Trauma exposure, resilience, social support, and PTSD construct validity among former prisoners of war.

BACKGROUND: The aim of this study was to investigate predictors of persistent symptoms of posttraumatic stress disorder (PTSD) and to examine the construct validity of PTSD in a national sample of 270 World War II and Korean Conflict prisoners of war (POWs). METHOD: POWs were interviewed at two points in time (1965 and 1990). Predictors included PTSD symptomatology measured in 1965 by items from the Cornell Medical Index (CMI), severity of captivity trauma, resilience factors, and post-trauma social support. The criterion, symptomatology in the early 1990s, was evaluated with the PTSD module of the Structured Clinical Interview for DSM (SCID). RESULTS: The CMI provided only partial coverage of PTSD criteria and appeared to provide only a general index of distress. Clustering of SCID items in two-dimensional space via multidimensional scaling analysis offers some construct validation for the DSM's differentiation of PTSD symptoms into criterion groups, although there was not a perfect match. Trauma severity is best related to PTSD symptomatology experienced in 1990, mitigated in part by greater education level and age at the time of trauma exposure. Surprisingly, 1965 distress added only a modest amount to the prediction of current distress, while post-trauma social support added none. CONCLUSIONS: These findings support previous work showing the severe psychological sequelae of POW status 40-50 years after captivity, and indicate that trauma severity during captivity is the best predictor of current PTSD symptomatology. Results also add to our understanding of the conceptual differentiation of PTSD symptoms into separate and distinct symptom clusters.

Sleep in a community sample of elderly war veterans with and without posttraumatic stress disorder.

BACKGROUND: Although sleep disturbances are commonly reported by individuals with posttraumatic stress disorder (PTSD), objective findings have been inconsistent, due in part to small sample sizes, comorbid psychiatric disorders, variations in the recentness of trauma exposure, and the use of PTSD subjects involved in psychiatric treatment. METHODS: A community sample of elderly males (n = 59) exposed to war trauma 28-50 years ago and free from sleep-affecting medications and disorders other than PTSD completed 3 nights of polysomnography. Of these participants, 30 met criteria for current PTSD; three were receiving supportive outpatient psychotherapy. RESULTS: Two statistically significant differences were observed: Those with PTSD had a higher percentage of rapid eye movement (REM) sleep and fewer arousals from non-REM sleep. The perceptions of sleep quality among the participants with PTSD were lower than the perceptions of non-PTSD participants. Although participants with untreated obstructive sleep apnea and sleep movement disorders were not included in the sample, many cases were detected on initial screening. Treatment resulted in improved sleep and increased feelings of well being. CONCLUSIONS: Alterations in REM and arousals characterized PTSD in this sample. When comorbid sleep disorders were ruled out, sleep was clinically similar across the groups. Trauma-related sleep disturbances that subjects reported as arising early in the course of the disorder appear to have declined over time.

Polysomnographic sleep is not clinically impaired in Vietnam combat veterans with chronic posttraumatic stress disorder.

BACKGROUND: Because sleep is typically disturbed in posttraumatic stress disorder (PTSD), this study was undertaken to evaluate a group of Vietnam combat veterans with the disorder using clinical polysomnographic techniques. METHODS: Eighteen Vietnam combat veterans with PTSD and 10 healthy non-combat-exposed Vietnam era veterans participated in 2 nights of polysomnographic study and a multiple sleep latency test. RESULTS: No significant differences between subjects and controls were noted except for greater sleep onset latency to stage 2 (p < .03), and lower arousals/hour from stages 3 & 4 (p < .04) on night 2, and lower subjectively estimated total sleep time on night 1 (p < .005) in the case of PTSD subjects. Otherwise, results from the second night served to replicate those from the first, and no significant differences appeared on 2 successive nights for any polysomnographic variable. No daytime hypersomnolence was detected. CONCLUSIONS: Polysomnographically recorded sleep was notably better than expected in the presence of clinically significant PTSD with typical histories of disrupted sleep. In these subjects, there is no clinically significant sleep disorder or typical pattern of sleep disturbance detectable by standard polysomnography.

Colon cancer: personality factors predictive of onset and stage of presentation.

