Continued from cover
with probable PTSD risk (the rate for participants with no exposure
policy makers, and the public to these outcomes. One of the important internal validity issues in evaluating the evidence, however, is the extent to which the assessment methods warrant
Longitudinal studies began appearing later than cross-sectional
data for a large convenience sample collected in the month before redeployment with screening data collected 4-10 months postde- ployment. Probable PTSD prevalence for active-duty soldiers
Researchers should be circumspect about results based solely on brief screening assessments, particularly if participants suspect that
the validation of combat-related PTSD screeners was conducted
prevalence among Reserve/Guard members has been found in other US service branches (Schell & Marshall, 2008; Smith, Ryan, et al., 2008), and among United Kingdom (UK) troops (Browne et
overlap with other psychological problems, non-exposure-related adversity and stress may affect the severity and types of symptoms endorsed on surveys that fail to establish an index event that would contextualize and constrain symptom reporting.
(generalizability). The foundation of generalizability is probability
days later, using the PCL. The rates of probable PTSD climbed from
branches in the Millennium Cohort Study who were assessed at enrollment and 3 years later, nearly 12,000 of whom were
- ment. They found probable PTSD incidence (new onset) rates of
though useful, does not index individual burden and also fails to capture patterns of deployment-related psychological problems.
clues about secondary prevention needs, which suggests the need also to look more closely at the symptoms in disaggregated ways.
Some studies have included groups of troops not deployed to
large probability sample of initial invasion troops from the UK with
researchers can report the prevalence of symptoms putatively linked to deployment experiences (reexperiencing and avoidance). By contrast, the emotional numbing and hyperarousal symptoms
PTSD rates with non-deployed troops. Using the PCL, they found
comorbid problems. For example, the relatively high predeployment
did not have higher rates. By contrast, PCL-based probable PTSD rates were appreciably lower among the non-deployed service
by anticipatory anxiety (hyperarousal) and conservation of emo- tional and relational resources (numbing) in preparation for deployment.
that UK armed forces were 1.5 times more likely to have probable PTSD if they were deployed 13 or more months in the past three
Similarly, it may be useful to disaggregate combat and operational experiences (i.e., war-zone exposures) into thematic categories. Candidates include: life-threat, loss, observing carnage and loss of life, morally challenging acts of omission or commission, betrayal of service and role expectations, and fatigue/exposure to the elements. These war-zone experiences are likely to lead to varying
in UK reservists to be due to family problems. Smith, Wingard, et al. (2008) found that prior assault experiences substantially increased risk for PTSD in both men and women deployed to OEF/
between combat exposure and PTSD, a more revealing analysis would be the relationship between different types of exposures and patterns of outcomes.
probable PTSD using Hotopf et al.’s (2006) data and found that childhood adversity, time in forward areas, witnessing others wounded or killed, perceived risk, role strain, and lower morale independently increased risk of probable PTSD.
that in clinical contexts, it is often safe to assume that symptom
Observations and Recommendations
assessment of functional impairment is important in treatment
The relatively rapid (compared to historical standards) accumulation of empirical information about PTSD and related outcomes has had tremendous value in alerting military commanders, service providers,
functional impact is particularly important. Arguably, while deployed and in garrison, a relatively high percentage of service
they are functionally resilient