Richard A. Kulka

Problems in families of male Vietnam veterans with posttraumatic stress disorder

Interviews were conducted with a nationally representative sample of 1,200 male Vietnam veterans and the spouses or co-resident partners of 376 of these veterans. The veteran interview contained questions to determine the presence of posttraumatic stress disorder (PTSD) and items tapping family and marital adjustment, parenting problems, and violence. The spouse or partner (S/P) interview assessed the S/Ps view of these items, as well as her view of her own mental health, drug, and alcohol problems and behavioral problems of school-aged children living at home. Compared with families of male veterans without current PTSD, families of male veterans with current PTSD showed markedly elevated levels of severe and diffuse problems in marital and family adjustment, in parenting skills, and in violent behavior. Clinical implications of these findings are discussed.

The prevalence of lifetime and partial post-traumatic stress disorder in vietnam theater veterans

A complete understanding of the consequences of service in a war zone includes examining the lifetime and current prevalence of post-traumatic stress disorder (PTSD), and of partial PTSD. Cases of partial PTSD are persons who have clinically significant symptoms of PTSD, but who do not meet the full diagnostic criteria. The National Vietnam Veterans Readjustment Study (NVVRS) estimated the lifetime prevalence of PTSD to be 30.9% among male theater veterans, 26.% among females; lifetime prevalence of partial PTSD was an additional 22.5% and 21.2%, respectively; current prevalence of partial PTSD was 11.1% in males and 7.8% in females. NVVRS findings indicate that of the 1.7 million veterans who ever experienced significant symptoms of PTSD after the Vietnam war, approximately 830,000 (49%) still experience clinically significant distress and disability from symptoms of PTSD. The contribution of partial PTSD represents an estimated additional 350,000 veterans.

Personal versus telephone surveys for collecting household health data at the local level.

Personal and telephone interview surveys were conducted simultaneously during 1981 in the same area (four counties in the area of Tampa Bay, Florida) and utilizing the same interview schedule. Following completion of the surveys, validity checks were made with the medical providers reported by a subsample of respondents to each mode. The telephone survey yielded a lower response rate but cost less than half the personal interview. There was some evidence of nonresponse bias in the telephone survey, and some relatively minor differences in responses were found between the two modes, but there was no conclusive evidence that the response differences resulted from mode effects. Telephone respondents appeared to be somewhat more accurate in their reporting of visits to medical providers, although accuracy comparisons must be interpreted with caution in view of the disparate success experienced for the two modes in securing permission forms for the release of medical record information.

The prevalence of post-traumatic stress disorder in the Vietnam generation: A multimethod, multisource assessment of psychiatric disorder

Findings from the Congressionally mandated National Vietnam Veterans Readjustment Study indicate that nearly one-half million Vietnam veterans—15.2% of the men and 8.5% of the women who served in Vietnam—suffer from post-traumatic stress disorder (PTSD) fifteen or more years after their military service. Current PTSD prevalence rates for Vietnam veterans are significantly and substantially higher than the rates for their comparable Vietnam generation peers, which range from 0.3% to 2.5%. Additionally, the current prevalence rate among male Vietnam veterans was found to differ significantly among race/ethnicity subgroups: 27.9% among Hispanic men, 20.6% among black men, 13.7% among white/other men. Multivariate analyses indicated that although background factors are significantly related to the current prevalence of PTSD, the current prevalence is much higher among Vietnam veterans than among era veteran and civilian counterpart comparison groups even after background differences are taken into account. These analyses also demonstrated the important role of exposure to combat and other types of war zone stress in the current prevalence of the disorder.

Course of Posttraumatic Stress Disorder 40 Years After the Vietnam War: Findings From the National Vietnam Veterans Longitudinal Study.

