Sarah E. Nunnink

The association of posttraumatic stress disorder and metabolic syndrome: a study of increased health risk in veterans

BackgroundThere is accumulating evidence for a link between trauma exposure, posttraumatic stress disorder (PTSD) and diminished health status. To assess PTSD-related biological burden, we measured biological factors that comprise metabolic syndrome, an important established predictor of morbidity and mortality, as a correlate of long-term health risk in PTSD.MethodsWe analyzed clinical data from 253 male and female veterans, corresponding to five factors linked to metabolic syndrome (systolic and diastolic blood pressure, waist-to-hip ratio and fasting measures of high-density lipoprotein (HDL) cholesterol, serum triglycerides and plasma glucose concentration). Clinical cut-offs were defined for each biological parameter based on recommendations from the World Health Organization and the National Cholesterol Education Program. Controlling for relevant variables including sociodemographic variables, alcohol/substance/nicotine use and depression, we examined the impact of PTSD on metabolic syndrome using a logistic regression model.ResultsTwo-fifths (40%) of the sample met criteria for metabolic syndrome. Of those with PTSD (n = 139), 43% met criteria for metabolic syndrome. The model predicted metabolic syndrome well (-2 log likelihood = 316.650, chi-squared = 23.731, p = 0.005). Veterans with higher severity of PTSD were more likely to meet diagnostic criteria for metabolic syndrome (Wald = 4.76, p = 0.03).ConclusionThese findings provide preliminary evidence linking higher severity of PTSD with risk factors for diminished health and increased morbidity, as represented by metabolic syndrome.

Military Sexual Trauma Research: A Proposed Agenda

Military sexual trauma (MST) is a widespread problem associated with negative psychological and physical health problems. This article presents the current state of MST research and highlights specific areas in need of more focused study. Areas that have produced the greatest body of knowledge include MST prevalence and psychological and physical health correlates. We propose a research agenda based on gaps noted in our research review and empirical and theoretical evidence of issues relevant to but not studied directly in MST populations. We present evidence that MST is qualitatively distinct from other forms of sexual maltreatment in terms of its relational and vocational context as well as the severity of associated psychological distress, examine underexplored gender and sexual issues in MST, and discuss the lack of treatment and prevention studies specific to MST. Specific recommendations are made throughout in an attempt to guide and advance the field.

Female veterans of the OEF/OIF conflict: Concordance of PTSD symptoms and substance misuse

This study examined the post-deployment rates of comorbid PTSD and substance abuse in a cohort of female veterans who served in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). Female OEF/OIF veterans and reservists (N=36) completed a battery of assessments as part of a larger study. Of the 36 participants, 11 (31%) screened positive for posttraumatic stress disorder (PTSD), 17 (47%) screened positive for high-risk drinking and 2 (6%) screened positive for drug abuse. Higher scores on measures of alcohol and drug use predicted positive PTSD status (p < or = 0.01) and alcohol misuse was significant in explaining unique variance of PTSD status (p < or = 0.05). Our findings suggest a trend toward increased problematic drinking among female OEF/OIF veterans and reservists and a relationship between substance misuse and PTSD. Future research should investigate needs for gender-specific PTSD and substance-abuse treatment needs.

The Peritraumatic Behavior Questionnaire: development and initial validation of a new measure for combat-related peritraumatic reactions

BackgroundPosttraumatic stress disorder (PTSD) is one of the most commonly observed stress-related conditions following combat exposure and its effective prevention is a high health-care priority. Reports of peritraumatic reactions have been shown to be highly associated with PTSD among combat exposed service members. However, existing instruments measuring peritraumatic symptoms were not specifically developed to assess combat-related peritraumatic stress and each demonstrates a different peritraumatic focus. We therefore developed the Peritraumatic Behavior Questionnaire (PBQ), a new military-specific rating scale focused upon the wide range of symptoms suggestive of combat-related peritraumatic distress in actively deployed Service Members. This study describes the development of the PBQ and reports on the psychometric properties of its self-rated version (PBQ-SR).Methods688 Marine infantry service members were retrospectively assessed by the PBQ-SR within the scope of the Marine Resiliency Study after their deployment to war zone. Participants have been additionally assessed by a variety of questionnaires, as well as clinical interviews both pre and post-deployment.ResultsThe PBQ-SR demonstrated satisfactory internal consistency, convergent and discriminant validity, as well as high correlation with trait dissociation prior to deployment. Component analysis suggested a latent bi-dimensional structure separating a peritraumatic emotional distress and physical awareness factor. The PBQ-SR total score showed high correlation to general anxiety, depression, poorer general health and posttraumatic symptoms after deployment and remained a significant predictor of PTSD severity, after controlling for those measures. The suggested screening cut-off score of 12 points demonstrated satisfactory predictive power.ConclusionsThis study confirms the ability of the PBQ-SR to unify the underlying peritraumatic symptom dimensions and reliably assess combat-related peritraumatic reaction as a general construct. The PBQ-SR demonstrated promise as a potential standard screening measure in military clinical practice, while It’s predictive power should be established in prospective studies.

