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      Research on PTSD prevalence in OEF/OIF Veterans: expanding investigation of demographic variables

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          Abstract

          Background

          A series of recent articles has reported on well-designed studies examining base rates of posttraumatic stress disorder (PTSD) screenings within the Operation Enduring Freedom (Afghanistan conflict)/Operation Iraqi Freedom (Iraq conflict) (OEF/OIF) military population. Although these studies have a number of strengths, this line of research points out several key areas in need of further examination.

          Objective

          Many OEF/OIF Veterans do not use available Veterans Affairs (VA) services, especially mental health care. This highlights the need to understand the differences between those who use and do not use the VA, especially as research with pre-OEF/OIF Veterans suggests that these two groups differ in significant ways. The high rates of PTSD-related concerns in non-VA users also points to a need to understand whether—and where—Veterans are seeking care outside the VA and the accessibility of evidence-based, trauma-focused treatments in the community and private sectors. Careful examination of relationship status is also paramount as little research has examined relationship status or other relationship context issues. Social support, especially from a spouse, can buffer the development of PTSD; however, relationship discord has the potential to greatly exacerbate PTSD symptomatology. Furthermore, given the additional risk factors for sexual minority Veterans to be exposed to trauma, the 2011 repeal of the US Military “Don't Ask, Don't Tell” policy, and the emergence of the VA as likely the largest health care provider for sexual minority Veterans, it will be critically important to study the trauma and mental health experiences of this group.

          Conclusions

          Studies that examine prevalence rates of PTSD in the returning cohort contribute significantly to our understanding of the US OEF/OIF military population. Further study of PTSD in relation to demographic variables such as VA and non-VA use, relationship status, and sexual orientation will provide rich data that will enhance our ability to develop policy and practice to provide the best care to this population.

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          Cognitive processing therapy for sexual assault victims.

          Patricia Resick, Monica Schnicke (1992)
          Cognitive processing therapy (CPT) was developed to treat the symptoms of posttraumatic stress disorder (PTSD) in rape victims. CPT is based on an information processing theory of PTSD and includes education, exposure, and cognitive components. Nineteen sexual assault survivors received CPT, which consists of 12 weekly sessions in a group format. They were assessed at pretreatment, posttreatment, and 3- and 6-month follow-up. CPT subjects were compared with a 20-subject comparison sample, drawn from the same pool who waited for group therapy for at least 12 weeks. CPT subjects improved significantly from pre- to posttreatment on both PTSD and depression measures and maintained their improvement for 6 months. The comparison sample did not change from the pre- to the posttreatment assessment sessions.
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            New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study.

            Tyler C Smith, Margaret A K Ryan, Deborah L. Wingard … (2008)
            To describe new onset and persistence of self reported post-traumatic stress disorder symptoms in a large population based military cohort, many of whom were deployed in support of the wars in Iraq and Afghanistan. Prospective cohort analysis. Survey enrolment data from the millennium cohort (July 2001 to June 2003) obtained before the wars in Iraq and Afghanistan. Follow-up (June 2004 to February 2006) data on health outcomes collected from 50 184 participants. Self reported post-traumatic stress disorder as measured by the posttraumatic stress disorder checklist-civilian version using Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. More than 40% of the cohort were deployed between 2001 and 2006; between baseline and follow-up, 24% deployed for the first time in support of the wars in Iraq and Afghanistan. New incidence rates of 10-13 cases of post-traumatic stress disorder per 1000 person years occurred in the millennium cohort. New onset self reported post-traumatic stress disorder symptoms or diagnosis were identified in 7.6-8.7% of deployers who reported combat exposures, 1.4-2.1% of deployers who did not report combat exposures, and 2.3-3.0% of non-deployers. Among those with self reported symptoms of post-traumatic stress disorder at baseline, deployment did not affect persistence of symptoms. After adjustment for baseline characteristics, these prospective data indicate a threefold increase in new onset self reported post-traumatic stress disorder symptoms or diagnosis among deployed military personnel who reported combat exposures. The findings define the importance of post-traumatic stress disorder in this population and emphasise that specific combat exposures, rather than deployment itself, significantly affect the onset of symptoms of post-traumatic stress disorder after deployment.
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              Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration.

              Bradley Karlin, Josef Ruzek, Kathleen M. Chard … (2010)
              Unlike the post-Vietnam era, effective, specialized treatments for posttraumatic stress disorder (PTSD) now exist, although these treatments have not been widely available in clinical settings. The U.S. Department of Veterans Affairs (VA) is nationally disseminating 2 evidence-based psychotherapies for PTSD throughout the VA health care system. The VA has developed national initiatives to train mental health staff in the delivery of Cognitive Processing Therapy (CPT) and Prolonged Exposure therapy (PE) and has implemented a variety of strategies to promote local implementation. In this article, the authors examine VA's national CPT and PE training initiatives and report initial patient, therapist, and system-level program evaluation results. Key issues, lessons learned, and next steps for maximizing impact and sustainability are also addressed. Published 2010. This article is a US Government work and is in the public domain in the USA.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur J Psychotraumatol
                Journal ID (iso-abbrev): Eur J Psychotraumatol
                Journal ID (publisher-id): EJPT
                Title: European Journal of Psychotraumatology
                Publisher: Co-Action Publishing
                ISSN (Print): 2000-8198
                ISSN (Electronic): 2000-8066
                Publication date (Electronic): 12 May 2015
                Publication date Collection: 2015
                Volume: 6
                Electronic Location Identifier: 10.3402/ejpt.v6.27322
                Affiliations
                [1 ]Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
                [2 ]Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
                [3 ]Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
                [4 ]Department of Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
                [5 ]Operational Stress Injury Clinic, Deer Lodge Centre, Winnipeg, MB, Canada
                [6 ]Psychology Service, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
                [7 ]Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
                Author notes
                [* ]Correspondence to: Lynnette A. Averill, Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Avenue, Bldg. 1, 9th Floor, 151E, West Haven, CT 06516, USA, Email: lynnette.averill@ 123456yale.edu

                Responsible Editor: Chris Brewin, University College London, United Kingdom.

                Article
                Publisher ID: 27322
                DOI: 10.3402/ejpt.v6.27322
                PMC ID: 4430556
                PubMed ID: 25971312
                SO-VID: bcde567e-87bd-4ae1-a7cc-f3c9ae76eacb
                Copyright © © 2015 Lynnette A. Averill et al.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format, and to remix, transform, and build upon the material, for any purpose, even commercially, under the condition that appropriate credit is given, that a link to the license is provided, and that you indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

                History
                Date received : 18 January 2015
                Date revision received : 30 March 2015
                Date accepted : 01 April 2015
                Categories
                Subject: Short Communication

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: ptsd,military veteran,oef/oif,prevalence rates,demographics,va service use,marital status,relationships,don't ask, don't tell,lgbt
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: ptsd, military veteran, oef/oif, prevalence rates, demographics, va service use, marital status, relationships, don't ask, don't tell, lgbt

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