Posttraumatic Stress Disorder and Depression in Battle-Injured Soldiers

Grieger, Thomas A.; Cozza, Stephen J.; Ursano, Robert J.; Hoge, Charles W.; Martinez, Patricia; Engel, Charles C.; Wain, Harold J.

doi:10.1176/ajp.2006.163.10.1777

Cited by 273 publications

(143 citation statements)

References 29 publications

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“…Recent longitudinal studies of PTSD have included many different groups of subjects, such as exposed disaster workers (1), refugees (2), a community sample (3), survivors of terrorists attacks (4), soldiers hospitalized following serious combat injury (5), patients with myocardial infarction (6), and victims of sexual and physical assault (7). Above all, longitudinal studies of patients following severe injury, especially those involved in motor vehicle accidents (MVAs), comprise one of the largest number of population samples studied (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Objectives Of the Studymentioning

confidence: 99%

Are patients after severe injury who drop out of a longitudinal study at high risk of mental disorder?

Nishi

Matsuoka

Nakajima

et al. 2008

Comprehensive Psychiatry

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Are patients after severe injury who drop out of a longitudinal study at high risk of mental disorder? Are patients after severe injury who drop out of a longitudinal study at high risk of mental disorder? AbstractIn longitudinal studies of traumatic stress, it is particularly important to examine the data for any differences between those who drop out and those who continue to participate, because reluctance to participate might reflect symptoms of avoidance frequently seen in posttraumatic stress disorder (PTSD). However, whether those who drop out are at high risk of PTSD remains unclear. Over a 25-month period, 188 consecutive patients with motor vehicle accident (MVA)-related injuries admitted emergently were enrolled and followed for 4 to 6 weeks. Baseline characteristics were compared between subjects who did and did not participate in the follow-up study. At 4 to 6 weeks, 66 (35.1%) of the participants had dropped out. Bivariate analyses revealed that those who dropped out were likely to be men, alcohol drinkers, smokers, and unconscious just after MVA and to have fewer years of education, less severe injuries, less posttraumatic symptoms, and lower cooperativeness as assessed by the Temperament and Character Inventory. Logistic regression analysis revealed that male sex, unconsciousness during MVA, low cooperativeness, and less severe injuries were significant predictors of dropout. The literature says that male sex and unconsciousness just after MVA might be protective factors against MVA-related PTSD, whereas low cooperativeness is a risk factor for general mental problems. To summarize, it is expected that those who drop from the follow-up are unlikely to have MVA-related PTSD, but might have mental problems independent of injury. In longitudinal studies of traumatic stress, it is particularly important to examine the data for any differences between those who drop out and those who continue to participate, because reluctance to participate might reflect symptoms of avoidance frequently seen in posttraumatic stress disorder (PTSD). However, whether or not those who drop out are at high risk for PTSD remains unclear. Over a 25-month period, 188 TITLE:consecutive patients with motor vehicle accident (MVA)-related injuries admitted emergently were enrolled and followed for 4-6 weeks. Baseline characteristics were compared between subjects who did and did not participate in the follow-up study. At 4-6 weeks, 66 (35.1%) of the participants had dropped out. Bivariate analyses revealed those who dropped out were likely to be men, alcohol drinkers, smokers, unconscious just after MVA, to have fewer years of education, less severe injuries, less posttraumatic symptoms, and lower cooperativeness as assessed by the Temperament and Cognitive

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Section: Objectives Of the Studymentioning

confidence: 99%

Are patients after severe injury who drop out of a longitudinal study at high risk of mental disorder?

Nishi

Matsuoka

Nakajima

et al. 2008

Comprehensive Psychiatry

View full text Add to dashboard Cite

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“…Some of these factors include under-and overreporting of symptoms, poor effort, and the presence of comorbid disorders. In a military population, service members who are wounded in combat, whether medically evacuated or treated in-theater, are at increased risk for posttraumatic stress disorder (PTSD; Ramchand et al, 2010), depression (Grieger et al, 2006), and/or chronic pain (Belanger et al, 2011;Dobscha et al, 2009;Hoge et al, 2008). These comorbidities can make it challenging to determine whether a service member does or does not suffer from residual symptoms associated with an MTBI.…”

mentioning

confidence: 99%

Influence of poor effort on neuropsychological test performance in U.S. military personnel following mild traumatic brain injury

