Presentation on theme: "Milton Lasoski, PhD New Mexico Veterans Affairs Health Care System"— Presentation transcript:
1Milton Lasoski, PhD New Mexico Veterans Affairs Health Care System COMBAT PTSDMilton Lasoski, PhDNew Mexico Veterans AffairsHealth Care System
2Various Reactions PTSD is only a Possible Path DepressionAnxietyPhobiasSubstance AbuseAggressionAdjustment
3Acknowledgements for use of Slides Gregory A. Leskin, Ph.D. National Center for PTSDAPA Sub-Committee on Resiliency and TerrorismJose Canive, MD New Mexico VAHCSMatthew Friedman PTSD 101 Course
4PTSDA. Traumatic event experienced with fear, helplessness, horror, extreme distressB. Re-experiencing (Intrusion)C. AvoidanceD. HyperarousalE. Symptoms present for 1 month or moreF. Distress social/occupational function
5Acute Stress Disorder (ASD): Criterion Three dissociative symptomsDerealizationNumbing or detachmentReduced awareness of surroundingsDepersonalizationDissociative amnesia
6Acute 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.
7B: Re-experiencing SXS (1) needed Distressing intrusive recollectionsDistressing Dreams of the eventReliving the experience (flashbacks)Distress at exposure to remindersPhysiological reactivity at exposure to trauma reminders
8C: Avoidance/Numbing SXS (3) needed Avoid thoughts/feelings that remindAvoid activities/situations that remindInability to recall aspects of the traumaDiminished interest in activitiesDetachment/Estrangement from othersRestricted range of affectSense of foreshortened future
9D: Hyperarousal Symptoms (2) needed Difficulty falling/staying asleepIrritability or outbursts of angerDifficulty concentratingHypervigilanceExaggerated startle
16PTSD SELF Report (Hoge, et al) Screened Positive and witnessed CasualtiesScreened Negative and witnessed Casualties80%48%
17PTSD SELF Report (Hoge, et al) OIF Vets who accessed MH SVS at least one timeScreened Positive for Mental Health Problems and accessed MH SVS1/360%
18Anxiety depression and PTSD four months after trauma 16 (43.8%)5124MDD 30ANX 3111 (36.7%)319 (61%)None (n=141)(67%)18
19PTSD Prevalence in US Adults National Comorbidity Survey NCS-Replication (2005)Large national probability samples (Ns > 5000)Benchmark for prevalence of mental disorders in USLifetime PTSD prevalence = 6.8% (NCS-R)9.7% women3.6% menCurrent PTSD prevalence = 3.6% (NCS-R)5.2% women1.8% men
20Prevalence Of Trauma And PTSD More Than 60% Experience A Traumatic Event In Their Life More Than 25% Experience Multiple Traumatic EventsKessler et al., 1999
21Combat Exposure in the NCS Lifetime prevalence of PTSD = 39% among combat veteransMale combat vs. all other male traumaHigher lifetime PTSD prevalenceGreater likelihood of delayed onsetGreater likelihood of unresolved symptoms
22Lifetime prevalence rates of trauma and their association with PTSD (%) Men WomenEvent PTSD Event PTSDNatural DisasterCriminal AssaultCombatRapeAny traumaKessler et al (1995)
23PTSD Prevalence in Vietnam Veterans National Vietnam Veterans Readjustment StudyLarge, nationally-representative sample of theater and era veterans and civilians (N >3000)Lifetime prevalence31% men, 26% womenCurrent prevalence ( )15% men, 8% women
24Lifetime Prevalence: Vietnam Veterans* SW American Indian 45%NP American Indian 57%Hispanic 34%African American 35%White %*NVVRS and Matsunaga: 8-year difference
25Prevalence of PTSD from Other Wars Gulf War veterans1:Population sample of over 11,000 Gulf War veteransCurrent 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 Epidemiology2 Hoge, et al. (2004). New England Journal of Medicine
26Military studies Risk Factors Effect Size Adverse Childhood .27 Trauma SeverityLack of social support
27PTSD Course in Veterans 214 Israeli combat veteransAssessed 1, 2, 3 & 20 years post-warDelayed 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.
28Longitudinal Course Of PTSD 94%Most People Who Develop PTSDRecover From It% w/PTSD symptoms47%42%?25%-15%W3m9mYearsShalev & Yehuda, 1999.
29PTSD and Comorbidity in the NCS PTSD elevated the odds of comorbidity in men & women
30Social 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.
31Social 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.
32Longitudinal Course Of PTSD 94%Most People Who Develop PTSDRecover From It% w/PTSD symptoms47%42%?25%-15%W3m9mYearsShalev & Yehuda, 1999.