effective in other roles and with other responsibilities. Some may want care because they are suffering, while others may see their experience as an occupational hazard and may expect a diminution over time, especially if they get sustained respite. The tacit assump- tion of epidemiologic studies appears to be that all cases need
especially at risk over time. More broadly, however, although the studies to date have made valuable contributions, all are hampered by one or more common limitations described above. All of these limitations are understand-
and functional impairment, the validity of this assumption would be enhanced.
research funding, and urgent need for empirical information about deployment-related outcomes that can inform operational decisions. The net result of the limitations, however, is that although the
us that adaptation to combat and operational experiences is an unfolding dynamic. Little is known about different trajectories of response to war stressors. Research has been mostly cross-sec- tional, which constrains causal inference and fails to provide useful primary and secondary prevention information. The studies that evaluated troops at two postdeployment intervals revealed an over- all increase in PTSD symptom burden with the passage of time
3 on the PTSD screener (noteworthy PTSD) were on a recovery trajectory endorsement that suggested a chronic trajectory.
PTSD early on had probable delayed PTSD at the six-month point
resilient course – no PTSD at both time points). Because of selection, training, leadership, cohesion, and pride (etc.), the high rate of enduring resilience is not surprising. A recovery trajectory is consistent with prior research
most distressed service members recover because of natural
resources and resourcefulness. A delayed trajectory, which was prominent in Grieger et al.’s (2006) longitudinal study of physically wounded soldiers, is also consistent with prior research. Docu-
related to them should be a high priority.
and the nation to an important problem, their contribution to our understanding of combat-related PTSD and their ability to inform
comparison groups, comprehensive clinical assessment of key
sive assessment of exposure and biological markers hypothesized to moderate or mediate the relationship of exposure with PTSD and related outcomes.
Bliese, P. D., Wright, K. M., Adler, A. B., Thomas, J. L., & Hoge,
Timing of postcombat mental health assess
ments. Psychological Services, 4, 141-148. When soldiers return from combat and peacekeeping operations, the United States and many NATO and Partnership for Peace countries conduct some
authors examined the degree to which timing was related to reported prevalence rates of mental health problems in a matched
Our review also suggests to us that the research to date has examined a narrow band of the potential risk and resilience predictors of the onset or course of probable PTSD. Descriptive epidemiology fails to identify the service members most in need of preventive care or the mechanisms of risk and resilience that, if known, would be targets for intervention. Cross-sectional research focused on chronic PTSD has revealed risk indicators associated with posttraumatic pathology,
120 days postdeployment relative to immediate reintegration. The
to soldiers returning from combat. [abstract adapted]
Browne, T., Hull, L., Horn, O., Jones, M., Murphy, D., Fear. N. T., et al.
Explanations for the increase in mental health problems in UK reserve forces who have served in Iraq. British Journal of Psychiatry, 190, 484-489. associated with ill health in reserve armed forces personnel. To investigate reasons for the excess of ill health in reservists, UK
Finally, future research should expand upon self-report surveys and evaluate behavioral, genetic, and other biological variables, as well as family experiences. Multi-systemic evaluations of the risk and
status was measured using self-report of common mental disorders, PTSD, fatigue, physical symptoms and well-being. Reservists reported higher exposure to traumatic experiences, lower unit
marital satisfaction. Most health outcomes could be explained by role, experience of traumatic events or unit cohesion in theatre. PTSD symptoms were the one exception and were paradoxically most powerfully affected by differences in problems at home rather
prevalence does not diminish over time. Consistent with a wealth of prior research, there is a robust association between the cumulative burdens of combat and operational stressors and probable PTSD. Of note, National Guard and Reservists may be
coming. [abstract adapted]