Appendix EMPIRICAL RESEARCH CONCERNING STRESS … · Gender effect sig. for MISS & BDI. Sig. interac-tion effect for gender by deployment. F sig. higher scores on MISS. No sig. effect

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Appendix

EMPIRICAL RESEARCH CONCERNING STRESS AND BOTHPTSD AND OTHER (NON-PTSD) HEALTH PROBLEMS

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Table A.1

Empirical Research Concerning Stress and PTSD

Study Objectives Sample ControlTime of

AssessmentExposure

Assessment MethodologyOutcome

Assessment Relevant Findings

Adler et al.,1994

Examined theprevalence of PTSDsymptoms followingdeployment.Examined therelationship betweenrank and type oftrauma exposure andsubsequent PTSDsymptoms.

German-based U.S.Army combat unitsexposed to front linecombat. Threecategories based onexposure: 1=noexposure to dead orwounded; 2=exposed tocivilian or Iraqicasualties; and3=exposed to U.S., Iraqiand civilian casualties.

N=4199; No exposure(27%); civilian or Iraqicasualties (37%); U.S.casualties (35%) Nogender specified

No 9–10 monthspost-PGW

Exposure to deadand woundedenemies andallies; Unitrelated stressassessed byreports of stressrelated to peerand hierarchicalsupport.

Correlationalstudy examiningthe relationshipbetween rank,degree ofexposure, andPTSD symptoms.

IES; PTSDSymptomsMeasure(derived fromtheBSI/IES/DSM-III-R); ExposureMeasureassessing unit-related stress

Exposure corr. with IESscores; Those exposed toU.S. casualties hadhighest IES scores. Maineffect for rank, exposure,and current unit relatedstress for both intrusionand avoidance (IES).Higher rank associatedwith less severe PTSDsymptoms.

Baker et al.,

19921To evaluate clinicalneeds of PGW vets inan Ohio VA outreachprogram.

Personnel in 19 Reserveunits within the CentralMidwest; Branch notspecified.

N=325


Questionnaireassessing war-time stressors.

Correlationalstudy examiningthe relationship ofdemographic vari-ables, childhoodexperiences, andcombat exposureto subsequentpsychologicalsequelae.

IES; BSI; MISS(cut-off=107);CopingStrategiesInventory;Childhoodvariables:childhoodtrauma.

Sig. corr. between childand combat stressors andMISS scores. Ethnicityand child stressors werecorr. w/ BSI scores,combat stress. Blackshad higher BSI, IESscores; Childhood stressassociated with higherBSI, IES, MISS. No genderdifferences. 5.9% PTSD.

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Table A.1 (continued)


AssessmentExposure



Baker et al.,1997

Examined relationshipbetween combatexposure andsubsequent symptomsof PTSD.

N=188

50% were help-seekingand 50% were non-treatment-seekingPGW veterans on activeduty.

YesPTSD group(N=24)comparedwith groupwithoutPTSD

Unspecified,but perhapsup to 3 yearsfollowingPGW

CombatExposure Scale;self-report

Correlationalstudy andbetween-groupcomparison ofveterans with andwithout PTSD.

MISS(cut-off=116)

Degree of combatexposure was positivelyassociated with PTSDsymptom severity scores.

Brandt et al.,1997

Examined therelationship betweenphysical injury duringPGW and psychiatricsymptoms.

Service membersadmitted to ArmyMedical Center from thePGW/68% traumaticinjury; 3 categoriescreated based onpresence of psychiatricsymptoms: a) fullpsychiatric diagnosis(disorder); b) symptomsof a psychiatric disorder;c) no psychiatricdisorder or symptoms.

M=139F=22

Yes51 of 161who exper-ienced non-traumaproce-dures

During PGW Admitted toMedical Centerfor traumaticincident duringPGW. (68%traumatic injury,no definitionspecified)

Correlationalstudy examiningthe relationshipbetween physicalinjury andpsychiatricsymptoms.

Medicalrecords used toestablish chartdiagnosis andpsychiatricsymptoms.

36% had psychiatricsymptoms; 21% had Axis Idisorder; 5% adjustmentdisorder; 4% PTSD;Patients who experiencedgreater traumaticexposure were more likelyto have psychiatricsymptoms.

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Deahl et al.,1994

Examined the effectsof psychologicaldebriefing following atrauma (PGW) onsubsequent morbidity.

British soldiers servingin Army War GraveService in the PGW.

N=42 trauma subjects

YesN=20

9 monthspost-PGW

Recovering andidentifying deadbodies of alliesand enemies

Between-groupstudy comparingdebriefed andnon-debriefedsubjects onmorbidity 9months followingreturn from PGW.

IES; GHQ 50% reported debriefingas helpful. No differencebetween debriefed andnondebriefed on GHQ orIES scores; Difference in“caseness” (GHQ>5,IES>12), and change inclose relationships.Positive corr. between“caseness” andperception of life threat.

