No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Forty-year follow-up of United States prisoners of war
Abstract
The authors performed structured psychiatric examinations of 188 former prisoners of war (POWs). Sixty-seven percent had had posttraumatic stress disorder. Of those affected, 29% had fully recovered, 39% still reported mild symptoms, 24% had improved but had moderate residual symptoms, and 8% had had no recovery or had deteriorated. Presence of posttraumatic stress disorder was not significantly correlated with other mental disorders. Delayed onset was not seen. The findings confirm the DSM-III concept of and criteria for posttraumatic stress disorder.
... About half of the Iraqi POWs (42,000) were captured during 1982, coinciding with a major Iranian offensive and 41 thousands Iraqi prisoners of war were released in 1990 (26) , meaning that approximately half of Iraqi prisoners of war had spent 6 to 13 years in captivity. Iran began to release prisoners again in a large numbers after 1998 and so the rest spent 14 to 21 years in prison (26). ...
... About half of the Iraqi POWs (42,000) were captured during 1982, coinciding with a major Iranian offensive and 41 thousands Iraqi prisoners of war were released in 1990 (26) , meaning that approximately half of Iraqi prisoners of war had spent 6 to 13 years in captivity. Iran began to release prisoners again in a large numbers after 1998 and so the rest spent 14 to 21 years in prison (26). According to the study conducted in1989 the POWs of the Second world War stayed for a period ranging from 6-26 months (13) ; the average length of captivity the POWs held in Vietnam was five years and three months (27) ; and for Croatian POWs duration of captivity ranged from 6-9 months (28) . ...
... There is broad agreement between these studies and any differences in prevalence could be due to differences in duration of captivity and the time elapsed since release because the studies took place at various times. In 1986 an American study indicated that 67% of the sample selected from of American former POWs of the Second World War experienced PTSD (26) ; Symptoms of PTSD were seen in (90.0% to 100%) of American POWs of the Korean conflict (27) ; and another study conducted in 1993 revealed that (78.0%) of Second World War Pacific theatre POWs were inflicted with PTSD (28) . These are similar to the results from Iraq and suggest that wartime captivity is difficult experience that is very likely to result in some level of PTSD. ...
Objective: To determine the prevalence of Posttraumatic Stress Disorder (PTSD) among Iraqi repatriatedprisoners of Iran-Iraq war, and the relationship with demographic factors.Methodology: A descriptive study was carried out from Oct. 18th, 2009 through Jan. 10th, 2010. A nonprobabilitybased snowball sampling technique was used to recruit 92 Iraqi repatriated prisoners of war(IRPOWs) who had visited Ministry of Human Rights. A data collection instrument was constructed thatconsisted of six demographic characteristics, and eight items to measure the level of PTSD in POWs. Data werecollected with the constructed instrument during a brief interview. Data were analyzed through the application ofdescriptive statistical analysis: percentages; frequencies and inferential statistic analysis (Pearson correlationcoefficient).Results: The study revealed that the majority of IRPOWs have some level of PTSD (78.3%). Proportions ofIRPOWs with low, medium and high severity PTSD: Low (29.3%); medium (32.6%) and high (16.4%).Statistically significant relationships were observed between PTSD and duration of captivity, marital status andlevel of education.Recommendations: The study recommends special mental health services centres are established withinprimary health care centres in order to diagnose and treat them and that further studies are conducted to exploreeffective treatments for IRPOWs
... About half of the Iraqi POWs (42,000) were captured during 1982, coinciding with a major Iranian offensive and 41 thousands Iraqi prisoners of war were released in 1990 (26) , meaning that approximately half of Iraqi prisoners of war had spent 6 to 13 years in captivity. Iran began to release prisoners again in a large numbers after 1998 and so the rest spent 14 to 21 years in prison (26). ...
... About half of the Iraqi POWs (42,000) were captured during 1982, coinciding with a major Iranian offensive and 41 thousands Iraqi prisoners of war were released in 1990 (26) , meaning that approximately half of Iraqi prisoners of war had spent 6 to 13 years in captivity. Iran began to release prisoners again in a large numbers after 1998 and so the rest spent 14 to 21 years in prison (26). According to the study conducted in1989 the POWs of the Second world War stayed for a period ranging from 6-26 months (13) ; the average length of captivity the POWs held in Vietnam was five years and three months (27) ; and for Croatian POWs duration of captivity ranged from 6-9 months (28) . ...
... There is broad agreement between these studies and any differences in prevalence could be due to differences in duration of captivity and the time elapsed since release because the studies took place at various times. In 1986 an American study indicated that 67% of the sample selected from of American former POWs of the Second World War experienced PTSD (26) ; Symptoms of PTSD were seen in (90.0% to 100%) of American POWs of the Korean conflict (27) ; and another study conducted in 1993 revealed that (78.0%) of Second World War Pacific theatre POWs were inflicted with PTSD (28) . These are similar to the results from Iraq and suggest that wartime captivity is difficult experience that is very likely to result in some level of PTSD. ...
... Should an individual be diagnosed with PTSD, this means he or she has met the diagnostic criteria for the disorder; with PTSS the individual may display symptoms but not meet the criteria for a clinical diagnosis. Studies assessing ex-POWs' post-traumatic reactions worldwide indicate substantial PTSD symptoms over three , four (Kluznik, Speed, Van Valkenburg, & Magraw, 1986), five (e.g., Kluznik et al.,1986;Sutker, Winstead, Galina, & Allain, 1991), and six decades after repatriation (e.g., Rintamaki, Weaver, Elbaum, Klama, & Miskevics, 2009). In fact, the PTSD rates in ex-POWs are quite high, with some studies indicating that up to 88% of ex-POWs reported substantial PTSD symptoms (Engdahl, Dikel, Eberly, & Blank, 1997;Port, Engdahl, & Frazier, 2001;Rintamaki et al., 2009). ...
... Should an individual be diagnosed with PTSD, this means he or she has met the diagnostic criteria for the disorder; with PTSS the individual may display symptoms but not meet the criteria for a clinical diagnosis. Studies assessing ex-POWs' post-traumatic reactions worldwide indicate substantial PTSD symptoms over three , four (Kluznik, Speed, Van Valkenburg, & Magraw, 1986), five (e.g., Kluznik et al.,1986;Sutker, Winstead, Galina, & Allain, 1991), and six decades after repatriation (e.g., Rintamaki, Weaver, Elbaum, Klama, & Miskevics, 2009). In fact, the PTSD rates in ex-POWs are quite high, with some studies indicating that up to 88% of ex-POWs reported substantial PTSD symptoms (Engdahl, Dikel, Eberly, & Blank, 1997;Port, Engdahl, & Frazier, 2001;Rintamaki et al., 2009). ...
This chapter reviews some of the findings of a multi-cohort longitudinal study spanning over three decades, focusing on the secondary post-traumatic stress symptoms among adult offspring of Israeli former prisoners of war (POWs) whose fathers were captured by the Egyptians and Syrians during the 1973 Yom Kippur War. The effects of captivity on the ex-POWs’ mental health and parenting as well as its consequential effects on their offspring are examined in the veterans (fathers), their wives (mothers), and their offspring. The chapter discusses offspring characteristics that may render them vulnerable or resilient: (1) gender; (2) the Big Five personality traits: openness, conscientiousness, extroversion, agreeableness, and neuroticism; and (3) differentiation of self. Findings include the strong intergenerational effects of trauma, particularly on sons; very late–onset results of PTSD in the fathers; the possible mediating effects of parental PTSD; and the role of the offspring’s genetic and personality characteristics.
