Publication year
2003
Citation Title
Risk factors for course of posttraumatic stress disorder among Vietnam veterans: A 14-year follow-up of American Legionnaires.
Journal Name
Journal of Consulting and Clinical Psychology
Journal Volume
71
Issue Number
6
Page Numbers
980-986
DOI
10.1037/0022-006X.71.6.980
Summary
A random sample of male Vietnam War Veterans who were members of the American Legion completed surveys in 1984 and 1998 to investigate risk factors of posttraumatic stress disorder (PTSD) in this cohort. High combat exposure, perceived negative community attitudes at homecoming, minority race, depression, and anger in 1984 predicted a more chronic course of PTSD.
Key Findings
Twelve percent of Vietnam Veterans met PTSD criteria in 1984, and 10% did in 1998; only 5% of the Veterans met PTSD criteria at both time points.
The strongest predictor for PTSD in 1998 was PTSD at the first assessment. Adjusting for other risk factors, Veterans with PTSD at the first assessment were almost four times more likely to meet criteria 1998 than those who did not meet criteria fourteen years prior.
High combat exposure (strongest predictor), perceived negative community attitudes at homecoming, and greater depression and anger in 1984 all predicted having PTSD at both 1984 and 1998, as well as continuing to have PTSD in 1998.
Veterans more involved in the community in 1984 were more likely to show remission in PTSD than those with less community involvement.
Implications for Program Leaders
Offer classes that encourage Service members and their families to access social and community support systems
Collaborate with community organizations to coordinate community-wide efforts to express appreciation to Service members and their families after deployment
Enhance education, activities, and curriculum related to coping behaviors and dealing with PTSD symptoms
Implications for Policy Makers
Support the development and evaluation of a range of services for Service members with PTSD that could be made available upon return from combat deployment
Encourage programs that provide ongoing support to family members whose Service member has PTSD, particularly offering programs for families whose loved one has high combat exposure and issues with depression and anger
Continue to provide support for programs that work to increase family readiness
Methods
A random sample of male members of American Legions in Colorado, Indiana, Maryland, Minnesota, Ohio, and Pennsylvania who had served in U.S Armed Forces during the official Vietnam War period were surveyed via mailed questionnaire in 1984 (Time 1) and again in 1998 (Time 2).
Participants answered questions about demographics, combat exposure, perceived social support, perceived negative community attitudes, discomfort disclosing Vietnam experiences, community involvement, and alcohol use. They also completed measures of depression and anger and PTSD at both times periods.
PTSD groups (PTSD at both times, PTSD at Time 1 only, PTSD at Time 2 only, and no PTSD) were compared on risk factors, and statistical analyses predicted PTSD at Time 2 using risk factors accounting for PTSD at Time 1.
Participants
One thousand three hundred seventy-seven Vietnam Veterans (100% male) participated in the study.
Ninety-nine percent of the sample was White, average age at first assessment was 39 years, most participants (86%) were married, and 95% had a high school education or more.
One hundred percent served between 1961 and 1975 in the Republic of Vietnam and/or its surrounding waters or airspace.
Limitations
Veterans suffering from PTSD may be less likely to belong to the American Legion and less likely to respond to two questionnaires; therefore, these results may not be representative.
Veterans with more PTSD symptoms in 1984 were less likely to participate in 1998, reducing generalizability.
The first survey took place at least 13 years after return from Vietnam and immediate mental health symptoms and/or consequences were not assessed.
All measures were self-reported and several unvalidated, one-item assessments of variables (perceived social support, perceived negative community attitudes, discomfort disclosing Vietnam experiences, community involvement) were used which threatens validity.
Avenues for Future Research
Explore the role of social support in the onset and course of PTSD
Include pre-deployment assessments of well-understood PTSD risk factors such as family and trauma history
Gather data on the impact of culture on the self-report and expression of PTSD and other anxiety conditions among Service members
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Risk factors affecting the course of posttraumatic stress disorder (PTSD) are poorly understood. As part of a larger study on characterizing exposure to herbicides in Vietnam, the authors investigated this issue in a random sample of 1,377 American Legionnaires who had served in Southeast Asia during the Vietnam War and were followed over a 14-year period. High combat exposure, perceived negative community attitudes at homecoming, minority race, depression symptoms at Time 1, and more anger at Time 1 predicted a more chronic course. Community involvement at Time 1 was protective and associated with decreased risk at Time 2. Discomfort in disclosing Vietnam experiences was associated with an increased risk for developing PTSD but did not predict its course. Combat exposure predicted PTSD course more strongly than any other risk factor. Findings suggest recovery from PTSD is significantly influenced by perceived social support.
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