Engel et al.,1993

Examined therelationship betweenprecombatsexual/physical abuseand postcombat PTSDsymptoms.

U.S. Army's First CavalryDivision; Active duty.

M=269F=28


Precombatexposure asassessed byinterview; CES

Correlationalstudy examiningrelationshipbetweenprecombat abuseand post-combatPTSD symptoms.

MISS-ODS;CES; DISInterview

M reported sig. morecombat exposure and Freported sig. moreprecombat abuse. F, butnot M, with precombatabuse reported sig.greater PTSD symptomsthan those with lessprecombat abuse. Freported sig. higherMISS-ODS scores. Sig.corr. between CES andMISS-ODS.

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Ford et al.,

19921Compared debriefedversus nondebriefedPGW vets onpsychologicalsequelae followingPGW.

Eight Reserve units andNational Guard unitsreturning from ODS toV.A. services in Oregon.Branch not reported.

N=55No gender specified.


Interviewassessing war-time stressors.Variablesincluded: familyseparation, directexposure,indirectexposure, andemotional stress.

Correlationalstudy examiningvets on post-PGWphysical andpsychologicalsymptoms.Examined changein symptoms afterdebriefing.

IES; GHQ;MaritalSatisfactionGlobal Rating

75% of entire groupreported post-PGW stressand personal and familyadjustment difficulties.Post-debriefing reportedsig. decrease in PTSDsymptoms, anxiety,depression, and socialdysfunction and a sig.increase in familyfunctioning.

Haley & Kurt,1997

Examined thepsychological andphysical symptomsreported by vetsfollowing the PGW.

Members of the 24thReserve Naval MobileConstruction Battalion.58% retired fromservice; 42% still active.

N=249

No 3 yrs/7months post-PGW

Bookletmeasuring war-time exposure

Descriptive studyexamining theprevalence ofhealth problemsin PGW vets.Factor analyzedreportedsymptoms.

Standard sur-vey measuringsymptoms, wartime exposure,andpsychologicaldistress (scalesincludedAnxiety, PTSD,somaticSymptoms,Health con-cerns).

70% reported serioushealth problemsattributed to war; sixmedical syndromessurfaced explaining 70%of variance. Traumaticstress subscale was notelevated in any group ofvets with the reportedmedical syndromes.

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Iowa PersianGulf StudyGroup, 1997

Compared deployedand nondeployed vetsself-report of symp-toms and illness 5 yrsfollowing PGW.

Stratified sample drawnfrom 4 study groups(PGW regular military,National Guard/Reserve, non-PGWregular military, andnon-PGW NationalGuard/reserve). Samplestratified for age, race,sex, rank, and branch.

N=3695M=91%White=91%Age < 25=91%

YesN=1799

5 yrs post-PGW

Military ExposureQuestionnaire;deployment asproxy

Between-groupstudy comparingdeployed versusnondeployed mili-tary personnel onpost-PGWpsychologicalsymptoms. Notdeployed to PGWas a control group.Stratified randomsample withproportionalallocations.

PCL-MIL (cut-off 50); BSI;PRIME-MD;CAGE

PGW military personnelsig. more PTSD, depres-sion, chronic fatigue,cognitive dysfunction,bronchitis, asthma, fi-bromyalgia, alcoholabuse, sex discomfortthan nondeployed PGWmilitary personnel.National Guard/reservereported more chronicfatigue and general healthproblems than regularmilitary.

McCarroll et al.,

1993a2Examined and com-pared the prevalenceof PTSD symptoms inPGW vets who han-dled human remainsversus PGW vets whodid not.

116 vets who handledremains were from Armymortuary Affairs Co.The 118 vets who didnot handle remainswere from army unitshandling logistic func-tions. No branch speci-fied.

N=234Males=84%

YesM=110 F=8

3–5 monthspost-return toU.S.

Recovering andidentifying deadallies and ene-mies.

Between groupstudy examiningand psychologicalsymptoms in PGWvets who handledremains and PGWvets who did nothandle remains.

IES; SCL-90-R Subjects who handledhuman remains reportedsig. more intrusive andavoidance symptoms.Inexperienced workersreported sig. more symp-toms than experiencedworkers. Positive corr.between number of re-mains handled and PTSDsymptoms.

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McCarroll et al.,

1995a2Examined the rela-tionship betweenhandling human re-mains on subsequentPTSD symptoms.

55 vets who handledremains were from ArmyMortuary Affairs Co.The 56 vets who did nothandle remains werefrom army units han-dling logistic functions.No branch specified.

N=55Male=84%

YesM=52 F=4

13–15 monthspost-returnfrom PGW(follow-up)

Recovering andidentifying deadallies and ene-mies.

Between groupdesign comparingPGV who handledremains with PGVwho did not han-dle remains on thepsychologicalsymptoms post-PGW.

