PTSD-diagnosed Veterans Research Articles

0670 Examination of neighborhood disadvantage and sleep in a sample of PTSD-diagnosed Veterans with trauma nightmares

Abstract Introduction The nature of sleep can leave sleepers vulnerable to environmental threats, requiring a balance between the demands for vigilance and the physiological requirement for sleep. Understanding the sleeping context is particularly relevant to understanding the dynamics of sleep disturbance observed in individuals with posttraumatic stress symptoms (PTSS) because of subsequent increased vigilance to threats. This study examined the associations between neighborhood disadvantage, sleep respiratory sinus arrhythmia (RSA), fear of sleep, and nightmare frequency in a sample of trauma-exposed Veterans. Methods Baseline data from an ongoing study examining sleep with trauma nightmares using ambulatory sleep measurement in a sample of U.S. military Veterans were analyzed. Participants completed assessments of nightmare frequency and fear of sleep, and slept on a mattress actigraphy system for at least seven nights, which captured sleep-period RSA as an index of autonomic activation. Neighborhood disadvantage was assessed with the Area Deprivation Index (ADI), a census-based socioeconomic index. For this study, participants’ zip codes were linked to 2020 ADI scores using the Neighborhood Atlas, and the census-block groups were ranked into state-level 1 to 10 deciles (split into halves- low and high). Higher ADI scores indicate greater disadvantage. The differences between the least and most disadvantaged groups were analyzed with binary logistic regression models. Results Data were available from 33 Veterans. The mean state-level ADI was 6.2 (SD = 2.7). Low and high state-level ADI scores were 4.3 (SD = 2, n = 19) and 8.7 (SD = 0.8, n = 14), respectively. Residing in zip codes with greater neighborhood disadvantage was associated with elevated fear of sleep (OR = 1.2, p = 0.04), and a trend for reduced sleep-period RSA (OR = 0.4, p = 0.05). No differences were observed for past week nightmare frequency. Conclusion In this sample of Veterans, living in the most disadvantaged neighborhoods was significantly associated with greater fear of sleep, and may be associated with reduced RSA. Sleep context may increase hypervigilance in turn serving as a mechanism by which trauma-induced sleep disruptions are maintained. Support (if any) Funded by the U.S. Department of Veterans Affairs, Veterans Health Administration Clinical Science Research and Development Service - IK2 CX001874.

Interpersonal trauma histories and relationship functioning among LGB Veteran couples seeking PTSD treatment

ABSTRACT Lesbian, gay, and bisexual (LGB) Veterans report greater emotional distress, trauma exposure, and PTSD rates than both LGB civilians and non-LGB Veterans. Traumatic experiences impact intimate relationships, potentially placing LGB Veterans at higher risk of relationship dysfunction secondary to trauma and PTSD. However, limited research has examined links between relationship functioning and trauma histories among couples with one or more LGB-identifying partners. In this exploratory study, participants include 21 couples from a larger treatment study comprising a PTSD-diagnosed Veteran and their significant other in which at least one partner identified as LGB. Variables included trauma experiences, PTSD symptom severity, and relationship satisfaction. A descriptive analysis revealed high relationship satisfaction despite high interpersonal trauma rates among both PTSD-diagnosed Veterans and their partners. Further, we found different patterns of relationship functioning depending on whether a participant had experienced sexual assault. These initial analyses present novel data on trauma in treatment-seeking LGB veteran couples and provide an important basis for future research on couple-based mental health treatments for this population.

An exploratory case study of the impact of psychiatric service dogs on problematic substance use among PTSD-diagnosed veterans

ABSTRACTBackground: Post-traumatic stress disorder (PTSD) and co-occurring problematic substance use is a health concern among Canadian military veterans. There are complex pathways to their problematic use of substances, including high-risk use of licit and illicit substances both pre and post PTSD diagnosis as well as access to prescribed PTSD medication with a potential for misuse.Methods: This exploratory case study examines whether and how the introduction of a psychiatric service dog (PSD) for veterans diagnosed with PTSD assists with addressing their problematic use of substances, both illicit and licit, including prescribed medications. Veterans’ prescription histories were reviewed one year prior to and one year after their match with a PSD. Interviews were held with the veterans at the second point in time to review their substance use.Results: A PSD assisted with decreasing the veterans’ PTSD symptoms and provided a steady source of additional personalized support. The veterans decreased their problematic use of prescribed and other licit and illicit substances. The veterans also stabilized or decreased their use of prescription medication.Conclusion: Psychiatric service dogs are a potential complementary health practice for PTSD diagnosed veterans who problematically use substances. This finding supports a call for further research.

