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The Posttraumatic Stress Disorders among the Soldiers Deployed to Iraq

According to the studies conducted on the recently returned service members, it is estimated that the rate of the posttraumatic stress disorders among the United States Iraq War soldiers exceeds 12 percent. It is also estimated that 16 percent of these soldiers examined one year after their return from war face the posttraumatic stress disorders. Also, the recent study of the combined US service done on its members that were deployed to Iraq revealed an estimate of around 14 percent of the soldiers facing the PTSD, with fresh cases exceeding the 7 percent mark among the combat-exposed personnel, which is also consistent with the previously indicated outcomes from the past wars. The key attributes of the deployment factors that are associated with PTSD are combat duties, noncombat deployment stressors, and the war threat appraisals. This study was carried out due to the concerns of the increased cases of PTSD cases as a result of the combat activities.

The understanding of the PTSD symptoms connected to the subsequent stressors caused by deployment is of much importance to the service members, particularly in the context of repeated wars. The occurrence of such PTSD symptoms, especially in the first-time war deployments, is of considerable concern. The careful study of these symptoms and the stressors may help in coming up with a more scientific way of curbing these cases. Thus, the primary aim of this research was: a) to establish whether PTSD symptom levels have changed due to the effect of deploying the soldiers to Iraq war, and b) to come up with well examined associations on the pre-existing PTSD symptoms and the deployment-related stressors following the pre and postdeployment of the soldiers into the war front.

This research procedure is based on sample experiments done on the participants. The targeted population for this study was male and female US Army soldiers who served in the Iraq war from April 2003 up to September 2006. This study involved the deployed and the non-deployed to Iraq soldiers across the two sessions, namely Time 1 and Time 2. The participants were then categorized as either deploys or non-deploys for Time 2 due to their deployment status on Times 1 and 2. The units which were not deployed were assessed at close time intervals to their deploying units. At the Time 1 sample group, the participants, regardless of the future outcomes, were functioning under the increased demands that were secondary to the anticipated deployment, because of the looming intensive desert training that they were to go through and also because of the idea of temporary geographic relocation and the separation they were to get from their families and friends (Vasterling et al., 2010, p. 42).

The measures used in the study were interviews and also the written surveys, which were verified by the service records. The stress exposures and PTSD symptoms were investigated through the use of questionnaires. The written surveys were only conducted among the small groups during the military installations as the principal study that indeed targeted the neuron-cognitive functioning. It was found out that Time 2 participants did not differ much from the Time 2 non-participants that were from the ethnic minority or had the marital status. Other measures used in tabulating the results were the use of PTSD screening casernes, the prior stressful life events, the use of some medications that are prescribed as psychoactive, and also the existence of psychiatric/alcohol disorders. The participants of Time 1 sample were kind of not well represented on the side of women and commissioned officers. The results showed that the deployed and the non-deployed participants of sample Time 1 did not differ much on the baseline variables, but the deploys served longer periods in the Army, and thus, were slightly older than the non-deploys. On the other hand, the results obtained from sample Time 2 on the deployed soldiers indicated higher levels of PTSD as compared to the non-deployed soldiers. The main reason of this disorder is continuous participation in the war-front, especially if the soldiers were receiving hostile fire and had concerns about homes and their families.

In conclusion, the prospective study found out that military deployment to the Iraq War is associated with the pre- and post-deployment and is causing increased cases of post-traumatic Stress Disorders, even after the US government adjusted the baseline levels of PTSD symptoms. Non-deployed soldiers, however, failed to show any symptoms of PTSD increases, thus suggesting that the pre-deployment and the post-deployment increases could not be only attributed to some nonspecific factors that are inherent in the military life. The findings also provide the strong evidence that deployment of the soldiers to the contemporary war zones results in the adverse health issues, and these consequences cannot be explained well through looking at the preexisting symptoms.

