Longitudinal analyses of family functioning in veterans and their partners across treatment.

Objective: This study evaluated the relations between posttraumatic stress disorder (PTSD) symptoms and poor family functioning in veterans and their partners. Method: Data were collected from Caucasian veterans with PTSD (N = 1,822) and their partners (N = 702); mean age = 53.9 years, SD = 7.36. Veterans completed the Posttraumatic Checklist Military Version (PCL-M) and, along with their partners, completed the McMaster Family Assessment Device (FAD-12). Assessments were conducted at intake into a treatment program at 3 months and 9 months posttreatment. Results: Structural equation models (SEMs) were developed for veterans as well as for veterans and their partners. Poor family functioning for veterans at intake predicted intrusion (β = .08), hyperarousal (β = .07), and avoidance (β = .09) at 3 months posttreatment. At 3 months posttreatment, family functioning predicted hyperarousal (β = .09) and avoidance (β = .10) at 9 months. For veterans and their partners, family functioning at intake predicted avoidance (β = .07) at 3 months, and poor family functioning at 3 months predicted intrusion (β = .09) and hyperarousal (β = .14) at 9 months. The reverse pathways, with PTSD symptoms predicting poor family functioning, were only evident with avoidance (β = .06). Conclusion: Family functioning may play a role in treatment for veterans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The implication of combat-induced stress reaction, PTSD, and attachment in parenting among war veterans.

This study examined parental functioning, parental satisfaction, and concern for offspring during their child's military service, among war veterans, some of whom suffered from acute combat-induced stress reaction (CSR) and posttraumatic stress disorder (PTSD). In addition, we examined the additive and interactive contributions of CSR, PTSD and attachment dimensions to parenting measures. The sample consisted of 477 participants divided into two groups: a clinical group of veterans who had been diagnosed with CSR on the battlefield (N = 267), and a matched control group of veterans who did not suffer from CSR (NCSR; N = 210). CSR, PTSD, avoidant-attachment, and anxious-attachment, were all related to lower levels of parental functioning and satisfaction. Veterans who suffered from both CSR and PTSD reported more concern for their offspring during their child's military service compared to veterans with PTSD but without antecedent CSR. Attachment dimensions and specifically attachment-avoidance, made the greatest contribution to parenting measures, followed by posttraumatic symptoms. In addition, attachment-avoidance moderated the relationship between posttraumatic symptoms and parental functioning. Theoretical and clinical implications of these results are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

PTSD among Israeli former prisoners of war and soldiers with combat stress reaction: a longitudinal study

OBJECTIVE: The aim of this study was to assess the long-term impact of war captivity and combat stress reaction on rates of posttraumatic stress disorder (PTSD) in Israeli veterans of the 1973 Yom Kippur war. METHOD: One hundred sixty-four former prisoners of war (POWs), 112 veterans who had had combat stress reaction, and 184 combat veteran comparison subjects filled out the PTSD Inventory, a self-report scale based on the DSM-III-R criteria for PTSD. The inventory diagnoses past and present PTSD, assesses its intensity, and provides a symptom profile. RESULTS: Thirty-seven percent of the veterans who had had combat stress reaction, 23% of the former POWs, and 14% of the comparison subjects had had diagnosable PTSD at some time in the past. The current rates were 13%, 13%, and 3%, respectively. The results showed different recovery rates over time: almost two-thirds of the veterans with combat stress reaction who had had PTSD in the past recovered, while less than one-half of the POW group showed this improvement. CONCLUSIONS: These findings indicate that small but significant proportions of the POWs and veterans with combat stress reaction were still suffering from PTSD almost two decades after the war. The different recovery rates in the two groups may reflect the differences in duration and severity of stressors, the impact of immediate intervention on long-term adjustment, or both.     

Coping, locus of control, social support, and combat-related posttraumatic stress disorder: A prospective study.

We examined the relations between coping, locus of control, and social support and combat-related posttraumatic stress disorder (PTSD). The sample consisted of 262 Israeli soldiers who suffered a combat stress reaction episode during the 1982 Lebanon war and were followed 2 and 3 years after their participation in combat. Cross-sectional analyses revealed significant relations between locus of control, coping, and social support and PTSD at the two points of assessment. Changes in PTSD from Time 1 to Time 2 were also associated with changes in coping. We discuss theoretical and methodological implications of the findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A confirmatory factor analysis of the Impact of Event Scale using a sample of World War II and Korean War Veterans.

