Posttraumatic stress disorder: an exploratory study examining rates of trauma and PTSD and its effect on client outcomes in community mental health

BACKGROUND: Rates of trauma and Posttraumatic Stress Disorder (PTSD) were examined in order to compare the profile in clients of an Australian Public Mental Health Service with that reported in the international literature for clients with major mental illness and to explore the effect of this on client health outcomes. Potential factors contributing to increased levels of trauma/PTSD in this group of clients and the issue of causality between PTSD and subsequent mental illness was also explored. METHODS: A convenience sample of 29 clients was screened for trauma and PTSD using the Posttraumatic Stress Diagnostic Scale™ (PDS) and selected outcome measures. Paired and independent samples t-test and ANOVA were applied to the data. RESULTS: High levels of undocumented trauma and PTSD were found. Twenty clients, (74%) reported exposure to multiple traumatic events; 33.3% (9) met DSM IV diagnostic criteria for PTSD. Significant difference was found for PTSD symptomatology, severity and impairment and for client and clinician-rated scores of Quality of Life (QOL) outcomes in the PTSD group. No effect for PTSD symptomatology on the Working Alliance (WA) was found. Factors that may influence higher rates of PTSD in this group were identified and included issues associated with the population studied, the predominance of assaultive violence found, and vulnerability and risks factors associated with re-traumatisation within the social and treating environments. CONCLUSION: A similar trauma and PTSD profile to that reported in the international literature, including greater levels of trauma and PTSD and a poorer QOL, was found in this small sample of clients. It is postulated that the increased levels of trauma/PTSD as reported for persons with major mental illness, including those found in the current study, are primarily related to the characteristics of the population that access public mainstream psychiatric services and that these factors have specific implications for service delivery, and raise issues of efficiency and effectiveness of resource use in achieving successful outcomes in public mental health services for clients with co-morbid PTSD. Further research with a more rigorous design is needed to test these preliminary findings within Australian Community Mental Health Services

September 11 and its impact on people around the globe

The type of "man-made disaster" represented by the September 11, 2001 attacks was different from any other that people in most parts of the world had experienced. In the absence of empirical data from which to assess the likely long-term impact of these attacks, trauma specialists from the world community were asked two questio tirety. Respondents indicated that their clients manifested traumatic stress reactions of varying degrees in the period immediately after the attacks, but that many clients appear to have since moved forward in therapy and begun to concentrate on recovery or on local issues

Posttraumatic stress disorder: an exploratory study examining rates of trauma and PTSD and its effect on client outcomes in community mental health.

BackgroundRates of trauma and Posttraumatic Stress Disorder (PTSD) were examined in order to compare the profile in clients of an Australian Public Mental Health Service with that reported in the international literature for clients with major mental illness and to explore the effect of this on client health outcomes. Potential factors contributing to increased levels of trauma/PTSD in this group of clients and the issue of causality between PTSD and subsequent mental illness was also explored.MethodsA convenience sample of 29 clients was screened for trauma and PTSD using the Posttraumatic Stress Diagnostic Scale (PDS) and selected outcome measures. Paired and independent samples t-test and ANOVA were applied to the data.ResultsHigh levels of undocumented trauma and PTSD were found. Twenty clients, (74%) reported exposure to multiple traumatic events; 33.3% (9) met DSM IV diagnostic criteria for PTSD. Significant difference was found for PTSD symptomatology, severity and impairment and for client and clinician-rated scores of Quality of Life (QOL) outcomes in the PTSD group. No effect for PTSD symptomatology on the Working Alliance (WA) was found. Factors that may influence higher rates of PTSD in this group were identified and included issues associated with the population studied, the predominance of assaultive violence found, and vulnerability and risks factors associated with re-traumatisation within the social and treating environments.ConclusionA similar trauma and PTSD profile to that reported in the international literature, including greater levels of trauma and PTSD and a poorer QOL, was found in this small sample of clients. It is postulated that the increased levels of trauma/PTSD as reported for persons with major mental illness, including those found in the current study, are primarily related to the characteristics of the population that access public mainstream psychiatric services and that these factors have specific implications for service delivery, and raise issues of efficiency and effectiveness of resource use in achieving successful outcomes in public mental health services for clients with co-morbid PTSD. Further research with a more rigorous design is needed to test these preliminary findings within Australian Community Mental Health Services

