Returning Home from Iraq and Afghanistan Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and Their Families (2010) / Chapter Skim
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3 SUMMARY OF FINDINGS FROM PREVIOUS CONFLICTS
3 SUMMARY OF FINDINGS FROM PREVIOUS CONFLICTS
Pages 39-60
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From page 39... ...
Although diagnoses such as PTSD [posttraumatic stress disorder] were not formally defined and adopted until the 1970's [formalized by inclusion in the third edition of the Diagnostic and Statistical Manual of Mental Disorders in 1980]
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From page 40... ...
deeds of veterans of the Trojan wars, as amply documented in the Iliad and the Odyssey and retold for Roman audiences in the Aeneid. Several Shakespearean plays refer to acute stress reactions and include particularly adverse characterizations of a "nefarious collection of war veterans," including Sir John Falstaff, Richard III, Iago, Macbeth, and Cassius.
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From page 41... ...
explicitly included epidemiologic studies of veterans of World War II, the Korean War, and more recent conflicts. The research evidence base on those cohorts is much narrower than that on cohorts of the Vietnam War and more recent conflicts, but evidence of persistent effects, especially with regard to psychologic consequences and PTSD, was observed in those who served in the earlier wars.
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From page 42... ...
. Comparative studies of health status among war cohorts have found that combat exposure and violence are generally associated with psychiatric disorders in World War II, Korean Conflict, and Vietnam-era veterans (Archibald and Tuddenham, 1965; Breslau and Davis, 1987; Elder and Clipp, 1989; Fontana and Rosenheck, 1994a; National Center for Posttraumatic Stress Disorder, 2008)
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From page 43... ...
Findings based on the proxy measures controlling for combat exposure indicated that 72% of Vietnam-veteran participants began their military service before 1969, 34% had a tactical primary Military Occupational Specialty, and 57% served in a combat unit (infantry, artillery, armor, cavalry, or engineer)
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From page 44... ...
In contrast, current PTSD prevalence estimates based on the same comprehensive assessment procedure among other era veterans were 2.5% in men and 1.1% in women and among civilian counterparts were 1.2% in men and 0.3% in women. Estimates of lifetime prevalence in Vietnam veterans, based on semistructured clinical interviews, were 30.9% in men and 26.9% in women.
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From page 45... ...
. More important, the NVVRS documented that the prevalence of major depression was closely related to the prevalence of PTSD: the prevalence of current major depression was 15.7% in male Vietnam veterans with current PTSD and 0.5% in those without and 23.0% in female veterans with current PTSD and 2.3% in those without.
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From page 46... ...
Similar secondary analyses that examined those relationships in female Vietnam veterans (Zatzick et al., 1997) found significant associations of current PTSD with five of the six domains with sociodemographic characteristics controlled and that the association remained with three domains (compromised physical health, bed days in preceding 2 weeks, and current unemployment)
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From page 47... ...
Findings indicated that Army veterans experienced excess deaths due to external causes, laryngeal cancer, and lung cancer, and Marine Corps veterans experienced excess deaths due to external causes. With the larger sample, it was possible to attribute the earlier finding of excess Marine Corps deaths to a lower-than-expected number of deaths in marines who had not served in Vietnam rather than to an excess in those who had.
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From page 48... ...
did extensive modeling of the correlates of PTSD prevalence among the multiple quasiexperimental comparison groups included in the design, such as high versus low–moderate war-zone stressor-exposure groups of theater veterans, theater veterans versus era veterans. The modeling found that the differences between groups in PTSD prevalence observed in the NVVRS cannot be explained fully by differences in premilitary characteristics or exposures, although there are important premilitary risk factors for combat-related PTSD.
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From page 49... ...
. In response to growing concerns about the physical and psychologic health of Gulf War veterans of the 1990–1991 conflict, Congress passed two laws in 1998, PL 105-277 and PL 105368, directing the secretary of veterans affairs, through the National Academy of Sciences, to review and evaluate the scientific and medical literature regarding associations between illness and exposure to toxic agents, environmental or wartime hazards, and preventive medicines or vaccines in members of the armed forces who were exposed to such agents and to identify "other
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From page 50... ...
Those results and growing concerns regarding the nature of OEF and OIF and the deployment of the veterans resulted in a more comprehensive review and evaluation of physiologic, psychologic, and psychosocial effects of deployment-related stress on military veterans from World War II through the conflicts in Afghanistan and Iraq, which placed the associations observed in 1991 Persian Gulf War veterans in this broader context (IOM, 2008)
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From page 51... ...
It was not until World War I that specific clinical syndromes came to be associated with combat duty; previously, such casualties were assumed to reflect poor discipline or cowardice. However, before the Vietnam War, psychiatric consensus held that soldiers who recovered from an episode of mental breakdown during combat would suffer no adverse longterm consequences, and psychiatric disability commencing after the war was believed to result from pre-existing conditions (Pols and Oak, 2007)
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From page 52... ...
Military personnel in Afghanistan and Iraq have been exposed to most of the circumstances and experiences of traditional combat seen in previous wars, but a signature and growing feature of the Iraq war in particular (and steadily growing in Afghanistan) is exposure to the tactics of insurgency warfare and guerilla attacks -- including suicide and car bombs, IEDs, sniper fire, and rocket-propelled grenades -- some of which are reminiscent of the Vietnam War.
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From page 53... ...
reviewed 22 epidemiologic studies of returnees from deployment to OEF and OIF and found that only one included clinical diagnostic assessment for PTSD and other psychiatric disorders. The other 21 studies identified "cases" solely on the basis of brief, self-report screening scales or from medical records.
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From page 54... ...
2000. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.
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From page 55... ...
1998. Risk factors for DSM-III-R posttraumatic stress disorder: Findings from the National Comorbidity Survey.
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1997. Posttraumatic stress disorder among female Vietnam veterans: A causal model of etiology.
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1999. Posttraumatic stress disorder in a national sample of female and male Vietnam veterans: Risk factors, war-zone stressors, and resilience-recovery variables.
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In Posttraumatic Stress Disorder: A Comprehensive Approach to Research and Treatment, edited by P Saigh and J
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1997. Posttraumatic stress disorder and functioning and quality of life in a nationally representative sample of male Vietnam veterans.
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