IES; SCL-90-R Sig. differences betweengroups on IES scores at13–15 months; Sig. de-crease in IES scores at 13–15 mo. Sig. higher IESscores for PGW vets whohandled remains. Sig.pos. corr. between ageand intrusion symptomsfor exposure group.

Perconte et al.,1993a

Examined stress levelin survivors of a mis-sile attack before andafter treatment inter-vention. Comparedstress levels with agroup of survivors whodid not receive treat-ment intervention.

PG quartermaster unithit by missile.

N=25Reserve troopsMale=84%

YesN=8

During PGW(2 monthspost-missileattack 4/91)

Missile attack (onsite; guard duty;nondeployed)

Pretest andposttest between-group designcomparing PGWvets receiving de-briefing with PGWvets not receivingdebriefing in aunit-based pro-gram.

MISS (cut-off107); BDI;SCL-90-R

On-site group sig. higherMISS and SCL-90-Rscores; F sig. higher BDI,MISS, SCL-90-R GSI atpre-Treatment than M.Sig. reduction in symp-toms post-Treatment. Nochange in symptoms fornondeployed post-Treatment.

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Perconte et al.,1993b

Examined war-relatedpsychological distressamong PGW vets fol-lowing PGW.

Community sample ofArmy, Navy, and MarineReservists. 126 activatedbut not deployed; 26deployed to Europe; 439deployed to Persian Gulfcombat theater.

N=581Male=88%White=91%

YesN=152

11 monthspost-PGW

Deployed versusnot deployed.

Between-groupdesign comparingdeployed PGWvets with nonde-ployed PGW vetson psychologicalsymptoms follow-ing trauma expo-sure. Examinedvariables of gen-der, race, andprior combat ex-posure.

MISS (cut-off107); BDI; SCL-90-R; MilitaryHistoryQuestionnaire

Sig. effect of deployment.No sig. effect of race; Sig.interaction effect of raceby deployment for MISS.Gender effect sig. forMISS & BDI. Sig. interac-tion effect for gender bydeployment. F sig. higherscores on MISS. No sig.effect of prior combat.

Sloan et al.,

1995a2Examined the effec-tiveness of theRorschach in detect-ing acute PTSD symp-toms in PGW vets.

Volunteer Marine re-servists all identified ashaving PTSD symptomsduring a general post-war debriefing. Troopsprovided security andprotected Iraqi prison-ers. No vets had priorpsychiatric history.

N=30All male

No 3–5.5 monthspost-war

No direct com-bat; Some reportseeing dead andwounded people.

Correlationalstudy examiningthe relationshipbetweenRorschach andMMPI-2 scalesmeasures of PTSD.

MMPI-2(various scales);Rorschach

Neg. corr. between PTSD(MMPI-2) & RorschachPTSD symptoms and in-dices of coping ability,personal resources, andpsych adjustment.

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Sloan et al.,

1995b2Examined the effec-tiveness of the MISS-ODS in assessing war-related PTSD symp-toms in noncombatPGW vets.

Same as Above No 3–5.5 monthspost-war


Correlationalstudy examiningthe relationshipbetween MISS-ODS scores forPTSD and DSM-III-R criteria forPTSD.

MMPI-2(various scales);MISS-ODS(cut-off 89)

Of the 17 DSM-III-R PTSDsymptoms vets reportedan avg of 3.33 symptoms.4 PTSD pos. according toDSM. 3 of these 4 metMISS-ODS cut-off forPTSD. Pos. corr. betweenMISS-ODS and PTSDsymptoms.

Sloan et al.,

19962Examined the effec-tiveness of MMPI-2scales, and the IES indetecting PTSDsymptoms in non-combat PGW vets.

Same as Above

N=66All male

No 3–5.5 monthspost-war


Correlationalstudy examiningthe relationshipbetween MMPI-2scale elevationand elevation onIES.

MMPI-2(various scales);IES; WSI-ODS(War StressInterview-ODS)

71% experienced 1 ormore symptoms of acutePTSD for at least 1 mo.post-PGW. MMPI-2 scalescores and IES scoreswere sig. corr. with PTSDsymptoms.

Sohler et al.,

19921Interim report of on-going study examiningthe psychological se-quelae on PGW vetsfollowing the PGW.Examined variables ofgender, deployment,and pre-PGW combatexposure.

National Guard/Reserveunits in North CentralFlorida. Branch notspecified.

M=397F=110

Yes 6 monthspost-PGW

Deployed versusnondeployed;CES.

Between-groupdesign comparingPGW vets de-ployed and notdeployed on psy-chological seque-lae post-PGW.Gender, unit, andcombat exposurewere also as-sessed.

IES; Prior warexperience;SCL-90-R (GSIscores)

Deployed had higher IESscores than non-de-ployed; F higher IESscores; Sig. interactioneffect for gender by de-ployment (i.e. higher IESscores for deployed Fthan M); Experienced vetsreported sig. fewerintrusive thoughts; Freported highersymptoms. CES sig. corr.with IES.

