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

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

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 ncptsd@va.gov

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

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

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.

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

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

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

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

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

Active Duty Self Report (Hoge,etal) PTSD and Reported Firefights 4.5% 8.2-9.3% 18.9-19.3% NO firefights 1-2 firefights 5 or more firefights

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%

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

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

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

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%

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

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

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

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

Lifetime prevalence rates of trauma and their association with PTSD (%) Men Women Event PTSD Event PTSD Natural Disaster 18.9 3.7 15.2 5.4 Criminal Assault 11.1 1.8 6.9 21.3 Combat 6.4 38.8 0.0 - Rape 0.7 65.0 9.2 49.5 Any trauma 60.7 8.1 51.2 20.4 Kessler et al (1995)

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 (1986-87) 15% men, 8% women

Lifetime Prevalence: Vietnam Veterans* SW American Indian 45% NP American Indian 57% Hispanic 34% African American 35% White 20% *NVVRS and Matsunaga: 8-year difference

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 = 6-11.5% 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

Military studies Risk Factors Effect Size Adverse Childhood .27 Trauma Severity .26 Lack of social support .43

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.

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.

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

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.

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.

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.