This study assessed the factor structure of the Impact of Event Scale (IES), a measure of intrusion and avoidance, using a sample of World War II and Korean War veterans who had experienced combat 40–50 years earlier. A series of 3 confirmatory factor analytic models were specified and estimated using LISREL 8.3. Model 1 specified a 1-factor model. Model 2 specified a correlated 2-factor model. Model 3 specfied a 2-factor model with additional cross-factor loadings for Items 2 and 12. Model 3 was found to fit the data. In addition, this model was found to be a better explanation of the data than the other models. Also in addition, the correlations between the Intrusion and Avoidance factors and the 4 subscales of the 28-item General Health Questionnaire were examined to determine the distinctiveness of the two IES factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Secondary traumatization among wives of posttraumatic combat veterans: A family typology.

Examined the relationship between family environment and the psychosocial adjustment of 127 wives of Israeli combat stress reaction (CSR) and 85 non-CSR veterans of the 1982 Lebanon War. Wives from conflict-oriented families were found to display the highest levels of psychological and behavioral problems, followed by wives from rigid-moral and midrange families. The healthiest wives in this sample came from expressive families. Results indicate that family environment has a similar effect on all wives, irrespective of whether or not the husband had suffered a wartime stress reaction. Findings show, however, that wives of traumatized veterans have to contend far more often than other wives with conflict and rigidity in family functioning, whereas wives of nontraumatized veterans tend to benefit from an expressive family environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is oxidative stress causally linked to unstable angina pectoris? A study in 100 CAD patients and matched controls

OBJECTIVE: This longitudinal study investigated the health effects of experiences during World War II among veterans by examining how well-being changed across the postwar years and varied by prewar individual attributes. METHOD: The subjects were men from the Stanford-Terman data archives who served in World War II and were born before 1925 (N = 328). Of these veterans, 236 were known to have been overseas during the war, and 64 had remained in the United States; 204 of the men who had been sent overseas experienced combat. Life history records were used to construct measures that described physical and emotional health over a range of time points and intervals in the postwar years. RESULTS: Exposure to combat predicted that a subject would experience physical decline or death during the postwar interval from 1945 to 1960, after the effects of self-reported physical health in 1945 and birth cohort were controlled. Rank and theater of engagement, however, were of little consequence, either additively or in interaction with combat. Self-worth before the war did not moderate the risk of physical decline or death that was associated with combat. CONCLUSIONS: Combat in World War II predicted that in the 15 years after the war, a subject would experience physical decline or death. There was no evidence that the effect of combat was more pronounced among men of different ranks, theaters of engagement, or levels of self-worth in 1940.     

The Australian Vietnam Veterans Health Study: II. self-reported health of veterans compared with the Australian population

BACKGROUND: Self-reported physical health status of Australian Vietnam veterans was determined 20-25 years after the war and its relation to combat was investigated. METHOD: An epidemiological cohort study of a simple random sample of Army veterans posted to Vietnam between 1964 and 1972 was conducted with personal interviews using the Australian Bureau of Statistics Health Interview Survey questionnaire to compare veterans with the Australian population and a 21-item combat exposure index used to measure the relationship of combat to physical health. RESULTS: Veterans reported greater health service usage and more recent health actions than population expectations. They also reported excess health problems in almost all recent illness disease categories except endocrine conditions and cardiovascular conditions; only 6 of 37 chronic disease groups were not elevated compared to the population. Adjustment for non-response changed estimates only slightly. Combat exposure was significantly related to reports of recent and chronic mental disorders, recent hernia and chronic ulcer, recent eczema and chronic rash, deafness, chronic infective and parasitic disease, chronic back disorders and symptoms, signs and ill-defined conditions. CONCLUSION: Combat exposure may have significantly increased reports of only some health problems. A general position to complain as a result of psychological conditions due to combat is not consistent with the lack of relationship between combat and reports of physical conditions.     

Food restriction and binge eating: A study of former prisoners of war.

Food restriction is correlated with binge eating, but evidence that restriction leads to binge eating is scanty. In this study we investigated postwar binge eating in 67 World War II combat veterans and 198 former prisoners of war. As predicted, binge eating was relatively rare in combat veterans but was significantly more prevalent in veterans who, as prisoners in German prisoner of war camps, lost significant amounts of weight during their captivity. Our data thus support the contention that starvation or dieting seems to precede binge eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Course and predictors of posttraumatic stress disorder among Gulf War veterans: A prospective analysis.