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Southwick et

al., 19932Examined the devel-opment of traumasymptoms over timein two reserve units.

New England NationalGuards randomly se-lected from medical unitand military police unit.

M=65F=19

No TwoAssessments:Time 1=1month post-PGW;Time 2=6months post-PGW

CES Longitudinalstudy examiningsymptom severityover time in tworeserve units.Examined effectsof gender and unitstatus.

MISS (cut-off89); 17-itemPTSDSymptomsScale; DSTQ(Desert StormTrauma Quest.)

MISS=3 PTSD pos. at 1mo/4 PTSD pos. at 6 mo.;PTSD Scale criteria= 8PTSD pos. at 1 mo/7 at 6mo. Pos. corr. betweenscores on MISS, CES, &DSTQ. No unit or genderdifferences. Increase inMISS but not PTSD scalesymptoms over time.

Southwick et

al., 19952Same as Above Same as Above

M=49F=13

No 2 year follow-up (2 yr/1month post-PGW)

CES Longitudinalstudy examiningsymptom severityover time in tworeserve units.Examined genderand unit effects.Compared medi-cal and policeunits.

MISS (cut-off89); 17-itemPTSDSymptomsScale (DSM-III-R); DSTQ(Desert StormTrauma Quest.)

At 2 yrs MISS=6 PTSDpos/DSM=8 PTSD pos.Medical unit had highersymptoms. Hyperarousalhigher at all 3 time points.Increase in intrusivememories and reactivitybetween 1 mo. and 2 yrs.Decrease in irritabilitybetween 6 mo. and 2 yrs.No gender differences.CES sig. corr. with PTSDsymptoms.

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Stretch et al.,1996(also Marloweet al., 1994)

Examined the preva-lence of PTSD symp-toms in active and re-serve deployed PGWvets and active and re-serve nondeployedPGW vets followingPGW.

Active duty and re-servists from PA andHawaii who were as-signed to Army, Navy,Air Force & Marines.Subjects were eitherdeployed (1524; active715; reserve 766) or notdeployed (2512; active1576; reserve 948) toODS.

Gender not specified.

YesN=2512

Mail survey; 2years post-PGW

Deployed versusnondeployed.Self-report ofstressors.

Between-groupdesign examiningprevalence ratesof PTSD symp-toms in activeversus reservists,and deployedversus nonde-ployed to PGW.

IES; BSI; 17-item PTSD al-gorithm de-rived from IESand BSI

Active duty=57 deployedsubjects PTSD pos. (8%)/21 of nondeployed PTSDpos. (1.3%); Reservists=70deployed PTSD pos.(9.2%)/20 nondeployedPTSD pos. (2.1%). Sig.corr. between stressorsand PTSD symptoms.

Sutker et al.,1993

Examined the rela-tionship between warstress and physicaland psychologicalsymptoms followingPGW in activated de-ployed and nonde-ployed troops.

Army National Guardand Army Reserve.Troops were distributedacross air reserve, medi-cal, and infantry supportspecialist, air ambu-lance, tactical fighters,maintenance, and quar-termaster.

N=215M=82%F=18%

YesN=60

4–10 monthspost-ODS

ODS-SES(divided groupsinto high and lowexposure).

Between-groupdesign comparingdeployed (highand low exposure)with nondeployed(no exposure) onvariables of post-ODS psychologicalsequelae.Compared PTSDpos. with PTSDneg. on personalcharacteristics.

BDI; STAI:ODS-SES; HSC;MISS (cut-off97); PCL-MIL(PTSD check-list-militaryversion)

High exposure group re-ported sig. higher MISS,PTSD Scale, BDI , anxietyand anger scores than didlow and no exposuregroups. High-exposedgroup sig. more difficul-ties sleeping, concentrat-ing, nervousness. Genderand race sig. corr. withPTSD.

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Sutker et al.,1994a

Examined the psycho-logical, physical, andpsychiatric disordersin Army reservists whoserved war-zone graveregistry duty in sup-port of ODS.

Army reservists of the35th Member ArmyReserve Quartermaster.

M=21F=3

No 8 monthspost-returnfrom PGW

ODS-SES; Open-ended assess-ment of most se-vere trauma ex-perienced atODS.

Descriptive studyexamining theprevalence of psy-chological, psy-chiatric, physicalsymptoms in armytroops who dealtwith remains 8months after re-turn from war.

Questionnaireassessing phys-ical, psycholog-ical, psychiatricvariables; BDI;SCID; PhysicalSymptomsChecklist;Anxiety-State;State-Anger(STAS). PTSDdiagnosis basedon DSM-III-R(SCID).

46% PTSD pos.; 91% ofPTSD pos. were clinicallydepressed (BDI>10), 85%of nonPTSD were notclinically depressed. AllPTSD pos. had elevatedphysical symptoms; 77%of nonPTSD had minimalconcern about physicalsymptoms.

