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Posttraumatic Stress Disorder Screening in the US Military and VA Populations

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Posttraumatic Stress Disorder and Related Diseases in Combat Veterans

Abstract

For 14 years, the US military has sent more than 2 million service members to Iraq and Afghanistan. Based on lessons learned from the first Persian Gulf War, US military personnel now undergo post-deployment medical and mental health screening for posttraumatic stress disorder (PTSD). Over the last 20 years, multiple studies have aided in refining this process to include adapting the questionnaires, including evidence-based screening tools, modifying the scheduled screening times, and identifying cutoff scores. However, this current process and the screening tools have their limitations, dominantly based on the requirement for self-report of symptoms. Future developments will focus on continued screening refinement, the application of screening tools in treatment monitoring, and developing PTSD measures which are not dependent on self-report measures.

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References

  1. DoD. Deployment Health Policies. 2015 http://www.health.mil/Policies?&query=deployment. Accessed 25 Aug. 2015.

  2. Kline A, Falca-Dodson M, Sussner B, Ciccone D, Chandler H, Callahan L, et al. Effects of repeated deployment to Iraq and Afghanistan on the health of New Jersey Army National Guard troops: implications for military readiness. AM J Public Health. 2010;100(2):276–83.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Baiocchi D. Measuring army deployments to Iraq and Afghanistan. Santa Monica: RAND corporation; 2013.

    Google Scholar 

  4. Terhakopian A, Sinaii N, Engel C, Schnurr P, Hoge C. Estimating population prevalence of posttraumatic stress disorder: an example using the PTSD checklist. J Trauma Stress. 2008;21(3):290–300.

    Article  PubMed  Google Scholar 

  5. McDonald S, Beckham J, Morey R, Calhoun P. The validity and diagnostic efficiency of the Davidson Trauma Scale in military veterans who have served since September 11th, 2001. J Anxiety Disord. 2009;23:247–55.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Martenyi F, Brown E, Zhang H, Koke S, Prakash A. Fluoxetine v. placebo in prevention of relapse in Posttraumatic stress disorder. Br J Psychiatry. 2002;181:315–20.

    Article  PubMed  Google Scholar 

  7. Kok B, Herrell R, Thomas J, Hoge C. Posttraumatic stress disorder associated with combat service in Iraq or Afghanistan: reconciling prevalence differences between studies. J Nerv Ment Dis. 2012;200(5):440–50.

    Article  Google Scholar 

  8. Hotopf M, Hull L, Fear N, Browne T, Horn O, Iversen A, et al. The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet. 2006;367(9524):1731–41.

    Article  PubMed  Google Scholar 

  9. Lapierre C, Schwegler A, LaBauve B. Posttraumatic stress and depression symptoms in soldiers returning from combat operations in Iraq and Afghanistan. J Traum Stress. 2007;20(6):933–43.

    Article  Google Scholar 

  10. Hoge C, Auchterlonie J, Milliken C. Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA. 2006;295:1023–32.

    Article  CAS  PubMed  Google Scholar 

  11. Vasterling J, Proctor S, Amoroso P, Kane R, Heeren T, White R. Neuropsychological outcomes of army personnel following deployment to the Iraq war. JAMA. 2006;296(5):519–29.

    Article  CAS  PubMed  Google Scholar 

  12. Tanielian T, Jaycox LH. Invisible wounds of war. Santa Monica: RAND Corporation; 2008.

    Google Scholar 

  13. US Army Medical Department. Mental Health Advisory Team (MHAT-V). Operation Iraqi Freedom06-08. 2008. http://armymedicine.mil/Pages/Mental-Health-Advisory-Team-V-Information-.aspx. Accessed 27 Aug 2015.

  14. Miliken C, Auchterlonie J, Hoge C. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA. 2007;298(18):2141–8.

    Article  Google Scholar 

  15. Santiago P, Ursano R, Gray C, Pynoos R, Spiegel D. A systemic review of PTSD prevalence and trajectories in DSM-5 defined trauma exposed populations: intentional and non-intentional traumatic events. PLoS ONE. 2013;8(4):e59236.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Brady K, Pearlstein T, Asnis G, Baker D, Rothbaum B, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder. JAMA. 2000;283(14):1837–44.