THE IMPACT OF SEXUAL FUNCTIONING PROBLEMS ON MENTAL WELL-BEING IN U.S. VETERANS FROM THE OPERATION ENDURING FREEDOM AND OPERATION IRAQI FREEDOM (OEF/OIF) CONFLICTS

ABSTRACT Substantial literature currently exists linking medically-related sexual problems and Health Related Quality of Life (HRQoL). This study explores the impact of global/non-medically linked sexual functioning problems and HRQoL in United States (U.S.) Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans. A total of 415 veterans newly registered to the Veterans Health Administration (VA) completed measures of demographic, mental health and physical health-related diagnoses and symptoms, including questions specific to sexual functioning. A multiple linear regression analysis was performed to examine associations between mental and physical component scores and sexual functioning problems. Age, hypertension, pain, depression, anxiety disorder, post-traumatic stress disorder, and substance abuse were included as covariates. Findings indicated that sexual dysfunction had a strong negative effect on the SF-36 Mental Component Summary (MCS) scale after adjusting for multiple physical and mental health characteristics. Although a number of covariates were significantly related to the MCS scale, sexual functioning problems exhibited a unique contribution to mental wellbeing. This study highlights the presence of sexual dysfunction in this rather young veteran cohort and its significant negative overall impact on wellbeing. Consequently, provider screening of sexual health needs within the VA system as part of holistic and veteran-centric healthcare model should be considered.

Identification of post traumatic stress disorder and risk factors in military first responders 6 months after Wen Chuan earthquake in China

BACKGROUND Military personnel commonly serve as first responders to natural disasters. Our aim is to identify Post-Traumatic Stress Disorder (PTSD) and determine risk in military responders to the Wen Chuan earthquake. METHODS Analyses were carried out on 1056 of the 1125 soldiers enrolled. In addition to social demographic characteristics, the Davidson Trauma Scale (DTS) and an Earthquake exposure screening scale were administered. RESULTS PTSD prevalence was 6.53% (69 cases). Logistic regression indicated that intensity of traumatic exposure (odds ratio 6.46, 95% CI 4.47-9.32, p<0.001), not having received psychological counseling (odds ratio 3.28, 95% CI 1.31-8.20, p<0.02) and regular drinking (odds ratio 2.42, 95% CI 1.04-5.62, p<0.05) were significant predictors of PTSD. Being a single-child, not being raised by both parents and regular smoking also independently predicted PTSD if intensity of earthquake traumatic exposure was not included in the model. LIMITATIONS The self-rated DTS was used to classify PTSD in this study and psychiatric co-morbidity outside of PTSD was not assessed in this sample. CONCLUSION PTSD is a concern for Military disaster responders; to identify those with high risk of developing PTSD would be important and beneficial.

Impact of childhood maltreatment on physical health-related quality of life in U.S. active duty military personnel and combat veterans

Previous studies have found an association between childhood maltreatment (CM) and health-related quality of life (HRQoL), and to a lesser extent have considered whether psychiatric symptoms may explain the relationship. This study aimed to further our understanding of the link between CM and HRQoL by testing whether posttraumatic stress disorder (PTSD) or depressive symptoms mediate the relationship between childhood maltreatment and physical HRQoL. Mediation models were examined in a sample of male Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) active duty and combat veterans (n=249). PTSD and depressive symptoms mediated the relationship between CM and overall physical HRQoL, as well as participation in daily activities due to physical health, bodily pain, and social functioning. Mediation of the relationship between childhood maltreatment and physical and social functioning by depression and PTSD symptoms may lend support to neurobiological hypotheses that childhood maltreatment sensitizes the nervous system and after repeated trauma may lead to the development of psychiatric symptoms, which have a major impact on morbidity and mortality.

Alcohol-Related Consequences Mediating PTSD Symptoms and Mental Health–Related Quality of Life in OEF/OIF Combat Veterans

Veterans returning from Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) have been found to be at increased risk for post-traumatic stress disorder (PTSD) and alcohol use disorders, leading to negative mental health-related quality of life (MHRQoL). The current study examined the unique impact of alcohol consumption levels versus alcohol-related consequences on the relationship between PTSD symptoms and MHRQoL in a sample of OEF/OIF combat veterans (N = 205, median age 29, 95% men). Mediation analyses indicated that the effect of PTSD symptoms on MHRQoL was explained only by alcohol-related consequences and not by alcohol consumption. Findings highlight the importance of including alcohol-related consequences in clinical assessment and intervention programs for OEF/OIF veterans. Additionally, this study enhances knowledge regarding the underlying mechanisms of functional impairment related to PTSD and alcohol use disorders.

Gender role stress mediates depression among veteran men with military sexual trauma.

Compared with survivors of other types of trauma, survivors of sexual trauma, particularly military sexual trauma (MST), are at greater risk for posttraumatic distress. Although traditionally masculine aspects of gender identity may mitigate the deleterious effects of trauma (Valdez & Lilly, 2014), it may, in some cases, exacerbate negative outcomes. Sexual victimization may undermine traditional gender expectations of power among male survivors, potentially explaining the added risk associated with this type of trauma. These dynamics may be even more pronounced for veteran men, given their involvement in a military culture that highly values masculinity. Accordingly, we hypothesized that masculine gender role stress (i.e., stress from not upholding masculine gender norms; Eisler & Skidmore, 1987) would be greater among veteran men with MST than those with other interpersonal trauma and would mediate the relationship between MST and posttraumatic distress (i.e., posttraumatic stress disorder [PTSD] and depressive symptoms). We found that while veteran men with MST (n = 52) reported greater PTSD and depressive symptom severity compared to men without MST (n = 52), there was no significant difference in overall gender role stress. Ad hoc analyses exploring specific aspects of gender role stress found that men with MST reported greater gender role stress related to emotionality and intellectual inferiority. Additionally, gender role stress related to emotionality fully mediated the relationship between MST and depression but not PTSD. The vulnerability and intense emotions that accompany MST are discussed in the context of gender role expectations and in terms of clinical implications.