William E. Schlenger

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.

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.

The Prevalence of Posttraumatic Stress Disorder Among American Indian Vietnam Veterans: Disparities and Context

This study employed data from two Congressionally mandated efforts (the American Indian Vietnam Veterans Project and the National Vietnam Veterans Readjustment Study) to examine differential prevalence of posttraumatic stress disorder (PTSD) among 5 ethnically defined samples of male Vietnam theater veterans. Lay interviews assessed individual experiences before, during, and after the war from 1,798 male Vietnam theater veterans. Clinical reinterviews using the SCID were conducted with subsamples (N = 487). The prevalence of both 1-month and lifetime PTSD was higher for the 2 American Indian samples than for Whites. Once logistic regressions controlled for differential exposure to war-zone stress, ethnicity was no longer a significant predictor of PTSD.

The Relationship Between Employment and Substance Use Among Students Aged 12 to 17

PURPOSE To examine the association between employment status and substance use among students aged 12 to 17 years. METHODS Secondary analysis of data from the 1995 and 1996 National Household Surveys on Drug Abuse was conducted. The survey is a primary source of data on licit and illicit drug use among noninstitutionalized Americans aged 12 years or older. Participants are interviewed at their places of residence. Multiple logistic regression procedures yielded estimated associations. RESULTS About one in six adolescents reported both going to school and holding a job. Approximately one-fourth of students smoked cigarettes, and one-third consumed alcohol in the past year. An estimated 1.6% of students were current heavy cigarette smokers, and 2.6% were current heavy alcohol users. One-year prevalence estimates of any illicit drug use and heavy illicit drug use were 16.7% and 1.8%, respectively. Among students employed full time, prevalence estimates increased to 9.7% for heavy cigarette smoking, 13.1% for heavy alcohol use, 38.1% for any illicit drug use, and 5.0% for heavy illicit drug use. Logistic regression analyses supported relatively high rates of cigarette use, alcohol use, illicit drug use, and heavy substance use among working students. Mental health problems, especially externalizing behavioral syndromes, were found to coexist with the use and heavy use of substances. The observed associations varied somewhat by gender. CONCLUSIONS The workplace may be an appropriate venue for establishing substance use prevention and early intervention programs focused on younger workers, including adolescents who work part time.

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.

Hispanic ethnicity and risk for combat-related posttraumatic stress disorder.

Hispanic veterans are said to exhibit higher risk of developing posttraumatic stress disorder (PTSD) than veterans of other racial/ethnic backgrounds. This prediction is based largely on findings from the National Vietnam Veterans Readjustment Study (NVVRS; R. A. Kulka et al., 1990a, 1990b). This article first summarizes the findings of the NVVRS with regard to race/ethnicity and PTSD, and then it makes a careful assessment of both the external and the internal validity of these findings. Conceptual issues are addressed and, where possible, further analyses of the NVVRS data set are conducted to identify factors that account for ethnic differences in rates of the disorder. Possible mediators of the effects of Hispanic ethnicity on vulnerability to PTSD are identified, including psychosocial factors (racial/ethnic discrimination and alienation) and sociocultural influences (stoicism and normalization of stress, alexithymia, and fatalism). Areas in which future research is needed are indicated.

Substance Use, Dependence, and Service Utilization Among the US Uninsured Nonelderly Population

OBJECTIVES We examined the prevalence and correlates of substance use, dependence, and service utilization among uninsured persons aged 12 to 64 years. METHODS We drew study data from the 1998 National Household Survey on Drug Abuse. RESULTS An estimated 80% of uninsured nonelderly persons reported being uninsured for more than 6 months in the prior year. Only 9% of these uninsured persons who were dependent on alcohol or drugs had received any substance abuse service in the past year. Non-Hispanic Whites were an estimated 3 times more likely than Blacks to receive substance abuse services. CONCLUSIONS Compared with the privately insured, uninsured persons had increased odds of having alcohol/drug dependence and appeared to face substantial barriers to health services for substance use problems.

Enhancing the precision of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder: An application of item response theory.

Item response theory was used to examine the measurement qualities of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder, with data taken from the 2,348 veteran participants in the National Vietnam Veterans Readjustment Study. Using Samejimas (1969) graded response model, estimates of each items discrimination and difficulty parameters were derived, and item and test information functions were then computed. Various item information patterns and sample items are discussed in terms of improved assessment of posttraumatic stress disorder

Correlates of Heterosexual Anal Intercourse Among At-Risk Adolescents and Young Adults

OBJECTIVES We sought to learn what factors are associated with anal intercourse among adolescents and young adults. We examined demographic, behavioral, relationship context, attitudinal, substance use, and mental health correlates of recent heterosexual anal intercourse among adolescents and young adults who reported engaging in recent unprotected sex. METHODS Among 1348 at-risk adolescents and young adults aged 15 to 21 years in 3 US cities, we assessed sexual risk behavior with each sexual partner in the past 90 days. Data were collected from 2000 to 2001. RESULTS Recent heterosexual anal intercourse was reported by 16% of respondents. Females who engaged in anal intercourse were more likely to be living with a sexual partner, to have had 2 or more partners, and to have experienced coerced intercourse. For males, only a sexual orientation other than heterosexual was a significant predictor of engaging in heterosexual anal intercourse. CONCLUSIONS Our findings document the prevalence of heterosexual anal intercourse among adolescents and young adults who had recent unprotected sex. Among females, the variables associated with anal intercourse relate to the context and power balance of sexual relationships. Different influences for males and females suggest different foci for interventions.