The Ethno-Racial Variations in Acute PTSD Symptoms

Before the research was conducted, the prior investigations have reported cases of increased risks of the posttraumatic stress disorders (PTSD) in the ethno-racial minority populations that have been recently associated with exposure to trauma, lack of access, and also engagement in the mental health treatment procedures, the medical morbidities, among other factors. The various factors related to the ethno racial minority status are being explored to shed light on the differential effects it has on the Post trauma stress disorders. The main affected population here is the African American one, with higher occurrence of the depression disorders, with double likelihood of the violence exposure, and also the higher rates of assault cases being reported as compared to their white counterparts. The US Department of Justice, under the Bureau of Statistics, did some research on the most common cases of misdiagnosis and the under-diagnosis of the mental health disorders and did found out that the African Americans were the ones that were most affected. The American Indians, on the other hand, had higher cases of trauma exposure as compared to the national samples, as they tend to experience and witness more accidents and violence cases.

The substantial percentage of the survivors who are admitted to the United States hospitals due to the injuries is the ethno-racial diverse patients. Exposure to the traumas that are coupled with many physical injuries leads to the increased risks of the development of post-trauma stress disorders (PTSD). According to the Centre of Disease Control (CDC) report of 2009, 29.5 million cases of emergency visits were recorded with primary injury diagnosis, while 1.9 million cases had resulted into inpatient admissions. The greater levels of post-traumatic emotional distress, also including the PTSD symptoms, have been linked to increasing risk factors of a person developing the PTSD after the injuries. More hypothesized investigations show that the African American, the Asians, the American Indians, and the Latinos who are victims of injuries report the higher levels of the acute PTSD symptoms as compared to their white counterparts.

So as to investigate this idea, some regression studies were conducted to assess the independent associations between the ethno-racial minority status and the acute PTSD symptoms through doing some adjustments on the relevant injury, clinical as well as demographic characteristics, which included the pre-injury trauma theory. The methodology used in this research procedure was choosing the participants who could speak English and also survivors of accidents or various violence-related injuries. The sample population was also above 18 years and lived within some 50 to 100 miles from the trauma centre. There were 9409 injured patients that were admitted to the Harborview Trauma Center at the time of research. 8454 people out of this figure were not approached in the survey, since they lived far than the stipulated distance or they were discharged from the centre before the approach, etc.

The measures used in this research included the checking of posttraumatic symptoms using the Posttraumatic Stress Disorder Checklists. Another measure used was classifying the participants according to the ethno-racial groups, whereby the participants were asked to report their views according to their ethical identification. The last measure used in the study was the posttraumatic stress predictors, in which the participants were requested during the interview to designate their education years and household incomes on the various ranging scales provided. The results ended up showing that the African American and the American Indian patients were less educated than the whites, and also the African Americans had the higher percentage of the uninsured status. Asian patients were reported to have higher household incomes, while a bigger percentage of old patients was recorded among the white patients. It was also the African Americans and the American Indians who recorded higher levels of some previously established risk factors that cause PTSD.

From these established results, it can be concluded that the investigation did explore the ethno-racial variations of the acute PTSD symptoms and more relational characteristics of large injury survivors analyzed in the single US trauma centre. These analyses were done through the use of SPSS 16.0 by comparing the clinical and the demographic characters of the patients who were sampled. The regression analyses were finally done to assess the independent association of ethno-racial heritage and the acute PTSD symptoms through adjusting other injury, clinical, and also demographic characteristics.

In conclusion, the research has identified that racial variations indeed lead to the high levels of reported Posttrauma Stress Disorder factors in the US. This is evident since the research found out that the African American survivors of trauma were the ones who showed the highest level of acute PTSD symptoms. After the accounting of various PTSD-related cases, it was also reported that the American Indians were the ones with highest burdens of the cumulative past trauma. The ethno-racial minority injury survivors also recorded more positive alcohol and drug toxic screens on their admissions to the hospitals as compared to the whites, hence coming to a conclusion that ethno-racial variations contribute to the PTSD.

Trauma Exposure and PTSD Symptoms among Homeless Mothers: Predicting Coping and Mental Health Outcomes

The study was done on seventy homeless mothers, who gave information about the traumas they had gone through and who were examined for the signs of posttraumatic stress. The study was undertaken 15 months after the events had taken place. High levels of PTSD were observed in this sample.

PTSD is a key potential consequence of the exposure to trauma. Its symptoms may also lead to increase of comorbid mental fitness conditions. Since not all people who have faced trauma develop negative outcomes, there is increased interest in this area as researchers try to find out factors that can protect individuals who face trauma from this disorder.