Sutker et al.,1994b

Examined and com-pared psychologicaland physical symp-toms post-PGW inPGW vets who weredeployed to gravesregistry with PGW vetswho remained state-side.

Army Reservists as-signed to 3 quartermas-ter co. that providedsupplies and logisticsupport; 40 were de-ployed to graves registry.

N=60Female=8%Hispanic=98%

YesN=20M=95%

12 monthspost-ODS

Graves RegistryDuty Scale; de-ployed versusnondeployed.

Between-groupdesign comparingPGW vets de-ployed to gravesregistry with PGWvets remainingstateside on post-PGW psychologi-cal sequelae.

BDI; STAS;STAI; SCID;PhysicalSymptomsChecklist;Graves RegistryDuty Scale;MISS-ODS(cutoff 97).

Exposure group reportedmore current and lifetimepsychiatric disorder thannonexposure group.Exposure group greaterPTSD symptoms, higherBDI, STAS, STAI, & physi-cal symptoms checklistscores. 53% of PTSD caseshad concurrent psycho-logical disorder.

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Sutker et al.,

1995a2Examined and com-pared the prevalenceof psychological symp-toms among militaryparticipants in war-zone exposed andstateside duty.Examined gender andethnicity between ex-posed and nonex-posed.

PG war-zone exposed(n=653) and statesideduty troops (n=259).Included Army, AirForce, Marine, NationalGuard, and reserve unitswho underwentpsychological debriefingpost-PGW.

N=912Female=13%White=63%

YesN=259M=83%F=17%

within 12months post-PGW

ODS-SES Between-groupstudy comparingwar-zone exposedand stateside dutyon psychologicalsymptoms post-PGW. Examinedgender and eth-nicity.

BDI; STAI;STAS; BSI;HSC; MISS-ODS (cut-off97)

Sig. more depression,anxiety, and somaticcomplaints for deployed;Minority sig. more symp-toms of depression; F sig.more somatic com-plaints. No main effect forgender and PTSD;Interaction effect genderby ethnicity for PTSD. 10–12% deployed PTSD pos.

Sutker et al.,

1995b2Examined and com-pared PTSD pos. andPTSD neg. subjects onthe availability of per-sonal and environ-mental resources.

Troops assigned toMarine, Air Force, Navy,Army Reserve, andNational Guard unitsdeployed to combat inPGW. Sample derivedfrom 1432 troops de-ployed as part of ODSwho underwent psycho-logical debriefing within1 year of return.

N=484M=88%F=12%

YesN=97M=87%F=13%

within 12months ofreturn fromPGW

ODS-SES Correlationalstudy examiningPTSD pos. vetswith PTSD neg.vets on personaland environ-mental resourcesavailable.

BDI; SCL-90-R;MISS-ODS(cut-off 97); SSQR;WOC

PTSD pos. vets reportedsig. less satisfaction w/social support, less familycohesion andexpressiveness, moreavoidant coping, self-blame, and wishfulthinking than PTSD neg.vets. No gender infospecified.

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Unger et al.,

19921Examined and com-pared PGW vets withNational Guard vetswho remained in U.S.on post-PGWpsychologicalsymptoms.

PGW vets followingreturn to Rhode Islandfrom deployment toPersian Gulf andNational GuardServicemen (NGS) whoremained in U.S.

N=85

YesN=51

Upon returnto RhodeIsland fromPersian Gulf;time notspecified

CES; deploymentas proxy

Between-groupdesign comparingdeployed andnondeployed re-serve personnelon post-PGW psy-chological seque-lae.

CES; SCL-90;MISS-ODS(cut-off 89).

Differences between NGSand PGW vets on CES,MISS, SCL-90-R (7 of 9scales). Of the PGW vets,50% under enemy fire sawsomeone killed; 75% feltin danger of being killed.Of PGW vets, 50%moderate-severeintrusive thoughts andavoidance and 35%nightmares.

Wolfe et al.,

19932Examined the rela-tionship between gen-der and psychologicaloutcome following ex-posure to war-zonestress.

PGW vets

N=2344Female=8%White=84%Mean age=30

No 5 days follow-ing returnfrom PGW

Survey(traditionalwartime activi-ties; nontradi-tional wartimeactivities; non-war-zone de-ployment experi-ences); Laufercombat and ODSexposure scales;self-generatedcategories.

Correlational de-sign examiningthe relationshipbetween exposure,gender, demo-graphics and sub-sequent psycho-logical symptomspost-PGW.

Ft. Devens ODSReunion Survey(exposure;psych. andphysical symp-toms); MISS(cut-off 89);BSI; Demo;DSM criteria.

F 9%, M 4% PTSD(MISS>89); F reportedhigher MISS, GSI PTSDcheck list. No gender dif-ferences for exposure.Gender, demo. (educ,marital status), Laufer ex-posure scores, ODS factorscores explain 12–17% ofvariance on (BSI, GSI,PTSD, MISS) outcomemeasures.