Trauma treatment for veterans in buprenorphine maintenance treatment for opioid use disorder

IntroductionOpioid use disorder (OUD) rates are high among veterans. PTSD is also prevalent among veterans; those with comorbidity have worse outcomes than those without comorbidity. This study assessed buprenorphine retention rates in veterans initiating OUD treatment, comparing veterans without PTSD to veterans with PTSD who were receiving versus not receiving concurrent trauma treatment. MethodsThis retrospective chart review examined consecutive referrals to buprenorphine maintenance (N = 140). PTSD diagnosis was identified by chart review and retention was defined as continuous buprenorphine maintenance 6-months post-admission. Logistic regression analyses compared buprenorphine retention for veterans without PTSD and PTSD-diagnosed veterans who received concurrent trauma treatment to a reference group of PTSD-diagnosed veterans who did not receive trauma treatment. Models adjusted for opioid type, age, and service-connected status. ResultsSixty-seven (47.9%) buprenorphine-seeking veterans carried a PTSD diagnosis; only 31.3% (n = 21) received trauma treatment while in buprenorphine maintenance, with 11.9% (n = 8) receiving evidence-based psychotherapy for PTSD. Among PTSD-diagnosed veterans who received trauma treatment, 90.5% (n = 19/21) were in buprenorphine maintenance at 6-months, compared to 23.9% (n = 11/46) of PTSD-diagnosed veterans without trauma treatment, and 46.6% (n = 34/73) of veterans without PTSD. In the full model, veterans with trauma treatment had 43.36 times greater odds of remaining in buprenorphine treatment than the reference group. ConclusionsMost PTSD-diagnosed veterans in buprenorphine treatment were not receiving trauma treatment. Those receiving concurrent trauma treatment had better retention, suggesting OUD and trauma can be simultaneously addressed. Future clinical trials should investigate trauma-focused treatment for veterans with comorbid PTSD who are seeking buprenorphine for OUD.

Psychiatric comorbidity and PTSD-related health problems in war veterans: Cross-sectional study

Background and objectivesPTSD rarely occurs on its own and opinions on the correlation between PTSD and its comorbidities are still divided. MethodsTo identify the comorbidity profile of psychiatric diagnoses in PTSD – affected war veterans and to determine the correlation with mental and health problems. Participants and methodsThe experimental group consisted of 154 war veterans with combat-related PTSD. The control group was made of 77 veterans without PTSD. The study applied a general demographic questionnaire, the Harvard Trauma Questionnaire – Bosnia and Herzegovina version and the MINI. ResultsA 97.4% of PTSD-diagnosed veterans satisfied criteria for other mental disorders and that 44.8% suffered chronic somatic problems. More frequently they suffered from current depressive episode (41.6%), past depressive episode (36.4%), depressive episode with melancholic features (36.4%), dysthymia (13.6%), panic disorder with agoraphobia (11.0%), generalized anxiety disorder (82.5%) alcohol abuse (34.4%) and suicidal ideation (26.0%). ConclusionThe study showed that chronic PTSD in war veterans was almost always accompanied by multiple psychiatric and often somatic comorbidities.

Over-reporting bias and the modified Stroop effect in Operation Enduring and Iraqi Freedom veterans with and without PTSD.

The current study investigated in a sample of Operation Enduring and Iraqi Freedom (OEF/OIF) veterans how a symptom overreporting response style might influence the association between PTSD diagnostic status and color-naming response latency for trauma-related stimuli during the Modified Stroop Task (i.e., the Modified Stroop Task effect, MST effect). It was hypothesized that, if an overreporting response style reflected feigning or exaggerating PTSD symptoms, an attenuated MST effect would be expected in overreporters with PTSD as compared with PTSD-diagnosed veterans without an overreporting style. If, however, overreporting stemmed from high levels of distress, the MST effect might be greater in overreporters compared with those with a neutral response style. The results showed that veterans with PTSD and an overreporting response style demonstrated an augmented MST effect in comparison with those with a more neutral style of response. Overreporters also reported greater levels of psychopathology, including markedly elevated reports of dissociative experiences. We suggest that dissociation-prone overreporters may misattribute emotional distress to combat experiences leading to the enhanced MST effect. Other possible explanations for these results are also discussed.

Patterns and Perceptions of Intimate Partner Violence Committed by Returning Veterans with Post-Traumatic Stress Disorder

Data from a recent mixed-methods study conducted among Veterans of Iraq and Afghanistan diagnosed with Post-Traumatic Stress Disorder (PTSD) raise important questions regarding the occurrence of Intimate Partner Violence (IPV) in this population. Three case studies illustrate two main findings. First, Veterans and family members participating in the study described three patterns of partner violence—violence committed in anger; dissociative violence; and parasomniac/hypnopompic violence—suggesting that distinct patterns of IPV may emerge in relation to PTSD symptoms. Second, participants’ descriptions suggest that common ideas about PTSD and war-related suffering can play an important role in influencing how Veterans and their partners respond to episodes of partner violence. It is important for those providing care to PTSD-diagnosed Veterans and their partners to understand when and how partner violence may occur, and how both parties may perceive and respond to it, in order to aid in developing appropriate plans for coping and safety-seeking.