IMPORTANCE The long-term course of readjustment problems in military personnel has not been evaluated in a nationally representative sample. The National Vietnam Veterans Longitudinal Study (NVVLS) is a congressionally mandated assessment of Vietnam veterans who underwent previous assessment in the National Vietnam Veterans Readjustment Study (NVVRS). OBJECTIVE To determine the prevalence, course, and comorbidities of war-zone posttraumatic stress disorder (PTSD) across a 25-year interval. DESIGN, SETTING, AND PARTICIPANTS The NVVLS survey consisted of a self-report health questionnaire (n = 1409), a computer-assisted telephone survey health interview (n = 1279), and a telephone clinical interview (n = 400) in a representative national sample of veterans who served in the Vietnam theater of operations (theater veterans) from July 3, 2012, through May 17, 2013. Of 2348 NVVRS participants, 1920 were alive at the outset of the NVVLS, and 81 died during recruitment; 1450 of the remaining 1839 (78.8%) participated in at least 1 NVVLS study phase. Data analysis was performed from May 18, 2013, through January 9, 2015, with further analyses continued through April 13, 2015. MAIN OUTCOMES AND MEASURES Study instruments included the Mississippi Scale for Combat-Related PTSD, PTSD Checklist for DSM-IV supplemented with PTSD Checklist for DSM-5 items (PCL-5+), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and Structured Clinical Interview for DSM-IV, Nonpatient Version. RESULTS Among male theater veterans, we estimated a prevalence (95% CI) of 4.5% (1.7%-7.3%) based on CAPS-5 criteria for a current PTSD diagnosis; 10.8% (6.5%-15.1%) based on CAPS-5 full plus subthreshold PTSD; and 11.2% (8.3%-14.2%) based on PCL-5+ criteria for current war-zone PTSD. Among female veterans, estimates were 6.1% (1.8%-10.3%), 8.7% (3.8%-13.6%), and 6.6% (3.5%-9.6%), respectively. The PCL-5+ prevalence (95% CI) of current non-war-zone PTSD was 4.6% (2.6%-6.6%) in male and 5.1% (2.3%-8.0%) in female theater veterans. Comorbid major depression occurred in 36.7% (95% CI, 6.2%-67.2%) of veterans with current war-zone PTSD. With regard to the course of PTSD, 16.0% of theater veterans reported an increase and 7.6% reported a decrease of greater than 20 points in Mississippi Scale for Combat-Related PTSD symptoms. The prevalence (95% CI) of current PCL-5+-derived PTSD in study respondents was 1.2% (0.0%-3.0%) for male and 3.9% (0.0%-8.1%) for female Vietnam veterans. CONCLUSIONS AND RELEVANCE Approximately 271,000 Vietnam theater veterans have current full PTSD plus subthreshold war-zone PTSD, one-third of whom have current major depressive disorder, 40 or more years after the war. These findings underscore the need for mental health services for many decades for veterans with PTSD symptoms.

Low adolescent self-esteem leads to multiple interpersonal problems: A test of social-adaptation theory.

This article reports the results of a study that annually monitored the self-esteem and interpersonal problems of over 100 boys during their sophomore, junior, and senior years of high school. Cross-lagged panel correlation differences show that low self-esteem leads to interpersonal problems in all three time lags when multiple interpersonal problems constitute the dependent variable but not when single interpersonal problem criteria constitute the dependent variable. These results are interpreted as supporting social-adaptation theory rather than self-perception theory. Implications for the conceptual status of personality variables as causal antecedents and for the assessment of individual differences are discussed.

Interviewing Older Adults: A Comparison of Telephone and Face-to-Face Modalities

This article examines telephone interviewing of older adults and compares it with face-to-face interviews. Specifically, the following issues are examined in several national surveys: (1) differences in age distributions between the samples of adults reached in both modes; (2) explanations for potential differences in age distributions; (3) differences between the two modes in demographic characteristics in the adults reached, in interview process and in response quality, and how these mode differences vary by age of the respondents. Telephone surveys tend to underrepresent older persons, and older persons who do participate in a telephone survey are disproportionately well educated. Implications of the lower response rate among older persons are softened by the fact that reponse distributions across a range of questions show little difference by interview mode between older persons and persons of other age groups. A. Regula Herzog is Assistant Research Scientist at the Institute for Social Research and the Institute of Gerontology at the University of Michigan, Ann Arbor, Michigan. Willard L. Rodgers is Associate Research Scientist at the Institute for Social Research at the University of Michigan, Ann Arbor, Michigan. Richard A. Kulka is Senior Survey Methodologist at Research Triangle Institute, Research Triangle Park, North Carolina. This article is a revised and abbreviated version of three papers presented at the 33rd Annual Meeting of the Gerontological Society, San Diego, November 1980. This research was supported by USPHS Grant No. AGO2038 from the National Institute on Aging. The authors wish to thank Lynn Dielman and Mary Grace Moore for able research assistance; Charles Cannell, Philip Converse, Richard Curtin, Robert Groves, Robert Kahn, and the late Angus Campbell for data from several unreleased surveys; and Charles Cannell, Robert Groves, and Berit Ingersoll for helpful comments on an earlier version of this paper. Public Opinion Quairter-ly Vol. 47 405-418 ? 1983 by the Tr-ustees of Columbia Univelsity Published by ElsevierScience Publishing Co, Inc. 0033-362X/83/0047-405/