... There has been growing interest in identifying risk factors for posttraumatic stress disorder (PTSD) over the past 30 years. Predictors of warzone-related PTSD have received particular interest as military personnel and veterans demonstrate high rates of PTSD, with symptoms often enduring across the lifespan (Kluznik, Speed, Van Valkenburg, & Magraw, 1986;Koenen, Stellman, Stellman, & Sommer, 2003;Solomon & Mikulincer, 2006;Tennant, Goulston, & Dent, 1986). Studies have identified premilitary, military, and postmilitary factors that contribute to the development and maintenance of PTSD in veterans (Cabrera et al., 2007;Green et al., 1986;Schnurr, Lunney, & Sengupta, 2004). ...
... Studies have identified premilitary, military, and postmilitary factors that contribute to the development and maintenance of PTSD in veterans (Cabrera et al., 2007;Green et al., 1986;Schnurr, Lunney, & Sengupta, 2004). However, because most studies have been cross-sectional, less is known about the ability of such variables to predict warzone-related PTSD in the decades following war (Kluznik et al., 1986;Tennant et al., 1986). Longitudinal studies have also typically assessed select subpopulations (e.g., POWs), with very few studies employing generalizable, nationally representative samples. ...
Background:
Few studies have longitudinally examined predictors of posttraumatic stress disorder (PTSD) in a nationally representative sample of US veterans. We examined predictors of warzone-related PTSD over a 25-year span using data from the National Vietnam Veterans Longitudinal Study (NVVLS).
Methods:
The NVVLS is a follow-up study of Vietnam theater veterans (N = 699) previously assessed in the National Vietnam Veterans Readjustment Study (NVVRS), a large national-probability study conducted in the late 1980s. We examined the ability of 22 premilitary, warzone, and postmilitary variables to predict current warzone-related PTSD symptom severity and PTSD symptom change in male theater veterans participating in the NVVLS. Data included a self-report Health Questionnaire survey and a computer-assisted telephone Health Interview Survey. Primary outcomes were self-reported PTSD symptoms assessed by the PTSD Checklist for DSM-5 (PCL 5) and Mississippi PTSD Scale (M-PTSD).
Results:
Predictors of current PTSD symptoms most robust in hierarchical multivariable models were African-American race, lower education level, negative homecoming reception, lower current social support, and greater past-year stress. PTSD symptoms remained largely stable over time, and symptom exacerbation was predicted by African-American race, lower education level, younger age at entry into Vietnam, greater combat exposure, lower current social support, and greater past-year stressors.
Conclusions:
Findings confirm the robustness of a select set of risk factors for warzone-related PTSD, establishing that these factors can predict PTSD symptom severity and symptom change up to 40 years postdeployment.
... Epidemiologic studies show that events involving interpersonal victimization (sexual assault, torture) are 'associated with the highest rates of chronic PTSD, \vhereas lower magnitude events (motor vehicle a~cidents, life-threatening illness, disaster) are associated with lower rates of trauma (2). The prevalence of chronic PTSD among torture survivors such as prisoners of war and concentration camp survivors is 50% to 75% (10)(11)(12)(13). In contrast, the prevalence rate of chronic PTSD in survivors of natural disasters is substantially lower (2',14,15). ...
... Other risk factors for PTSD include having a histol)' of behavioural or psychological problems. Persons with child-Severity of the stressor (23), or neurotic (I) personalities prior to the traumatic event have an increased risk for the development ofPTSD (12). Several cognitive risk factors, including lower intelligence (24), have also been associated with increased risk for PTSD. ...
Because only a proportion of persons exposed to traumatic events develop posttraumatic stress disorder (PTSD), it has become important to elucidate the factors that increase the risk for the development of PTSD following trauma exposure as well as the factors that might serve to protect individuals from developing this condition. Putative risk factors for PTSD may describe the index traumatic event or characteristics of persons who experience those events. Recent data have implicated biological and familial risk factors for PTSD. For example, our recent studies have demonstrated an increased prevalence of PTSD in the adult children of Holocaust survivors, even though these children, as a group, do not report a greater exposure to life-threatening (Diagnostic and Statistical Manual of Mental Disorders [DSM-IV] Criterion A) events. These studies are reviewed. It is difficult to know to what extent the increased vulnerability to PTSD in family members of trauma survivors is related to biological or genetic phenomena as opposed to experiential ones. because of the large degree of shared environment in families. In particular, at-risk family members, such as children, may be more vulnerable to PTSD as a result of witnessing the extreme suffering of a parent with chronic PTSD rather than because of inherited genes. But even if the diathesis for PTSD were somehow "biologically transmitted" to children of trauma survivors, the diathesis is still a consequence of the traumatic stress in the parent. Thus, even the most biological of explanations for vulnerability must at some point deal with the fact that a traumatic event has occurred.
... However, the UK studies that have been completed to date have used small samples. Reports of delayed-onset PTSD3637383940414243444546474849 have typically been based on small scale studies or case reports. No compelling evidence has been presented that a delayed PTSD syndrome exists. ...
... Older non-UK studies showed that, after onset, PTSD symptoms tended to remain chronic and unremitting [44, 49,58596061, with combat veterans with PTSD tending to have a worse prognosis than their civilian counterparts [62]. Whether there is something about combat as a precipitating trauma that makes subsequent PTSD more chronic and treatment resistant, or something about veterans that does the same, is unclear. ...
... Data collected in a nationwide study of Vietnam veterans revealed that a significant proportion failed to recover prestress levels of functioning and exhibited psychological distress involving cognitive, affective, and physiological disturbances within the two decades following combat participation (Kulka et al., 1990). Chronic symptoms of psychological discomfort have also been reported among World War II (WWII) combat veterans (Elder & Clipp, 1989;Grinker & Spiegel, 1945) and prisoner-of-war (POW) survivors of WWII (Kluznik, Speed, Van Valkenburg, & Magraw, 1986;Sutker, Allain, & Winstead, 1993;Zeiss & Dickman, 1989) and the Korean conflict (Sutker, Winstead, Galina, & Allain, 1991). Recently, research has documented problems with anxiety, depression, and PTSD in 16%-19% of Persian Gulf War troops within the first year of return from war zone duty (Sutker, Uddo, Brailey, & Allain, 1993). ...
Posttraumatic stress disorder (PTSD) can occur subsequent to war stress, but not all troops are negatively affected. A discriminant function model was used to study associations between personal and environmental resources and psychological outcomes subsequent to war zone stress. Among 775 Persian Gulf War exposed troops, 2 subsets were identified: 97 with PTSD diagnoses and 484 who had no psychological distress. A discriminant function, double cross-validated in random subsamples, classified 87% of troops, and demographic and stress severity variables did not alter results significantly. Personality hardiness commitment, avoidance coping, and perceived family cohesion emerged as consistent predictors of PTSD diagnosis. Findings suggest personal characteristics and environmental factors may alter vulnerability to negative war stress outcomes. Work is needed to identify mechanisms and causal pathways by which resource factors enhance or lower stress resistance.
