1. Milton Lasoski, PhD New Mexico Veterans Affairs Health Care System
COMBAT PTSD
Milton Lasoski, PhD
New Mexico Veterans Affairs
Health Care System

2. Various Reactions PTSD is only a Possible Path
Depression
Anxiety
Phobias
Substance Abuse
Aggression
Adjustment

3. Acknowledgements for use of Slides
Gregory A. Leskin, Ph.D. National Center for PTSD
APA Sub-Committee on Resiliency and Terrorism
Jose Canive, MD New Mexico VAHCS
Matthew Friedman PTSD 101 Course

4. PTSD
A. Traumatic event experienced with fear, helplessness, horror, extreme distress
B. Re-experiencing (Intrusion)
C. Avoidance
D. Hyperarousal
E. Symptoms present for 1 month or more
F. Distress social/occupational function

5. Acute Stress Disorder (ASD): Criterion
Three dissociative symptoms
Derealization
Numbing or detachment
Reduced awareness of surroundings
Depersonalization
Dissociative amnesia

6. Acute Stress Disorder (ASD): How predictive is it?
Prospective studies find that a high proportion of those diagnosed with ASD develop PTSD.
However, in terms of people who eventually developed PTSD, about half of those met criteria for ASD.

7. B: Re-experiencing SXS (1) needed
Distressing intrusive recollections
Distressing Dreams of the event
Reliving the experience (flashbacks)
Distress at exposure to reminders
Physiological reactivity at exposure to trauma reminders

8. C: Avoidance/Numbing SXS (3) needed
Avoid thoughts/feelings that remind
Avoid activities/situations that remind
Inability to recall aspects of the trauma
Diminished interest in activities
Detachment/Estrangement from others
Restricted range of affect
Sense of foreshortened future

9. D: Hyperarousal Symptoms (2) needed
Difficulty falling/staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Hypervigilance
Exaggerated startle

10. Active Duty Self Report (Hoge,etal) PTSD/ GAD/ Depression
Pre-Deployment
OEF Post-Deployment
OIF Post-Deployment 9%
11%
15—17%

11. Active Duty Self Report (Hoge,etal) ETOH Abuse
17%
24%
35%
Pre-Deployment
OEF Post-Deployment
OIF Post-Deployment

12. Active Duty Self Report (Hoge,etal) PTSD and Reported Firefights
4.5% % %
NO firefights
1-2 firefights
5 or more firefights

13. PD Health Assessment and MH Sxs Utilization (Hoge, et al)
Peace Keeping Deployment
OEF Post-Deployment
OIF Post-Deployment
8.5%
11.3%
19.1%

14. PD Health Assessment and MH Sxs Utilization (Hoge, et al)
Active Military
National Guard
Women
Men
18.4%
21%
23.6%
18.6%

15. PTSD SELF Report (Hoge, et al)
Peace Keeping Deployment
OEF Post-Deployment
OIF Post-Deployment
2.1%
4.7%
9.8%

16. PTSD SELF Report (Hoge, et al)
Screened Positive and witnessed Casualties
Screened Negative and witnessed Casualties
80%
48%

17. PTSD SELF Report (Hoge, et al)
OIF Vets who accessed MH SVS at least one time
Screened Positive for Mental Health Problems and accessed MH SVS
1/3
60%

18. Anxiety depression and PTSD four months after trauma
16 (43.8%) 5 12 4
MDD 30
ANX 31
11 (36.7%) 3
19 (61%)
None (n=141)(67%) 18

19. PTSD Prevalence in US Adults
National Comorbidity Survey NCS-Replication (2005)
Large national probability samples (Ns > 5000)
Benchmark for prevalence of mental disorders in US
Lifetime PTSD prevalence = 6.8% (NCS-R)
9.7% women
3.6% men
Current PTSD prevalence = 3.6% (NCS-R)
5.2% women
1.8% men

20. Prevalence Of Trauma And PTSD
More Than 60% Experience A Traumatic Event In Their Life More Than 25% Experience Multiple Traumatic Events
Kessler et al., 1999

21. Combat Exposure in the NCS
Lifetime prevalence of PTSD = 39% among combat veterans
Male combat vs. all other male trauma
Higher lifetime PTSD prevalence
Greater likelihood of delayed onset
Greater likelihood of unresolved symptoms

22. Lifetime prevalence rates of trauma and their association with PTSD (%)
Men Women
Event PTSD Event PTSD
Natural Disaster
Criminal Assault
Combat
Rape
Any trauma
Kessler et al (1995)

23. PTSD Prevalence in Vietnam Veterans
National Vietnam Veterans Readjustment Study
Large, nationally-representative sample of theater and era veterans and civilians (N >3000)
Lifetime prevalence
31% men, 26% women
Current prevalence ( )
15% men, 8% women

24. Lifetime Prevalence: Vietnam Veterans*
SW American Indian 45%
NP American Indian 57%
Hispanic 34%
African American 35%
White %
*NVVRS and Matsunaga: 8-year difference

25. Prevalence of PTSD from Other Wars
Gulf War veterans1:
Population sample of over 11,000 Gulf War veterans
Current PTSD prevalence = 10%
Afghanistan2:
Army (N=1962)
Current PTSD prevalence = %
Iraq2:
Army (N=894), current PTSD prevalence = 13-18%
Marine (N=815), current PTSD prevalence = 12-20%
1 Khan, Natelson, Mahan, Kyung, & Frances (2003). Amer. J. of Epidemiology
2 Hoge, et al. (2004). New England Journal of Medicine

26. Military studies Risk Factors Effect Size Adverse Childhood .27
Trauma Severity
Lack of social support

27. PTSD Course in Veterans
214 Israeli combat veterans
Assessed 1, 2, 3 & 20 years post-war
Delayed onset of PTSD at Yr 20:
No PTSD at Yr 1: 34.5%
No PTSD at Yr 3: 31.6%
No PTSD Yrs 1-3: 8.6% .
Shalev & Yehuda, 1999.

28. Longitudinal Course Of PTSD
94%
Most People Who Develop PTSD
Recover From It
% w/PTSD symptoms
47%
42% ?
25%-15% W 3m 9m
Years
Shalev & Yehuda, 1999.

29. PTSD and Comorbidity in the NCS
PTSD elevated the odds of comorbidity in men & women

30. Social Support Issues To disclose or not to disclose. (Bolton et al
Self-disclosure about events to significant others/ military personnel was related to lower levels of PTSD severity.  
The reactions to self-disclosure by partner/spouse, family, friends, and other military personnel were significantly associated with PTSD symptoms severity. In each instance, more positive reactions were related to lower levels of PTSD symptoms severity.

31. Social Support Issues To disclose or not to disclose. (Bolton et al
Social Support Issues To disclose or not to disclose? (Bolton et al., 2003), Cont.
No differences were detected in PTSD symptoms between veterans whose disclosures were met with an overall negative or nonvalidating response and those who did not disclose at all.
This later finding suggests that negative or nonvalidating responses by other to self-disclosure may negate the potentially beneficial effects of discussing the experience.
However, it may also indicate that there are equally negative effects of not disclosing when the alternative is disclosure followed by a negative response.

32. Longitudinal Course Of PTSD
94%
Most People Who Develop PTSD
Recover From It
% w/PTSD symptoms
47%
42% ?
25%-15% W 3m 9m
Years
Shalev & Yehuda, 1999.