Research on Veterans with PTSD

Research Summary Table: Veterans with PTSD

Post-traumatic stress disorder (PTSD) is an acute or chronic condition which a person experiences an incident that causes physical, emotional, or psychological harm. There are many incidents that can lead to PTSD such as sexual assault, car accident, natural disaster, physical abuse, and the most common is war zone deployment (Trakalo, 2015). The symptoms of this disorder vary from person to person. This paper will discuss PTSD in military Veterans, its prevalence and impact on society.

Coping

Coping is a concept consisting of individual cognition, perception, and behavior. Another simpler definition of coping is how a person responds to stressors. There are variable levels of stressors, they can be physical, psychological, or both that a person experience throughout the lifespan (Giddens, 2013). Poor coping skills can develop a lot of physical and mental health problems such as malnutrition, depression, anxiety disorder, and suicide attempt.  PTSD occurs on veterans returning home from deployment. One report documents 23% American soldiers who came back home from Iraq and Afghanistan, were diagnosed for PTSD. This rate is 16% higher than the national population (Smith et al., 2017). Symptoms of PTSD are nightmare, irritability, depressed mood, agitation, anxiety, social isolation and substance dependence (Trakalo, 2015).

Post-traumatic stress disorder

Military Veterans are high risk to develop PTSD because of a hazardous work environment and lack of family support. The disorder usually occurs after witnessing or experiencing a devastating event such as gunfire, loss of friends in the war, loss of extremities, bully and sexual assault. Prolonged PTSD without appropriate treatment can lead to suicide and harm others. Working in a combat zone is horrendous. According to the Department of Defense and the Department of Veterans Affairs, there are 22 veterans succumb to suicide each day (Finley et al., 2015). In other words, there is at least one in five Veterans committed suicide each day (Conard, Armstrong, Young, & Hogan, 2015). The treatments for PTSD are pharmacological, non-pharmacological therapy, or a combination of both. The pharmacological therapy includes benzodiazepines, antidepressants, antipsychotic which can cause some adverse effects such as sleep disturbance, confusion, memory impairment, and substance abuse. Non-pharmacological treatments include counseling, meditation, art therapy, music therapy, acupuncture, physical activity, and the most important is social support (Trakalo, 2015). The support from family and society play a key role in improving an individual with PTSD, which helps them get back on their feet as they were before deployment.

Prevalence and Impact on Society

As reported by Veteran's Health Administration Office of Public Health, there were over 2.7 million military members who served during Afghanistan and Iraq, have been diagnosed for PTSD- War-related events (Ciarleglio et al., 2018). In society, there are many different levels of stressful events that everyone has to face every day. For these Veterans, it is more than that. They have to face unwanted memories, trauma events that happened during deployment. Those flashbacks are easily triggered by daily events such as the smell of fuel,  the sound of shooting on TV, or images of blood. If Veterans do not find appreciate treatments, their mental condition could get more complicated, leading to serious harm to society. They could hurt or kill other innocent people such as shooting gun massacres, public bombing. Social support reduces the negative effects of deployment experiences by assisting Veterans with coping skills, increase their sense of communication and motivation (Johnson, 2018). Social support is considered as many occurring resources, such as family members, coworkers, friends, organizations who provide material, psychological during stressful events (Lincoln, 2000). Social support can help Veterans return, adapt normally to civilian life, as well as continue contributing to society.

What is the Problem?

The problem is suicide and depression associated with PTSD Veterans.  Veterans that experienced war-zone related PTSD commonly experienced major depression, alcohol abuse, and non-alcohol substance abuse. According to a study conducted by Ciarleglio et al. (2018), 36.7% of veterans experienced depression, 2.2% experienced alcohol abuse, and 1.9% experienced non-alcohol substance abuse. Compared to those in the general population, the incidents of suicide have been much lower than service members. However, following Operation Enduring Freedom and Operation Iraqi Freedom, suicide rates have been steadily on the rise amongst the younger generation veteran and active duty service member populations (Finley et al., 2015). The purpose of this paper is to clarify the effectiveness of social support for Veterans with PTSD.

