A recent medical study, published in the British Medical Journal and reported on Friday, suggests that "the risk of combat-related post-traumatic stress disorder (PTSD) increased by two- to threefold in military personnel who had significant mental or physical problems before deployment, according to a study of 5,400 veterans." In other words, those who were vulnerable beforehand, were even more susceptible to PTSD than their peers. Hmmmn.
It's always interesting, and is going to stay interesting, to contemplate what, if any, predictive or predisposing factors there are for who develops later develops combat-based PTSD and why. At the very least, this study throws yet more analysis into the mix, in a story that will continue developing for years.
According to the BMJ, the conclusion of the study was that:
"Low mental or physical health status before combat exposure significantly increases the risk of symptoms or diagnosis of post-traumatic stress disorder after deployment. More vulnerable members of a population could be identified and benefit from interventions targeted to prevent new onset post-traumatic stress disorder."
The study, which was supported by the U.S. Department of Defense, reported that:
"More
than half of post-combat PTSD diagnoses involved veterans who ranked
below the 15th percentile in mental or physical health at baseline,
Cynthia LeardMann, of the Naval Health Research Center in San Diego,
and colleagues reported online in BMJ.
"We
have identified an at-risk population whose functional health seems to
predict vulnerability to PTSD after combat deployment," the authors
said. "In theory, such a population could be targeted for PTSD
prevention programs, early intervention after exposures to stress, or
even protection from stressful exposures, when possible."
The findings came from
the Millennium Cohort Study, which has accumulated data on military
personnel since 2001, before the wars in Afghanistan and Iraq.
Investigators collected follow-up data from June 2004 to February 2006.
A previous report based on
the study suggested that combat exposure -- as opposed to deployment --
significantly increased the risk of new-onset PTSD. Building on that
observation, the authors examined the association between baseline
mental and physical health and the risk of new symptoms or a diagnosis
of PTSD.
The current analysis
involved 5,410 combat veterans who completed baseline and follow-up
questionnaires. The questionnaire includes a 17-item self-report
measure of PTSD symptoms.
Baseline health status
was determined by participants' scores on the mental and physical
summaries of the SF-36V (veterans) health survey. A new PTSD diagnosis
was based on DSM-IV criteria (derived from the questionnaires) or
self-reported physician diagnosis.
The analysis showed that
7.3% of the participants had new-onset symptoms or a diagnosis of PTSD
at follow-up by DSM-IV criteria. When self-reported physician diagnosis
was included, the rate increased to 8.6%.
The authors stratified
the participants into three groups according to mental and health
status scores: below the 15th percentile, 15th to 85th percentile, and
above the 85th percentile.
Combat veterans who
scored below the 15th percentile of the mental summary had a relative
risk of PTSD of 3.51 compared with those in the 15th to 85th
percentile.
A score below the 15th percentile of the physical summary more than doubled the risk of PTSD (RR 2.22).
Overall, 58% of new PTSD diagnoses involved combat veterans who were below the 15th percentile for either summary.
Subgroups at increased risk for new PTSD symptoms or diagnosis included:
Editor's Note: The full reference is: LeardMann
CA, et al "Baseline self reported functional health and vulnerability
to post-traumatic stress disorder after combat deployment: Prospective
U.S. military cohort study." The full citation is: BMJ 2009; 339: DOI:10.1136/bmj.b1273. For the link to the full article, click here.
