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PubMed1991

Prevalence of somatic and psychiatric disorders among former prisoners of war.

American former prisoners of war (POWs) are an aging group who seek health care with increasing frequency. To examine the prevalence of long-term physical and emotional consequences of captivity in this population, the authors analyzed medical and psychiatric examination data for 426 former POWs. Detailed psychiatric diagnostic criteria were used to assess the POWs' mental health. Compared with general population groups, POWs had moderately elevated lifetime prevalence rates of depressive disorders and greatly elevated rates of posttraumatic stress disorder (PTSD), although their rates of hypertension, diabetes, myocardial infarction, bipolar disorder, schizophrenia, and alcoholism were not elevated. POWs who lost more than 35 percent of their body weight during captivity had higher rates of anxiety disorder, depressive disorders, PTSD, and schizophrenia, compared with other POWs.

Alcoholism↗
PubMed2006

Military deployment to the Gulf War as a risk factor for psychiatric illness among US troops.

BACKGROUND: Several studies document an excess of psychiatric symptoms among veterans of the the 1991 Gulf War. However, little is known about the prevalence of psychiatric disorders in those who were deployed to that conflict. AIMS: To compare the 12-month prevalence and associated risk factors for DSM Axis I psychiatric diagnoses between random samples of Gulf War-deployed veterans and veterans of the same era not deployed to the Persian Gulf (era veterans). METHOD: Interview data from 967 Gulf War veterans and 784 era veterans were examined to determine current health status, medical conditions, symptoms and Axis I psychiatric disorders. Logistic regression models evaluated risk factors for psychiatric disorder. RESULTS: Gulf War veterans had a significantly higher prevalence of psychiatric diagnoses, with twice the prevalence of anxiety disorders and depression. Lower rank, female gender and divorced or single marital status were significant independent predictors of psychiatric disorder. CONCLUSIONS: Deployment to the Gulf War is associated with a range of mental health outcomes more than 10 years after deployment.

Adult↗
PubMed2006

Opioid substitution treatment reduces substance use equivalently in patients with and without posttraumatic stress disorder.

OBJECTIVE: The purpose of this study was to determine whether opioid-dependent patients with diagnosed posttraumatic stress disorder (PTSD) have poorer long-term outcomes in opioid substitution treatment than do patients without PTSD. METHOD: This prospective observational study examined outcomes of 255 opioid-dependent patients (men = 248) entering opioid substitution treatment at eight clinics in the Veterans Health Administration (VHA). Subjects were interviewed at treatment entry, 6 months, and 1 year about substance use and related problems, health status, treatment satisfaction, and non-VHA health care utilization. Medical records were reviewed to obtain toxicology results, health care utilization data, and diagnoses. Medical record review identified a diagnosis of PTSD in 71 (28%) patients. Substance-use and mental-health outcomes and health care utilization in the first year following treatment entry were compared between patients with and without a diagnosis of PTSD. RESULTS: Patients with and without PTSD had similar treatment responses. Although patients with PTSD had longer histories of drug use at intake, at 1-year follow-up they showed reductions in heroin, cocaine, and alcohol use, comparable to patients without the disorder. PTSD patients received higher doses of opiate medication, attended more psychosocial treatment sessions for substance-use disorder, and had better treatment retention. Psychiatric symptoms for patients with PTSD were more severe at intake and showed little improvement throughout treatment. CONCLUSIONS: Opioid substitution therapy is as effective at reducing substance use in PTSD patients as it is in patients without the disorder, but additional services are needed for treatment of psychological problems that are largely unchanged by treatment for addiction.

Adult↗
PubMed1994

Posttraumatic stress disorder in male and female Dutch Resistance veterans of World War II in relation to trait anxiety and depression.

In this study, 680 male and 144 female Dutch Resistance veterans of World War II were evaluated on Posttraumatic Stress Disorder, trait anxiety, and depression. Approximately 27% of these men and 20% of these women showed current Posttraumatic Stress Disorder. Resistance veterans, as a group, appeared comparable to the controls from Dutch validation studies on trait anxiety and depression. Gender differences were not observed. Veterans with current PTSD symptoms scored higher on trait anxiety and depression than the remaining veterans and were comparable on trait anxiety and depression to psychiatric patients. Correlational analyses showed that there was a strong association between trait anxiety and depression. Posttraumatic Stress Disorder correlated highly with trait anxiety and depression.

Aged↗
PubMed1996

Prevalence of posttraumatic stress disorder, depression and anxiety in a community sample of New Zealand Vietnam War veterans.