This study examined premorbid personality correlates of colon cancer and stage of presentation of colon cancer to health care providers. Sixty-one male veterans who completed the MMPI between 1947 and 1975 and were then diagnosed with colon cancer between 1977 and 1988 were matched with control patients. A 21-factor solution of the MMPI [1] was used to seek potential personality differences between colon cancer cases and their controls in terms of presence of colon cancer and stage of presentation for this disease. A stepwise conditional regression analysis found significant differences between the colon cancer and control groups on the Aggressive Hostility variable (p < 0.018). A multivariate analysis of variance conducted across the stages of colon cancer presentation found that patients who presented later on for colon cancer had higher Phobia scores (p < 0.05). Religious Fundamentalism was also related to presentation (p < 0.05), but in a nonlinear manner. Discussion is related to previous findings regarding the relationship between personality and development of cancer, as well as to implications for patient screening.

Structural models of captivity trauma, resilience, and trauma response among former prisoners of war 20 to 40 years after release.

Long-term responses to captivity trauma were measured in a national sample of American former prisoners of war. Their responses included negative affect, positive affect, and somatic symptoms as assessed by the Cornell Medical Index in 1967 and the Center for Epidemiological Study Depression Scale in 1985. These responses were strongly associated with captivity trauma (as indexed by captivity weight loss, torture, and disease) and resilience (as indexed by age and education at capture). Symptoms reported in 1967 were related to symptoms reported in 1985, suggesting symptom stability. These results are consistent with a model of trauma response that incorporates both trauma exposure and individual resilience. The findings are interpreted within a theoretical view of trauma response as adaptive when viewed from an evolutionary perspective.

Prevalence and correlates of depressive symptoms among former prisoners of war.

Studies of former prisoners of war (POWs) provide valuable insights into posttraumatic adaptation because they gather information from a large population who survived the traumatic experiences of military captivity. Previous studies of POWs have shown elevated rates of psychiatric symptoms and disorders. This report presents evidence from a longitudinal study of three large, representative, national samples of former POWs. The study finds that depressive symptomatology, as measured by the Center for Epidemiologic Studies Depression Scale, is elevated in World War II POWs from the Pacific and European theaters and in Korean conflict POWs. Decades later, depressive symptomatology is found to be strongly associated with prior treatment in captivity. Differences in depressive symptomatology among the three POW groups can be attributed to captivity-related factors and to buffering factors, such as age at capture and education.

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.

Comorbidity of psychiatric disorders and personality profiles of American World War II prisoners of war.

To characterize the effects of trauma sustained more than 40 years ago, prevalence of psychiatric disorders and personality dimensions were examined in a sample of 62 former World War II POWs. The negative effects of their experiences are reflected in their multiple lifetime diagnoses and in their current personality profiles. Fifty percent met DSM-III posttraumatic stress disorder (PTSD) criteria within 1 year of release; 18 (29%) continued to meet the criteria 40 years later at examination (chronic PTSD). A lifetime diagnosis of generalized anxiety disorder was found for over half the entire sample; in 42% of those who never had PTSD, 38% of those with recovery from PTSD, and 94% of those with chronic PTSD. Ten percent of those without a PTSD diagnosis had experienced a depressive disorder, as had 23% of those with recovery from PTSD and 61% of the POWs with chronic PTSD. The combination of depressive and anxiety disorders also was frequent in the total sample (61%). Current MMPIs of three groups with psychiatric diagnosis were compared with those of POWs who had no diagnoses and with a group of Minnesota normal men. Profile elevations for the groups, from highest to lowest, were: POWs with chronic PTSD, POWs with recovery from PTSD, POWs with other psychiatric diagnoses, POWs with no disorders, and Minnesota normal men. Symptoms of anxiety, depression, and somatic concerns combined with the personality styles of suppression and denial characterize the current adjustment of negatively affected POWs.

Age, education, maltreatment, and social support as predictors of chronic depression in former prisoners of war.

This study examined the relationships of prisoner of war captivity trauma variables and individual protective variables to current depressive symptoms as indexed by the CES-D and its components. The sample consisted of 989 U.S. former POWs of World War II and the Korean War, who have been followed since the mid 1950s. Depressive symptoms persisted over 40 years later. Age, education, medical symptoms during captivity, and level of social support were related to later levels of adjustment. Theoretical and methodological implications of the findings were discussed.