... It could be argued that it was the stress of being captured and held prisoner under harsh conditions that led to the substantial uncontrollable binge eating in these former POWs. Certainly, one would expect to find increased reports of PTSD and other stress-related symptoms in these men, as previous studies have shown (e.g., Kluznick et al., 1986;Zeiss & Dickman, 1989). However, binge eating is not a symptom of PTSD (American Psychiatric Association, 1987), nor has trauma alone, without food restriction or emphasis on body shape, been shown to cause binge eating. ...
Food restriction is correlated with binge eating, but evidence that restriction leads to binge eating is scanty. In this study we investigated postwar binge eating in 67 World War II combat veterans and 198 former prisoners of war. As predicted, binge eating was relatively rare in combat veterans but was significantly more prevalent in veterans who, as prisoners in German prisoner of war camps, lost significant amounts of weight during their captivity. Our data thus support the contention that starvation or dieting seems to precede binge eating.
... There are individual differences in the frequency with which people experience intrusions and the distress they elicit (Ehlers & Steil, 1995;Halligan et al., 2002;Kluznik et al., 1986). This has led researchers to examine the factors that may contribute to elevated intrusion vulnerability (Marks et al., 2018). ...
Background and objectives:
Research shows that individuals with heightened trait anxiety are more likely to experience intrusions; however, the mechanism that accounts for this relationship is unclear. Two alternative hypotheses were tested to determine the nature of the associations between trait anxiety, attentional bias to negative information, and intrusion vulnerability.
Methods:
Intrusions were elicited using the trauma film paradigm, and post-event attentional bias to negative information was assessed using the dot-probe task. Participants then completed a week-long intrusions diary.
Results:
Results showed that attentional bias to negative information mediated the effect of heightened trait anxiety on elevated intrusion frequency. It was also revealed that heightened trait anxiety was associated with elevated intrusion-related distress, though attentional bias to negative information did not mediate this relationship.
Limitations:
Our sample was comprised of undergraduate students who were not selected based on a previous pathology. Replication in clinical samples is warranted.
Conclusions:
These findings provide new insight regarding individual differences in the experience of intrusions and suggest that both the frequency and distress associated with intrusions could represent clinical targets.
... Resilience has been investigated in a variety of populations and contexts for decades (Cooper et al. 2020). Beginning in the 1970s with studies of children facing significant adversity (Garmezy & Streitman 1974;Werner & Smith 1982), from the 1980s onwards, trauma responses in adults and the development of posttraumatic stress disorder were investigated (Hendin & Haas 1984;Kluznik et al. 1986), and resilience in professional groups exposed to high levels of stress became a focus in the 2000s (Kimbrel et al. 2011;Martinussen & Richardsen 2006). There is evidence that the work nurses undertake has the potential for psychological harm, with high levels of burnout and other stress-related conditions reported internationally (Craigie et al. 2015;Hegney et al. 2015;Ray et al. 2013;Woo et al. 2020). ...
In the context of pressures faced by the nursing profession including increasing patient acuity and global nursing shortages, the importance of nurse resilience has gained attention in research and practice. Resilience is viewed as a protective factor that enables individuals to avoid psychological harm and continue in their work. There is limited evidence on the impact of external factors such as work conditions on nurse resilience. This study aimed to explore how external factors influence nurse resilience and to incorporate this knowledge into an updated definition of nurse resilience. As part of a two‐phase mixed methods study, focus groups were conducted to obtain qualitative data to explore nurse's perceptions of resilience and factors they felt affected their resilience. Data analysis identified three main themes derived from 10 subthemes: Perceptions of Resilience, Pressures and Challenges, and Support and Strategies contributed to understanding how external factors can affect nurse resilience. A range of factors emerged including the impact of workplace conditions, organizational philosophy, the performance of managers, and the teams nurses work within, which were not reflected in an earlier definition of nurse resilience derived through a concept analysis. These factors were incorporated in an updated definition of nurse resilience. Understanding resilience in the nursing profession and the external factors that affect it is critical to the development of effective research, policies, interventions, and work environments to protect nurse well‐being, promote nurse retention, and ensure the provision of quality patient care.
... For example, the prevalence of PTSD in Prisoner of War (POW) samples is higher w hen compared to samples of veterans who were not POW s (Friedman, Schnurr, & McDonagh-Coyle, 1994). Indeed, prevalence ofPTSD in non-POW US veteran groups is estimated at 30% (Kulka et aI., 1991), compared to 67% in POW US veteran groups (Kluznik, Speed, Van Valkenburg, & McGraw, 1986). ...
p>This thesis investigates the relationship between perceptions of social support and the narrative coherence of traumatic war memories. The aim was to understand the way in which social support impacts on the process of reconciliation of war memories, with implications for provision of therapy to currently and formerly serving veterans.
In order to provide a lifespan perspective, war veterans from the Second World (WWII), Korean War, Falklands War, Gulf War and Britain’s ‘Small’ Wars participated in semi-structured one-to-one interviews based on perceptions of social support (comradeship, family support, and societal support), media representation of war, and commemoration. Analysis of narrative content was based on the perceptions of social support, and the subsequent analysis of narrative form explored the coherence of war memories as an indication of reconciliation. Coherence was operationalised as the presence of orientation and storied structure, consistency in affect, and uniting theme(s) running through the narrative. Data from the Imperial War Museum was used to provide triangulation of the social support themes, and was analysed using thematic analysis.
Archival data from the Mass Observation Archive was also consulted to corroborate the findings from the interview data, providing a deeper understanding of the role of societal support using thematic analysis. In addition, a questionnaire study was conducted to probe perceptions of media representation and perceptions towards veterans. Findings suggest that veterans can reconcile their memories earlier in life, and that communicating with family members within a supportive society may aid reconciliation. This has implications for future interventions.</p
... Our findings were lower than the 67.0% prevalence reported by Kluznik, Speed, VanValkenburg, and Magraw among former U.S prisoners of war [39] . However, they were considerably higher than the lifetime prevalence of 1.6-33.2% ...
Abstract
Objectives
To determine the lifetime prevalence of full and subsyndromal PTSD, associated factors, and the quality of life (QOL) of internally displaced older adults in Riyom, Nigeria.
Method
A cross sectional study using a multistage sampling technique was used to recruit 200 internally displaced older adults in a rural community in Nigeria. Lifetime DSM-IV PTSD diagnosis was made using the CIDI. The similarities between DSM-IV and DSM-5 made it possible to closely approximate DSM-5 diagnosis using DSM-IV symptoms and the CIDI measures of these symptoms were used to approximate DSM-5 criteria. A semi structured questionnaire was used to assess the sociodemographic and putative risk factors and QOL was assessed using the WHOQOL-BREF. Associations between full and subsyndromal PTSD and the putative risk factors were analyzed using logistic regression with significant value at p-value less than 0.05 and confidence interval (CI) of 95%.
