Bringing the War Back Home

Seal, Karen H.; Bertenthal, Daniel; Miner, Christian R.; Sen, Sáunak; Marmar, Charles R.

doi:10.1001/archinte.167.5.476

Cited by 814 publications

(207 citation statements)

References 20 publications

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“…When entered into the same model simultaneously along with other factors, each remained a significant predictor, with mTBI history the most robust. PTSD and depression have been well documented in OIF/OEF veterans [6,23,[48][49][59][60][61][62][63][64][65][66][67]. This is a notable finding because other studies have found diminished effects of TBI when PTSD and depressive symptom severity were taken into account [6,62].…”

Section: Discussionmentioning

confidence: 97%

“…As described elsewhere [46], International Classification of Diseases, 9th Revision, Clinical Modification [47] diagnostic codes in VHA administrative data for posttraumatic stress disorder (PTSD) and depression were used to identify these common disorders documented in OIF/OEF veterans [6,46,[48][49]. We limited this identification to codes assigned in two or more encounters [48] in primary care, mental health, women's health, or rehabilitation clinics or from an inpatient stay during fiscal years 2007-2009.…”

Section: Psychiatric Diagnosesmentioning

confidence: 99%

“…We limited this identification to codes assigned in two or more encounters [48] in primary care, mental health, women's health, or rehabilitation clinics or from an inpatient stay during fiscal years 2007-2009.…”

Section: Psychiatric Diagnosesmentioning

confidence: 99%

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Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Pogoda¹,

Hendricks²,

Iverson³

et al. 2012

JRRD

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Abstract-With the use of Veterans Health Administration and Department of Defense databases of veterans who completed a Department of Veterans Affairs comprehensive traumatic brain injury (TBI) evaluation, the objectives of this study were to (1) identify the co-occurrence of self-reported auditory, visual, and vestibular impairment, referred to as multisensory impairment (MSI), and (2) examine demographic, deployment-related, and mental health characteristics that were potentially predictive of MSI. Our sample included 13,746 veterans with either a history of deployment-related mild TBI (mTBI) (n = 9,998) or no history of TBI (n = 3,748). The percentage of MSI across the sample was 13.9%, but was 17.4% in a subsample with mTBI history that experienced both nonblast and blast injuries. The factors that were significantly predictive of reporting MSI were older age, being female, lower rank, and etiology of injury. Deployment-related mTBI history, posttraumatic stress disorder, and depression were also significantly predictive of reporting MSI, with mTBI history the most robust after adjusting for these conditions. A better comprehension of impairments incurred by deployed servicemembers is needed to fully understand the spectrum of blast and nonblast dysfunction and may allow for more targeted interventions to be developed to address these issues.

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Section: Discussionmentioning

confidence: 97%

Section: Psychiatric Diagnosesmentioning

confidence: 99%

See 1 more Smart Citation

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Pogoda¹,

Hendricks²,

Iverson³

et al. 2012

JRRD

View full text Add to dashboard Cite

show abstract

“…A sense of futility or hopelessness can further diminish the patient's willingness to participate in medical care. Detecting PTSD and trauma-related distress in the medical environment can be difficult to differentiate from traumatic brain injury (TBI) or symptoms due to other psychiatric disorders such as depression [26][27]. PTSD and depression have many symptoms in common, such as sleep disturbance, decreased participation in activities, estrangement from others, and decreased concentration.…”

Section: Posttraumatic Stress Disorder Patients In Medical Settingsmentioning

confidence: 99%

Pharmacotherapy for posttraumatic stress disorder: Review with clinical applications

Jeffreys

Capehart²,

Friedman³

2012

JRRD

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Abstract-Posttraumatic stress disorder (PTSD) is a prevalent psychiatric diagnosis among veterans and has high comorbidity with other medical and psychiatric conditions. This article reviews the pharmacotherapy recommendations from the 2010 revised Department of Veterans Affairs/Department of Defense Clinical Practice Guideline (CPG) for PTSD and provides practical PTSD treatment recommendations for clinicians. While evidence-based, trauma-focused psychotherapy is the preferred treatment for PTSD, pharmacotherapy is also an important treatment option. First-line pharmacotherapy agents include selective serotonin reuptake inhibitors and the selective serotonin-norepinephrine reuptake inhibitor venlafaxine. Second-line agents have less evidence for their usefulness in PTSD and carry a potentially greater side effect burden. They include nefazodone, mirtazapine, tricyclic antidepressants, and monoamine oxidase inhibitors. Prazosin is beneficial for nightmares. Benzodiazepines and antipsychotics, either as monotherapy or used adjunctively, are not recommended in the treatment of PTSD. Treating co-occurring disorders, such as major depressive disorder, substance use disorders, and traumatic brain injury, is essential in maximizing treatment outcomes in PTSD. The CPG provides evidence-based treatment recommendations for treating PTSD with and without such cooccurring disorders.

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“…Many studies have aimed at estimating the prevalence of PTSD following deployment and have reported greatly varying rates. In general, higher PTSD prevalences have been found for the war in Iraq (9.8–19.9%) than for the war in Afghanistan (Hoge, Auchterlonie, & Milliken, 2006; Hoge et al, 2004; Seal, Bertenthal, Miner, Sen, & Marmar, 2007). These differences might, to some degree, reflect different methodological choices such as time of assessment, instruments and case definition, but they might also reflect actual differences in the toll of wars and missions (Sundin et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Perceived danger during deployment: a Rasch validation of an instrument assessing perceived combat exposure and the witnessing of combat consequences in a war zone

Karstoft

Nielsen

2018

European Journal of Psychotraumatology

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The potential stressors associated with military deployment are related to an increased risk of adverse mental health outcomes. Perceived exposure to combat has been found to be proportional to the severity of post-deployment posttraumatic stress disorder (PTSD). However, other perceived adversities during deployment, such as witnessing danger, distress, and hardship in the war zone, have been less systematically studied, but might play an equally substantial role for post-deployment mental health. The development and validation of scales that assess these related constructs are needed to distinguish their contribution to post-deployment risk of PTSD. We evaluated the validity of 10 items measuring perceived danger distributed to all deployed personnel with the Danish Defense since 1998. We hypothesize two scales: Exposure to Danger and Combat (EDC) and Witnessing Consequences of War (WCW). Two military cohorts deployed to Afghanistan in 2009 (Cohort 1, N = 276) and 2013 (Cohort 2, N = 273) were included. Questionnaire data was collected six months after homecoming, including deployment experiences and post-deployment reactions. We tested the construct validity of the 10 items of perceived danger with Rasch models (RM), focusing specifically on presence of subscales, and differential item functioning (DIF) across cohorts. We confirmed the existence of two separate subscales, EDCS and WCWS, both with adequate reliability. None of the subscales fitted a pure RM, but adequate fit was found for graphical log-linear RMs with evidence of DIF for the ECDS. However, adjusting the score to account for DIF had practically no effect, suggesting that the total non-adjusted mean score can be used in future cohort comparisons. Perceived exposure to combat and danger and witnessing consequences of war are related, but essentially distinct, concepts, each providing unique information about deployment adversities. Future studies should evaluate their shared and unique contribution to the risk of post-deployment PTSD.

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Bringing the War Back Home

Cited by 814 publications

References 20 publications

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Pharmacotherapy for posttraumatic stress disorder: Review with clinical applications

Perceived danger during deployment: a Rasch validation of an instrument assessing perceived combat exposure and the witnessing of combat consequences in a war zone

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