The clinical question written in PICOT format is: In Veterans with PTSD, does social support reduce the risk of suicide and depression compared without social support? This

question will guide to measure the outcome and benefits of social support in treatment for Veterans with PTSD. Success in findings is indicated by reducing the rate of suicide, anxiety disorder, depression, or improving quality of living in Veterans.

Citation

• Ciarleglio, M. M., Aslan, M., Proctor, S. P., Concato, J., Ko, J., Kaiser, A. P., & Vasterling, J. J. (2018). Associations of Stress Exposures and Social Support with Long-Term Mental Health Outcomes Among U.S. Iraq War Veterans. Behavior Therapy, 49(5), 653667. https://doi.org/10.1016/j.beth.2018.01.002

Type: Quantitative

Design: Prospective study (longitudinal follow-up study)   Sample size of study included 375 people.

The population was service members and military veterans who deployed in Iraq approximately 7.5 years ago.

Data were collected from three different assessment during 20032014 as part of the Neuro-cognition Deployment Health Study and VA Cooperative Studies Program. Then, data is divided into three group before, during, after deployment. Finally, they compare with different outcomes such as PTSD, anxiety, substance abuse.     Strength: This study has a large number of participant and the duration of study was long enough to acquire valuable data.

Limitation:

Because of the long observation period, researchers were not able to assess the impact of relatively recent after deployment stressors compared with those occurring.

The research study showed a notable correlation between veteran social support and mental wellbeing. In fact, increased levels of social support following a deployment strongly correlated with lower occurrences of PTSD, depression, and anxiety.

• Conard, P. L., Armstrong, M. L., Young, C., & Hogan, L. M. (2015). Nursing Advocacy for Women Veterans and Suicide. Journal of Psychosocial Nursing & Mental Health Services, 53(3), 2430. https://doi.org/10.3928/02793695-20150220-01

Type: Quantitative

Design:

Description        Population of this study were women veteran who served from Vietnam, Gulf I, Iraq, and Afghanistan and are receiving treatment at civilian health facilities.

This article combined different research and statistic, thus there are various sample size.        Data were collected from Veterans Administration health facilities and National Center for Veterans Analysis and Statistics in 2011. They were also divided into different war frame.          Strength:

The authors collected variety of article, related to female suicide in healthcare and military. Thus, the sources consisted of multiple aspects such as culture, timeframe, situation. Limitation:

Participants may not be honest when they know they are being observed.

Author bias may affect the finding.

Nurses play an important role in deterring suicide cases. They serve as advocates, listeners, and influential defenders to veterans, especially women. Bridging the communication gap through screening efforts is vital for suicide prevention.

• Duax, J. M., Bohnert, K. M., M. Rauch, S. A., & Defever, A. M. (2014). Posttraumatic stress disorder symptoms, levels of social support, and emotional hiding in returning veterans. Journal of Rehabilitation Research & Development, 51(4), 571578. https://doi.org/10.1682/JRRD.2012.12.0234

Type:

Quantitative

Design:

Cross-azsectional study        The sample size consisted of 734 veterans. The population was OIF/OEF-war veterans who registered at Veterans Integrated Service Network 11, VA Ann Arbor Healthcare System (VAAAHS) during 2006-2009        Veterans were contacted by telephone or in person to complete a screening survey about how they felt about life after deployment. The questionnaire was administered by Serving Returning Veterans Mental Health Program and included questions pertaining to demographics, perceived levels of social support, work and social adjustment, mental health and medical problems, and treatment utilization.

Strength:

The study had a large number of participants. There were also large amounts of data that was collected by government sources.

Limitation:

Findings may not reliable because Study did not include additional assessment sources that could affect the outcome

Soldiers that display difficulties expressing their feelings with their immediate social groups are at a higher risk of acquiring PTSD or PTSD symptoms. Research has attested that 32% to 44% of soldiers that conceal or mask their emotions are at-risk for PTSD or PTSD symptoms.

• Finley, E. P., Bollinger, M., No?«l, P. H., Amuan, M. E., Copeland, L. A., Pugh, J. A., Dassori, A., Palmer, R., Bryan, C., Pugh, M. J. V. (2015). A National Cohort Study of the Association Between the Polytrauma Clinical Triad and Suicide-Related Behavior Among US Veterans Who Served in Iraq and Afghanistan. American Journal of Public Health, 105(2), 380387. https://doi.org/10.2105/AJPH.2014.301957

Type:

Quantitative

Design:

Retrospective cohort study        The sample size included 211652 members.

