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

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Presentation on theme: "COMBAT PTSD Milton Lasoski, PhD New Mexico Veterans Affairs Health Care System."— Presentation transcript:

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

2 Various Reactions PTSD is only a Possible Path DepressionDepression AnxietyAnxiety PhobiasPhobias Substance AbuseSubstance Abuse AggressionAggression AdjustmentAdjustment

3 Acknowledgements for use of Slides Gregory A. Leskin, Ph.D. National Center for PTSDGregory A. Leskin, Ph.D. National Center for PTSD APA Sub-Committee on Resiliency and TerrorismAPA Sub-Committee on Resiliency and Terrorism Jose Canive, MD New Mexico VAHCSJose Canive, MD New Mexico VAHCS Matthew Friedman PTSD 101 Course 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 symptomsThree 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.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.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 recollectionsDistressing intrusive recollections Distressing Dreams of the eventDistressing Dreams of the event Reliving the experience (flashbacks)Reliving the experience (flashbacks) Distress at exposure to remindersDistress at exposure to reminders Physiological reactivity at exposure to trauma remindersPhysiological reactivity at exposure to trauma reminders

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

9 D: Hyperarousal Symptoms (2) needed Difficulty falling/staying asleepDifficulty falling/staying asleep Irritability or outbursts of angerIrritability or outbursts of anger Difficulty concentratingDifficulty concentrating HypervigilanceHypervigilance Exaggerated startleExaggerated startle

10 Active Duty Self Report (Hoge,etal) PTSD/ GAD/ Depression Pre-DeploymentPre-Deployment OEF Post- DeploymentOEF Post- Deployment OIF Post- DeploymentOIF Post- Deployment 9%9% 11%11% 1517%1517%

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

12 Active Duty Self Report (Hoge,etal) PTSD and Reported Firefights NO firefightsNO firefights 1-2 firefights1-2 firefights 5 or more firefights5 or more firefights 4.5%4.5% % % % %

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

14 PD Health Assessment and MH Sxs Utilization (Hoge, et al) PD Health Assessment and MH Sxs Utilization (Hoge, et al) Active MilitaryActive Military National GuardNational Guard WomenWomen MenMen 18.4%18.4% 21%21% 23.6%23.6% 18.6%18.6%

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

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

17 PTSD SELF Report (Hoge, et al) PTSD SELF Report (Hoge, et al) OIF Vets who accessed MH SVS at least one timeOIF Vets who accessed MH SVS at least one time Screened Positive for Mental Health Problems and accessed MH SVSScreened Positive for Mental Health Problems and accessed MH SVS 1/31/3 60%60%

18 Anxiety depression and PTSD four months after trauma 3 PTSD (43.8%) MDD (36.7%) None (n=141)(67%) ANX (61%)

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 Kessler et al., 1999 More Than 60% Experience A Traumatic Event In Their Life More Than 25% Experience Multiple Traumatic Events

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 MenWomen EventPTSDEvent PTSD Natural Disaster Criminal Assault Combat Rape Any trauma Kessler et al (1995) Lifetime prevalence rates of trauma and their association with PTSD (%)

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%SW American Indian 45% NP American Indian 57%NP American Indian 57% Hispanic34%Hispanic34% African American35%African American35% White20%White20% *NVVRS and Matsunaga: 8-year difference

25 Prevalence of PTSD from Other Wars Gulf War veterans 1 : –Population sample of over 11,000 Gulf War veterans –Current PTSD prevalence = 10% Afghanistan 2 : –Army (N=1962) –Current PTSD prevalence = % Iraq 2 : –Army (N=894), current PTSD prevalence = 13-18% –Marine (N=815), current PTSD prevalence = 12-20% 1 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 FactorsEffect Size Adverse Childhood.27 Trauma Severity.26 Lack of social support.43

27 PTSD Course in Veterans Shalev & Yehuda, 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%

28 Most People Who Develop PTSD Recover From It Longitudinal Course Of PTSD 94% 47% 42% 25%-15% 3mW9mYears % w/PTSD symptoms Shalev & Yehuda, ?

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., 2003) Self-disclosure about events to significant others/ military personnel was related to lower levels of PTSD severity.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.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., 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 Most People Who Develop PTSD Recover From It Longitudinal Course Of PTSD 94% 47% 42% 25%-15% 3mW9mYears % w/PTSD symptoms Shalev & Yehuda, ?


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