To some extent, exposure to trauma and PTSD depend on how the individual copes with stress that occurs later in life, as this relates to mental health in the future. Although previous study shows that facing life stress increases coping behavior, some types of coping generally lead to significant adjustments. On the other hand, avoidant methods of coping with trauma such as drug abuse and denial lead to individual being more depressed and to higher levels of PTSD symptoms.

Researchers have proposed that previous trauma history and PTSD symptoms may affect the manner in which one copes with stressful experience later in life. Empirical evidence shows that individuals who faced previous trauma are less adaptive to highly stressful situations in future than those who did not have trauma experiences in the past. Research also shows that women who are homeless report more psychological distress than their low-income housed counterparts as[E1]  a result of victimization from the society and other stressful issues in life.

This study investigated the potential relationship between previous trauma and PTSD symptoms process of coping in response to other causes of stress later in life, and subsequent results in a group of seventy homeless mothers. The researchers hypothesized that homeless mothers who experienced life time traumas and showed a lot of PTSD symptomatology at baseline are likely to show worse adjustment at 15 months. Moreover, they hypothesized that previous trauma exposure relationship with PTSD symptomatology and the later adjustments can be mediated using avoidant and active coping.

The data used was collected using Connecticut Homeless Families Program. The data used for this investigation was from 12 sites, which included programs giving shelters to the homeless. The participants in the program were recruited through street outreach, program that provided shelter to the homeless, and drop-in-centers. The program referred the study participants to the research team. The research staff then screened the study referrals.

The participants were selected according to the following characteristics:

(1) Currently without homes;

(2) Had a child aged less than 16 years and parental rights of that child;

(3) Had substance use disorder history in the past year.

Structured research interviews were conducted by interviewers from Connecticut Department of Mental Health and Addiction Services Research Division, who had been trained to collect data. Initial interviews were face to face, and follow ups were conducted after every three months until 15 months, most of which were face to face and sometimes through telephone when there were geographical difficulties.

Each participant was paid for each completed interview and for keeping their first schedule appointments. Each participant was required to complete a contract during the baseline interview to facilitate follow-up. These contracts were regularly checked. Data included demographics, current trauma symptoms, and trauma history. Measures taken during the study included:

1. Prior trauma and posttraumatic stress symptoms;

2. Most stressful event;

3. Psychological symptoms.

Results confirmed that participants had experienced high levels of trauma in their lifetime. 93% reported having undergone at least one traumatic event in their lifetime, while 73% endorsed multiple traumatic events in their lives. From the results, an intercorrelation between the study variables and meditational analysis was drawn.

The results confirmed that the homeless mothers faced high levels of trauma in their lifetime (93% reported). Most of them experienced multiple traumas. Being homeless was one of the stressing factors for over one third of them. This supports Goodman et al. (1991) view that being homeless can be traumatizing. Relationship between various variables showed that the number of previous traumas is related to PTSD symptom severity.

The study supports the researchers’ hypothesis that prior trauma and PTSD symptomatology affect subsequent general adjustments to stressors. From the study, it appeared that some of the harmful impacts of trauma exposure and distress are mediated via avoidant coping and not diminished approach coping. No relationship was observed between trauma experienced previously and active coping. The results are consistent with others done on previous studies, such as those of sexual assault victims. Researchers faced limitations such as:

1. Limited sample size;

2. Potential method bias (mostly due to the fact that the sample was drawn from those women who were receiving services or who were connected with the shelter system);

3. Ability to determine the causal relationship was limited by the correlation nature of the study;

4. The nature of most of the stressors reported by the participants did not correspond with the criterion of traumatic events.

The study supports the need to consider the effects of trauma when designing interventions to enhance the outcomes for this vulnerable group. This study encourages future studies on testing the mechanisms through which trauma history and previous PTSD symptoms may affect psychological adjustment in the future within the less privileged populations. This would be beneficial in comprehending the complex relationship between these factors.

How Type of Treatment and Presence of PTSD affect Employment, Self-regulation, and Abstinence

This study was conducted to investigate the effects of substance use, self-regulation, and unemployment on people with and those without PTSD who had moved to the community from substance use treatment centers. The participants who had been recruited from substance abuse treatment centers (150 and 32 of them) had been diagnosed with lifetime PTSD.

In the second year of follow up, individuals with PTSD in the normal after care condition illustrated significant lower levels of self-regulation as compared to the ones in the Oxford House condition having or not having PTSD. These results emphasize the need of settings that support abstinence after substance use treatment, especially for those people with PTSD.