Results
Mean age of participants was 69.4 ± 10.1 years. Lifetime prevalence were 61.5% and 59.0% for full PTSD, and an additional lifetime prevalence of subsyndromal PTSD were 21.5% and 35.5% using DSM-IV and DSM-5, respectively. Lower average monthly income was associated with increased odds of endorsing full and subsyndromal PTSD using DSM-IV and DSM-5. In addition, the factors associated with increased odds of having full PTSD using DSM-IV include participants who were farmers, insurgent attacks as nature of the traumatic event (TE), TE experienced by a close relative, and lack of someone to confide in after the TE (OR = 3.299, CI = 1.236–8.805, p = 0.017); (OR = 1.180, CI = 1.002–1.390, p = 0.047); (OR = 3.190, CI = 1.200–8.478, p = 0.020); and (OR = 1.654, CI = 1.200–2.250, p = 0.020), respectively. The factors associated with increased odds of developing full PTSD using DSM-5 include participants who directly witnessed the TE (OR = 9.511, CI = 2.524–35.850, p = 0.001) and nature of trauma (OR = 1.311, CI = 1.090–1.577, p = 0.004). Participants who had poor access to health care after the TE and who had a diagnosis of a medical illness had increased odds of subsyndromal PTSD using DSM-5 (OR = 11.952, CI = 1.630–87.623, p = 0.015; (OR = 0.024, CI = 0.002–0.373, p = 0.008) . There was demonstrable impairment in the psychological, social, and environmental domains of QOL in participants who met the diagnosis for full and subsyndromal PTSD with variance in results across DSM-IV and DSM-5.
Conclusion
Traumatized older adults showed high prevalence of full and subsyndromal PTSD with substantial impairment in their QOL. Participants with low socioeconomic status, who directly witnessed the TE, had close relatives murdered, and lacked someone to confide in after the TE had higher likelihood of being diagnosed with full and subsyndromal PTSD across both diagnostic systems.
... High rates of PTSD have been found among ex-POWs worldwide, across a range of wars and eras (Engdahl et al. 1997;Port et al. 2001;Rintamaki et al. 2009). Moreover, for many repatriated POWs, PTSD was not only found upon homecoming but rather persisted for extensive periods of time, spanning as long as several decades after repatriation (Kluznik et al. 1986;Sutker et al. 1991;Rintamaki et al. 2009). For others, symptom manifestation erupted long after repatriation, following several relatively symptom-free years. ...
This chapter is devoted to an examination of the aftermath of war captivity as implicated in the next (second) generation. Capitalizing on findings from a nearly three-decade and four-wave longitudinal study, we present cumulative evidence regarding the psychological and interpersonal ramifications of war captivity for Israeli former prisoners of war (ex-POWs) and underscore the intergenerational effects of the fathers’/ex-POWs’ experiences on their adult offspring. Taking into consideration the relational context of the family system, the chapter addresses post-traumatic phenomena manifesting among the offspring as impacted by their fathers’ trauma and post-traumatic stress symptoms, their mothers’ secondary traumatic stress, and the complex interaction of familial subsystems, such as the marital and the parental relationships. Clinical and societal implications are drawn, and directions for future research in the field are discussed and encouraged.
... PTSD rates for former prisoners of war (POWs) traumatized in early life are even higher than those reported for veterans. Kluznik et al. (1986) examined 188 former US POWs 40 years after WWII and reported a PTSD prevalence of 67%. The authors argued that the higher rate of PTSD in POWs resulted from the more severe trauma they experienced in captivity. ...
... In the study by Potts higher levels of posttraumatic stress were associated with poorer physical health. Studies of former south-east Asian POWs revealed high rates of PTSD: current PTSD 56% [24], 59% [25], 70% [26] and 85% [27]; lifetime PTSD 67% [28], 78% [26] and almost 80% [29]. This is much higher than the 11% found in this investigation. ...
Objective: Studying the rates of posttraumatic stress disorder (PTSD) in people who experienced World War II, but who have subsequently lived in different environments is a way of looking at the impact of recovery environment on PTSD. Immigrants had less support in terms of the social cohesion in their home country, but were not subjected to the same triggers of war-related intrusions.
Method: Posttraumatic stress disorder was investigated in citizens from the Netherlands who emigrated to Australia in the post-World War II years (n = 251). Immigrants born between 1920 and 1930 (n = 171) were compared with a same-aged group living in Holland (n = 1461) for stressful war experiences and the extent of PTSD.
Results: Those who had been exposed to the most severe war stress were over-represented in the immigrant group. Immigrants with current PTSD more often stated that motives for migration were threat of a third world war, disappointment with Dutch society and personal problems. We were unable to demonstrate specific effects of emigration on the prevalence of current PTSD.
Conclusions: This study suggests that exposure to severe war stress promoted the need to emigrate. The comparable PTSD scores of the groups of war victims living in Australia and the Netherlands support the notion that extreme war stress may be considered the primary determining factor in the development of PTSD, and that actual post-war living circumstances are, in the long term, of subordinate importance.
... Events associated with torture or prolonged victim-ization are associated with the highest estimates for chronic PTSD. The prevalence of chronic PTSD among torture survivors such as prisoners of war and concentration camp survivors is about 50% (Kluznick et al 1986;Goldstein et al 1987;Yehuda et al 1995a). In contrast, the prevalence rate of chronic PTSD in survivors of natural disasters is about 4% (Shore et al 1989); however, even among those who are exposed to very severe and prolonged trauma, there is usually a substantial number of individuals who do not develop PTSD. ...
Posttraumatic stress disorder (PTSD) is a psychiatric condition that is directly precipitated by an event that threatens a person's life or physical integrity and that invokes a response of fear, helplessness, or horror. In recent years it has become clear that only a proportion of those exposed to fear-producing events develop or sustain PTSD. Thus, it seems that an important challenge is to elucidate aberrations in the normal fear response that might precipitate trauma-related psychiatric disorder. This paper summarizes the findings from recent studies that examined the acute and longer term biological response to traumatic stress in people appearing to the emergency room immediately following trauma exposure. In the aggregate, these studies have demonstrated increased heart rate and lower cortisol levels at the time of the traumatic event in those who have PTSD at a follow-up time compared to those who do not. In contrast, certain features associated with PTSD, such as intrusive symptoms and exaggerated startle responses, are only manifest weeks after the trauma. The findings suggest that the development of PTSD may be facilitated by an atypical biological response in the immediate aftermath of a traumatic event, which in turn leads to a maladaptive psychological state.
... Accordingly, peritraumatic, posttraumatic, and pretrauma risk factors have each been associated with increased risk for the development of chronic PTSD. Some of these factors include the severity of the trauma (Foy, Sipprelle, Rueger & Carroll, 1984; Giller, 1 992a); the presence of comorbid psychopathology (McFarlane, 1989); subsequent exposure to reactivating environmental events (Kluznick et al., 1986;Schnurr, Friedman & Rosenberg, 1993;Solomon & Preager, 1992;True et al., 1993;Yehuda, et al., 1995a); history of stress, abuse or trauma (Bremner, Southwick, Johnson, Yehuda & Charney, 1993;Zaidi & Foy, 1994); history of behavioral or psychological problems (Helzer, Robins & McEvoy, 1987); and low IQ prior to the trauma . ...
