Advertisement

Prevalence and Risk Factors for Post-Traumatic Stress Disorder Symptoms Among National Guard/Reserve Component Service Members Deployed to Iraq and Afghanistan

  • Melissa A. PolusnyEmail author
  • Meredith A. Martyr
  • Christopher R. Erbes
  • Paul A. Arbisi
  • Mark Kramer
  • Elizabeth Gibson
  • Heather Oleson
Reference work entry

Abstract

Over the past decade, the USA has relied on unprecedented deployments of National Guard and Reserve Component service members to support sustained military operations in Afghanistan and Iraq. In this chapter, we review the empirical literature on the prevalence of PTSD among service members following deployment to Iraq and Afghanistan. Methodological issues to be considered when evaluating prevalence estimates across studies are reviewed, and the results of meta-analyses comparing PTSD prevalence rates for reserve and active components are critically examined. Finally, we summarize findings from the literature on risk and protective factors associated with PTSD that might account for the heightened risk of PTSD among Reservists during the post-deployment reintegration period.

Keywords

Post-traumatic stress disorder (PTSD) Military Combat Prevalence Epidemiology Risk factors National Guard Military Reservist Iraq Afghanistan 

List of Abbreviations

BCT

Brigade combat team

DOD

Department of Defense

DSM-IV

Diagnostic and Statistical Manual of Mental Disorders, 4th edition

NG/R

National Guard/Reserve

OEF

Operation Enduring Freedom

OIF

Operation Iraqi Freedom

OND

Operation New Dawn

PCL

PTSD Checklist

PC-PTSD

Primary Care PTSD Screen

PDHA

Post-Deployment Health Assessment

PDHRA

Post-Deployment Health Reassessment

PTSD

Post-traumatic stress disorder

References

  1. Adler AB, Wright KM, Bliese PD, Eckford R, Hoge CW. A2 diagnostic criterion for combat-related posttraumatic stress disorder. J Trauma Stress. 2008;21:301–8.CrossRefPubMedGoogle Scholar
  2. Allison-Aipa TS, Ritter C, Sikes P, Ball S. The impact of deployment on the psychological health status, level of alcohol consumption, and use of psychological health resources of postdeployed U.S. Army Reserve soldiers. Mil Med. 2010;175:630–7.CrossRefPubMedGoogle Scholar
  3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV). Washington, DC: American Psychiatric Association; 1994.Google Scholar
  4. Arbisi PA, Kaler ME, Kehle-Forbes SM, Erbes CR, Polusny MA, Thuras P. The predictive validity of the PTSD Checklist in a nonclinical sample of combat-exposed National Guard troops. Psychol Assess. 2012;24:1034–40.CrossRefPubMedGoogle Scholar
  5. Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA. Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther. 1996;34:669–73.CrossRefPubMedGoogle Scholar
  6. Bliese PD, Wright KM, Adler AB. Timing of postcombat mental health assessments. Psychol Serv. 2007;4:141–8.CrossRefGoogle Scholar
  7. Bliese PD, Wright KM, Adler AB, Cabrera O, Castro CA, Hoge CW. Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. J Consult Clin Psychol. 2008;76:272–81.CrossRefPubMedGoogle Scholar
  8. Bolton EE, Litz BT, Glenn DM, Orsillo S, Roemer L. The impact of homecoming reception on the adaptation of peacekeepers following deployment. Mil Psychol. 2002;14:241–51.CrossRefGoogle Scholar
  9. Bray RM, Pemberton MR, Lane ME, Hourani LL, Mattiko MJ, Babeu LA. Substance use and mental health trends among U.S. military active duty personnel: key findings from the 2008 DoD Health Behavior Survey. Mil Med. 2010;175:390–9.CrossRefPubMedGoogle Scholar
  10. Browne T, Hull L, Horn O, et al. Explanations for the increase in mental health problems in UK reserve forces who have served in Iraq. Br J Psychiatry. 2007;190:484–9.CrossRefPubMedGoogle Scholar
  11. Cabrera OA, Hoge CW, Bliese PD, Castro CA, Messer SC. Childhood adversity and combat as predictors of depression and post-traumatic stress in deployed troops. Am J Prev Med. 2007;33:77–82.CrossRefPubMedGoogle Scholar