OBJECTIVE: The aim of the paper is to investigate the prevalence of posttraumatic stress disorder (PTSD), depression and anxiety in a community sample of New Zealand Vietnam War veterans. METHOD: Data were collected as part of a national survey on the health and mental health of New Zealand Vietnam veterans. Five hundred and seventy-three randomly selected male Vietnam veterans participated in a postal survey. The questionnaire contained a number of demographic, biographical and psychological measures. RESULTS: The results revealed that 10% of the veterans could be classified as PTSD cases and that these veterans exhibited high levels of depression and anxiety. In PTSD cases, 15% were also classified with anxiety, 6% with depression, and 73% were classified with both anxiety and depression. In PTSD cases 94% were classified with more than one additional disorder. In non-PTSD cases 27% were classified with anxiety, and 1% with depression, while 12% experienced both anxiety and depression. CONCLUSIONS: The consequences of comorbidity for research and treatment are discussed and it is suggested that health professionals should be attentive to military experience as a predictor of these disorders.

Adult↗
PubMed1976

School psychological emergency interventions proposal for guidelines based on recent Israeli experience.

The Yom Kippur War and its stressful aftermath created a number of special psychological effects in Israeli schools. During that period mental health and counseling services were available and made use of in the educational system. Extensive experiences permit an attempt to delineate guidelines for future school psychological emergency interventions. These guidelines rest on the supposition that the planning and delivery of professional emergency interventions resemble those governing routine mental health services in a number of crucial aspects. Firstly, the need for an educated anticipation of problems, their kinds, their ecology and other characteristics. Schematically, three categories of emergency reactions could be expected in schools: shock and grief, and other acute disturbances; fear and its psychological concomitants; confusion, perplexity, and their attitudinal accompaniments. It is noted that the stressful event can also generate positive effects. Secondly, the necessity for a preliminary, on the spot, assessment of psychological affliction in any specific emergency case. Such examination should be done against the background of the total emergency situation (locally and country-wide), as well as the chronic characteristics of the particular school or system. Third, the requirement for deliberate planning of the intervention program. In this phase, judgements have to be made about the recipients of the aid, the methods of help and the levels at which professional services will be extended. Fourth, the consideration of important clinical and community psychological principles during the execution of the program.

Adaptation, Psychological↗
PubMed1999

[Cerebrovascular accidents in Sarajevo during the war].

PURPOSE: Neurologists in the main hospital in Sarajevo (Bosnia-Herzegovinia), we worked in the neurological department throughout the war and the siege of the town, from 1992/4/6 to 1995/12/15. We report on strokes which happened during that period, comparing stroke incidence and severity in relation to those two years before. We reviewed 3002 cases of stroke recorded in the neurological department registry from 01/01/90 to the end of the war. RESULTS: The activity of the department was reduced by about 40 p. 100, as was the population of the town. Yet the number of strokes decreased only by 26.5 p. 100. The comparative incidence of strokes increased by 25 p. 100 during the war. Sex ratio and age incidence were the same. The relative role of atherosclerosis, cardiac embolic sources, intracranial and meningeal hemorrhage remained the same. The incidence of intracranial hemorrhage increased by 20 p. 100. Death, evaluated after one month, increased by 36 p. 100. Death by intracranial hemorrhage increased by 30 p. 100, those by cardiac embolic infarction by 26 p. 100 and those by atherosclerosis by 20 p. 100. At the end of the first year of the war, mortality was 65 p. 100 in comparison with the previous year and death by meningeal hemorrhage increased by 74 p. 100 for the first two years of the war. The major changes in life conditions have produced change in medical conditions. Patients had to stop their treatment because there was no more medecine in the city, and, among others, no more drugs for anticoagulation, diabetes mellitus, cardiopathy.... In the hospital, medical doctors, nurses, drugs, food and even heating were missing. So stopping the treatment for vascular disease together with the high level of stress generated by daily shelling can explain the increase in stroke incidence and especially, the hemorragic cases. The poor life conditions which weakened people and the lack of treatment at the acute stage of the disease and also later, when secondary events occurred, can explain the high mortality observed. CONCLUSION: We recognize the bias of our study: the war itself, the condition in which we have carried out this work and the use of a hospital registry. Nevertheless, it seems that morbidity not directly due to the battle can change during a war like this one. This study also demonstrates, "a contrario", that preventive treatment and care of stroke at the acute phase, as they are currently recommended, are useful.