It is now well established that memory consolidation in both animals and humans is influenced by stress-responsive neuromodulators. Recent theories have attempted to apply knowledge about the effect of these neuromodulators on memory, in order to explain the nature of memory-related impairments in trauma survivors with posttraumatic stress disorder (PTSD). However, as will be described in this chapter, most existing theories have not incorporated recent information about biological aspects of PTSD in their formulations. Accordingly, current theories using only extant knowledge of the neurochemistry of stress have not been able to account for several important aspects of memory-related phenomenology in PTSD. For example, current theories do not explain the heterogeneity among trauma survivors in the prevalence of memory-related impairments, nor do they account for how different types of memory-related symptoms can occur over the course of an individual’s illness. A consideration of these questions requires knowledge of the biological events that occur at the time of the trauma and during the course of PTSD and an appreciation that these biological events represent an atypical, rather than a normal stress response. Furthermore, as most individuals do not develop long-term PTSD symptoms, current models of memory processing in PTSD must also account for the complex risk factors, other than similar exposures to traumatic events, that give rise to PTSD and PTSD-related memory impairments. This chapter will describe differences in the acute and chronic neurobiological response to trauma in individuals who develop PTSD versus those who do not, and will discuss the relevance of these findings to understanding the biological underpinnings of memory impairments in PTSD. Furthermore, a theoretical formulation of how to explore cognitive impairments in PTSD by considering possible risk factors for disturbed memory processing in response to trauma will be presented.
... Nearly 25% of a sample of WWII POWs reported that they had experienced difficulties with PTSD symptoms continuously, while 62% indicated they were periodically troubled by these symptoms over the course of 40 years (Zeiss and Dickman, 1989). Another study with former WWII POWs indicated that 67% had PTSD at some point in their lifetimes, with approximately 29% fully recovered, 39% reporting mild symptoms, 24% reporting moderate symptoms, and 8% reporting no improvement or worsening of symptoms (Kluznik et al., 1986). ...
... T he development of posttraumatic stress disorder (PTSD) as a psychological condition was sparked by empirical research that examined two primary populations-war veterans (Kluznick, Speed, Van Valkenburg, & Magraw, 1986;Speed, Engdhal, Schwatz, & Eberly, 1989;Ursano, Boydstun, & Wheatley, 1981) who were predominately male and adult rape survivors (Davis, Taylor, & Bench, 1995;Foa, Riggs, & Gershuny, 1995;Foa, Steketee, & Rothbaum, 1989) who were mostly female. Both bodies of literature apply the framework of PTSD to understand the response of survivors; however, examination of these early studies reveals gender-related differences in the event-specific experience of males and females. ...
This article investigates gender differences in trauma symptoms from baseline to end of treatment (trauma-focused cognitive behavioral therapy or parent–child interaction therapy) in children ages 7–18 years. Multivariate analysis of covariance (MANCOVA) and trend analysis
using analysis of covariance (ANCOVA) were conducted on baseline and end of treatment University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) total scores. Results suggest that female children start at higher reported total posttraumatic stress disorder
rates than males, but both groups experience significant symptom reduction during the course of treatment. At posttreatment, girls are still reporting higher symptom levels on the UCLA PTSD-RI than boys, suggesting that their clinical presentation at discharge may differ despite significant
treatment gains. A full factorial model including the interaction of dose and gender was not significant. Identification of these gender-specific response patterns are an important consideration in treatment and discharge planning for children who have been trauma-exposed and are presenting
for treatment with post trauma exposure disturbances.
... Most of what is known about the long-term effects of service relates specifically to combat or imprisonment and resulting psychological distress, PTSD symptom clusters, or mortality rates. There is evidence of persistent, and even intensified, effects of service during World War II on veterans after 5 years (e.g., Futterman and Pumpian-Mindlin 1951), 15 years (e.g., Archibald et al. 1962), 20 years (e.g., Archibald and Tuddenham 1965), 30 years (e.g., Klonoff et al. 1976), 40 years (e.g., Kluznick et al. 1986;Schrueder, Kleijn, and Rooijmans 2000;Spiro et al. 1994;Zeiss and Dickman 1989), and 50 years (e.g., Dirkzwager, Bramser, and Van Der Ploeg 2001;Hunt and Robbins 2001a;Port, Engdahl, and Frazier 2001). The incidences of these effects and the processes and mechanisms that drive them, however, have not been clearly explicated. ...
Most scholarship on aging is based on cohorts born early in the 20th century, and these cohorts have had significant experience with war. Wartime experiences may therefore be critical but largely hidden variables underlying current scientific knowledge about aging. Evidence marshaled in this article illustrates the powerful insights gained when research on this topic is guided by life-course propositions and data. It reveals how wartime military service, especially during World War 11, affected the short- and long-ranging development of recruits. It also highlights the need to better account for the potential legacies of service for physical, psychological, and social functioning in late life. These matters will become increasingly important as sizable World War 11 and Korean veteran populations move through advanced old age, and as the Vietnam veteran population moves into old age. Systematic attention to the effects of wartime service is necessary to determine the degree to which contemporary knowledge about aging can be generalized to future cohorts.
This study investigated the intergenerational transmission of trauma from Croatian war veterans to their children who were born after the war. This was done by measuring the frequency of relational anger and relational guilt expressed by children of Croatian war veterans in structured interviews. Children were administered: a demographic questionnaire; the Trauma Symptom Checklist for Children (TSCC); and the Relationship Anecdotes Paradigm (RAP) structured interview. Comparing children with high and low paternal exposure to combat trauma was defined narrowly as the father’s veterans’ status–former POW or non-former POW. The results did not support the hypotheses that greater parental exposure to war trauma would be related to children expressing relational anger and relational guilt more frequently. An alternative and more comprehensive measure of parental trauma was then developed that combined self-reports of wartime experiences and current sense of safety by both parents. This broader and more comprehensive measure of trauma did find that children who expressed more relational anger and guilt had parents with higher rates of exposure to war trauma. The results suggested the importance of assessing parental exposure to trauma comprehensively – both parents with dimensional rather than categorical measures of trauma exposure – in order to better identify children who may be struggling with difficult though sub-clinical posttraumatic emotions like relational anger and guilt. The clinical implications of the study are that clinicians can help veterans’ families overcome the potentially limited awareness and restrictive coping strategies they may have developed in response to parental trauma. Therapists can help children explore the combination of curiosity and anxiety they may feel about their parents’ past traumatic experiences, and the post-traumatic worldviews and interpersonal styles they may have internalized from their parents. Ukrainian translation of the paper was provided by Kateryna Bagan.
This study aims to establish the effect of self-perceived social support on the intensity of Post-Traumatic Stress Disorder (PTSD) symptoms and Mental Health-Related Quality of Life (MHRQoL) in veterans more than two decades after exposure to trauma in the Homeland War in Croatia, which took place from 1990 to 1995. The sample comprised 259 Croatian Homeland War veterans diagnosed with PTSD, with at least 6 months of combat experience. Among them, 90 subjects had also experienced imprisonment in enemy prison camps (at least 1 month of captivity). The subjects were evaluated using the questionnaire on self-perceived social support, sociodemographic questionnaire, PTSD self-report checklist (PCL-5) and Short Form (SF-36) Health Survey questionnaire. A general regression model analysis was performed to determine whether social support affected patients' MHRQoL and intensity of the PTSD symptoms. The obtained results showed that veterans who had a more positive perception of social support after the events of the war had less intense PTSD symptoms and better MHRQoL. Furthermore, captivity and socioeconomic status were shown to be important predictors of PTSD and MHRQoL. The nonimprisoned veteran group was more likely to develop more severe PTSD symptoms and have poorer MHRQoL compared to the group of former prisoners of war (ex-POWs). This could be due to better postwar care and social support, which ex-POWs received after their release from captivity.