Participation in the 1990 Decennial Census Politics, Privacy, Pressures

2.50 This content downloaded from 207.46.13.105 on Wed, 25 May 2016 06:47:29 UTC All use subject to http://about.jstor.org/terms 406 HERZOG, RODGERS, AND KULKA research has been directed specifically to the use of telephone surveys with older adults. This paper represents an initial effort in that direction. In the type of telephone interview survey considered here, a random-digit dialing method for identifying sample households is used, and interviews with a random adult in each sample household are conducted from a central location. (For a detailed presentation of telephone interviewing methodology see Groves and Kahn, 1979; for a discussion of the sampling procedures see Waksberg, 1978.) A comparison of telephone and face-to-face interview surveys must therefore consider several areas of potential differences between the two: (1) their ability to reach a representative sample of the older population; (2) the nature of the interview process itself; and (3) the quality of the responses obtained. In general, the representativeness of a sample may be jeopardized in two ways. First, the sample may be drawn inaccurately and/or from a frame which systematically excludes certain members of the population. Second, persons who are identified by sampling procedures as respondents may not participate in the survey, thereby introducing systematic bias. With respect to the first point, persons without a telephone are systematically excluded from samples of telephone subscribers. However, this constitutes less of a problem when sampling older persons than when sampling the total population because older persons are slightly more likely than younger persons to have a telephone (Thornberry and Massey, 1978). With respect to the second point, response rates are generally somewhat lower for telephone interviews than similar interviews conducted face-to-face (Groves and Kahn, 1979). Moreover, older adults may be particularly likely to decline an interview on the telephone, since they are more likely than younger adults to have hearing problems (Corso, 1977), less likely to be used to the telephone, and likely to have less formal education. On the other hand, some older persons may be more likely to agree to participate in an interview when contacted by telephone than when contacted in person, because many of them are concerned about being victimized (Clemente and Kleiman, 1976) and interviews by telephone do not require them to admit a stranger to their home. In sum, it is difficult to predict how well telephone interviews will compare with face-to-face interviews in reaching the elderly population, since several potentially important factors apparently work in opposite directions. For several reasons the telephone interview process is expected to be more stressful and demanding than the face-to-face interview, particularly for older respondents. The failing sensory capacities of This content downloaded from 207.46.13.105 on Wed, 25 May 2016 06:47:29 UTC All use subject to http://about.jstor.org/terms INTERVIEWING OLDER ADULTS 407 older persons and their concerns about their performance (Botwinick, 1978) may make an interview which relies entirely on auditory communication particularly stressful. Telephone interviews also limit the amount and nature of feedback that an interviewer can provide to put a respondent at ease and to make the task more personal (Singer, 1981), factors of importance for good learning performance among older persons (Botwinick, 1978). Finally, telephone interviews often proceed at a more rapid pace than do face-to-face interviews (Groves and Kahn, 1979; Groves, 1978),1 and high speed is yet another factor known to be particularly detrimental to the perceptual and learning performance of older respondents (Botwinick, 1978; Corso, 1977). This paper examines telephone interviewing with older adults and compares this mode with face-to-face interviewing. Specifically, it addresses the following three issues: (1) differences in age distributions between the samples of adults that are reached by both modes; (2) explanations for potential differences in age distributions; (3) differences between the two modes in demographic characteristics of the adults that are reached, in interview process, and in response quality, and how these mode differences vary by age of the respondents.

Aggression, deviance, and personality adaptation as antecedents and consequences of alienation and involvement in high school.

Theoretical perspectives on survey participation suggest that survey participation is a form of community involvement, reflecting a sense of civic obligation that also motivates such behavior as voting, serving on juries, and paying taxes. Using data from the Survey of Census Participation (SCP), we investigate this hypothesis with respect to mail response to the 1990 census. We examine such motivating factors as structural and attitudinal measures of alienation as well as more proximal measures of knowledge of and attitudes toward the census and concerns about privacy and confidentiality. We also examine a variety of constraining factors, including literacy, facility with the English language, and available time to complete the form. Using multivariate analysis, we explore the relative effects of these factors on the likelihood of returning the completed census form by mail and discuss the implications of our findings for participation in the census and political participation more generally.

Impact of the WIC Program on Food Expenditures

Alienation from, or involvement in, the social and educational systems of the high school are investigated in an effort to determine the extent that school experiences may influence aggressive and deviant behavior in school and personality styles or orientations. Drawing upon longitudinal data collected from 250 boys followed from grades 8 through 12, potential antecedent-consequence relationships between dimensions of alienation and involvement and these two basic types of student outcomes are examined by cross-lagged panel analyses. Differences between cross-lagged panel correlations provide evidence that student reactions and attachments to school manifest relationships with aggression, deviance, and personality, serving as both antecedents and consequences of these student adaptations. The major findings provide evidence that (1) boys who more frequently break school rules and engage in aggressive or deviant behavior may often come to have more negative attitudes toward school staff and less involvement in school; and (2) student involvement and participation in school life can influence certain aspects of adolescent personality. Possible evidence of reciprocal causation is presented and discussed, as are additional theoretical and methodological implications of the data.