Lange

Pancholi

Bhagwat

et al. 2012

Journal of Clinical and Experimental Neuropsychology

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The purpose of this study was to examine the influence of poor effort on neuropsychological test performance in military personnel following mild traumatic brain injury (MTBI). Participants were 143 U.S. service members who sustained a TBI, divided into three groups based on injury severity and performance on the Word Memory Test and four embedded markers of poor effort: MTBI-pass (n = 87), MTBI-fail (n = 21), and STBI-pass (n = 35; where STBI denotes severe TBI). Patients were evaluated at the Walter Reed Army Medical Center on average 3.9 months (SD = 3.4) post injury. The majority of the sample was Caucasian (84.6%), was male (93.0%), and had 12+ years of education (96.5%). Measures included the Personality Assessment Inventory (PAI) and 13 common neurocognitive measures. Patients in the MTBI-fail group performed worse on the majority of neurocognitive measures, followed by the Severe TBI-Pass group and the MTBI-pass group. Using a criterion of three or more low scores <10th percentile, the MTBI-fail group had the greatest rate of impairment (76.2%), followed by the Severe TBI-Pass group (34.3%) and MTBI-pass group (16.1%). On the PAI, the MTBI-fail group had higher scores on the majority of clinical scales (p < .05). There were a greater number of elevated scales (e.g., 5 or more elevated mild or higher) in the MTBI-fail group (71.4%) than in the MTBI-pass group (32.2%) and Severe TBI-Pass group (17.1%). Effort testing is an important component of postacute neuropsychological evaluations following combat-related MTBI. Those who fail effort testing are likely to be misdiagnosed as having severe cognitive impairment, and their symptom reporting is likely to be inaccurate.

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“…Foremost among these are those concerning methodological issues that should be considered when investigating physical and emotional symptoms and diagnoses. There are numerous examples of published studies in recent years exploring the presentation, treatment, and presumed interactions between physical and emotional health problems in this population [48][49][50][51]. Most of these studies utilize symptom measures or diagnoses extracted from medical records to identify individuals presumed to meet criteria for two or more discrete disorders (e.g., TBI or PTSD, chronic pain or PTSD) and seek to identify differences that can differentiate between the conditions examined.…”

Section: Discussionmentioning

confidence: 99%

Pain and psychiatric comorbidities among two groups of Iraq and Afghanistan era Veterans

et al. 2016

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Abstract-This study aimed to (1) identify the prevalence and severity of pain and psychiatric comorbidities among personnel who had been deployed during Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) and (2) assess whether the Department of Veterans Affairs (VA) Polytrauma System of Care and an OIF/OEF/OND registry reflect real differences among patients. Participants (N = 359) were recruited from two VA hospitals. They completed a clinical interview, structured diagnostic interview, and selfreport measures. Results indicated pain was the most common complaint, with 87% experiencing pain during the prior week and 56% reporting moderate or severe pain. Eighty percent of participants met criteria for at least one of seven assessed comorbid problems (moderate or severe pain, postconcussional disorder, posttraumatic stress disorder [PTSD], anxiety disorder, mood disorder, substance use disorder, psychosis), and 59 percent met criteria for two or more problems. PTSD and postconcussional disorder rarely occurred in the absence of pain or other comorbidities (0.3% and 0%, respectively). The Polytrauma group had more comorbid psychiatric conditions ( χ 2 = 48.67, p < 0.05) and reported greater severity of symptoms (p < 0.05) than the Registry group. This study confirmed the high prevalence of pain and concurrent mental health problems among personnel returning from military deployment.

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Posttraumatic Stress Disorder and Depression in Battle-Injured Soldiers

Abstract: Early severity of physical problems was strongly associated with later PTSD or depression. The majority of soldiers with PTSD or depression at 7 months did not meet criteria for either condition at 1 month.

Cited by 273 publications

References 29 publications

Are patients after severe injury who drop out of a longitudinal study at high risk of mental disorder?

Are patients after severe injury who drop out of a longitudinal study at high risk of mental disorder?

Influence of poor effort on neuropsychological test performance in U.S. military personnel following mild traumatic brain injury

Pain and psychiatric comorbidities among two groups of Iraq and Afghanistan era Veterans

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