Nurse resilience is attracting increasing attention in research and practice. Possession of a high level of resilience is cited as being crucial for nurses to succeed professionally and manage workplace stressors. There is no agreed definition of nurse resilience. A concept analysis was undertaken to examine nurse resilience using a priori selected analysis framework. This concept analysis aims to systematically analyse resilience as it relates to nurses and establish a working definition of nurse resilience. Sixty‐nine papers met the search criteria for inclusion. Key attributes of nurse resilience were social support, self‐efficacy, work–life balance/self‐care, humour, optimism, and being realistic. Resilience enables nurses to positively adapt to stressors and adversity. It is a complex and dynamic process which varies over time and context and embodies both individual attributes and external resources. Sustaining nurse resilience requires action and engagement from both individuals and organizations.
Acute and post-traumatic stress disorders are two conditions caused specifically by violence. These are severe disorders, with deep biological, psychological and social effects. The Program to assist in and study violence (PROVE) was created in 2004. As of May 2009 the assistance changed to a multidisciplinary approach. A total 1,445 cases were seen between that date and November 2009, and new patients were included, 76 adults and 27 children. The most common traumatic events were hold-ups and kidnapping (adults) and murder of a relative and sexual abuse (children). The multidisciplinary system is effective with high adherence (87%/6 months).
The clinical management of posttraumatic stress disorder (PTSD) is as complex as the condition itself. Pharmacotherapy is an important component of this treatment process, which also includes psychosocial interventions and, in most cases, entails long-term efforts. The authors propose a systematic approach to the pharmacological treatment of PTSD using algorithmic techniques. After a careful history-taking phase and a review of available psychotropic agents, the practitioner usually ends up dealing with either PTSD alone or, more frequently, accompanied by other identifiable syndromes. Various antidepressants have demonstrated efficacy in the former, while the latter requires a management aimed at depressive, anxiety/dissociative, hypomanic/manic, or psychotic symptoms. The proposed algorithm provide guidelines for treatment issues such as medication choice, medication dose, maintenance pharmacotherapy, alternative options, and eventual outcomes. Algorithms summarize current information and suggest pharmacotherapy guidelines as a significant component of a comprehensive PTSD management program.
Os transtornos de estresse agudo e de estresse pós-traumático são duas condições específicas causadas pela violência. São quadros graves, com repercussões biológicas, psicológicas e sociais profundas. Foi criado programa para atender e estudar a violência (Prove), em 2004. A partir de maio de 2009, houve mudança do atendimento que passou a ser multidisciplinar. Foram realizados 1.445 atendimentos dessa data até novembro de 2009 e incluídos 76 novos pacientes adultos e 27 crianças. Os eventos traumáticos mais frequentes foram assalto e sequestro (adultos) e assassinato de um familiar e abuso sexual (crianças). O sistema multidisciplinar é efetivo e apresenta alta adesão (87%/6 meses).
Objectives:
This prospective study aims to assess the role of fathers' posttraumatic stress disorder (PTSD) symptoms (PTSS), the course of these symptoms over the years, and the relationship between these symptoms and their adult offspring's own PTSS and level of differentiation of self.
Method:
A sample of 123 Israeli father-child dyads (79 ex-prisoners of war [ex-POWs] dyads and a comparison group of 44 veterans' dyads) completed self-report measures. The fathers participated in 2 waves of measurements (1991 and 2008), while the offspring took part in 2013-2014.
Results:
Increase in the fathers' PTSS over the years was related to high levels of his offspring's PTSS. Among ex-POWs' offspring, self-differentiation mediated the association between the father's PTSS and offspring's PTSS. Thus, a greater increase in the ex-POWs' PTSS over time was correlated to lower levels of the offspring's self-differentiation, which in turn was correlated to higher rates of PTSS.
Conclusion:
Veterans' PTSS as well as offspring's self-differentiation are mechanisms of the intergenerational transmission of captivity trauma.
The experience of military personnel has informed our understanding of the mental health impacts of trauma over the centuries. This chapter provides an overview of the range of potentially traumatic events (PTEs) that military personnel are exposed to and the rates of PTSD across different types of deployment and trauma exposure. The particular association between PTSD and “moral injury” is highlighted. Within the military context, morale, leadership, and unit cohesion have been found to be important predictors of PTSD. These are potentially modifiable factors and, along with advances in resilience training, point to the potential for primary prevention of PTSD. Military organizations around the world are working toward early detection and intervention for mental health problems with widespread use of psychological first aid and routine screening. Through this work, the experience of military personnel is at the core of advances in our understanding of trauma and strategies to mitigate its impact. Finally, this chapter canvasses the unique challenges of managing PTSD in the military context with respect to case identification, the need to understand military cultural, and return to work issues.
In this chapter we present cumulative evidence about the psychological and interpersonal ramifications of war captivity on Israeli former prisoners of war (ex-POWs). Specifically, we address the associations between ex-POW husbands’ posttraumatic distress (i.e., PTSD) with their wives’ secondary traumatization. We also present findings from recent studies of both partners assessing their mutual and bidirectional influences regarding both distress and marital adjustment. Clinical implications and directions for future research in the field are presented.
There have been rapid advances made in the pharmacological treatment of chronic posttraumatic stress disorder (PTSD) in the last decade. Based on numerous controlled clinical trials, antidepressants are the first-line pharmacological treatment for this disorder. Multiple studies suggest the selective serotonin reuptake inhibitors (fluoxetine, sertraline, and paroxetine) are efficacious in reducing PTSD-specific symptoms and improving global outcome; tricyclic anti-depressants (imipramine) and monoamine oxidase inhibitors (phenelzine) have also been found to be efficacious. For those who are resistant or refractory to antidepressant treatment, prazosin is emerging as a beneficial adjunctive agent in treating PTSD-related sleep disturbances and nightmares, and atypical antipsychotics (risperidone, olanzapine) appear to be efficacious against a broad range of symptoms, though their potential for causing metabolic side effects may limit their use. Controlled clinical trials are needed to assess whether anticonvulsants, cortisol, and sympatholytics are efficacious, and how and when pharmacotherapy can supplement or enhance psychotherapy outcomes. The pace of advances in recent years suggests that the promise of even more effective pharmacological treatments for PTSD is likely to be realized in the coming years.
