean of 38 months (SD, 24 months), and had been demobilized a mean of 2.3 months before data collection (SD, 2.4 months). The children were exposed to a high level of potentially traumatic events (mean [SD], 11.1 [2.99]). The most commonly reported traumatic experiences were having witnessed shooting (92.9%), having witnessed someone wounded (89.9%), and having been seriously beaten (84%). A total of 54.4% reported having killed someone, and 27.8% reported that they were forced to engage in sexual contact. Of the 169 interviewed, 59 (34.9%; 95% confidence interval, 34.4%-35.4%) had a PTSD symptom score higher than 35. Children who showed more PTSD symptoms had significantly less openness to reconciliation (rho= -0.34, P < .001) and more feelings of revenge (rho= 0.29, P < .001). PTSD symptoms are associated with less openness to reconciliation and more feelings of revenge among former Ugandan and Congolese child soldiers. The effect of psychological trauma should be considered when these children are rehabilitated and reintegrated into civilian society.

Multiple Physical Illnesses Common In Iraq War Veterans With PTSD

Back to table of contents Previous article Next article Professional NewsFull AccessMultiple Physical Illnesses Common In Iraq War Veterans With PTSDAaron LevinAaron LevinSearch for more papers by this authorPublished Online:19 Jan 2007https://doi.org/10.1176/pn.42.2.0004aPosttraumatic stress disorder (PTSD) is closely linked to physical symptoms in soldiers a year after their return from Iraq, even after controlling for wounds or injuries.Combat veterans reporting significant symptoms of either physical illness or PTSD should be evaluated for both conditions, said the latest report on postcombat mental health from the Walter Reed Institute of Research in Silver Spring, Md. The study was published in the January American Journal of Psychiatry.The researchers sur veyed 2,863 soldiers from four U.S. Army combat infantry brigades a year after their return from duty in Iraq. The soldiers were asked about their overall health, as well as alcohol misuse, symptoms of depression and PTSD, sick-call visits, missed work days, and somatic symptoms. Unlike with most screening questionnaires, the soldiers responded anonymously. Soldiers completed the 17-item National Center for PTSD Checklist, the Patient Health Questionnaire Depression Scale–9, and an alcohol screening test. The Patient Health Questionnaire–15 was used to assess somatic symptoms.About 80 percent of the participants were under age 30, 97 percent were male, 56 percent were enlisted personnel, and 17 percent had been injured or wounded.Overall prevalence of PTSD was 16.6 percent. A comparable group of soldiers recorded a prevalence of 5 percent before deployment. However, of those wounded or injured at least once, 31.8 percent (150 of 471) met PTSD criteria, compared with 13.6 percent (311 of 2,287) of unwounded troops (odds ratio=2.97).The veterans who screened positive for PTSD also had poor self-rated health, two or more sick-call visits, and two or more missed workdays even after controlling for combat injuries.About 47 percent of soldiers screening positive for PTSD rated their physical health as fair or poor, compared with 20 percent of those who screened negative. Also, 71 percent of those with PTSD reported sleep problems, compared with 26 percent without PTSD (see chart).“Approximately one-third of the soldiers who screened positive for PTSD had high somatic symptom severity.. .confirming the strong association between PTSD and indicators of physical health independent of physical injury,” wrote Charles Hoge, M.D., and colleagues from Walter Reed.This association may be mediated by biological, psychological, behavioral, or attentional processes, they suggested.The study may be limited by its reliance on self-reports rather than clinician interviews. Although the respondents were not selected randomly, they do represent soldiers who have been most heavily exposed to combat.The results may also be a conservative reflection of the soldiers' health since those who might have been hospitalized or going to medical appointments on the days the surveys were taken were excluded.Physicians and other health professionals in the military services, the Department of Veterans Affairs, and civilian primary and specialty practices should evaluate both the physical and mental health of combat veterans, Hoge and his team concluded.“Association of Posttraumatic Stress Disorder With Somatic Symptoms, Health Care Visits, and Absenteeism Among Iraq War Veterans” is posted at<www.ajp.psychiatryonline.org/cgi/content/full/164/1/150>.▪ ISSUES NewArchived

Association of Posttraumatic Stress Disorder With Somatic Symptoms, Health Care Visits, and Absenteeism Among Iraq War Veterans

Studies of soldiers from prior wars conducted many years after combat have shown associations between combat-related posttraumatic stress disorder (PTSD) and physical health problems. The current Iraq war has posed a considerable PTSD risk, but the association with physical health has not been well studied. The authors studied 2,863 soldiers using standardized self-administered screening instruments 1 year after their return from combat duty in Iraq. Among all participants, 16.6% met screening criteria for PTSD. PTSD was significantly associated with lower ratings of general health, more sick call visits, more missed workdays, more physical symptoms, and high somatic symptom severity. These results remained significant after control for being wounded or injured. The high prevalence of PTSD and its strong association with physical health problems among Iraq war veterans have important implications for delivery of medical services. The medical burden of PTSD includes physical health problems; combat veterans with serious somatic concerns should be evaluated for PTSD.

Association of Posttraumatic Stress Disorder With Somatic Symptoms, Health Care Visits, and Absenteeism Among Iraq War Veterans

Association of Posttraumatic Stress Disorder With Somatic Symptoms, Health Care Visits, and Absenteeism Among Iraq War Veterans