    Article  CAS  PubMed  Google Scholar 

  17. Davidson J, Baldwin D, Stein D, Kuper E, Benattia I. Treatment of posttraumatic stress disorder with venlafaxine extended release: a 6-month randomized controlled trial. Arch Gen Psychiatry. 2006;63:1158–65.

    Article  CAS  PubMed  Google Scholar 

  18. Davidson J, Pearlstein T, Londborg P, Brady K, Rothbaum B, et al. Efficacy of sertraline in preventing relapse of posttraumatic stress disorder: results of a 28-week double-blind, placebo-controlled study. Am J Psychiatry. 2001;158:1974–81.

    Article  CAS  PubMed  Google Scholar 

  19. Davidson J, Rothbaum B, van der Kolk B, Sikes C, Farfel G. Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Arch Gen Psychiatry. 2001;58:485–92.

    Article  CAS  PubMed  Google Scholar 

  20. GlaxoSmithKline. A study of the maintained efficacy and safety of paroxetine versus placebo in the long-term treatment of posttraumatic stress disorder. Unpublished. 2001. http://www.gsk-clinicalstudyregister.com/study/29060/650#rs. Accessed 27 Aug 2015.

  21. Martenyi F, Brown E, Zhang H, Prakash A, Koke S. Fluoxetine versus placebo in posttraumatic stress disorder. J Clin Psychiatry. 2002;63(3):199–206.

    Article  CAS  PubMed  Google Scholar 

  22. Martenyi F, Soldatenkova V. Fluoxetine in the acute treatment and relapse prevention of combat-related Posttraumatic stress disorder: analysis of the veteran group of a placebo-controlled, randomized clinical trial. Eur Neuropsychopharmacol. 2006;16:340–9.

    Article  CAS  PubMed  Google Scholar 

  23. Raskin M, Peskind E, Kanter E, Petrie E, Radant A. Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: a placebo-controlled study. Am J Psychiatry. 2003;160:371–3.

    Article  Google Scholar 

  24. Raskin M, Peterson K, Williams T, Hoff D, Hart K. A Trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan. Am J Psychiatry. 2013;170:1003–10.

    Article  Google Scholar 

  25. Schneier F, Neria Y, Pavlicova M, Hembree E, Jung Suh E, et al. Combined prolonged exposure therapy and paroxetine for PTSD related to the world trade center attack: a randomized controlled trial. Am J Psychiatry. 2012;169:80–8.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Shalev A, Freedman S, Peri T, Brandes D, Sahar T, Orr S. Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry. 1998;155:630–7.

    Article  CAS  PubMed  Google Scholar 

  27. Shih R, Schell T, Hambarsoomian K, Marshall G, Belzberg H. Prevalence of PTSD and major depression following trauma-center hospitalization. J Trauma. 2010;69(6):1560–6.

    Article  PubMed Central  PubMed  Google Scholar 

  28. van der Kolk B, Spinazzola J, Blaustein M, Hopper J, Hopper E, et al. A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance. J Clin Psychiatry. 2007;68:37–46.

    Article  PubMed  Google Scholar 

  29. Goldberg M. Costs of military pay and benefits in the defense budget: Congressional Budget Office. 2012. https://www.cbo.gov/publication/43574. Accessed 26 Aug 2015.

  30. Hoge C, Castro C, Messer S, McGurk D, Cotting D. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J. 2004;351:13–22.

    Article  CAS  Google Scholar 

  31. Tanielian T, Jaycox L. Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica: RAND Corporation; 2008.

    Google Scholar 

  32. Hoge C, Castro C, Messer S, McGurk D, Cotting D, Koffman R. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J. 2004;351:13–22.

    Article  CAS  Google Scholar 

  33. US Congress. National Defense Authorization Act (NDAA), F.Y. 2008, H.R. 1585, Section 1710. http://www.gpo.gov/fdsys/pkg/CRPT-110hrpt477/pdf/CRPT-110hrpt477.pdf. Accessed 28 Aug 2015.

  34. Kang H. Analysis of VA health care utilization among US global war on terrorism veterans: operation Iraqi freedom and operation enduring freedom. Washington, DC: VHA Office of Public Health and Environmental Hazards; 2008.

    Google Scholar 

  35. Seal K, Maguen S, Cohen B, Gima K, Metzeler T, Ren L, et al. VA mental health services utilization in Iraq and Afganistan veterans in the first year of receiving new mental health diagnoses. J Traum Stress. 2010;23(1):5–16.