Acute Disease↗
PubMed1951

Treatment of closed head injuries.

Cerebral concussion is a physiological disturbance in the brain that follows a blow on the head. The cardinal symptom is a disturbance in consciousness varying from a complete loss of consciousness to a dazed state. The phenomenon is self-limited and completely reversible. In cerebral contusion there is actual injury to the brain. The symptoms that result vary according to the amount and location of the damage. A very small amount of damage in certain areas of the brain may be fatal, while extensive damage in other areas will be survived. Even when a patient is unconscious after a head injury, certain simple neurologic tests can be done to determine with some accuracy the extent and location of brain damage. When the patient regains consciousness, further bedside tests can be carried out to increase the accuracy of diagnosis. Careful observation of the patient at frequent intervals is necessary to judicious application of appropriate treatment. The physician must be on the alert constantly for signs of intracranial hemorrhage and should be ready to intervene surgically if necessary. In most cases of injury to the head, treatment consists of supplying to the patient elements that are necessary to maintain physiologic conditions and of combating disorders arising from specific injuries to the brain.

Brain↗
PubMed1992

Mortality of former prisoners of war and other Australian veterans.

OBJECTIVE: This second summary article from an epidemiological review of the health of former prisoners of war (POWs) and other Australian veterans, commissioned by the Sir Edward Dunlop Medical Research Foundation, reports on studies of mortality. DATA SOURCES: The MEDLARS database, from 1966 to the present, under the terms military personnel, veterans, veterans' disability claims, combat disorders and prisoners (matched against war); databases of the Department of Veterans' Affairs (Victoria) and the Central Library, Commonwealth Department of Defense, under the term "prisoner of war"; and the microfiche listings of the Department of Veterans' Affairs, under "prisoner of war" and "repatriation". Only studies in English or French were reviewed, reaching a total of 172. STUDY SELECTION: Four studies in this paper constitute the main evidence about postwar mortality in Australians who were POWs of World War II or Vietnam veterans. Other mortality studies are cited in the complete literature review published elsewhere. DATA EXTRACTION: Only the data with an epidemiological basis are considered here. DATA SYNTHESIS: All-cause mortality rates were no greater in former POWs or Vietnam veterans than in the general Australian male population. There was, however, evidence of increased mortality among former POWs compared with other non-POW veterans, and among Vietnam veterans in one particular corps compared with veterans of the same era who served in Australia. CONCLUSIONS: Elevated early postwar mortality of young former POWs implicates diseases with short latent periods (including psychiatric disorders). This is consistent with the greater health risks of this group of survivors that were identified in the earlier review of morbidity. Mortality among former POWs and other veterans requires continued surveillance because a "healthy worker effect" (or exclusion of unfit persons from the armed forces) may partly conceal increased morbidity or mortality that should be attributed to war service.

Adult↗
PubMed1991

Chronic morbidity of former prisoners of war and other Australian veterans.

OBJECTIVE: This report is the first summary article from a review of studies on long-term morbidity associated with war service or internment, commissioned by the Sir Edward Dunlop Medical Research Foundation. DATA SOURCES: The Medlars database, from 1966 to the present, under the terms military personnel, veterans, veterans' disability claims, combat disorders and prisoners (matched against war); databases of the Department of Veterans' Affairs (Victoria) and the Central Library, Commonwealth Department of Defence, using the term "prisoner of war"; and the microfiche listings of the Department of Veterans' Affairs, under "prisoner of war" and "repatriation". Only studies in English or French were reviewed, reaching a total of 172. STUDY SELECTION: Forty-eight studies are considered in the present summary, presenting the most significant evidence about long-term morbidity attributable to war-time experiences. Studies concerning Australian veterans are emphasised. DATA EXTRACTION: Studies considered valid were summarised for an annotated bibliography, but only reports of major public health significance are reviewed here. DATA SYNTHESIS: The review confirms that strongyloidiasis, peptic ulcer, anxiety states, depression and hepatitis B are more prevalent in former prisoners of war than in relevant comparison groups. We have not identified further diagnoses that should be attributed specifically to war-time exposures. Attribution of long-term neurological and musculoskeletal disorders to war-time exposures remains uncertain. CONCLUSIONS: Former prisoners of war and veterans constitute a population of survivors highly selected by the rigours of war and imprisonment. Occurrence of the five conditions listed above may be reasonably attributed to war-time exposure. We recommend further research on ageing (including neurological, visual, hearing and musculoskeletal disability), family disruption and rehabilitation strategies in these groups.

Australia↗