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      Veterans are not the only ones suffering from posttraumatic stress symptoms: what do we know about dependents’ secondary traumatic stress?

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          Abstract

          Purpose

          Previous research has mainly focused on veterans’ mental health problems, especially on posttraumatic stress disorder (PTSD). Less is known about the impact that the veteran’s experienced potentially traumatic events (PTEs) might have on their significant others. Therefore, we reviewed the scientific literature to find out what is known about the prevalence of secondary traumatic stress (STS) in significant others of veterans.

          Methods

          We systematically searched Pubmed, PsycINFO, Embase, Cochrane Library and PILOTS for relevant articles. This search resulted in 3100 records from which we included 48 articles.

          Results

          Two studies that reported on parental PTSD did not find evidence that parents were affected by their offspring’s experience. Nine studies that reported on PTSD in mainly adult children of veterans found only scant evidence that children were affected by their parent’s experienced PTE. Twenty-seven studies investigated PTSD symptoms in partners of veterans. Here results varied largely between studies with PTSD rates between 0 and 51 %.

          Conclusions

          Overall, we found the strongest evidence of STS in partners of help-seeking veterans with PTSD. The lack of clarity provided by the currently available evidence suggests a pressing need for further work to examine this subject in more detail.

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          Most cited references51

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          Maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors.

          Linda M. Bierer, Rachel Yehuda, James Schmeidler … (2008)
          A significant association between parental PTSD and the occurrence of PTSD in offspring has been noted, consistent with the idea that risk for the development of PTSD is transmitted from parent to child. Two recent reports linking maternal PTSD and low offspring cortisol prompted us to examine the relative contributions of maternal vs. paternal PTSD in the prediction of PTSD and other psychiatric diagnoses in offspring. One hundred seventeen men and 167 women, recruited from the community, were evaluated using a comprehensive psychiatric battery designed to identify traumatic life experiences and lifetime psychiatric diagnoses. 211 of these subjects were the adult offspring of Holocaust survivors and 73 were demographically comparable Jewish controls. Participants were further subdivided based on whether their mother, father, neither, or both parents met diagnostic criteria for lifetime PTSD. A higher prevalence of lifetime PTSD, mood, anxiety disorders, and to a lesser extent, substance abuse disorders, was observed in offspring of Holocaust survivors than controls. The presence of maternal PTSD was specifically associated with PTSD in adult offspring of Holocaust survivors. However, other psychiatric diagnoses did not show specific effects associated with maternal PTSD. The tendency for maternal PTSD to make a greater contribution than paternal PTSD to PTSD risk suggests that classic genetic mechanisms are not the sole model of transmission, and paves way for the speculation that epigenetic factors may be involved. In contrast, PTSD in any parent contributes to risk for depression, and parental traumatization is associated with increased anxiety disorders in offspring.
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            A latent class analysis of dissociation and posttraumatic stress disorder: evidence for a dissociative subtype.

            Erika Wolf, Mark W Miller, Annemarie Reardon … (2012)
            The nature of the relationship of dissociation to posttraumatic stress disorder (PTSD) is controversial and of considerable clinical and nosologic importance. To examine evidence for a dissociative subtype of PTSD and to examine its association with different types of trauma. A latent profile analysis of cross-sectional data from structured clinical interviews indexing DSM-IV symptoms of current PTSD and dissociation. The VA Boston Healthcare System and the New Mexico VA Health Care System. A total of 492 veterans and their intimate partners, all of whom had a history of trauma. Participants reported exposure to a variety of traumatic events, including combat, childhood physical and sexual abuse, partner abuse, motor vehicle accidents, and natural disasters, with most participants reporting exposure to multiple types of traumatic events. Forty-two percent of the sample met the criteria for a current diagnosis of PTSD. Item-level scores on the Clinician-Administered PTSD Scale. A latent profile analysis suggested a 3-class solution: a low PTSD severity subgroup, a high PTSD severity subgroup characterized by elevations across the 17 core symptoms of the disorder, and a small but distinctly dissociative subgroup that composed 12% of individuals with a current diagnosis of PTSD. The latter group was characterized by severe PTSD symptoms combined with marked elevations on items assessing flashbacks, derealization, and depersonalization. Individuals in this subgroup also endorsed greater exposure to childhood and adult sexual trauma compared with the other 2 groups, suggesting a possible etiologic link with the experience of repeated sexual trauma. These results support the subtype hypothesis of the association between PTSD and dissociation and suggest that dissociation is a highly salient facet of posttraumatic psychopathology in a subset of individuals with the disorder.
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              Posttraumatic stress disorder associated with combat service in Iraq or Afghanistan: reconciling prevalence differences between studies.

              Charles W Hoge, R Herrell, Jonathan B Kok … (2012)
              Studies of posttraumatic stress disorder (PTSD) prevalence associated with deployment to Iraq or Afghanistan report wide variability, making interpretation and projection for research and public health purposes difficult. This article placed this literature within a military context. Studies were categorized according to deployment time-frame, screening case definition, and study group (operational infantry units exposed to direct combat versus population samples with a high proportion of support personnel). Precision weighted averages were calculated using a fixed-effects meta-analysis. Using a specific case definition, the weighted postdeployment PTSD prevalence was 5.5% (95% CI, 5.4-5.6) in population samples and 13.2% (12.8-13.7) in operational infantry units. Both population-level and unit-specific studies provided valuable and unique information for public health purposes; understanding the military context is essential for interpreting prevalence studies.
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                Author and article information

                Contributors
                Julia Diehle: julia.diehle@kcl.ac.uk
                Journal
                Journal ID (nlm-ta): Soc Psychiatry Psychiatr Epidemiol
                Journal ID (iso-abbrev): Soc Psychiatry Psychiatr Epidemiol
                Title: Social Psychiatry and Psychiatric Epidemiology
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0933-7954
                ISSN (Electronic): 1433-9285
                Publication date (Electronic): 21 October 2016
                Publication date PMC-release: 21 October 2016
                Publication date (Print): 2017
                Volume: 52
                Issue: 1
                Pages: 35-44
                Affiliations
                [1 ]King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK
                [2 ]Department of Psychological Medicine, King’s College London, London, UK
                [3 ]Academic Department of Military Mental Health, Department of Psychological Medicine, King’s College London, London, UK
                Article
                Publisher ID: 1292
                DOI: 10.1007/s00127-016-1292-6
                PMC ID: 5227001
                PubMed ID: 27770173
                SO-VID: ce47bd9e-588e-49f8-9669-767988c3a708
                Copyright © © The Author(s) 2016
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 1 April 2016
                Date accepted : 10 October 2016
                Funding
                Funded by: Help for Heroes
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © Springer-Verlag Berlin Heidelberg 2017

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: ptsd,sts,vicarious trauma,veterans,family
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: ptsd, sts, vicarious trauma, veterans, family

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