PTSD and Use of Outpatient General Medical Services Among Veterans of the Vietnam War

Schlenger, William E.; Mulvaney-Day, Norah; Williams, Christianna S.; Kulka, Richard A.; Corry, Nida H.; Mauch, Danna; Nagler, Caryn F.; Ho, Chia-Lin; Marmar, Charles R.

doi:10.1176/appi.ps.201400576

Cited by 15 publications

(14 citation statements)

References 41 publications

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“…Of the 20 US studies, 16 were conducted in collaboration with the US Veterans Health Administration (VA). Four approaches were used to identify those with PTSD and comorbidities: assessing for comorbid PTSD and neurocognitive and psychiatric disorders among a general sample of veterans (n = 13), assessing for comorbid PTSD among veterans diagnosed with other neurocognitive and psychiatric disorders (n = 7), assessing for comorbid neurocognitive and psychiatric disorders among veterans diagnosed with PTSD (n = 2), and assessing for comorbid PTSD and neurocognitive and psychiatric disorders among veterans who were prisoners of war (POWs) (n = 2) …”

Section: Resultsmentioning

confidence: 99%

“…PTSD was ascertained using four methods: International Classification of Disease Ninth Revision (ICD‐9) codes that were determined by health care providers and captured in local and national electronic databases as part of routine clinical care (n = 12); diagnostic interviews based on DSM criteria using the Structured Clinical Interview for DSM (SCID), the Clinician‐Administered PTSD Scale (CAPS), and the Diagnostic Interview Schedule (DIS) (n = 8); a clinician‐administered screening, Primary Care PTSD Screen (PC‐PTSD) (n = 1); and self‐reported measures, PTSD Checklist (PCL), and Mississippi Scale for Combat‐Related PTSD (n = 3) . Studies that used DSM criteria‐based instruments to diagnose PTSD used five different editions of the DSM: DSM‐II‐R (n = 1), DSM‐III (n = 2), DSM‐III‐R (n = 3), DSM‐IV (n = 3), and DSM‐5 (n = 1) .…”

Section: Resultsmentioning

confidence: 99%

“…Studies that used DSM criteria‐based instruments to diagnose PTSD used five different editions of the DSM: DSM‐II‐R (n = 1), DSM‐III (n = 2), DSM‐III‐R (n = 3), DSM‐IV (n = 3), and DSM‐5 (n = 1) . Comorbid neurocognitive and psychiatric disorders were ascertained using similar approaches: ICD‐9 codes (n = 11); diagnostic interviews based on DSM criteria (n = 5); self‐report scales for anxiety and depression (n = 4); clinician‐administered rating scales including standardized neuropsychological tests, Minnesota Multiphasic Personality Inventory (MMPI), and Alcohol Use Disorder Identification Test (AUDIT) (n = 5); and unspecified measures (n = 2) …”

Section: Resultsmentioning

confidence: 99%

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Neurocognitive and psychiatric comorbidities of posttraumatic stress disorder among older veterans: A systematic review

Kang

McConnell

2019

Int J Geriat Psychiatry

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Objectives Posttraumatic stress disorder (PTSD) is associated with neurocognitive and psychiatric comorbidities, and older adults experience comorbid illnesses disproportionately. Little is known about the comorbidities of PTSD among older veterans. This systematic review examines the prevalence, incidence, and patterns of neurocognitive and psychiatric comorbidities of PTSD among older veterans and explores the factors associated with these comorbidities. Methods A systematic literature review was performed using PubMed, CINAHL, and PsycINFO databases. The search was limited to peer‐reviewed articles published in English from January 1980 to October 2018. Eligible studies examined the comorbid neurocognitive and psychiatric disorders of PTSD among veterans aged 60 and older. Results Twenty‐four studies met the criteria for inclusion. The risk for dementia was higher in veterans with PTSD than those without PTSD; hazard ratios ranged from 1.21 to 1.77. Depressive disorder was the most prevalent psychiatric comorbidity with estimates ranging from 33% to 52.3%, followed by generalized anxiety disorder (14%‐15%) and substance use disorders (1.9%‐11.3%). Factors consistently associated with PTSD comorbidities included age, combat‐related exposures, clinical conditions, and health‐related and psychosocial outcomes. Conclusions Despite heterogeneity in research designs and methodological limitations, this review highlights the need to consider comorbid neurocognitive and psychiatric disorders among older veterans with PTSD in order to individualize care approaches. Future research should incorporate factors associated with neurocognitive and psychiatric comorbidities of PTSD into study designs that can help improve prediction of comorbidity and generate evidence for developing and implementing tailored treatments in older veterans.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Neurocognitive and psychiatric comorbidities of posttraumatic stress disorder among older veterans: A systematic review