According to Najavits (2009), Posttraumatic stress disorder is associated with the increased use of substances. Previous studies have shown that poor substance outcome leads to PTSD and high psychiatric distress related to comorbid disorders.

Theorists claim that substance use by individuals is a coping technique for depressed people. Patients diagnosed with PTSD, according to the report, were more likely to be affected by depression levels as opposed to individuals without PTSD. PTSD is characterized by intense feelings of anxiety and fear, which may make victims to withdraw from the society and circumstances that may depress them. Impairments of self-regulation character are also a major symptom of PTSD. This results in a decline in person’s capacity to logically control responses to priorities, aims, and environmental requirements. And this leads to severe emotional distress, phases of dissociation, lack of faith in relationships as well as loss of meaning of life. The cognitive structures of these exposed individuals become impaired over time, since their bodies have experienced a lot of stress; hence, they become too dependent on substances. These structures are responsible for running emotional responses. Reticence of cognitive regulation processes may influence how individuals make decisions and their impulse control, which also results into substance abuse. On the other hand, individuals who have high self-control have less problems of impulse related character. High self-control is also related to improved psychological adjustment. Employment also positively affects individuals with PTSD and S.U.Ds. Work appeared to be a satisfying and meaningful method to broad the economic and social networks for individuals suffering from psychological disorders. However, despite the economic and mental merits that are associated with being employed, it is difficult to find a job when one is having PTSD. Having PTSD status significantly reduces the chances of employment.

Oxford House is one of the settings that increases abstinence levels and promotes employment. In Oxford House, residents learn behavior and skills that will let them get back to normal, independent settings after sustaining abstinence. Members of the Oxford House also attend programs that help them abstain. This house has shown both effectiveness and practicability of self sustaining recovery environments. When individuals in Oxford House condition were compared with the ones that underwent usual after care, the ones in Oxford House showed lower levels of substance use.

This study used two treatment groups, i.e. usual aftercare versus Oxford House, to analyze participants based on their self-control scores, substance use, and levels of unemployment. The researcher hypothesized that those individuals with posttraumatic disorder who were members of usual aftercare programs would experience the worst outcomes of substance use coupled with higher unemployment levels as well as lower self-control scores compared to those individuals who were not diagnosed with this disorder in this kind of aftercare program and those who were enrolled in Oxford House. The researchers also suggested that the ones with PTSD in the Oxford House are likely to show similar outcomes of substance use, employment, and self control levels to the ones without the disorder in this institution.

Data was collected in a span of four years (from 2002 till 2005). There were 150 participants who were recruited. These participants were selected from residential treatment centers of substance abuse located in the northern regions of Illinois. The participants of the study were approached at the treatment centers, where discussions with participants were held and the written consents were obtained after the discussion. Each participant was given incentives for baseline participation and an equal amount on each subsequent interview. Chi square and independent sample t-tests were used; they indicated no key differences between situations on socio-demographic variables.

Measures undertaken in the study included:

1. Diagnostic Interview Schedule-IV (D.I.S-IV);

2. Self-Regulation;

3. Addiction Severity Index (ASI).

To test the study’s hypotheses, the researchers examined the variations in self-regulation, levels of unemployment and substance use effects among individuals with and without PTSD. These individuals were either assigned to the Oxford House or to the usual aftercare conditions.

This study found that there was a key distinction in self control scores among the four groups. The PTSD group in the usual aftercare condition had the least self-regulation levels as compared to the two Oxford House groups. The findings of this study imply that settings that support abstinence are important for the individuals with PTSD. It is argued that stability and responsibilities associated with Oxford House help people control emotions and behavior. From this study, Oxford House is an appropriate environment for individuals in recovery from substance abuse as well as those with comorbid PTSD and SUD.

The study had a limited sample; therefore, the researchers suggest that future study should include larger groups. Future studies should also try to assess other variables such as mental health treatment that is carried out after discharge from substance abuse treatment settings.

Considering PTSD from the Perspective of Brain Processes: A Psychological Construction Approach

Posttraumatic stress disorder (PTSD) refers to a complex psychiatric disorder where symptoms from various domains are experienced, and they appear to be a consequence of a combination of several mechanisms.

