Journal of Behavioral Medicine

, Volume 37, Issue 5, pp 849–859 | Cite as

The long-term implications of war captivity for mortality and health

  • Zahava Solomon
  • Talya Greene
  • Tsachi Ein-Dor
  • Gadi Zerach
  • Yael Benyamini
  • Avi Ohry
Article

Abstract

The current study aims to (1) assess the long-term impact of war captivity on mortality and various health aspects and (2) evaluate the potential mediating role of posttraumatic stress disorder (PTSD) and depressive symptoms. Israeli ex-prisoners of war (ex-POWs) (N = 154) and a matched control group of combat veterans (N = 161) were assessed on health conditions and self-rated health 18 years post-war (1991: T1). The whole population of ex-POWs, and the T1 sample of controls were then contacted 35 years after the war (2008: T2), and invited to participate in a second wave of measurement (ex-POWs: N = 171; controls: N = 116) Captivity was implicated in premature mortality, more health-related conditions and worse self-rated health. PTSD and depressive symptoms mediated the relationship between war captivity and self-rated health, and partially mediated the relationship between war captivity and health conditions, and these effects were amplified with age. Aging ex-POWs who develop psychiatric symptomatology should be considered a high-risk group entering a high-risk period in the life cycle. It is important to monitor ex-POWs and provide them with appropriate medical and psychological treatment as they age.