The population was OEF/OIF-war veterans getting care at VA hospital in 2009-2011        Using date from the Department of Veterans Affair for inpatient and outpatient to identify the outcomes suicide ideation and attempt suicide during each of three years of the study Then data were divided into 4 categories: neither ideation nor attempt, ideation only, attempt only, and both ideation and attempt.

Strength:

The study had a large number of participants. There were also large amounts of data that was collected by government sources.

Limitation:

There were veterans got care at the VA but not enrolled in the system. The provider may not enter the correct coding of SRB. The VA data do not report on completed suicides        Despite of the moderate SRB form Polytrauma clinical trial, there was still a huge increased risk of depression, PTSD and substance addiction. Suicide ideation was also tremendously elevated when PTSD was associated with depression, or substance addiction.

• Griffith, J. (2015). Cross (Unit)-Level Effects of Cohesion on Relationships of Suicide Thoughts to Combat Exposure, Postdeployment Stressors, and Postdeployment Social Support. Behavioral Medicine, 41(3), 98106. https://doi.org/10.1080/08964289.2014.987719

Type: Quantitative

Design:

Case-control study        The sample size consisted of 4567 people.

The population was service members of 50 companies who had been deployed and showed sign of stressor associated with suicidal ideation.           Service members were requested to complete survey R-URI after coming back from deployment.  The survey consisted of 80 questions relating to deployment experience of coping stress, and behavioral health.        Strength:

Participants did not have to fill out their name, age, rank, unit in the form to remain anonymous. The questions in survey were specific about incident occurs during deployment. Limitation:

Because the data were collected after deployment and some members had received care, so the result might not be accurate. Plus, there was a limit of social support in war zone compared with peace zone.          Common precursors of suicidal ideations are combat exposure and post-deployment stressors. Military units that exhibit higher levels of cohesion and unity tend to have a lower risk of suicidal ideations among their soldiers.

• Smith, B. N., Wang, J. M., Vaughn-Coaxum, R. A., Di Leone, B. A. L., & Vogt, D. (2017). The role of postdeployment social factors in linking deployment experiences and current posttraumatic stress disorder symptomatology among male and female veterans. Anxiety, Stress & Coping, 30(1), 3951. https://doi.org/10.1080/10615806.2016.1188201

Type:

Quantitative

Design:

retrospective comparative study (via questionnaire)        The sample size had 998 participants. The population was service members who returned home from Afghanistan or Iraq war. Then data were collected from 496 responders.        Based on Defense Data Center, the researchers sent out mail to veterans who returned from home. Attach to the mail was the survey and detail information about the purpose of study. It also mentioned all standards of protecting human subject. After research sent second time for those who did not participate in the first time and included gift card.        Strength:

There were a large group of participants in this study. The questions in survey were specific about incident occurs during deployment. Limitation:

Participants reported their PTSD without any proof from any Healthcare facility or credible providers. Plus, participant might not be honest because research know their information from Data source        Study showed there was a high risk of PTSD symptom in individual who received lower social support in both genders. Women and men had some different pathways. In women, sexual harassment is at a higher rate. Men received lower social support than women.        3

• Stana, A., Flynn, M. A., & Almeida, E. (2017). Battling the Stigma: Combat Veterans' Use of Social Support in an Online PTSD Forum. International Journal of Men's Health, 16(1), 2036. https://doi.org/10.3149/jmh.1601.20

Type:

Quantitative

Design:

The sample size had 466 posts of 63 people

The population was military members who deployed to war zone and were diagnosed for PTSD; and their spouses        Researcher conducted a study by opening an online forum. There were questions and posts relating to different support groups. Then data were collected according to participants responses.         Strength:

Participants were anonymous because of online forum. Thus, responses were more honest, and comfortable about their feeling.

Limitation:

There are many different aspects might affect veterans such as age, gender, different war zone. Plus, veterans might be diagnosed inaccuracy due to the limit of health care access and support. Research has shown that support groups are far more advantageous for mental wellbeing than emotional support. The support groups that yield the most effective and positive results for soldiers are informational (52.7%) and community (19.3%) systems.

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