Several interviews are available for assessing PTSD. These interviews vary in merit when compared on stringent psychometric and utility standards. Of all the interviews, the Clinician-Administered PTSD Scale (CAPS-1) appears to satisfy these standards most uniformly. The CAPS-1 is a structured interview for assessing core and associated symptoms of PTSD. It assesses the frequency and intensity of each symptom using standard prompt questions and explicit, behaviorally-anchored rating scales. The CAPS-1 yields both continuous and dichotomous scores for current and lifetime PTSD symptoms. Intended for use by experienced clinicians, it also can be administered by appropriately trained paraprofessionals. Data from a large scale psychometric study of the CAPS-1 have provided impressive evidence of its reliability and validity as a PTSD interview.

The development of a Clinician-Administered PTSD Scale.

background The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. methods We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. results Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. conclusions This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care.

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Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.

Meta-analyses were conducted on 14 separate risk factors for posttraumatic stress disorder (PTSD), and the moderating effects of various sample and study characteristics, including civilian/military status, were examined. Three categories of risk factor emerged: Factors such as gender, age at trauma, and race that predicted PTSD in some populations but not in others; factors such as education, previous trauma, and general childhood adversity that predicted PTSD more consistently but to a varying extent according to the populations studied and the methods used; and factors such as psychiatric history, reported childhood abuse, and family psychiatric history that had more uniform predictive effects. Individually, the effect size of all the risk factors was modest, but factors operating during or after the trauma, such as trauma severity, lack of social support, and additional life stress, had somewhat stronger effects than pretrauma factors.

Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(02)08336-8.pdf

Health consequences of intimate partner violence.

A review of 2,647 studies of posttraumatic stress disorder (PTSD) yielded 476 potential candidates for a meta-analysis of predictors of PTSD or of its symptoms. From these, 68 studies met criteria for inclusion in a meta-analysis of 7 predictors: (a) prior trauma, (b) prior psychological adjustment, (c) family history of psychopathology, (d) perceived life threat during the trauma, (e) posttrauma social support, (f) peritraumatic emotional responses, and (g) peritraumatic dissociation. All yielded significant effect sizes, with family history, prior trauma, and prior adjustment the smallest (weighted r = .17) and peritraumatic dissociation the largest (weighted r = .35). The results suggest that peritraumatic psychological processes, not prior characteristics, are the strongest predictors of PTSD.

Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis.

Trauma and the Vietnam war generation: Report of findings from the National Vietnam Veterans Readjustment Study.

ContextThe terrorist attacks of September 11, 2001, represent an unprecedented
exposure to trauma in the United States.ObjectivesTo assess psychological symptom levels in the United States following
the events of September 11 and to examine the association between postattack
symptoms and a variety of indices of exposure to the events.DesignWeb-based epidemiological survey of a nationally representative cross-sectional
sample using the Posttraumatic Stress Disorder (PTSD) Checklist and the Brief
Symptom Inventory, administered 1 to 2 months following the attacks.Setting and ParticipantsSample of 2273 adults, including oversamples of the New York, NY, and
Washington, DC, metropolitan areas.Main Outcome MeasuresSelf-reports of the symptoms of PTSD and of clinically significant nonspecific
psychological distress; adult reports of symptoms of distress among children
living in their households.ResultsThe prevalence of probable PTSD was significantly higher in the New
York City metropolitan area (11.2%) than in Washington, DC (2.7%), other major
metropolitan areas (3.6%), and the rest of the country (4.0%). A broader measure
of clinically significant psychological distress suggests that overall distress
levels across the country, however, were within expected ranges for a general
community sample. In multivariate models, sex, age, direct exposure to the
attacks, and the amount of time spent viewing TV coverage of the attacks on
September 11 and the few days afterward were associated with PTSD symptom
levels; sex, the number of hours of television coverage viewed, and an index
of the content of that coverage were associated with the broader distress
measure. More than 60% of adults in New York City households with children
reported that 1 or more children were upset by the attacks.ConclusionsOne to 2 months following the events of September 11, probable PTSD
was associated with direct exposure to the terrorist attacks among adults,
and the prevalence in the New York City metropolitan area was substantially
higher than elsewhere in the country. However, overall distress levels in
the country were within normal ranges. Further research should document the
course of symptoms and recovery among adults following exposure to the events
of September 11 and further specify the types and severity of distress in
children.

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Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11.

A complete understanding of the consequences of service in a war zone includes examining the lifetime and current prevalence of post-traumatic stress disorder (PTSD), and of partial PTSD. Cases of partial PTSD are persons who have clinically significant symptoms of PTSD, but who do not meet the full diagnostic criteria. The National Vietnam Veterans Readjustment Study (NVVRS) estimated the lifetime prevalence of PTSD to be 30.9% among male theater veterans, 26.% among females; lifetime prevalence of partial PTSD was an additional 22.5% and 21.2%, respectively; current prevalence of partial PTSD was 11.1% in males and 7.8% in females. NVVRS findings indicate that of the 1.7 million veterans who ever experienced significant symptoms of PTSD after the Vietnam war, approximately 830,000 (49%) still experience clinically significant distress and disability from symptoms of PTSD. The contribution of partial PTSD represents an estimated additional 350,000 veterans.

The prevalence of lifetime and partial post-traumatic stress disorder in vietnam theater veterans

Findings from the Congressionally mandated National Vietnam Veterans Readjustment Study indicate that nearly one-half million Vietnam veterans—15.2% of the men and 8.5% of the women who served in Vietnam—suffer from post-traumatic stress disorder (PTSD) fifteen or more years after their military service. Current PTSD prevalence rates for Vietnam veterans are significantly and substantially higher than the rates for their comparable Vietnam generation peers, which range from 0.3% to 2.5%. Additionally, the current prevalence rate among male Vietnam veterans was found to differ significantly among race/ethnicity subgroups: 27.9% among Hispanic men, 20.6% among black men, 13.7% among white/other men. Multivariate analyses indicated that although background factors are significantly related to the current prevalence of PTSD, the current prevalence is much higher among Vietnam veterans than among era veteran and civilian counterpart comparison groups even after background differences are taken into account. These analyses also demonstrated the important role of exposure to combat and other types of war zone stress in the current prevalence of the disorder.

B. Kathleen Jordan

Papers

Trauma and the Vietnam war generation: Report of findings from the National Vietnam Veterans Readjustment Study.

Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11.

The prevalence of lifetime and partial post-traumatic stress disorder in vietnam theater veterans

The prevalence of post-traumatic stress disorder in the Vietnam generation : a multimethod, multisource assessment of psychiatric disorder

Assessment of posttraumatic stress disorder in the community: Prospects and pitfalls from recent studies of Vietnam veterans.