Although legitimacy of PTSD as a key diagnosis has been confirmed and has led to a lot of critical insights into how this disorder works, there is a lot of controversy that remains. The key unresolved issue is the core features of this disorder. This disorder is currently classified as an anxiety disorder by DSM.

In both human and animal PTSD neuroscience models, the common hypothesis is that the amygdale (a significant fear circuitry factor) is hyperactive to incoming stimulus, and this hyperactivity is said to lead to fearful responses coming from a constant interruption in homeostasis. Both Etkin and Wager noted that fear may be a feature of specific phobias and social anxiety disorder associated with a wider range of emotion regulation dysfunction.

The aim in this study is to investigate if dysregulated fear is the most beneficial and productive approach to deducing the existing brain proof in psychological terms. The questions raised are whether PTSD is a Fear-Based Disorder and whether amygdala is specific to the emotion fear in PTSD. Amygdala is generally broadly accepted as a part of the brain that is extremely crucial in establishing fear. Fear, in animal research, is defined as “the behavioral adaptation that makes animals and man sense threats and responds to them promptly” (LeDoux, 2008).

Behavioral adaptations can be inherited as well as actions performed by a creature in order to survive. Past studies have confirmed that amygdala has a vital role in various behavioral adaptations that organisms use to respond to a threat. Previous studies show that the amygdala is not constantly activated at the time of fearful experiences at a rate greater than the one expected by chance. Even though a rise in amygdale activation was constantly observed in other emotional experiences like sadness and anger, the studies of fear experience did not constantly report a rise in amygdala response. The opinion of fear was constantly associated with a rise in amygdala activation, although this is not proof that the amygdala is a requirement for the sensitivity of fear. Hyper responsiveness in the amygdala is a fundamental feature of PTSD, although this does not imply that PTSD has an anomaly in fear.

Does the Prefrontal Cortex Inhibit a Subcortical Fear Circuit? One factor in the hyperreactive, under regulated fear hypothesis is that PTSD signs arise from lowered regulation capability associated with hyperesponsivity of paralimbic cortical regions, such as the ventromedial prefrontal cortex in the medial orbitofrontal cortex, and immediately posteriorly, the subgenual anterior cingulate cortex. The fact that the cortex restrains subcortical regions is frequently taken as a proof that more evolutionarily recent cognitive parts of the brain control the more ancient emotional parts, and any disruption of this control leads to psychopathology such as observed in PTSD.

Mammalian nervous systems share the same basic architecture in which the cortex modulates subcortical target regions. This is achieved by a complex set of cascading projections. These projections either excite or subdue subcortical activity. These multiple descending pathways from cortical areas to subcortical autonomic regions in the hypothalamus, periaqueductal gray, and brainstem produce a complex pattern of autonomic regulation that results into the counterintuitive hypothesis that in PTSD, the cortex might be selectively enhancing automatic reactivity.

This article aims to bring in the psychological construction approach as a method of understanding the brain basis of PTSD and at the same time give new interpretations and insights for research in the future. Even though this approach is not common in psychology, it is consistent with a lot of unified approaches that try to find out biological and psychological processes that are common to several forms of psychopathology.

This approach also corresponds to the present neurotransmitter models of anxiety, which show that various neurotransmitters and receptors provide multiple and frequently contrasting functions in the modulation of nervous states, depending on the exact cerebral circuits they interact.

When combined with trans-diagnostic approaches to mental illness, this approach perspective assists in recognizing the present psychiatric diagnostic areas, such as other complex psychological areas like e.g. emotions, which are heterogeneous, and also the results of more general causes that may lead to other mental disorders.

In addition, psychological construction approach can help explain the rising realization that psychiatric groups, just like other complex psychological category, are not natural types. Psychological construction offers a different approach to description and causes of PTSD and also suggests significant results of neuroimaging studies of PTSD.

Previous approaches to understanding the brain basis of psychopathology have been typically focused on finding out the neural basis of a particular process by use of a specific task to isolate that process. There has been an increased recognition over the past few years that ful understanding of the neural networks and interactions among these vital networks that produce a mental state also requires examining data across multiple tasks.

The researchers suggest that comparing PTSD to other disorders will prevent researchers from making declarations about the specificity of regions in the brain or PTSD networks that are also visible in other disorders.

 

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