  12. Calhoun PS, McDonald SD, Guerra VS, Eggleston AM, Beckham JC, Straits-Troster K. Clinical utility of the Primary Care–PTSD Screen among U.S. veterans who served since September 11, 2001. Psychiatry Res. 2010;178:330–5.CrossRefPubMedGoogle Scholar
  13. Cohen GH, Fink DS, Sampson L, Galea S. Mental health among reserve component military service members and veterans. Epidemiol Rev. 2015;37:7–22.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Defence Statistics. Unique UK armed forces personnel deployed to Iraq and/or Afghanistan by financial year of earliest deployment to either Iraq and/or Afghanistan. 2014. London, UK, Ministry of Defence. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/360627/PUBLIC_1411731267.pdf. Accessed on 27 May 2015.
  15. Department of Defense. DoD personnel & procurement statistics. DoD [serial online] 2008; Accessed 11 Dec 2008.Google Scholar
  16. Dirkzwager AJE, Bramsen I, van der Ploeg HM. Social support, coping, life events, and posttraumatic stress symptoms among former peacekeepers: a prospective study. Personal Individ Differ. 2003;34:1545–59.CrossRefGoogle Scholar
  17. Dohrenwend BP, Turner JB, Turse NA, Adams BG, Koenen KC, Marshall R. The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods. Science. 2006;313:979–82.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Duma SJ, Reger MA, Canning SS, McNeil JD, Gahm GA. Longitudinal mental health screening results among postdeployed U.S. soldiers preparing to deploy again. J Trauma Stress. 2010;23:52–8.PubMedGoogle Scholar
  19. Elhai JD, Gray MJ, Kashdan TB, Franklin CL. Which instruments are most commonly used to assess traumatic event exposure and posttraumatic effects?: a survey of traumatic stress professionals. J Trauma Stress. 2005;18:541–5.CrossRefPubMedGoogle Scholar
  20. Fear NT, Jones M, Murphy D, et al. What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. Lancet. 2010;375:1783–97.CrossRefPubMedGoogle Scholar
  21. Ferrier-Auerbach AG, Erbes CR, Polusny MA, Rath CM, Sponheim SR. Predictors of emotional distress reported by soldiers in the combat zone. J Psychiatr Res. 2010;44:470–6.CrossRefPubMedGoogle Scholar
  22. Fontana A, Rosenheck R. Posttraumatic stress disorder among vietnam theater veterans: a causal model of etiology in a community sample. J Nerv Ment Dis. 1994;182:677–84.CrossRefPubMedGoogle Scholar
  23. Friedman MJ. Veterans’ mental health in the wake of war. N Engl J Med. 2005;352:1287–90.CrossRefPubMedGoogle Scholar
  24. Gray MJ, Bolton EE, Litz BT. A longitudinal analysis of PTSD symptom course: delayed-onset PTSD in Somalia peacekeepers. J Consult Clin Psychol. 2004;72:909–13.CrossRefPubMedGoogle Scholar
  25. Green BL, Grace MC, Lindy JD, Gleser GC, Leonard A. Risk factors for PTSD and other diagnoses in a general sample of Vietnam veterans. Am J Psychiatr. 1990;147:729–33.CrossRefPubMedGoogle Scholar
  26. Griffith J. Citizens coping as soldiers: a review of deployment stress symptoms among reservists. Mil Psychol. 2010;22:176–206.CrossRefGoogle Scholar
  27. Han SC, Castro F, Lee LO, et al. Military unit support, postdeployment social support, and PTSD symptoms among active duty and National Guard soldiers deployed to Iraq. J Anxiety Disord. 2014;28:446–53.CrossRefPubMedGoogle Scholar
  28. Harvey SB, Hatch SL, Jones M, et al. Coming home: social functioning and the mental health of UK Reservists on return from deployment to Iraq or Afghanistan. Ann Epidemiol. 2011;21:666–72.CrossRefPubMedGoogle Scholar
  29. Harvey SB, Hatch SL, Jones M, et al. The long-term consequences of military deployment: a 5-year cohort study of United Kingdom reservists deployed to Iraq in 2003. Am J Epidemiol. 2012;176:1177–84.CrossRefPubMedGoogle Scholar
  30. Highfill-McRoy RM, Larson GE, Booth-Kewley S, Garland CF. Psychiatric diagnoses and punishment for misconduct: the effects of PTSD in combat-deployed Marines. BMC Psychiatry. 2010;10:88.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Hines LA, Sundin J, Rona RJ, Wessely S, Fear NT. Posttraumatic stress disorder post Iraq and Afghanistan: prevalence among military subgroups. Can J Psychiatry. 2014;59:468–79.PubMedPubMedCentralGoogle Scholar