Keywords

Prisoners of war Health Posttraumatic stress disorder Depression Mortality 

References

  1. American Psychiatric Association (APA). (1987). Diagnostic and statistical manual of mental disorders (3rd ed., revised). Washington, DC: American Psychiatric Association.Google Scholar
  2. Beckham, J. C., Moore, S. D., Feldman, M. E., Hertzberg, M. A., Kirby, A. C., & Fairbank, J. A. (1998). Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder. American Journal of Psychiatry, 155, 1565–1569.PubMedGoogle Scholar
  3. Beebe, G. W. (1975). Follow-up studies of World War II and Korean War prisoners. II. Morbidity, disability, and maladjustments. American Journal of Epidemiology, 101, 400–422.PubMedGoogle Scholar
  4. Breslau, N., Davis, G. C., & Schultz, L. R. (2003). Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Archives of General Psychiatry, 60, 289–294.PubMedCrossRefGoogle Scholar
  5. Buckley, T. C., Mozley, S. L., Bedard, M. A., Dewulf, A. C., & Greif, J. (2004). Preventive health behaviors, health-risk behaviors, physical morbidity, and health-related role functioning impairment in veterans with post-traumatic stress disorder. Military Medicine, 169, 536–540.PubMedGoogle Scholar
  6. Byers, A. L., Covinsky, K. E., Barnes, D. E., & Yaffe, K. (2011). Dysthymia and depression increase risk of dementia and mortality among older veterans. American Journal of Geriatric Psychiatry. doi: 10.1097/JGP.0b013e31822001c1
  7. Campbell, R., Greeson, M. R., Bybee, D., & Raja, S. (2008). The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: A mediational model of posttraumatic stress disorder and physical health outcomes. Journal of Consulting and Clinical Psychology, 76, 194.PubMedCrossRefGoogle Scholar
  8. Ciccone, D. S., Chandler, H. K., & Kline, A. (2010). Catastrophic appraisal of acute and chronic pain in a population sample of New Jersey National Guard troops. The Clinical Journal of Pain, 26, 712–721.PubMedGoogle Scholar
  9. Cloitre, M., Cohen, L. R., Edelman, R. E., & Han, H. (2001). Posttraumatic stress disorder and extent of trauma exposure as correlates of medical problems and perceived health among women with childhood abuse. Women and Health, 34, 1.PubMedCrossRefGoogle Scholar
  10. Cohen, B. M., & Cooper, M. Z. (1954). A Follow Up Study of World War II Prisoners of War: Veterans Administration. National Research Council, Division of Medical Sciences.Google Scholar
  11. Creasey, H., Sulway, M. R., Dent, O., Broe, G. A., Jorm, A., & Tennant, C. (1999). Is experience as a prisoner of war a risk factor for accelerated age-related illness and disability? Journal of the American Geriatrics Society, 47, 60–64.PubMedGoogle Scholar
  12. Derogatis, L. R. (1977). SCL-90R (revised version) manual I. Baltimore: John Hopkins University School of Medicine.Google Scholar
  13. Derogatis, L. R., & Unger, R. (2010). Symptom Checklist-90-Revised. The Corsini Encyclopedia of Psychology. Wiley, New York.Google Scholar
  14. Engdahl, B. E., Harkness, A. R., Eberly, R. E., Page, W. F., & Bielinski, J. (1993). Structural models of captivity trauma, resilience, and trauma response among former prisoners of war 20 to 40 years after release. Social Psychiatry and Psychiatric Epidemiology, 28, 109–115.PubMedCrossRefGoogle Scholar
  15. Foley, D., Ancoli-Israel, S., Britz, P., & Walsh, J. (2004). Sleep disturbances and chronic disease in older adults: Results of the 2003 National Sleep Foundation Sleep in America Survey. Journal of Psychosomatic Research, 56, 497–502.PubMedCrossRefGoogle Scholar
  16. Friedman, M. J., & Schnurr, P. P. (1995). The relationship between trauma, PTSD, and physical health. In M. J. Friedman, D. S. Charney, & A. Y. Deutch (Eds.), Neurobiological and clinical consequences of stress: From Normal adaptation of PTSD (pp. 507–524). New York: Lippincott-Raven.Google Scholar
  17. Guest, C. S., & Venn, A. J. (1992). Mortality of former prisoners of war and other Australian veterans. The Medical Journal of Australia, 157, 132.PubMedGoogle Scholar
  18. Hayes, A. F., Preacher, K. J., & Myers, T. A. (2011). Mediation and the estimation of indirect effects in political communication research. In E. P. Bucy & H. R. Lance (Eds.), Sourcebook for political communication research: Methods, measures, and analytical techniques (pp. 434–465). New York: Routledge.Google Scholar
  19. Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5, 377–391.CrossRefGoogle Scholar
  20. Hoge, C. W., Terhakopian, A., Castro, C. A., Messer, S. C., & Engel, C. C. (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. American Journal of Psychiatry, 164, 150.PubMedCrossRefGoogle Scholar
  21. Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 21–37.Google Scholar
  22. Kang, H. K., Bullman, T. A., & Taylor, J. W. (2006). Risk of selected cardiovascular diseases and posttraumatic stress disorder among former World War II prisoners of war. Annals of Epidemiology, 16, 381–386. doi: 10.1016/j.annepidem.2005.03.004 PubMedCrossRefGoogle Scholar
  23. Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R. (2002). Psychoneuroimmunology and psychosomatic medicine: Back to the future. Psychosomatic Medicine, 64, 15–28.PubMedCrossRefGoogle Scholar
  24. Kross, E. K., Gries, C. J., & Curtis, J. R. (2008). Posttraumatic stress disorder following critical illness. Critical Care Clinics, 24, 875–887. doi: 10.1016/j.ccc.2008.06.002 PubMedCrossRefGoogle Scholar
  25. Litz, B. T., Keane, T. M., Fisher, L., Marx, B., & Monaco, V. (1992). Physical health complaints in combat-related post-traumatic stress disorder: A preliminary report. Journal of Traumatic Stress, 5, 131–141.CrossRefGoogle Scholar
  26. McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840, 33–44.PubMedCrossRefGoogle Scholar
  27. McFarlane, A., Atchison, M., Rafalowicz, E., & Papay, P. (1994). Physical symptoms in post-traumatic stress disorder. Journal of Psychosomatic Research, 38, 715–726.PubMedCrossRefGoogle Scholar
  28. McFarlane, A. C., Weber, D. L., & Clark, C. R. (1993). Abnormal stimulus processing in posttraumatic stress disorder. Biological Psychiatry, 34, 311–320.PubMedCrossRefGoogle Scholar
