PTSD Scale [CAPS] or the Mississippi Scale for Combat-Related PTSD) (Proctor et al. 1998). Current PTSD (time 2) was diagnosed in 8.1% of the Fort Devens group, 7.6% of the New Orleans group, and none of the Germany group. Health status and function were lower in the Fort Devens cohort. The three most prevalent symptoms in the Fort Devens group were “forgetfulness,” “fatigue,” and “unsatisfactory sleep.”

Wolfe et al. (1999b) also recruited cases from the Fort Devens and Germany cohorts with a stratified random-sampling strategy (148 from the Fort Devens group, 73 from the New Orleans group, and 48 from the Germany group). They used the Laufer Combat Scale to assess exposure to combat situations and the Mississippi Scale for Combat-Related PTSD to assess PTSD. The deployed Fort Devens group had higher levels of current and lifetime PTSD and current and lifetime MDD than the Germany group; little else regarding psychiatric function was different between the groups. Compared with the PTSD prevalence in the general population (7.8%) (Kessler et al. 1995), the Germany group (controls) had much lower rates of PTSD. However, the low prevalence estimates in the controls increases from zero to 5-8% when the veterans are deployed to active war situations. A strength of this study is that it is characterized by direct interview.

A different study of the cohort examined above (Wolfe et al. 1999a) looked at the course and predictors of PTSD and found that there was a higher rate of PTSD at time 2 (8%) than at time 1 (3%), indicating the development of new cases. Responders at time 2 were more likely to be younger, belong to racial minorities, and be deployed; however, the absence of differences in PTSD rates due to those characteristics indicates a lack of selection bias at time 2. Women were significantly more likely to have PTSD (OR 3.2 at time 1; OR 2.3 at time 2), although their numbers were very low at each assessment.

Brailey et al. (1998) studied Gulf War veterans on their return from service (an average of 9 months after their return) with a face-to-face debriefing and psychologic assessment, comparing Gulf War-deployed (n = 876) with nondeployed veterans (n = 396 mobilized but not deployed), including National Guard and reserve troops. A subset of 349 received a followup assessment an average of 16 months later. They used standard psychiatric rating scales for their assessments including: the Beck Depression Inventory (BDI), the State Anger, State Anxiety, the Brief Symptom Inventory (BSI) Depression, BSI Anxiety, BSI Hostility, and the Health Symptom Checklist (HSC). The deployed veterans had higher scores than the nondeployed on the BDI, the State Anger, the BSI Anxiety, and the HSC. When the Gulf War-deployed veterans were reassessed on average of 16 months later, they showed increases on all scales, including the BDI, the State Anger, the BSI Anxiety, the BSI Hostility, HSC, and on both PTSD scales (the 17-item DSM-III R PTSD Checklist and the Mississippi Scale for Desert Storm War Zone Personnel). They showed increased rates of depression (6.9% to 13.8%), PTSD (2.3% to 10.6%), and hostility (4.9% to 13.8%). The authors correlated war stress with those symptoms and found that the higher the war-zone stress, the more severe the depressive and anxiety symptoms. Troops who were assigned to high-risk activities, such as grave registration, showed a high prevalence of PTSD (46%), depression (25%), and substance abuse (13%).

Goss Gilroy et al. (1998) assessed all 3,113 Canadian Gulf War veterans deployed to the war zone and a comparison group of nondeployed veterans with a mail questionnaire; the methodologic details are in Chapter 4. Using the PCL-M, the investigators found that symptoms of PTSD were 2.5 times more prevalent in the deployed than in the nondeployed veterans (OR 2.69, 95% CI 1.7-4.2). Using the PRIME-MD, the investigators found that the deployed had



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