Rates and predictors of posttraumatic stress disorder (PTSD) over time are not well understood. This study is the first to look at the rates of PTSD immediately following war and 2 years later using a large cohort (N?=?2,949) of Gulf War veterans. Using a cut score to indicate presumptive PTSD, 3% of participants exceeded the cutoff at Time 1 compared with 8% at Time 2. Those who exceeded the cutpoint at Time 1 were up to 20 times more likely to exceed the cutpoint at Time 2 than those who did not exceed the cutpoint at Time 1. Women and those with high levels of combat exposure were at increased risk for PTSD at both times. Being young, being single, and having previous combat experience were associated with increased risk at Time 1 only, whereas reservists and enlisted personnel were at increased risk at Time 2 only. These findings indicate that, although low initially, rates of PTSD increased substantially over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Combat exposure and adult psychosocial adjustment among U.S. Army veterans serving in Vietnam, 1965–1971.

This study investigated the relationship between combat exposure and adult antisocial behavior in a sample of 2,490 male Army veterans of the Vietnam War who completed questionnaires about their psychological functioning. After adjustment for history of childhood behavior problems, posttraumatic stress disorder diagnosis, and demographic and military characteristics, it was found that veterans who experienced high and very high levels of combat were twice as likely to report adult antisocial behavior as veterans with no or low levels of combat and were also more likely to meet criteria for antisocial personality disorder. The results indicate that exposure to traumatic events during late adolescence or early adulthood is associated with multiple adult adjustment problems in vocational, interpersonal, and societal functioning. Treatment focusing on the effects of the trauma is likely to be necessary but not sufficient for improving affected veterans' behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality patterns among Black, White, and Hispanic combat veterans.

Little is known about racial and ethnic differences in personality pathology in combat veterans. This investigation explored the relationship between race, ethnicity, and personality disorders (PDs) in a sample of 96 combat veterans. Ethnoracial group status was based on self-identification, and the groups were mutually exclusive. PDs were assessed with the MCMI-III, posttraumatic stress disorder (PTSD) was assessed with the Clinician Administered PTSD scale, and combat exposure was assessed with the Combat Exposure Scale. The findings suggest that Hispanic veterans were more likely to have cluster A PDs compared to non-Hispanic veterans, even after controlling for demographics, level of combat exposure, and current PTSD. Implications of the results for the research and treatment of culturally diverse individuals with PDs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of psychotherapeutic treatments for PTSD: a meta-analysis of controlled clinical trials

This meta-analysis synthesized the results from controlled, clinical trials of psychotherapeutic treatments for posttraumatic stress disorder (PTSD). Psychotherapeutic modalities included behavioral, cognitive, and psychodynamic treatments, in group and individual settings. Participants in the studies included combat veterans from the Vietnam and Lebanon Wars, crime-related victims, and severe bereavement sufferers. The impact of psychotherapy on PTSD and psychiatric symptomatology was significant, d = .52, r = .25, when measured immediately after treatments were administered. Similarly, there was no decay in the effect of treatment at follow-up, d = .64, r = .31. Moreover, for target symptomes of PTSD and general psychological symptomes (intrusion, avoidance, hyperarousal, anxiety, and depression), effect sizes were significant, ranging from r's of .2-.49. Results suggest substantial promise for improving psychological health and decreasing related symptoms for those suffering from PTSD.     

Inpatient diagnosis of Posttraumatic Stress Disorder.

Attempted to distinguish among 3 types of inpatient veterans: (a) those with a diagnosis of posttraumatic stress disorder (PTSD) and combat experience; (b) those with a diagnosis other than PTSD and with combat experience; and (c) non-PTSD, noncombat patients. 75 Vietnam-era veterans classified in these groups were administered an assessment battery that included the Minnesota Multiphasic Personality Inventory (MMPI), State-Trait Anxiety Inventory, and Profile of Mood States. Results show no differences among the groups on premorbid variables. PTSD Ss, however, responded in a more pathological direction on psychometric and adjustment variables. A discriminant analysis using these variables correctly classified 85% of the Ss in the 3 groups. Time spent in combat was highly correlated with PTSD variables such as intrusion and numbing experiences; total stress; and symptoms of anxiety, depression, and anger. Results also cross-validate the MMPI-based PTSD scale developed by T. Keane et al (see record 1985-02913-001). (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative life events, coping responses, and combat-related psychopathology: A prospective study.

This study examined the relations of life events and coping responses to combat-related psychopathology among 255 Israeli soldiers who suffered a combat stress reaction episode during the 1982 Lebanon War. Follow-ups 1 and 2 years after their participation in combat found (a) significant effects of psychopathology at 1 year after the war on the occurrence of negative life events and the choice of coping responses during the following year; (b) unique and significant effects of negative life events and coping responses on psychopathology at 2 years after the war; (c) a significant interaction between life events and coping responses on psychopathology; and (d) a significant indirect effect of negative life events on psychopathology via the choice of coping responses. Theoretical implications of the findings were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Together in pain: Attachment-related dyadic processes and posttraumatic stress disorder.

