Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care

Hoge, Charles W.; Castro, Carl A.; Messer, Stephen Craig; McGurk, Dennis; Cotting, Dave I.; Koffman, Robert

doi:10.1056/nejmoa040603

Cited by 4,134 publications

(4,168 citation statements)

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“…The BAI and BDI‐II are considered to have good high internal consistency and reliability (Beck et al., 1988; Dozois, Dobson, & Ahnberg, 1998). The Hoge Combat Scale was administered to characterize military combat experiences (Hoge et al., 2004). Finally, a tDCS satisfaction questionnaire was administered to quantify potential tDCS side effects and tolerability.…”

Section: Methodsmentioning

confidence: 99%

“…Posttraumatic stress disorder (PTSD) is a disabling and often long‐term condition among returning veterans (Hoge et al., 2004; Terhakopian, Sinaii, Engel, Schnurr, & Hoge, 2008). The core deficit in PTSD has been conceptualized as pathological fear conditioning with a failure to recall extinction (Pitman, 1988; VanElzakker, Dahlgren, Davis, Dubois, & Shin, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Transcranial direct current stimulation may modulate extinction memory in posttraumatic stress disorder

et al. 2017

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BackgroundAbnormalities in fear extinction and recall are core components of posttraumatic stress disorder (PTSD). Data from animal and human studies point to a role of the ventromedial prefrontal cortex (vmPFC) in extinction learning and subsequent retention of extinction memories. Given the increasing interest in developing noninvasive brain stimulation protocols for psychopathology treatment, we piloted whether transcranial direct current stimulation (tDCS) during extinction learning, vs. during consolidation of extinction learning, might improve extinction recall in veterans with warzone‐related PTSD.MethodsTwenty‐eight veterans with PTSD completed a 2‐day Pavlovian fear conditioning, extinction, and recall paradigm. Participants received one 10‐min session of 2 mA anodal tDCS over AF3, intended to target the vmPFC. Fourteen received tDCS that started simultaneously with extinction learning onset, and the remaining 14 participants received tDCS during extinction consolidation. Normalized skin conductance reactivity (SCR) was the primary outcome measure. Linear mixed effects models were used to test for effects of tDCS on late extinction and early extinction recall 24 hr later.ResultsDuring early recall, veterans who received tDCS during extinction consolidation showed slightly lower SCR in response to previously extinguished stimuli as compared to veterans who received tDCS simultaneous with extinction learning (p = .08), generating a medium effect size (Cohen's d = .38). There was no significant effect of tDCS on SCR during late extinction.ConclusionsThese preliminary findings suggest that testing the effects of tDCS during consolidation of fear extinction may have promise as a way of enhancing extinction recall.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transcranial direct current stimulation may modulate extinction memory in posttraumatic stress disorder

et al. 2017

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“…Traumatic experiences while on deployment were measured using an eight-item questionnaire, derived from the larger 34-item Combat Exposure Scale (Hoge et al, 2004; Killgore et al, 2008), which asked participants to indicate whether they had ever experienced the indicated scenario on any deployment. Items were meant to capture a wide array of combat-related traumatic experiences.…”

Section: Methodsmentioning

confidence: 99%

“…Research has suggested a dose–response relation between deployment-related trauma and the subsequent risk of mental health issues (Dohrenwend, Turner, Turse, & Adams, 2006; Hoge et al, 2004). In the past 15 years, rates of deployment have increased, with more than 40,000 Canadian Forces personnel having been deployed in support of the mission in Afghanistan (Zamorski & Boulos, 2014).…”

Section: Introductionmentioning

confidence: 99%

Deployment-related trauma and post-traumatic stress disorder: does gender matter?

Frank

Zamorski

Lee

et al. 2018

European Journal of Psychotraumatology

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Objective: Military research has attempted to identify whether women have an increased vulnerability to mental health issues following deployment-related trauma, but findings have been mixed. Most studies have controlled for childhood abuse, but not other non-deployment trauma (e.g. life-threatening illness), which may partly explain previous mixed results. This study assessed gender differences in the association between deployment-related trauma and post-traumatic stress disorder (PTSD) while controlling for non-deployment trauma.Methods: Data came from the 2013 Canadian Forces Mental Health Survey. Regular or reserve personnel who had been deployed at least once were included in this study (n = 5980). Logistic regression was used to examine the interaction between gender and deployment-related trauma in predicting lifetime PTSD.Results: After controlling for non-deployment trauma, the association of gender with PTSD went from being significant to being marginally significant. The interaction between gender and deployment-related trauma was not significant.Conclusion: Though controlling for non-deployment trauma did not completely dissipate gender differences in PTSD, such differences were greatly reduced, indicating that these may be partly related to traumatic experiences outside deployment. As gender did not moderate the link between deployment-related trauma and PTSD, the findings suggest that trauma experienced while on deployment does not disproportionately affect women compared to their male counterparts.

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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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Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care

Cited by 4,134 publications

References 29 publications

Transcranial direct current stimulation may modulate extinction memory in posttraumatic stress disorder

Transcranial direct current stimulation may modulate extinction memory in posttraumatic stress disorder

Deployment-related trauma and post-traumatic stress disorder: does gender matter?

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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