    Google Scholar 

  36. Friedman M, Marmar C, Baker D, Sikes C, Farfel G. Randomized, double-blind comparison of sertraline and placebo for posttraumatic stress disorder in a Department of Veterans Affairs setting. J Clin Psychiatry. 2007;68(5):711–20.

    Article  CAS  PubMed  Google Scholar 

  37. Hyams KC, Riddle J, Trump DH, Wallace MR. Protecting the health of United States military forces in Afghanistan: applying lessons learned since the Gulf War. Clin Infect Disease 2002;34(Suppl 5):S208–14.

    Article  Google Scholar 

  38. Department of Defense. Post Deployment Health Assessment, DD Form 2796. May 1999. http://www.gulflink.osd.mil/medical/storyboard/dd2796.pdf. Accessed 25 Aug 2015.

  39. Wright KM, Huffman AH, Adler AB, Castro CA. Psychological screening program overview. Mil Med. 2002;167:853–61.

    Google Scholar 

  40. Wright KM, Thomas JL, Adler AB, Ness JW, Hoge CW, Castro CA. Psychological screening procedures for deploying US forces. Mil Med 2005;170(7):555–62.

    Article  PubMed  Google Scholar 

  41. US Congress. Ronald W. Reagan National Defense Authorization Act (NDAA), F.Y. 2005, H.R. 4200, Section 723. http://www.gpo.gov/fdsys/pkg/PLAW-108publ375/html/PLAW-108publ375.htm. Accessed 25 Aug 2015.

  42. Warner CH, Appenzeller GN, Mullen K, Warner CM, Grieger TS. Soldier attitudes towards mental health and seeking care upon return from combat. Mil Med 2008;173:563–69.

    Article  PubMed  Google Scholar 

  43. Warner CH, Breitbach J, Appenzeller GN, Yates VD, Grieger TS, Webster W. Division mental health: its role in the new Brigade Combat Team structure part II: re-deployment and post-deployment. Mil Med 2007;172:912–17.

    Article  PubMed  Google Scholar 

  44. Warner C, Appenzeller G, Parker J, Warner C, Hoge C. Effectiveness of mental health screening and coordination of in-theater care prior to deployment to Iraq: a cohort study. Am J Psychiatry. 2011;168:378–85.

    Article  PubMed  Google Scholar 

  45. US Congress. National Defense Authorization Act (NDAA), F.Y. 2012, H.R. 4310, Sections 582 & 1212. https://www.govtrack.us/congress/bills/112/hr4310/text. Accessed 25 Aug 2015.

  46. Engel C, Oxman T, Yamamato C, Gould D, Barry S, et al. RESPECT-Mil: feasibility of a systems-level coliaborative care approach to depression and Posttraumatic stress disorder in military primary care. Milit Med. 2008;173(10):935–40.

    Article  Google Scholar 

  47. Engel C, Oxman T, Yamamato C, Gould D, Barry S, et al. RESPECT-Mil: feasibility of a systems-level coliaborative care approach to depression and Posttraumatic stress disorder in military primary care. Mil Med. 2008;173(10):935–40.

    Google Scholar 

  48. http://digitalcommons.ohsu.edu/etd/929/

  49. Forbes D, Creamer M, Biddle D. The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD. Behav Res Ther. 2001;39:977–86.

    Article  CAS  PubMed  Google Scholar 

  50. Bodkin J. Is PTSD caused by traumatic stress? J Anxiety Disord. 2007;21:176–82.

    Article  PubMed  Google Scholar 

  51. Warner C, Appenzeller G, Grieger T, Belenkiy S, Breitbach J, et al. Importance of anonymity to encourage honest reporting in mental health screening after combat deployment. Arch Gen Psychiatry. 2011;68(10):1065–71.

    Article  PubMed  Google Scholar 

  52. Bliese P, Wrigh K, Adler A, Castro C, Hoge C, et al. Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. J Consult Clin Psychol. 2008;76(2):272–81.

    Article  PubMed  Google Scholar 

  53. Prins A, Ouimette P, Kimerling R, Cameron R, Hugelshofer D. The primary care PTSD screen (PC-PTSD): development and operating characteristics. Prim Care Psychiatry. 2004;9:9–14.