Examining MMPI-2 F-family scales in PTSD-diagnosed veterans of Operation Enduring Freedom and Operation Iraqi Freedom.

Our study examined Minnesota Multiphasic Personality Inventory-2 (MMPI-2) F-family validity scales (F, Fb, F-K, Fp) in treatment-seeking veterans diagnosed with posttraumatic stress disorder (PTSD) related to Operation Enduring or Iraqi Freedom (OEF/OIF). Seventy-nine percent of veterans had F T scores over 65, 54% elevated F over 80 T; and 71% elevated Fb above 65 or 80. Fewer veterans elevated F-K ( 13; 22%) and Fp ( 100 T; 5%). Differences emerged between veterans with and without elevated ( 65 T) F scores on F-family validity scales, clinical scales, and self-report measures of psychopathology. Elevations for F-family validity scales at various cut points are reported.

DOMESTIC VIOLENCE IN VETERANS WITH POSTTRAUMATIC STRESS DISORDER WHO SEEK COUPLES THERAPY

Domestic violence rates among veterans with posttraumatic stress disorder (PTSD) are higher than those of the general population. Individuals who have been diagnosed with PTSD who seek couples therapy with their partners constitute an understudied population. Self-report measures of domestic violence, relationship satisfaction, and intimacy were administered at intake to 179 couples seeking relationship therapy at a Veterans Affairs clinic. Couples in which the veteran was diagnosed with combat-related PTSD were compared with two other groups based on the veteran's primary diagnosis (depression, adjustment disorder/V-code). Both the PTSD- and depression-diagnosed veterans perpetrated more violence than did those with adjustment/V-code diagnoses. Domestic violence rates among depressed and PTSD-diagnosed veterans were much higher than those found in previous research. Implications for assessment and treatment are discussed.

Self-reported problems: a comparison between PTSD-diagnosed veterans, their spouses, and clinicians

This study investigated self-reported problems in a sample of help-seeking Vietnam veterans, comparing the veteran's own view with clinician and spouse perspectives, with the aim of examining convergence in reports across different informants. Veterans with PTSD ( N=459) were asked to list and rate their five most serious problems. Spouses and treating clinicians completed the same questionnaire in relation to the veteran. Rates of endorsement for each problem area, and levels of agreement between raters, were calculated. Veterans, spouses, and clinicians were all likely to rate anger as a high priority, with veterans also likely to nominate anxiety and depression. Spouses were likely to nominate more observable behavioural problems such as interpersonal difficulties and avoidance, while clinicians were likely to nominate indications of psychopathology, such as anxiety, depression, and intrusive thoughts. Agreement across raters was generally high, although interpretation of agreement levels was complex.

Qualitative block design analysis in posttraumatic stress disorder.

Qualitative and quantitative Block Design performance was examined in Vietnam combat veterans with PTSD diagnoses (n = 23) and Vietnam combat veterans without PTSD or other mental disorders diagnoses (n = 19). Results indicated that PTSD-diagnosed veterans committed more single block rotations than the comparison sample, and that their errors occurred more frequently in right hemispace than errors made by the comparison sample. The two groups did not differ in the number of configural errors made, errors committed in left hemispace, or in quantitative performance measures. Findings are suggestive of relative left hemisphere hypoactivation and are congruent with prior research documenting cerebral asymmetries in emotional disorders.

Assessment of Intellectual Resources in Gulf War Veterans: Relationship to PTSD

War stress frequently leads to the subsequent development of psychopathology including posttraumatic stress disorder (PTSD), but recent research has indicated that individual difference factors may alter vulnerability to trauma-related distress. In an effort to examine the potential buffering effects of intellectual resources on PTSD development, this study assessed intellectual functioning in subsets of Persian Gulf War zone veterans with and without PTSD diagnoses. The two subsets, comprised of 18 PTSD-diagnosed and 23 psychopathology-free Persian Gulf War veterans, were compared on a multi-faceted test of intellectual functioning, the Wechsler Adult Intelligence Scale-Revised. As compared to psychopathology-free veterans, PTSD-diagnosed veterans performed significantly more poorly on tasks of verbal intellectual functioning including those tasks thought to reflect premorbid functioning. The two groups did not differ on visuospatial tasks or on a task of attention. Findings suggest that intellectual resources, particularly verbal skills, may buffer development of stress-related psychopathology following trauma exposure.