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Gulf War and Health, Volume 6: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress
the Mississippi Scale for Combat-Related PTSD, the SCID, and the PTSD Scale of the Minnesota Multiphasic Personality Inventory.
The estimated prevalence of current PTSD was 15.2% in all male theater veterans and 8.5% in female theater veterans (Kulka et al. 1990). The prevalence of current (6-month) PTSD was 2.5% in male and 1.1% in female era veterans and 1.2% and 0.3%, respectively, in civilians. The prevalence of lifetime PTSD was 30.6% in male theater veterans and 26.9% in female theater veterans. High levels of war-zone stress, including exposure to at least one traumatic event, were reported by 75.2% of the male theater veterans and 9.2% of the era veterans, and 32.9% of the veterans reporting low or moderate war-zone stress also reported definite traumatic experiences. The prevalence estimate of PTSD among veterans with high war-zone exposure was 35.8% in men and 17.5% in women. The likelihood of having PTSD was increased in men who were in the Army or Marine Corps, were in junior enlisted pay grades, were 17-19 years old when they entered Vietnam, had served on active duty for more than 4 but less than 20 years, had ever been wounded or injured in combat, or had received a combat medal. Women who had more war-zone stress, were younger, or had been on active duty for more than 4 but less than 20 years had increased prevalence of PTSD. PTSD was highly comorbid with other psychiatric disorders: 75% of men with PTSD had a lifetime diagnosis of alcohol abuse or dependence, 44% had generalized anxiety disorder (GAD), and more than 20% had another psychiatric disorder.
The NVVRS has been criticized for overestimating the lifetime rate of PTSD. To address that issue, Dohrenwend et al. (2006) reanalyzed the NVVRS data from the military records of 1200 Vietnam theater veterans with a records-based military-history measure (MHM) of exposure to war-zone stressors. They found that 96.5% of veterans categorized as probably having had low exposure with the MHM had reported their exposure as low or moderate in the NVVRS, and 72.1% of those categorized as having had very high exposure with the MHM had reported their exposure as high. Over 86% of the veterans with war-related PTSD described events judged by the blind raters to have been personally life-threatening or to have involved witnessing death of or physical harm to others. A diagnosis of PTSD was based on the SCID and included a functional assessment with the Global Assessment of Functioning scale. The military records of the clinical subset of 260 veterans examined for the NVVRS were re-examined for this study. A dose-response relationship between PTSD and exposure to war-zone stressors was established. Current (as of 1988) war-related PTSD was diagnosed in 0.3% of low-exposure veterans, 14.4% of moderate-exposure, 27.0% of high-exposure, and 28.1% of very high-exposure. Lifetime war-related PTSD prevalence was 22.5%, and current war-related PTSD prevalence 12.2%. When Dohrenwend et al. adjusted the diagnoses for impairment of functioning and documentation of exposure to war-related traumatic events, the prevalence of lifetime and current war-related PTSD dropped to 18.7% and 9.1%, respectively, in the veteran subset.
Jordan et al. (1991) used the NVVRS data to determine that the most prevalent current disorders among male theater veterans were alcohol abuse or dependence (11%) and GAD (5%); these rates were not different from those of Vietnam-era veterans or civilians. The most prevalent current disorders in female Vietnam-theater veterans were depression and GAD (both 4%). Although the rate of depression was higher in female theater veterans than in female era veterans or civilians, that was not the case for GAD, which did not differ significantly among the groups.
Overall, Jordan et al. (1991) found that the NVVRS showed few differences in the prevalence and distribution of psychiatric disorders among veterans who saw combat in Vietnam