  32. Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004;351:13–22.CrossRefPubMedGoogle Scholar
  33. Hotopf M, Hull L, Fear NT, et al. The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet. 2006;367:1731–41.CrossRefPubMedGoogle Scholar
  34. Interian A, Kline A, Janal M, Glynn S, Losonczy M. Multiple deployments and combat trauma: do homefront stressors increase the risk for posttraumatic stress symptoms? J Trauma Stress. 2014;27:90–7.CrossRefPubMedGoogle Scholar
  35. Iowa Persian Gulf Study Group. Self-reported illness and health status among Gulf War veterans. A population-based study. The Iowa Persian Gulf Study Group. JAMA. 1997;277:238–45.CrossRefGoogle Scholar
  36. Iversen AC, Fear NT, Ehlers A, et al. Risk factors for post-traumatic stress disorder among UK Armed Forces personnel. Psychol Med. 2008;38:511–22.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Kang HK, Natelson BH, Mahan CM, Lee KY, Murphy FM. Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: a population-based survey of 30,000 veterans. Am J Epidemiol. 2003;157:141–8.CrossRefPubMedGoogle Scholar
  38. Keene SD. The effective use of reserve personnel in the U.S. military: lessons from the United Kingdom reserve model. 2015. Carlisle Barracks: United States Army War College Press; 2015.Google Scholar
  39. Kim PY, Thomas JL, Wilk JE, Castro CA, Hoge CW. Stigma, barriers to care, and use of mental health services among active duty and National Guard soldiers after combat. Psychiatr Serv. 2010;61:582–8.CrossRefPubMedGoogle Scholar
  40. King DW, King LA, Foy DW, Keane TM, Fairbank JA. Posttraumatic stress disorder in a national sample of female and male Vietnam veterans: risk factors, war-zone stressors, and resilience-recovery variables. J Abnorm Psychol. 1999;108:164–70.CrossRefPubMedGoogle Scholar
  41. King LA, King DW, Fairbank JA, Keane TM, Adams GA. Resilience-recovery factors in post-traumatic stress disorder among female and male Vietnam veterans: hardiness, postwar social support, and additional stressful life events. J Pers Soc Psychol. 1998;74:420–34.CrossRefPubMedGoogle Scholar
  42. Kline A, Falca-Dodson M, Sussner B, 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;100:276–83.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Koenen KC, Stellman JM, Stellman SD, Sommer Jr JF. Risk factors for course of posttraumatic stress disorder among Vietnam veterans: a 14-year follow-up of American Legionnaires. J Consult Clin Psychol. 2003;71:980–6.CrossRefPubMedGoogle Scholar
  44. Kok BC, Herrell RK, Thomas JL, Hoge CW. Posttraumatic stress disorder associated with combat service in Iraq or Afghanistan: reconciling prevalence differences between studies. J Nerv Ment Dis. 2012;200:444–50.CrossRefPubMedGoogle Scholar
  45. Lapierre CB, Schwegler AF, LaBauve BJ. Posttraumatic stress and depression symptoms in soldiers returning from combat operations in Iraq and Afghanistan. J Trauma Stress. 2007;20:933–43.CrossRefPubMedGoogle Scholar
  46. Luxton DD, Greenburg D, Ryan J, Niven A, Wheeler G, Mysliwiec V. Prevalence and impact of short sleep duration in redeployed OIF soldiers. Sleep. 2011;34:1189–95.PubMedPubMedCentralGoogle Scholar
  47. Maguen S, Lucenko BA, Reger MA, et al. The impact of reported direct and indirect killing on mental health symptoms in Iraq war veterans. J Trauma Stress. 2010;23:86–90.PubMedGoogle Scholar
  48. Maguen S, Luxton DD, Skopp NA, Madden E. Gender differences in traumatic experiences and mental health in active duty soldiers redeployed from Iraq and Afghanistan. J Psychiatr Res. 2012;46:311–6.CrossRefPubMedGoogle Scholar
  49. Marshall BD, Prescott MR, Liberzon I, Tamburrino MB, Calabrese JR, Galea S. Coincident posttraumatic stress disorder and depression predict alcohol abuse during and after deployment among Army National Guard soldiers. Drug Alcohol Depend. 2012;124:193–9.CrossRefPubMedGoogle Scholar