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Wolfe et al.,

19962Examined vets re-sponse to deploymentduring ODS.

PGW vets.

Time 1:M=2136F=208Time 2:M=1687F=162

No TwoAssessments:Time 1=within 5 daysof return;Time 2=18–20 monthspost-deployment.

Same as above Longitudinalstudy examiningthe prevalence ofPTSD symptomsover time in PGWvets.

Same as above No gender differences forexposure; F. higher MISS;30% in clinical sig. rangeon BSI. Increase in reportof exposure and PTSDsymptoms from Time 1 toTime 2. Exposure, gender,avoidance, social sup-port, & family cohesionexplain 15% of variance inPTSD symptoms.

1In Rosenheck, Robert, et al., Returning Persian Gulf Troops: First Year Findings, West Haven, Connecticut: Department of Veterans Affairs, March 31, 1992.2Data presented on the same sample.

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Table A.2

Empirical Research Concerning Stress and Other (Non-PTSD) Health Problems


AssessmentExposure



Baker et al.,1

1992VA Report,Chap 7

To evaluate clinicalneeds of PGW vets inan Ohio VA outreachprogram.

Convenience sample;N=325; Reserve andGuard troops;All services:

male=74%white=87%response rate=66%


Self-reportsurvey ofmilitary andPGWexperiences.

Cross-sectionalsurvey;Needsassessment.

IES;BSI;MISS

Combat-exposed troopsexperienced higherlevels of distress on BSI,MISS and intrusionsubscale of IES.

Brandt et al.,1997

To examinepsychiatric problemsof PGW surgicalpatients evacuatedfrom theater forcombat andnoncombat-relatedproblems.

N=161;All services:

male=88%white=66%

YesN=51 of 161whoexperiencednontrauma-relatedprocedures.

During andafter PGW

Admitted tomedical centerfor traumaticincident duringPGW.

Medical recordsused to establishdiagnosis.

Frequency ofAxis IPsychiatricDisorders

Trauma associatedw/greater likelihood ofAxis I disorder.

Ford et al.,1

1992VA Report,Chap 10

Evaluation ofpsychosocialdebriefing programfor PGW vets andfamilies.

N=55 help-seekers;Guard and Reservists:

male=70%age=23–55N=40 PGW vets,others deployedelsewhere.


War StressInterview;Self-report.

Cross-sectionalsurvey;Self-reportbefore and afterdebriefing.

IES;GHQ;Maritalsatisfactionand familyrelations.

Symptoms appear toabate after debriefing;No differences in GHQor IES between troopsdeployed to ODS orEurope.Slightly higher IES due toreadjustment stressorsrather than ODS stress.

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Deahl et al.,1994

Examined the effectsof psychologicaldebriefing following atrauma (PGW) onsubsequentmorbidity.

British soldiers servingArmy war grave service;N=62

Yes20 of 62

9 monthspost-PGW

Recovering andidentifying deadbodies of alliesand enemies.

Between-groupstudy comparingdebriefed andnondebriefed onmorbidity.

GHQ No difference on GHQscores between debriefedand nondebriefed;Health problems morelikely in those whoperceived a life threat.

Haley andKurt, 1997

To determinewhether symptomscan be explained dueto multiple chemicalexposures.

Convenience sample;N=249;Reserve constructionbattalion:male=100%response rate= unknown

No 11/943 years/7monthspost-PGW

Self-reportedexposure tovarious risksand self-reportedsymptoms ofcognitiveimpairment.

Self-reportedsurvey ofexposure andsymptoms;Factor-analyzedreportedsymptoms.

Self-reportedsymptoms

Combat stress not relatedto 3 syndromes;Symptoms linked toother exposures.

Iowa PersianGulf StudyGroup,1997

To compareprevalence of self-reported problems indeployed andnondeployed vets.

Stratified randomsample of 3695 active,reserve, and Guardtroops:

male=91%white=91%age <25=91%response rate=76%all from Iowa

YesN=1799M=91%F=9%

5 yearspost-PGW

Deployment;militaryexposure quest.

Epidemiologicstudy; self-reported.

Prime-MD;CAGE;BSI;PTSD-Checklist;SF-36

Deployed had higherprevalence of selectedmental and physicalhealth symptoms andsyndromes;Reservists more chronicfatigue and alcohol abusethan regular military;Most PGW exposuresrelated to medical andpsychiatric conditions.

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Kizer et al.,1995

To assess nature ofsymptoms reportedby a National Guardunit that includedpersonnelw/unexplainedsymptoms.

Unit w/high rate ofunexplained symptoms;N=59;

male=90%age=23–59(mean 39)response rate=36%–78%

Yes;N=3927Some fromsame unit,others fromsimilarunits.

12/94–3/95 All served inPGW; self-report measureof variousexposures.

Comparison ofthoseexperiencingsymptomsw/vetsfrom same andother units.

