Structure of posttraumatic stress disorder symptoms and psychosocial functioning in Veterans of Operations Enduring Freedom and Iraqi Freedom.

Posttraumatic stress disorder (PTSD) is one of the most prevalent psychiatric conditions in Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF-OIF), but little is known about the structure of PTSD symptoms, and associations between PTSD symptom clusters and psychosocial functioning in this population. A total of 272 OEF-OIF Veterans in Connecticut completed a mail survey containing measures of psychopathology, resilience, and psychosocial functioning. Confirmatory factor analyses revealed that the 4-factor dysphoria model, which is comprised of separate re-experiencing, avoidance, dysphoria, and hyperarousal symptom clusters, provided the best representation of PTSD symptom structure in this sample. Dysphoria symptoms were independently associated with a broad range of psychosocial measures, even after controlling for age, combat exposure, and other PTSD symptom clusters. Re-experiencing symptoms were associated with alcohol use problems, and avoidance symptoms were associated with increased psychosocial difficulties and decreased perceptions of postdeployment social support. These results suggest that dysphoria symptoms were strongly related to a broad range of psychosocial measures in this sample of OEF-OIF Veterans. Dysphoria symptoms may deserve special attention in the assessment and treatment of symptomatic OEF-OIF Veterans.

Pietrzak RH ，Goldstein MB ，Malley JC ，Rivers AJ ，Southwick SM ... -  《PSYCHIATRY RESEARCH》

Subsyndromal posttraumatic stress disorder is associated with health and psychosocial difficulties in veterans of Operations Enduring Freedom and Iraqi Freedom.

This study examined health and psychosocial correlates of subsyndromal/partial posttraumatic stress disorder (PTSD) and full PTSD in veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). Five hundred and fifty-seven OEF/OIF veterans in Connecticut completed measures of PTSD and health and psychosocial functioning. A total 22.3% of the sample met screening criteria for partial PTSD and 21.5% for full PTSD. Veterans with partial PTSD reported an intermediate level of impairment (e.g., health ratings, work problems, relationship problems) relative to veterans without PTSD and veterans with full PTSD. These results suggest that subsyndromal/partial PTSD is associated with significant health and psychosocial difficulties and underscore the importance of assessing for partial PTSD in OEF/OIF veterans.

Pietrzak RH ，Goldstein MB ，Malley JC ，Johnson DC ，Southwick SM ... -  《-》

Risk and protective factors associated with suicidal ideation in veterans of Operations Enduring Freedom and Iraqi Freedom.

Little is known about variables associated with suicidality in veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). A total of 272 OEF/OIF veterans completed a survey containing measures of psychopathology, resilience, and social support. Thirty-four respondents (12.5%) reported contemplating suicide in the two weeks prior to completing the survey. Suicide contemplators were more likely to screen positive for posttraumatic stress disorder (PTSD), depression, and an alcohol problem, and scored higher on measures of psychosocial difficulties, stigma, and barriers to care, and lower on measures of resilience and social support. Logistic regression analysis revealed that positive PTSD and depression screens, and increased psychosocial difficulties were associated with suicidal ideation, and that increased postdeployment social support and sense of purpose and control were negatively associated with suicidal ideation. Interventions for PTSD, depression, and psychosocial difficulties, and to bolster postdeployment social support and resilience may be helpful in preventing suicidal ideation in OEF/OIF veterans.

Pietrzak RH ，Goldstein MB ，Malley JC ，Rivers AJ ，Johnson DC ，Southwick SM ... -  《-》

Psychological resilience and postdeployment social support protect against traumatic stress and depressive symptoms in soldiers returning from Operations Enduring Freedom and Iraqi Freedom.

A number of studies have examined the prevalence and correlates of posttraumatic stress disorder (PTSD), depression, and related psychiatric conditions in soldiers returning from Operations Enduring Freedom and Iraqi Freedom (OEF/OIF), but none have examined whether factors such as psychological resilience and social support may protect against these conditions in this population. A total of 272 predominantly older reserve/National Guard OEF/OIF veterans completed a mail survey assessing traumatic stress and depressive symptoms, resilience, and social support. Resilience scores in the full sample were comparable to those observed in civilian outpatient primary-care patients. Respondents with PTSD, however, scored significantly lower on this measure and on measures of unit support and postdeployment social support. A hierarchical regression analysis in the full sample suggested that resilience (specifically, increased personal control and positive acceptance of change) and postdeployment social support were negatively associated with traumatic stress and depressive symptoms, even after adjusting for demographic characteristics and combat exposure. These results suggest that interventions to bolster psychological resilience and postdeployment social support may help reduce the severity of traumatic stress and depressive symptoms in OEF/OIF veterans.

Pietrzak RH ，Johnson DC ，Goldstein MB ，Malley JC ，Southwick SM ... -  《-》

An examination of the relation between combat experiences and combat-related posttraumatic stress disorder in a sample of Connecticut OEF-OIF Veterans.

Combat exposure is an important risk factor for posttraumatic stress disorder (PTSD). However, little research has examined specific combat experiences associated with PTSD and confirmatory factor analytically (CFA)-derived re-experiencing, avoidance, dysphoria, and hyperarousal symptom clusters. A total of 285 predominantly older National Guard/Reservist OEF-OIF Veterans completed an anonymous mail survey that assessed demographics and deployment history, a broad range of combat experiences, PTSD, and unit and postdeployment social support. Personally witnessing someone from one's unit or an ally unit being seriously wounded or killed (β = 0.22), and being exposed to "friendly" fire (β = 0.14) and land mines/traps (β = 0.13) were the only three combat experiences associated with severity of combat-related PTSD symptoms, after adjustment for age, relationship status, unit support, postdeployment social support, and other combat experiences. Differential patterns of associations were observed for specific combat experiences in relation to CFA-derived symptom clusters (e.g., experiencing "friendly" fire was associated with re-experiencing and dysphoria symptoms, but not avoidance and hyperarousal symptoms). Personally witnessing someone from one's unit or an ally unit being seriously wounded or killed (odds ratio [OR] = 4.34; 95% confidence interval [CI] = 1.62-11.61) and being exposed to "friendly" fire (OR = 2.94; 95%CI = 1.16-7.47) emerged as independent predictors of a positive screen for probable PTSD. Results of this study suggest that witnessing someone in one's unit or ally unit being seriously wounded or killed while in a combat zone and being exposed to "friendly" fire are most strongly associated with combat-related PTSD in this sample of OEF/OIF Veterans. Examination of the relation between specific combat experiences and combat-related PTSD in OEF/OIF Veterans may help inform etiologic models of PTSD, and guide prevention and treatment approaches in this population.

Pietrzak RH ，Whealin JM ，Stotzer RL ，Goldstein MB ，Southwick SM ... -  《-》