Kang

McConnell

2019

Int J Geriat Psychiatry

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“…Third, participants in this study were combat veterans who recently returned from deployment. The time immediately following deployment is a critical period in the course of PTSD, with early symptom severity predicting later course (Marmar et al., ; Orcutt, Erickson, & Wolfe, ; Schlenger et al., ). Understanding the symptom course in this early, critical period can inform what services are needed during this time.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Natural Course of Co‐Occurring PTSD and Alcohol Use Disorder Among Recent Combat Veterans

Possemato

Maisto

Barrie

et al. 2017

Journal of Traumatic Stress

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Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur in veterans, yet little is known about the longitudinal course of PTSD and drinking in comorbid populations. This study assessed the natural course of daily alcohol consumption and weekly changes in PTSD symptoms in 112 recent combat veterans over the course of 11 months. Latent class growth mixture modeling was used to classify individuals into distinct classes with similar PTSD symptom and alcohol use growth trajectories. We then investigated theorized predictors of class membership including sociodemographics; pre-, peri-, and postdeployment factors; coping; symptom severity; and number of mental health/substance use appointments attended. Results revealed that most participants had severe and nonremitting PTSD. Trajectories for alcohol use included gradual and drastic declines, and chronic low-level drinking. The use of behavioral health services (odds ratio = 2.47) and fewer current stressors (odds ratio = 0.42) predicted AUD remission. Because little variation was observed in the PTSD course, our study did not observe coordinated fluctuations of PTSD symptoms and heavy drinking. Our findings suggest that treatment impacts the course of AUD and that recent combat veterans who do not seek PTSD treatment may have chronic and severe PTSD symptoms.

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The mental health of Vietnam theater veterans—the lasting effects of the war: 2016–2017 Vietnam Era Health Retrospective Observational Study

Cypel

Schnurr

Schneiderman

et al. 2022

Journal of Traumatic Stress

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Mental health data from the 2016-2017 Vietnam Era Health Retrospective Observational Study (VE-HEROeS) were analyzed by cohort, represented by United States Vietnam theater veterans (VTs) who served in Vietnam, Cambodia, and Laos; nontheater veterans (NTs) without theater service; and age-and sexmatched nonveterans (NVs) without military service. The exposure of interest was Vietnam theater service. Surveys mailed to random samples of veterans (n = 42,393) and nonveterans (n = 6,885) resulted in response rates of 45.0% for veterans (n = 6,735 VTs, M age = 70.09, SE = 0.04; n = 12,131 NTs) and 67.0% for NVs (n = 4,530). We examined self-report data on four mental health outcomes: probable posttraumatic stress disorder (PTSD), depression, psychological distress, and overall mental health functioning. Weighted adjusted odds ratios (aORs) between each outcome and cohort were estimated, controlling for covariates in four models: cohort plus sociodemographic variables (Model 1), Model 1 plus physical health variables (Model 2), Model 2 plus potentially traumatic events (PTEs;Model 3), and Model 3 plus other military service variables (Model 4). Mental health outcome prevalence was highest for VTs versus other cohorts, with the largest aOR, 2.88, for PTSD, 95% CI [2.46, 3.37], p < .001 (Model 4, VT:NT). Physical health and PTEs contributed most to observed effects; other service variables contributed least to aORs overall. Mental health dysfunction persists among VTs years after the war's end. The present results reaffirm previous findings and highlight the need for continued mental health surveillance in VTs.

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PTSD and Use of Outpatient General Medical Services Among Veterans of the Vietnam War

Cited by 15 publications

References 41 publications

Neurocognitive and psychiatric comorbidities of posttraumatic stress disorder among older veterans: A systematic review

Neurocognitive and psychiatric comorbidities of posttraumatic stress disorder among older veterans: A systematic review

Natural Course of Co‐Occurring PTSD and Alcohol Use Disorder Among Recent Combat Veterans

The mental health of Vietnam theater veterans—the lasting effects of the war: 2016–2017 Vietnam Era Health Retrospective Observational Study

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