Standardizedinterview andphysical exam;13 chronicsymptoms.

Target group reportedsymptoms of non-specific origin;No organic causedetected;5 of 13 symptoms weresignificantly greater intarget group: chronicdiarrhea, other GIcomplaints,concentration problems,trouble finding words,fatigue.Exposure data notpresented.

Labatte andSnow, 1992

To assesspsychological impactof exposure to intense“friendly fire”incident during PGW.

Targeted sample; N=56;Active-duty Army troopsinvolved in ground war

No 9/914 monthspost-PGW

Self-reportedcombatexposure.

Self-reportsurvey

17-itemchecklist ofsymptoms;primary focuson sleepdisturbance,alcohol use.

29% still had nightmaresand 38% reportedincreased alcohol use;Personal injury moreimportant than exposureto dead soldiers incontributing toadjustment problems.

McCarroll etal., 1993a

To see if exposure tohuman remains wasrelated to elevatedPTSD scores.

N=234males=84%

Yes(118 of 234)Deployedbut did nothandlehumanremains.

3–5 mos.post-PGW

Handledremains in GulfWar.

Comparison oftwo groups.

SCL-90-R No differences in SCL-90-R between groups.Significant differences onIES.

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McCarroll, etal., 1995a

To see if soldiers whohandled war dead hadlater symptoms ofPTSD

N=55male=84%

YesN=56

13–15months post-PGW

Handledremains in GulfWar

Comparison oftwo groups.

SCL-90-R No differences betweengroups in SCL-90-R.Significant differences onIES.

Perconte,1993a

To evaluate treatmentof intervention forsurvivors of missileattack.

Quartermaster unit hitby missile; N=25;reserve troops:

male=84%response rate=80%

YesN=8 of 20

3/91–4/912 monthspost-missileattack

On-site duringmissile attack;War stresssurvey

Treatmentw/control groupand pre-postbetween-groupdesign.

BDI;SCL-90-R

On-site group hadgreater SCL scores pre-treatment, but notdepression.Exposure severity linkedto greater distress.

Perconte,1993b

To examine level ofpsych. distress amongPGW veterans.

Convenience sample;N=581;Army, Navy,Marine Reservists:

male=88%white=91%response rate=95%126 activated but notdeployed; 26 deployedto Europe; 429 deployedto PGW

Yes 11 monthspost-PGW

Military HistoryQuest; unitsrank ordered bywar-stressexposure

Comparison ofdeployed andnondeployedtroops.

BDI;SCL-90-R(GSI)

Distress higher amongdeployed.Among deployed, distresshigher among females;No race effects;GSI and MISS but notBDI scores increasedw/war stress rank order(units with more combatstress).

Sohler, 19921 To assess thepsychologicalsequelae of PGWservice;Examined gender,deployment, and pre-PGW exposure.

N=507;

Reserve and Guardtroops:female=21%

N=288 PGW deployedN=199 not activated

Yes 7/91–9/916 monthspost-PGW

Deployed versusnondeployed;CES

Between-groupdesigncomparingdeployed andnondeployedvets on healthand self-reportedpsych./physicalhealthsymptoms.

SCL;IES

Deployed report higherIES than not deployed;No differences on SCL-90-R.

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Stretch et al.,

19952

(also Marloweet al. 1994)

Examined self-assessed physicalhealth of PGWveterans.

Active duty andreservists from PA andHI; included all services:

deployed=1524nondeployed=2512

Yes 2/93–8/93 Deployment;Self report ofstressors

Cross-sectionalsurvey;Self-report

Checklist ofphysicalsymptoms

Deployed troopsreported more physicalhealth complaints evenafter adjusting fordemographics.

Stretch et al.,

19962

(also Marloweet al. 1994)

Examined self-assessedpsychological healthof PGW veterans.

Active duty andreservists from PA andHI:

deployed=1524nondeployed=2512

Yes 2/93–8/93 Deployment;Self report ofstressors

Cross-sectionalself-admin-istered survey ofpsychologicalsymptoms

BSI;IES

Higher BSI (4%) amongdeployers;Relationship is weak withcontrol fordemographics.

Sutker et al.,1993

Examinedrelationship betweenwar stress andphysical/psych. symptomsfollowing PGW inactivated deployedand nondeployedtroops.

Convenience sample;N=215;Army NationalGuard/reserve troops

YesN=60 of 215

4–10 monthspost-PGW

ODS-SES Between-groupdesigncomparingdeployed (highand low)w/nondeployedon psych. andphysical healthmeasures.

BDI;STAI;Trait AngerScale;HSC

Deployed w/highexposure had higherdepression, anxiety, andphysical healthcomplaints thannondeployed;Deployed w/lowexposure reportsymptom levels morecomparable tonondeployed.

Sutker et al.,1994a

Examinedpsychological,physical, andpsychiatric disordersin Army Reservistswho served graveregistry duty in PGW.