Among traumatic events caused by humans, torture is unique as an activity devoted to the confinement, control, and destruction of other people. Torture is reviewed as a concept in this chapter, and torture methods as they are used today will be described, together with the prevalence of torture practices. Furthermore, the consequences for the individual and for society are considered. The review is based on research findings reported in the professional literature and on the clinical experience gained at the International Rehabilitation and Research Center for Torture Victims (RCT) in Copenhagen, Denmark. Symptoms related to torture practices have received increasing attention over the past 25 years. At the time when the RCT was established in 1984, interest was focused on the aims of torture, its physical and psychological methods, its aftereffects, and treatment of the individual survivor. The focus of the RCT has gradually enlarged to address the needs of the family and friends surrounding the torture survivor. At the same time it was recognized that, when torture is practiced in a society, the state of health throughout the whole society suffers. Thus attention has little by little shifted from the individual survivor to society at large in recognition of the fact that torture is an effective weapon against the social freedoms found in democratic societies.
The experience of military personnel has informed our understanding of the mental health impacts of trauma over the centuries. This chapter provides an overview of the range of potentially traumatic events (PTEs) that military personnel are exposed to and the rates of PTSD across different types of deployment and trauma exposure. The particular association between PTSD and “moral injury” is highlighted. Within the military context, morale, leadership, and unit cohesion have been found to be important predictors of PTSD. These are potentially modifiable factors and, along with advances in resilience training, point to the potential for primary prevention of PTSD. Military organizations around the world are working toward early detection and intervention for mental health problems with widespread use of psychological first aid and routine screening. Through this work, the experience of military personnel is at the core of advances in our understanding of trauma and strategies to mitigate its impact. Finally, this chapter canvasses the unique challenges of managing PTSD in the military context with respect to case identification, the need to understand military cultural, and return to work issues.
A simple and powerful idea underlies this chapter as well as the volume as a whole. In essence it stipulates that good clinical practice must be guided by state-of-the-art knowledge concerning the topic of interest. Relevant sources of information may include: (1) psychosocial theory and associated empirical research; (2) prior clinical experience; (3) and personal life experiences. The remainder of the chapter provides an overview of available knowledge concerning the nature of traumatic stress. The material represents a synthesis of the aforementioned sources of information.
Posttraumatic stress disorder appears to be associated with a complex array of abnormalities in several biological systems. Despite the fact that systematic research in this area is at a relatively early stage, robust findings from a number of experimental approaches suggest that PTSD patients exhibit distinctive physiological, neuropharmacological, and neuroendocrinological alterations. In addition, there is a wealth of psychological and neurobiological theory and data that may be directly applicable to our understanding of PTSD. Moreover, unlike most other psychiatric disorders, there are several animal models that may be directly applicable to PTSD, including conditioned fear (Kolb, 1987, 1988), two-factor theory (Keane, Zimering, & Caddell, 1985), learned helplessness to inescapable shock (van der Kolk, Greenberg, Boyd, & Krystal, 1985), and kindling (Friedman, 1988, 1991; van der Kolk, 1987).
In the 10th revision of the International Classification of Diseases, Chapter 5, one may read that posttraumatic stress disorder (PTSD) arises as a delayed and/or protracted response to a stressful event or situation of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone (e.g., natural or man-made disaster, combat, serious accident, witnessing the violent death of others, being the victim of torture, terrorism, rape or other crime). ([WHO]a)
The pathogenic effects of traumatic events have been consistently documented over a large range of populations and occurrences (Wilson & Raphael, 1993). At the same time, considerable variability in human response to trauma has been documented (e.g., Solomon, Mikulincer, & Waysman, 1991). Although many survivors are able to put the trauma behind them and resume their lives, others are detrimentally affected. They may suffer a deterioration of health and social functioning, along with a large variety of psychological disturbances, including anxiety, depression, somatization (Solomon, 1993), and posttraumatic stress disorder (PTSD), which is the most common and conspicuous psychological sequela of trauma (American Psychiatric Association, 1994).
We studied the prevalence of long-term posttraumatic stress disorder (PTSD) symptoms in a population of men from Alsace-Lorraine who were forcibly drafted into the German armed forces during World War II (WW II), subsequently taken prisoners on the Russian front, and kept in Soviet captivity until repatriation to France several months or years later. They can be considered a homogeneous group with respect to age and their cultural and geographical backgrounds.
The consequences of torture and other extreme interpersonal trauma show many similarities across groups of survivors. Thus, data about assessment and intervention approaches with other traumatized populations are potentially valuable for survivors of torture. However, determining with accuracy the generalizability of findings from one group to another is challenging. The differences in the physical, psychological, sociocultural, and economic variables, both within and between disparate groups, have significant implications for assessment approaches, diagnostic validity, and treatment interventions. Because of the scarcity of empirical data specifically on the assessment and treatment of torture survivors, little consensus exists about which assessment and intervention approaches are best to use.
Warfare exposes combatants and civilians to one of the most severe and often enduring stressors that humans can experience. Although removed from the threats of combat, prisoners of war (POWs) face other horrific experiences, including torture, starvation, enforced labor, gross physical and social deprivation, random brutality, and summary execution; the experiences vary accordingly to the theater of war and the nature of the captors. This article assesses the medical and psychological consequences of being a POW in conflicts mainly from the era of World War II and the Korean War and draws largely on controlled studies.
It is apparent from clinical experience and the literature that persons, who experience severe physical or mental trauma, are susceptible to premature aging (or psychological symptomatology). Long-term follow-up of repatriated prisoners of war also confirm this observation. Coping with physical and mental sequelae of captivity means a constant struggle to maintain some kind of homeostasis. Often, this delicate equilibrium fails. Claude Bernard stated that To have a free life, independent of the external environment, requires a constant internal environment (Bernard, 1957, P. 8). This is the underlying principle of homeostasis. When it collapses due to wear and tear processes, premature aging/morbidity process takes place.
ously rapid succession and telecast and watched repeatedly around the world. Catastrophic events of war and organized violence, including terrorism, dramatically disrupt the fabric and order of a society, presenting vivid proof of the vulnerability of its members, threatening psychological adaptation and mental health, and cultivating a culture of fear. Research documents high rates of psychological difficulties in the majority of individuals exposed to such events, including depression, anxiety, guilt, pathological grief reactions, restlessness, sleep disturbances, psychosomatic com plaints, and posttraumatic stress disorder. The relatively new diagnosis of Posttraumatic Stress Disorder, or PTSD, has received much attention in analysis of the mental health impact of the events of September 11. In this paper, research on PTSD is reviewed and related to the terrorist attacks of September 11, and some
Objective.
—To examine factors related to long-term psychological functioning in political ex-prisoners who had been subjected to systematic torture.Design.
—The psychological status of 55 tortured political activists, 55 nontortured political activists, and 55 subjects with no history of torture or political activism was assessed using Structured Clinical Interview for DSM-III for psychiatric assessment, Semi-structured Interview for Survivors of Torture, and other self-rated and assessor-rated measures of anxiety, depression, and posttraumatic stress disorder (PTSD). Correlational and multiple regression analyses were used to assess the independent effects of precaptivity, captivity, and postcaptivity variables as predictors of long-term psychological status among the torture survivors.Setting.
—Istanbul, Turkey.Main Outcome Measures.
—Number of lifetime and current PTSD symptoms, and scores on the Beck Depression Inventory, Hamilton Depression Rating, Hamilton Anxiety Scale, and State-Trait Anxiety Inventory.Results.