Australian Vietnam veterans: Factors contributing to psychosocial problems

Objective: The objective of the present paper is to present comprehensive models of the current psychosocial morbidity of Australian Vietnam veterans. Seldom has research in this area attempted to 'untangle' direct and indirect influences on current functioning via possible pre-army, Vietnam and homecoming pathways, Method: The Australian Vietnam Veterans' Health Study gathered data on a sample of 641 veterans throughout Australia drawn randomly from army Vietnam tour lists of the era. The data arose from interview and army records of the era, and fall into four temporal categories: pre-army, Vietnam service, homecoming after Vietnam, and current state. Path analysis models of the veterans' current psychological morbidities and social wellbeing are used to identify direct aetiological influences of earlier era constructs on current state, free of confounding by indirect (often selection) effects. Results: Our results indicate that psychological morbidity (particularly posttraumatic stress disorder) is largely influenced by combat and poor homecoming experiences, although pre-military characteristics do play some direct roles in symptomatology. Social dysfunction measures show smaller effects of the Vietnam War, which may be accounted for by an indirect association with Vietnam-related psychological morbidity. Some social measures show evidence of compensatory influences of combat, high combat leading to social dysfunction because of morbidity, but simultaneously being associated with healthier social disposition (possibly because of increased ex-service activity). Conclusions: For Australian Vietnam veterans, combat-related and homecoming effects persist on a range of psychosocial endpoints 20-30 years after exposure. These effects are not explicable in terms of veterans' pre-Vietnam characteristics

The Australian Vietnam Veterans Health Study: III. Psychological health of Australian vietnam veterans and its relationship to combat

Background. Self-reported psychiatric status of Australian Vietnam war veterans was determined 20-25 years after the war and its relation to combat was investigated. Method. A simple random sample of Australian Army Vietnam veterans was interviewed nationally using standardized interviews and self-completion tests to assess the prevalence of lifetime and current psychiatric illness and its relationship to combat. Army records were used to extract data on the cohort for use in regression-based adjustment for non-response. Results. The conditions mainly affecting the Australian veterans were alcohol abuse or dependence, post-traumatic stress disorder, somatoform pain disorder and social and simple phobias. This profile is different from American studies of Vietnam veterans. All lifetime and 6-month recent disorders except depressive illness, melancholia, pathological gambling and somatization disorder were significantly related to combat exposure but not with posting to a combat unit. Less than half of the current one-month diagnoses were related to combat, possibly because of low power conferred by the relative rarity of these conditions. Conclusions. The results confirm a range of psychological problems in former warriors may linger 20 or more years from their war exposure and may be directly affected by exposure to war trauma

The Australian Vietnam Veterans Health Study: II. Self-reported health of veterans compared with the Australian population

Background. Self-reported physical health status of Australian Vietnam veterans was determined 20-25 years after the war and its relation to combat was investigated. Method. An epidemiological cohort study of a simple random sample of Army veterans posted to Vietnam between 1964 and 1972 was conducted with personal interviews using the Australian Bureau of Statistics Health Interview Survey questionnaire to compare veterans with the Australian population and a 21-item combat exposure index used to measure the relationship of combat to physical health. Results. Veterans reported greater health service usage and more recent health actions than population expectations. They also reported excess health problems in almost all recent illness disease categories except endocrine conditions and cardiovascular conditions; only 6 of 37 chronic disease groups were not elevated compared to the population. Adjustment for non-response changed estimates only slightly. Combat exposure was significantly related to reports of recent and chronic mental disorders, recent hernia and chronic ulcer, recent eczema and chronic rash, deafness, chronic infective and parasitic disease, chronic back disorders and symptoms, signs and ill-defined conditions. Conclusion. Combat exposure may have significantly increased reports of only some health problems. A general disposition to complain as a result of psychological conditions due to combat is not consistent with the lack of relationship between combat and reports of physical conditions

The Australian Vietnam Veterans Health Study: I. Study design and response bias

Background. The Australian Vietnam Veterans Health Study was set up to examine the post-war health of former soldiers 20 or more years after service and to examine the relation of combat exposure to physical and mental health. Method. A prospective cohort study of a simple random sample of 1000 male Australian Army Vietnam veterans used information gathered from Army records, from personal interview and questionnaires. Military records were used to examine response bias by determining the differences between 641 interviewed veterans, 50 known deceased veterans and 309 non-respondents (including 48 refusers and 213 non-traceable). Results. Differences were evident between respondents and non-respondents, with logistic regression modelling pointing to pre-enlistment employment, antisocial behaviour, intelligence and post-Vietnam AWOL (absent without leave) as the most important discriminants, with non-respondents performing worse. Compared to respondents, deceased left school earlier, had higher rank in Vietnam and at discharge, had a higher overall number of charges but not a higher rate overall, and were less likely to have gone AWOL. Deceased also received more casualty reports than respondents and non-respondents, were better behaved during service, and were better emotionally adjusted than non-respondents. Respondents compared with the Australian population had equivalent or better current socioeconomic status. Conclusion. There seems little bias due to non-response, but deceased tend to come from an older cohort than the other two groups