    Article  Google Scholar 

  54. Dobie D, Kivlahan D, Maynard C, Bush K, McFall M. Screening for Posttraumatic stress disorder in female Veteran’s Affairs patients: validation of the PTSD checklist. Gen Hosp Psychiatry. 2002;24:367–74.

    Article  PubMed  Google Scholar 

  55. Blanchard E, Jones-Alexander J, Buckley T, Forneris C. Psychometric properties of the PTSD checklist (PCL). Behav Res Ther. 1996;34(8):669–73.

    Article  CAS  PubMed  Google Scholar 

  56. Cook J, Elhai J, Arean P. Psychometric properties of the PTSD checklist with older primary care patients. J Traum Stress. 2005;18(4):371–6.

    Article  Google Scholar 

  57. Passos R, Figueira I, Mendlowicz M, Moraes C, Coutinho E. Exploratory factor analysis of the Brazilian version of the Posttraumatic Stress Disorder Checklist—Civilian Version (PCL-C). Rev Bras Psiquiatr. 2012;34:155–61.

    Article  PubMed  Google Scholar 

  58. Semage S, Sivayogan S, Forbes D, O’Donnell M, Monaragala R, et al. Cross-cultural and factorial validity of PTSD check list—military version (PCL-M) in Sinhalese language. Eur J Psychotraumatol. 2013;4:19707.

    Google Scholar 

  59. Monson C, Gradus J, Young-Xu Y, Schnurr P, Price J. Change in posttraumatic stress disorder symptoms: do clinicians and patients agree? Psychol Assess. 2008;20(2):131–8.

    Article  PubMed  Google Scholar 

  60. Wilkins K, Lang A, Norman S. Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depress Anxiety. 2011;28:596–606.

    Article  PubMed Central  PubMed  Google Scholar 

  61. Thomas J, Wilk J, Riviere L, McGurk D, Castro C. Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq. Arch Gen Psychiatry. 2010;67(6):614–23.

    Article  PubMed  Google Scholar 

  62. McDonald S, Thompson N, Stratton K, Calhoun P, MIRECC W. Diagnostic accuracy of three scoring methods for the davidson trauma scale among U.S. military Veterans. J Anxiety Disord. 2014;28(2):160–8.

    Article  PubMed  Google Scholar 

  63. Davidson J, Tharwani H, Connor K. Davidson Trauma Scale (DTS): normative scores in the general population and effect sizes in placebo-controlled SSRI trials. Depress Anxiety. 2002;15(2):75–8.

    Article  PubMed  Google Scholar 

  64. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Psychol Assess. 1997;9(4):445–51.

    Article  Google Scholar 

  65. Shoeb M, Weinstein H, Mollica R. The Harvard trauma questionnaire: adapting a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Iraqi refugees. Int J Soc Psychiatry. 2007;53:447–63.

    Article  PubMed  Google Scholar 

  66. Zhang L, Li H, Benedek D, Li X, Ursano R. A strategy for the development of biomarker tests for PTSD. Med Hypotheses. 2009;73(3):404–9.

    Article  PubMed  Google Scholar 

  67. Su T, Zhang L, Chung M, Chen Y, Bi Y, Chou Y. Levels of the potential biomarker p11 in peripheral blood cells distinguish patients with PTSD from those with other major psychiatric disorders. J Psychiatric Res. 2009;43(13):1078–85.

    Article  Google Scholar 

  68. van Zuiden M, Geuze E, Willemen H, Vermetten E, Maas M, Heijnen C, et al. Pre-existing high glucocorticoid receptor number predicting development of posttraumatic stress symptoms after military deployment. Am J Psychiatry. 2011;168(89–96):89.

    Article  PubMed  Google Scholar 

  69. von Känel R, Begré S, Abbas C, Saner H, Gander M, Schmid J. Inflammatory biomarkers in patients with posttraumatic stress disorder caused by myocardial infarction and the role of depressive symptoms. Neuroimmunomodulation. 2009;17(1):39–46.

    Google Scholar 

  70. Heim C, Ehlert U, Hellhammer D. The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology. 2000;25(1):35.

    Article  Google Scholar 

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Lee, D., Warner, C., Hoge, C. (2015). Posttraumatic Stress Disorder Screening in the US Military and VA Populations. In: Ritchie, E. (eds) Posttraumatic Stress Disorder and Related Diseases in Combat Veterans. Springer, Cham. https://doi.org/10.1007/978-3-319-22985-0_2

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