—Effect of captivity experience on various life areas (eg, family and social, economic, and employment status) and other postcaptivity psychosocial stressors were associated with PTSD symptoms, anxiety, and depression. Perceived severity of torture was related to PTSD symptoms but not to anxiety or depression. Lack of social support predicted anxiety and depression but not PTSD. Family history of psychiatric illness correlated with higher scores on most measures. Impact of captivity experience on family was the strongest predictor of PTSD symptoms.Conclusions.
—These findings point to three types of stressors related to different aspects of psychopathology in survivors of torture: perceived severity of torture, secondary effects of captivity experience on various life areas, and general psychosocial stressors following captivity. Different interventions may be needed for three components of survivors' traumatic experience: cognitive and behavioral strategies for treatment of PTSD symptoms, marital or family strategies for minimizing the impact of the trauma on the family, and strategies for enhancing social support to minimize postcaptivity depression and anxiety.(JAMA. 1994;272:357-363)
Résumé : Cet article dresse une synthèse des données épidémiologiques concernant les Etats de stress post-traumatiques. Après une présentation des taux d'exposition et de la prévalence du PTSD en population générale, est introduite la question des victimes d'expériences traumatiques spécifiques. Selon le type de traumatisme subi, la prévalence du PTSD varie de manière substantielle. Sont présentés, les résultats d'études relatives aux situations de guerre menées sur les militaires et les populations civiles, notamment les enfants et les adolescents. Sont ensuite présentés les résultats d'études relatives aux agressions, telles que les actions terroristes et les agressions sexuelles, notamment celles commises contre des mineurs. Enfin, sont présentés les résultats d'études relatives aux catastrophes naturelles ou industrielles et aux accidents, particulièrement les accidents de la route.
Objectives:
To assess the long-term effects of the prisoner of war (POW) experience on U.S. World War II (WWII) veterans.
Design:
Exploratory study.
Setting:
Participants were recruited through the Hines Veterans Affairs Hospital; a POW reunion in Orlando, Florida; and the WWII veterans periodical, "The QUAN."
Participants:
One hundred fifty-seven American military veterans who were former WWII POWs.
Measurments:
Participants completed a mailed survey describing their POW experiences, POW effects on subsequent psychological and physical well-being, and ways in which these experiences shaped major decisions in their lives.
Results:
Participants from the European and Pacific theaters reported that their captivity during WWII affected their long-term emotional well-being. Both groups reported high rates of reflection, dreaming, and flashbacks pertaining to their POW experiences, but Pacific theater POWs did so at higher rates in the present than in the past. Large portions of both groups reported greater rumination on POW experiences after retirement. Finally, 16.6% of participants met the requirements of a current, clinical diagnosis of posttraumatic stress disorder (PTSD) based on the Mississippi PTSD scale, with PTSD rates in Pacific theater POWs (34%) three times those of European theater POWs (12%).
Conclusion:
Traumatic memories and clinical levels of PTSD persist for WWII POWs as long as 65 years after their captivity. Additionally, rumination about these experiences, including flashbacks and persistent nightmares, may increase after retirement, particularly for those held in the Pacific theater. These findings inform the current therapeutic needs of this elderly population and future generations of POWs from other military conflicts.
Scopo - Presentare una esaustiva review degli studi riguardanti l'epidemiologia del DPTS condotti nella popolazione generale, tra i soggetti a rischio, e, infine, tra gruppi clinicamente selezionati. Disegno - Attraverso Excepta Medica Psychiatry CD-ROM 1980-1993 (ottobre), utilizzando come parola chiave «Post-Traumatic Stress Disorder», sono stati identificati 1.057 articoli pubblicati nel periodo considerate Sono stati anche consultati altri data base della letteratura medica (MEDLINE CD-ROM 1988-1993); è stata quindi operata una ricerca manuale su tutti i numeri del Journal of Traumatic Stress. Risultati - In totale, 135 lavori che hanno soddisfatto i criteri di inclusione prescelti sono stati inclusi nella review. I due terzi (n = 86, 64%) di queste ricerche sono state condotte negli USA. Solo 8 (6%) sono le indagini effettivamente realizzate nei paesi del Terzo Mondo. L'ampiezza del campione varia da un minimo di 11 soggetti, numero riscontrato in due studi, sino ad un massimo di 22.436, per un campione medio di 500 e mediano di 108. Per quanto attiene ai metodi di valutazione, in un terzo degli studi (n = 45, 33%), i ricercatori hanno impiegato un questionario (auto- o etero- somministrato). In un altro terzo delle ricerche elencate (n = 44, 33%) e stata somministrata un'intervista strutturata (la DIS, la SCID, o la SADS), mentre nei rimanenti studi la valutazione diagnostica si è basata o su una procedura clinica non strutturata, o sulla somministrazione di altri strumenti specifici dai quali è possibile inferire una diagnosi di DPTS (M-PTSD, IES, SCL-90-R,o pochi altri). In 77 studi (57%) i ricercatori hanno basato la loro valutazione sui criteri diagnostici propri del DSM-III, mentre in altri 55 (41%) su quelli del DSM-III-R. La prevalenza del DPTS e analizzata quindi separatamente per le diverse popolazioni studiate. Conclusioni - Nell'arco di soli 13 anni, a partire cioe dalla definizione di criteri diagnostici operazionali ben definiti per il DPTS, sono stati condotti numerosi studi volti ad indagare la prevalenza, i fattori di rischio, la storia naturale, il decorso e l' esito di questo disturbo tra campioni diversi di popolazioni a rischio; inoltre, anche il livello qualitativo di queste ricerche, per quanto attiene alia sofisticazione metodologica, si è accresciuto sensibilmente in un tempo tutto sommato breve. Molte aree, pero', restano tuttora inesplorate, ed inoltre appare imperativo avviare ricerche estensive tra le popolazioni dei paesi in via di sviluppo, maggiormente esposte a disastri naturali o provocati dall'uomo.
In recent years, behavior therapists have made a deliberate effort to expand their horizons to include underserved populations. The application of behavioral and cognitive behavioral procedures to anxiety disorders in the elderly represents one such beginning effort. In this review, we will present an overview of available literature concerning the psychopathology, assessment, and behavioral treatment of the anxiety disorders in later life. As will be noted, research is beginning to elucidate specific features and treatment of anxiety in the elderly, although the majority of this attention has been directed at Generalized Anxiety Disorder, specific phobias, and non-clinical anxiety complaints. Areas for future research are highlighted throughout this review, in the hopes of stimulating increased attention in these areas.
We examined perceptions of services and benefits held by former U.S. prisoners of war (POWs) and their spouses using qualitative research methods. Subjects were male ex-POWs (n = 16) and their spouses (n = 9) recruited through a national POW organization to participate in focus groups designed to learn about perceptions of care within the Veterans Affairs (VA) system. Questions pertained to ways in which participants were satisfied and dissatisfied with VA health services and benefits, current needs for which services or benefits are unavailable, and barriers to care and benefits. Qualitative analyses revealed that veterans generally rely on the VA for medical care and financial benefits and are typically satisfied with the quality of care and benefits they receive. However, four broad categories of concern were noted: Perceptionsregarding staff; Availabilityof needed services; Accessto services; and Inconsistencyin care. These results point towards areas for potential VA quality improvements efforts.
ResearchGate has not been able to resolve any references for this publication.