N=24;Army Reservistsassigned toQuartermaster unit:

male=21female=3

No 8 mos.post-PGW

ODS-SES Descriptive studyexaminingprevalence ofself-reportedhealth problemsand diagnosedpsychiatricdisorders.

BDI;STAI;Trait AngerScale;HSC;SCID

Body handlers hadelevated physical andpsych. symptoms relativeto civilian norms;55% diagnosed w/currentAxis I disorder.

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Sutker et al.,1994b

Examined impact ofgraves registrationduty on psych. andphysical symptoms.

N=60;Army Reservistsassigned toQuartermaster unit:

female=8%Hispanic=98%

YesN=20 of 60non-deployed

12 mos.post-PGW

Graves RegistryDuty Scale

Between-groupdesigncomparingdeployed andnondeployed.

SCID;STAI;Trait AngerScale;BDI;HSC

Deployed body handlershad higher incidence ofPTSD and somaticcomplaints.

Sutker et al.,1995a

Examined prevalenceof psychological andphysical symptoms inPGW vets;examined gender andethnicity indeployed/non-deployed.

N=912;Reserve and Guard vets;All services:

female=13%white=63%age=29 (8.4)

YesN=259non-deployed

Within 12mos.post-PGW

ODS-SES Between-groupstudy comparingwar-zoneexposed andstateside vets.

BDI;STAI;STAS;HSC

Somatic and psych.symptoms higher amongdeployed troops;Females significantlymore health complaintsthan males.

Sutker et al.,1995b

Compared PTSD pos.and PTSD neg.subjects on theavailability ofpersonal andenvironmentalresources.

National guard unitsdeployed to combat inPGW. Sample derivedfrom 1432 troops whounderwentpsychological debriefingwithin 1 year of return.

N=484M=88%F=12%

YesN=97M=87%F=13%

Within 12months ofreturn fromPGW

ODS-SES Correlationalstudy examiningPTSD-pos.subjects withPTSD-neg.subjects onpersonal andenvironmentalresourcesavailable.

BDI;SCL-90-R;MISS-ODS(cut-off 97);SSQR;WOC

PTSD-pos. subjectsreported sig. lesssatisfaction w/socialsupport, less familycohesion andexpressiveness, moreavoidant coping, self-blame, and wishfulthinking than PTSD-neg.subjects.

Unger et al.,

19921

VA Report,Chap 8

Examined physicaland psych. symptomsin deployed and non-deployed troops.

N=85;Reserve and Guard vets;No demographicsprovided.

YesN=51 of 85

Upon returnto RhodeIsland; timenot specified

CES;Deployment asproxy for stressexposure.

Between-groupdesigncomparingdeployed andnondeployedtroops.

SCL-90 Deployed troops hadsignificantly higherphysical and psych.symptoms except fordepression (somatizationnot clear).

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Wolfe et al.,1993

Examinedrelationship betweengender and healthoutcomes followingwar-zone exposure.

N=2344;Active duty Armytroops:

female=8%white=84%age=30 (9.2)all deployed

No 5 days afterreturn fromPGW.

Laufer Combatand ODSExposure Scales;Self-report.

Correlationaldesignexaminingrelationshipbetweenexposure,demographics,and symptoms.

BSI;MISS

Combat and ODS scoressign. related to BSI/GSI,MISS and PTSD; self-generated stresscategories were notrelated.

Wolfe et al.,

19962Explored patterns ofreadjustment at twotime periods post-PGW.

Time 1: N=2344Time 2: N=1853response rate=79%

Follow-up ofparticipants in Wolfe etal. (1993)

No Time 1:within 5 daysof return toU.S.Time 2: 18–20mos. afterdeployment.

Self-reportcombatexposure.

Same as above Same asabove

30% scored in clinicallysignificant range on BSIat Time 1;Significant correlationexposure and MISS;More health problems insubjects who exceededPTSD cut-off at Time 2;Combat exposure reportsincreased over time.

Wolfe et al.,

19982Examined therelationship betweenvarious exposures,including combatexposure, and bodilysymptoms.

PGW vetsN=2119

Follow-up ofparticipants in Wolfe etal. (1993)

No 18–24months post-PGW.

Laufer Combatand ODSExposure Scales;Self-report.

Multipleregressionframework (seeabove).

Healthsymptomchecklist

Combat and ODSexposure scales positivelyassociated with symptomscores in univariateanalyses. Relationshipbecomes nonsignificantafter controlling forPTSD symptom scoresand other measures.

1In Rosenheck, Robert, et al., Returning Persian Gulf Troops: First Year Findings, West Haven, Connecticut: Department of Veterans Affairs, March 31, 1992.2Data presented on the same sample.

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Documents

Appendix EMPIRICAL RESEARCH CONCERNING STRESS … · Gender effect sig. for MISS & BDI. Sig. interac-tion effect for gender by deployment. F sig. higher scores on MISS. No sig. effect