  29. Miller, G., Chen, E., & Cole, S. W. (2009). Health psychology: Developing biologically plausible models linking the social world and physical health. Annual Review of Psychology, 60, 501–524.PubMedCrossRefGoogle Scholar
  30. Muthén, L. K., & Muthén, B. O. (2010). Mplus user’s guide, v 6.1. Los Angeles, CA: Muthen and Muthen, UCLA.Google Scholar
  31. Nefzger, M. D. (1970). Follow-up studies of World War II and Korean War prisoners: I. Study plan and mortality findings. American Journal of Epidemiology, 91, 123–138.PubMedGoogle Scholar
  32. Nice, D. S., Garland, C. F., Hilton, S. M., Baggett, J. C., & Mitchell, R. E. (1996). Long-term health outcomes and medical effects of torture among US Navy prisoners of war in Vietnam. Comment. The journal of the American Medical Association, 276, 416–417.CrossRefGoogle Scholar
  33. Ohry, A., Solomon, Z., Neria, Y., Waysman, M., Bar-On, Z., & Levy, A. (1994). The aftermath of captivity: An 18-year follow-up of Israeli ex-POWs. Behaviorial Medicine, 20, 27–33. doi: 10.1080/08964289.1994.9934613 CrossRefGoogle Scholar
  34. O’Toole, B. I., Marshall, R. P., Grayson, D. A., Schureck, R. J., Dobson, M., Ffrench, M., et al. (1996). The Australian Vietnam veterans health study: III. Psychological health of Australian Vietnam veterans and its relationship to combat. International Journal of Epidemiology, 25, 331–340.PubMedCrossRefGoogle Scholar
  35. Page, W. F., & Brass, L. M. (2001). Long-term heart disease and stroke mortality among former American prisoners of war of World War II and the Korean Conflict: Results of a 50-year follow up. Military Medicine, 166, 803–808.PubMedGoogle Scholar
  36. Page, W. F., Engdahl, B. E., & Eberly, R. E. (1991). Prevalence and correlates of depressive symptoms among former prisoners of war. Journal of Nervous and Mental Disease, 179, 670–677.PubMedCrossRefGoogle Scholar
  37. Peveler, R. C., & Fairburn, C. G. (1990). Measurement of neurotic symptoms by self-report questionnaire: Validity of the SCL-90R. Psychological Medicine, 20, 873–879.PubMedCrossRefGoogle Scholar
  38. Polusny, M. A., Erbes, C. R., Arbisi, P. A., Thuras, P., Kehle, S. M., Rath, M., et al. (2009). Impact of prior Operation Enduring Freedom/Operation Iraqi Freedom combat duty on mental health in a predeployment cohort of National Guard soldiers. Military Medicine, 174, 353–357.PubMedCrossRefGoogle Scholar
  39. Rubin, D. B. (1987). Multiple imputation for nonresponse in surveys. New York: Wiley.CrossRefGoogle Scholar
  40. Ruthig, J. C., & Chipperfield, J. G. (2007). Health incongruence in later life: Implications for subsequent well-being and health care. Health Psychology, 26, 753.PubMedCrossRefGoogle Scholar
  41. Schafer, J. L. (1997). Analysis of incomplete multivariate data. London: Chapman & Hall.CrossRefGoogle Scholar
  42. Schnurr, P. P., & Green, B. L. (2004). A context for understanding the physical health consequences of exposure to extreme stress. Washington, DC: American Psychological Association.Google Scholar
  43. Schnurr, P. P., & Spiro, A. (1999). Combat exposure, posttraumatic stress disorder symptoms, and health behaviors as predictors of self-reported physical health in older veterans. The Journal of Nervous and Mental Disease, 187, 353.PubMedCrossRefGoogle Scholar
  44. Solomon, Z. (1993). Combat stress reaction: The enduring toll of war. New York: Plenum Press.CrossRefGoogle Scholar
  45. Solomon, Z., Benbenishty, R., Neria, Y., Abramowitz, M., Ginzburg, K., & Ohry, A. (1993). Assessment of PTSD: Validation of the revised PTSD Inventory. Israel Journal of Psychiatry and Related Sciences, 30, 110–115.PubMedGoogle Scholar
  46. Solomon, Z., & Dekel, R. (2005). Posttraumatic stress disorder among Israeli ex-prisoners of war 18 and 30 years after release. Journal of Clinical Psychiatry, 66, 1031–1037.PubMedCrossRefGoogle Scholar
  47. Solomon, Z., Dekel, R., & Mikulincer, M. (2008). Complex trauma of war captivity: A prospective study of attachment and post-traumatic stress disorder. Psychological Medicine, 38, 1427–1434. doi: 10.1017/S0033291708002808 PubMedCrossRefGoogle Scholar
  48. Solomon, Z., Horesh, D., Ein-Dor, T., & Ohry, A. (2012). Predictors of PTSD trajectories following captivity: A 35-year longitudinal study. Psychiatry Research, 199, 188–194. doi: 10.1016/j.psychres.2012.03.035 PubMedCrossRefGoogle Scholar
  49. Solomon, Z., Kotler, M., & Mikulincer, M. (1988). Combat related posttraumatic stress disorder among the second generation of Holocaust survivors: Preliminary findings. American Journal of Psychiatry, 145, 865–868.PubMedGoogle Scholar
  50. Solomon, Z., Neria, Y., Ohry, A., Waysman, M., & Ginzburg, K. (1994). PTSD among Israeli former prisoners of war and soldiers with combat stress reaction: A longitudinal study. American Journal of Psychiatry, 151, 554.PubMedGoogle Scholar
  51. Taft, C. T., Stern, A. S., King, L. A., & King, D. W. (1999). Modeling physical health and functional health status: The role of combat exposure, posttraumatic stress disorder, and personal resource attributes. Journal of Traumatic Stress, 12, 3–23.PubMedCrossRefGoogle Scholar
  52. Ursano, R. J., & Rundell, J. R. (1990). The prisoner of war. Military Medicine, 155, 176–180.PubMedGoogle Scholar
  53. Wolkowitz, O. M., Reus, V. I., & Mellon, S. H. (2011). Of sound mind and body: Depression, disease, and accelerated aging. Dialogues in Clinical Neuroscience, 13, 25.PubMedGoogle Scholar
  54. Yehuda, R. (1999). Biological factors associated with susceptibility to posttraumatic stress disorder. Canadian Journal of Psychiatry, 44, 34–39.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Zahava Solomon
    • 1
  • Talya Greene
    • 1
  • Tsachi Ein-Dor
    • 2
  • Gadi Zerach
    • 3
  • Yael Benyamini
    • 1
  • Avi Ohry
    • 4
    • 5
  1. 1.Bob Shapell School of Social WorkTel Aviv UniversityTel AvivIsrael
  2. 2.New School of PsychologyInterdisciplinary Center (IDC)HerzilyaIsrael
  3. 3.Department of Behavioral SciencesAriel University Center of SamariaArielIsrael
  4. 4.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  5. 5.Section of Rehabilitation MedicineReuth Medical CenterTel AvivIsrael

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