  50. Martin CB. Routine screening and referrals for post-traumatic stress disorder (PTSD) after returning from Operation Iraqi Freedom in 2005, US Armed Forces. MSMR. 2007;14:2–7.Google Scholar
  51. Milliken CS, Auchterlonie JL, Hoge CW. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA. 2007;298:2141–8.CrossRefPubMedGoogle Scholar
  52. Ministry of Defence. Reserves in the Future Force 2020: Valuable and valued. London: The Stationery Office Limited; 2013.Google Scholar
  53. Mulligan K, Jones N, Woodhead C, Davies M, Wessely S, Greenberg N. Mental health of UK military personnel while on deployment in Iraq. Br J Psychiatry. 2010;197:405–10.CrossRefPubMedGoogle Scholar
  54. Peterson AL, Wong V, Haynes MF, Bush AC, Schillerstrom JE. Documented combat-related mental health problems in military noncombatants. J Trauma Stress. 2010;23:674–81.CrossRefPubMedGoogle Scholar
  55. Phillips CJ, Leardmann CA, Gumbs GR, Smith B. Risk factors for posttraumatic stress disorder among deployed US male marines. BMC Psychiatry. 2010;10:52.CrossRefPubMedPubMedCentralGoogle Scholar
  56. Pietrzak RH, Goldstein MB, Malley JC, Johnson DC, Southwick SM. Subsyndromal posttraumatic stress disorder is associated with health and psychosocial difficulties in veterans of Operations Enduring Freedom and Iraqi Freedom. Depress Anxiety. 2009;26:739–44.CrossRefPubMedGoogle Scholar
  57. Polusny MA, Erbes CR, Murdoch M, Arbisi PA, Thuras P, Rath MB. Prospective risk factors for new-onset post-traumatic stress disorder in National Guard soldiers deployed to Iraq. Psychol Med. 2011a;41:687–98.CrossRefPubMedGoogle Scholar
  58. Polusny MA, Kehle SM, Nelson NW, Erbes CR, Arbisi PA, Thuras P. Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in national guard soldiers deployed to Iraq. Arch Gen Psychiatry. 2011b;68:79–89.CrossRefPubMedGoogle Scholar
  59. Prins A, Ouimette P, Kimerling R, et al. The primary care PTSD screen (PC-PTSD): development and operating characteristics. Prim Care Psychiatry. 2003;9:9–14.CrossRefGoogle Scholar
  60. Ramchand R, Schell TL, Karney BR, Osilla KC, Burns RM, Caldarone LB. Disparate prevalence estimates of PTSD among service members who served in Iraq and Afghanistan: possible explanations. J Trauma Stress. 2010;23:59–68.PubMedGoogle Scholar
  61. Riddle JR, Smith TC, Smith B, et al. Millennium Cohort: The 2001-2003 baseline prevalence of mental disorders in the U.S. military. J Clin Epidemiol. 2007;60:192–201.CrossRefPubMedGoogle Scholar
  62. Riviere LA, Kendall-Robbins A, McGurk D, Castro CA, Hoge CW. Coming home may hurt: risk factors for mental ill health in US reservists after deployment in Iraq. Br J Psychiatry. 2011;198:136–42.CrossRefPubMedGoogle Scholar
  63. Rona RJ, Hooper R, Jones M, et al. Mental health screening in armed forces before the Iraq war and prevention of subsequent psychological morbidity: follow-up study. BMJ. 2006;333:991–5.CrossRefPubMedPubMedCentralGoogle Scholar
  64. Sharkansky EJ, King DW, King LA, Wolfe J, Erickson DJ, Stokes LR. Coping with Gulf War combat stress: mediating and moderating effects. J Abnorm Psychol. 2000;109:188–97.CrossRefPubMedGoogle Scholar
  65. Shen YC, Arkes J, Pilgrim J. The effects of deployment intensity on post-traumatic stress disorder: 2002-2006. Mil Med. 2009;174:217–23.CrossRefPubMedGoogle Scholar
  66. Shen YC, Arkes J, Kwan BW, Tan LY, Williams TV. Effects of Iraq/Afghanistan deployments on PTSD diagnoses for still active personnel in all four services. Mil Med. 2010;175:763–9.CrossRefPubMedGoogle Scholar
  67. Stretch RH. Posttraumatic stress disorder among U.S. Army Reserve Vietnam and Vietnam-era veterans. J Consult Clin Psychol. 1985;53:935–6.CrossRefPubMedGoogle Scholar
  68. Sundin J, Fear NT, Iversen A, Rona RJ, Wessely S. PTSD after deployment to Iraq: conflicting rates, conflicting claims. Psychol Med. 2010;40:367–82.CrossRefPubMedGoogle Scholar