We used actor–partner interdependence modeling to explore associations among attachment-related dyadic processes, posttraumatic stress disorder (PTSD) in war veterans, and secondary traumatic stress (STS) in their wives. A sample of 157 Israeli couples (85 former prisoners of war and their wives and a comparison group of 72 veterans not held captive and their wives) completed self-report scales assessing attachment insecurities (anxiety, avoidance) and PTSD symptoms. For both groups of veterans and their wives, attachment anxiety was associated with the severity of their own and their spouses' PTSD and STS. Avoidant attachment was associated with PTSD and STS only in couples that included a former prisoner of war. A complex pattern of associations involving avoidant attachment was observed in the actor–partner analyses of these couples. The study demonstrates that attachment-related dyadic processes play a role in the development and maintenance of PTSD in traumatized veterans and STS in their wives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Objective versus subjective measurement of stress and social support: Combat-related reactions.

Combat intensity, social support, and related stress reactions were studied among two subject groups: 382 soldiers who experienced combat stress reaction (CSR) during the 1982 Israeli-Lebanon War and a matched control group of 334 soldiers who participated in the same military units but who did not experience CSR. Both objective and subjective indicators of stress and social support were predictive of CSR. Subjective indicators, however, were stronger predictors than objective indicators. Soldiers who later developed posttraumatic stress disorder (PTSD) were more likely to have had CSR, to perceive themselves as having been in more intensive combat, and to have perceived themselves as receiving less social support than soldiers who did not develop PTSD. The CSR was clearly the best predictor of PTSD. The effect of the objective versus the subjective experience of stress and social support is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans.

This study examined (a) the relationships between posttraumatic stress disorder (PTSD) symptom clusters and marital intimacy among Israeli war veterans and (b) the role of self-disclosure and verbal violence in mediating the effects of PTSD avoidance and hyperarousal symptoms on marital intimacy. The sample consisted of 219 participants divided into 2 groups: ex-prisoners of war (ex-POWs; N = 125) and a comparison group of veterans who fought in the same war but were not held in captivity (N = 94). Ex-POWs displayed higher levels of PTSD symptoms and verbal violence and lower levels of self-disclosure than did controls. Although ex-POWs and controls did not differ in level of marital intimacy, they did, however, present a different pattern of relationships between PTSD clusters and intimacy. In ex-POWs, self-disclosure mediated the relations between PTSD avoidance and marital intimacy. Verbal aggression was also found via indirect effect of hyperarousal on marital intimacy. The results point to the importance of self-disclosure and verbal violence as interpersonal mechanisms for the relations between posttraumatic symptoms on marital intimacy of ex-POWs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social relationships and PTSD symptomatology in combat veterans.

The primary purpose of this study is to determine if recent combat veterans discriminate between different sources of social support, and then preliminarily investigate the relationship of social support source on posttraumatic stress disorder (PTSD) symptomatology. Participants included 83 married male combat veterans. Principal-axis factor analysis with equamax rotation observed four distinct latent factors for each source of support examined. ANOVAs were performed to determine the relationship of each source of support from the distinct latent factors on the level of PTSD. Results indicate that the level of PTSD is related to support received from a significant other, F(1, 81) = 30.36, p F(1, 81) = 8.10, p = .006, and military peers, F(1, 81) = 6.70, p = .011, but not friends, F(1, 81) = 1.79, p = .18. In general, higher levels of support from each category were associated with lower levels of PTSD in combat veterans. The results suggest that combat veterans distinguish between specific sources of social support, which may have a protective effect on the level of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention, learning, and memory performances and intellectual resources in Vietnam veterans: PTSD and no disorder comparisons.

Attention, learning, memory, and estimated intellectual potential were examined in 26 Vietnam veterans diagnosed with posttraumatic stress disorder (PTSD) and in 21 Vietnam veterans without mental disorders. Results revealed PTSD-associated cognitive deficits on tasks of sustained attention, working memory, initial learning, and estimated premorbid intelligence but not on measures of focus of attention, shift of attention, or memory savings. Cognitive task performances adjusted for estimated native intelligence remained negatively correlated with PTSD severity. An intellectual measure adjusted for cognitive task performances was negatively correlated with PTSD severity, even after the authors statistically controlled the level of combat exposure. Results suggested that although intellectual resources may constitute a vulnerability-protective factor for PTSD development, PTSD was associated with cognitive impairment independent of intellectual functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)