  69. Terhakopian A, Sinaii N, Engel CC, Schnurr PP, Hoge CW. Estimating population prevalence of posttraumatic stress disorder: an example using the PTSD checklist. J Trauma Stress. 2008;21:290–300.CrossRefPubMedGoogle Scholar
  70. Thomas JL, Wilk JE, Riviere LA, McGurk D, Castro CA, Hoge CW. 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;67:614–23.CrossRefPubMedGoogle Scholar
  71. U.S. Army Surgeon General. Operation Iraqi Freedom (OIF-I) Mental Health Advisory Team (MHAT-I) Report. 2003.Google Scholar
  72. VA Office of Public Health. Analysis of VA health care utilization among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans. 2014. Department of Veteran Affairs.Google Scholar
  73. van Zuiden M, Heijnen CJ, Maas M, et al. Glucocorticoid sensitivity of leukocytes predicts PTSD, depressive and fatigue symptoms after military deployment: a prospective study. Psychoneuroendocrinology. 2012;37:1822–36.CrossRefPubMedGoogle Scholar
  74. Vasterling JJ, Proctor SP, Friedman MJ, et al. PTSD symptom increases in Iraq-deployed soldiers: comparison with nondeployed soldiers and associations with baseline symptoms, deployment experiences, and postdeployment stress. J Trauma Stress. 2010;23:41–51.PubMedGoogle Scholar
  75. Vogt DS, Samper RE, King DW, King LA, Martin JA. Deployment stressors and posttraumatic stress symptomatology: comparing active duty and National Guard/Reserve personnel from Gulf War I. J Trauma Stress. 2008;21:66–74.CrossRefPubMedGoogle Scholar
  76. Warner CH, Appenzeller GN, Grieger T, et al. Importance of anonymity to encourage honest reporting in mental health screening after combat deployment. Arch Gen Psychiatry. 2011a;68:1065–71.CrossRefPubMedGoogle Scholar
  77. Warner CH, Appenzeller GN, Mobbs A, et al. Effectiveness of battlefield-ethics training during combat deployment: a programme assessment. Lancet. 2011b;378:915–24.CrossRefPubMedGoogle Scholar
  78. Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM, editors. The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. Paper presented at: the Annual Meeting of the International Society for Traumatic Stress Studies, San Antonio; 1993.Google Scholar
  79. Wolfe J, Keane TM, Kaloupek DG, Mora CA, Wine P. Patterns of positive readjustment in Vietnam combat veterans. J Trauma Stress. 1993;6:179–93.CrossRefGoogle Scholar
  80. Wolfe J, Erickson DJ, Sharkansky EJ, King DW, King LA. Course and predictors of posttraumatic stress disorder among Gulf War veterans: a prospective analysis. J Consult Clin Psychol. 1999;67:520–8.CrossRefPubMedGoogle Scholar
  81. Wright KM, Cabrera OA, Eckford RD. The impact of predeployment functional impairment on mental health after combat. Psychol Trauma. 2012;4:260–9.CrossRefGoogle Scholar
  82. Wright BK, Kelsall HL, Sim MR, Clarke DM, Creamer MC. Support mechanisms and vulnerabilities in relation to PTSD in veterans of the Gulf War, Iraq War, and Afghanistan deployments: a systematic review. J Trauma Stress. 2013;26:310–8.CrossRefPubMedGoogle Scholar
  83. Xue C, Ge Y, Tang B, et al. A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans. PLoS One. 2015;10:e0120270.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland (outside the USA) 2016

Authors and Affiliations

  • Melissa A. Polusny
    • 1
    • 2
    • 3
    Email author
  • Meredith A. Martyr
    • 1
    • 4
  • Christopher R. Erbes
    • 1
    • 2
    • 3
  • Paul A. Arbisi
    • 1
    • 3
    • 5
  • Mark Kramer
    • 1
    • 3
  • Elizabeth Gibson
    • 1
    • 3
  • Heather Oleson
    • 1
    • 2
    • 3
  1. 1.Minneapolis VA Health Care SystemMinneapolisUSA
  2. 2.Center for Chronic Disease Outcomes ResearchMinneapolisUSA
  3. 3.Department of PsychiatryUniversity of Minnesota Medical SchoolMinneapolisUSA
  4. 4.Department of Educational PsychologyUniversity of Minnesota – Twin CitiesMinneapolisUSA
  5. 5.Department of PsychologyUniversity of Minnesota – Twin CitiesMinneapolisUSA

Personalised recommendations