Posttraumatic stress disorder in Iraq and Afghanistan war veterans

¶ … break out of war in Afghanistan and Iraq propelled alarming forecasts about its most likely psychiatric effects. The chief of recuperation or readjustment therapy services at the Department of Veterans Affairs (VA) asserted that as high as 30% of soldiers deployed to Iraq may establish posttraumatic tension ailment (PTSD) (Dentzer, 2003), a disorder that can arise following experience of gruesome, dangerous occasions, such as battle, natural catastrophes, and rape. PTSD patients do not simply remember their injury; they reexperience it as vibrant sensory recollections (flashbacks), horror stories, and invasive ideas. They feel reduced or small and mentally detached from the family, friends and loved ones, yet likewise stressful, cranky, and hyper-vigilant as if risk were permanently present.

Psychiatry ratified the PTSD medical diagnosis in 1980, mainly in feedback to the belated awareness of its signs in Vietnam veterans whose troubles had actually long been improperly comprehended and dealt with. Undoubtedly, the most strenuous epidemiological research ever before done on Vietnam veterans had actually reported that 30.9% of guys who served in this war established PTSD (Kulka et al., 1990), consequently laying a basis for very early forecasts about PTSD amongst Iraq veterans. Keen to stay clear of the errors of the Vietnam period, American, British, and Dutch governments introduced epidemiological studies analyzing the mental wellness of soldiers returning from Iraq and Afghanistan, intending to determine the frequency of PTSD and allow its very early detection and therapy.

The Epidemiology of PTSD

Some years later, the information of PTSD, and its ramifications turn out to be remarkably positive. The wars have definitely triggered PTSD, however at rates far lower than lots of prior conflicts had and thus lower than the overall rates that were actually anticipated. The most methodologically sound studies have actually evaluated multitudes of military workers (or veterans) arbitrarily tested from the total populace of American and British soldiers who have actually served in Iraq and Afghanistan. These researches reveal that the proportion of soldiers that have actually established PTSD varies from 2.1% to 13.8%. (Sundin et al., 2010).

The most extensive research on American soldiers is the United States Millennium Cohort research, a population-based, longitudinal examination of active service and Reserve/National Guard workers (Smith et al., 2008). It includes arbitrary samples agent of the sub-populace of deployed war veterans and soldiers, alongside the deployed non-combatants, and non-deployed non-combatants. For this reason, it stays clear of the predispositions related to ease samples or from samples drawn from those looking for therapy. In addition, the topics were without PTSD at baseline, consequently offering quotes of PTSD attributable to military injury alone, not to trauma taking place prior to a soldier's enlistment in the service. Evaluating 47,837 participants of the Armed Forces, the analysts discovered that 4.3% of workers deployed to Afghanistan or Iraq established PTSD. Amongst deployed workers, 7.6% of those sample respondents reporting fight exposure established the condition, whereas 1.4% experienced this amongst those reposndents who were not experiencing battle. Of those who had actually never ever been deployed overseas, 2.3% established PTSD in feedback to stateside injury (e.g., mishaps on military bases). To be sure, rates of 4.3% amongst all deployed combatants and 7.6% amongst combatants are not unimportant. Yet these figures are much lower than the anticipated figure of 30% for all deployed soldiers, noncombatants along with combatants (Dentzer, 2003; Kulka et al., 1990).

Annotated Bibliography

Article 1: 'World Assumptions and Combat-Related Posttraumatic Stress Disorder' by Dekel and colleagues (2004)

Summary

Dekel, Rachel; Solomon, Zahava; Elklit, Ask; Ginzburg and Karni investigated the relationship between the

1. Individual world assumptions

2. Combat stress reactions, posttraumatic stress disorder (PTSD), and PTSD's itinerary.

The sample was the three groups of Israeli veterans who were divided as follow:

109 veterans who experienced CSR on the combat zone

98 decorated veterans

189 control participants.

Respondents finished homogeneous questionnaires that assessed PTSD and world supposition. Both CSR and severe PTSD were linked with lesser levels of self-esteem and beliefs about the kindness of people. Additionally, Dekel, Rachel; Solomon, Zahava; Elklit, Ask; Ginzburg and Karni saw a linear connection between self-esteem perceptions and levels of mental status. Dekel, Rachel; Solomon, Zahava; Elklit, Ask; Ginzburg and Karni looked at the findings of the study thinking the extraordinary characteristics and sense of warfare.

Assessment and Critique

The approach of the study was a good one as it helped integrate the war veterans' personal opinions, albeit only a part of their personal opinions, with the potential development of PTSD. This provided a good insight on how personal perceptions also influenced easier development of PTSD or how personal perceptions could counter the extent of PTSD. Furthermore, the approach of personal strengths and weaknesses of the individual have rarely been integrated in studies and usually prior experiences are also ignored, but this study was a good approach as it did integrate at least one aspect.

Reflection

This above chosen study could help in the development of this proposed study by helping the researcher understand that the individual structure of eth war veterans must also e taken into account in order to clearly understand the extent of PTSD development amongst them. This proposed study will also thus be able to include a strong perception and support of the integration of personalized factors of war veterans as well.

Article 2: 'The Relationships between Posttraumatic Stress Symptom Clusters and Marital Intimacy Among War Veterans' by Solomon and colleagues (2008)

Summary

This particular research investigated the following:

Connections between the PTSD symptom cluster and the marriage intimacy of the Israeli warfare veterans.

The function of self-disclosure and oral hostility in mediating the effects of PTSD prevention and agitated arousal symptoms on marriage intimacy.

The sample for the study comprised of 219 respondents that were split into 2 main groups:

1. Ex-prisoners of war (ex-POWs; N. 125)

2. Comparison group of veterans who battled in the similar war but were not captivated (N94).

According to the results the Ex-POWs showed superior levels of PTSD symptoms and verbal hostility and inferior levels of self-disclosure as compared to controls. Even though ex-POWs and controls did not vary in level of marital understanding, they did, though, showed a dissimilar pattern of associations between PTSD clusters and understanding.

In ex-POWs, self-disclosure mediated the associations between PTSD avoidance and marital understanding. Verbal violence was also discovered via indirect effect of agitated arousal on marital understanding.

The findings showed the significance of self-disclosure and verbal hostility as interpersonal mechanisms for the associations among posttraumatic symptoms on marital understanding of ex-POWs.

Assessment and Critique

This study was a good approach towards understanding how captive war veterans when captured can have a different form of PTSD as opposed to those war veterans who had not been captured in war or had not been victims of the retaliations of war. This approach is not a common one amongst many studies but could actually provide good comparative grounds for future research and is definitely an area of research that could help in understanding the realms of impact that war veterans have to go through in their normal lives.

Reflection

The above study can help establish a comparative ground for this study as well. It will help the researcher also establish a good understanding of the different types and levels of PTSD that can occur with exposure to different experiences at war. This will add a profound dimension and depth to the paper that only a few prior studies could match.

Article 3: 'Deployment Stressors and Posttraumatic Stress Symptomatology: Comparing Active Duty and National Guard/Reserve Personnel from Gulf War I' by Vogt and colleagues (2008)

Summary

Due to the increased use of the National Guard and Reserve military workers in the present scenario has raised many questions that whether the employment experiences and their relations with posttraumatic strain symptomatology vary for on duty and NG/R military workers.

There are very few studies to date which can be found related to this issue and moreover it is still uncertain that whether the impact of this military status varies for men and women or not. Vogt, Dawne S.; Samper, Rita E.; King, Daniel W.; King, Lynda A and Martin, James A dealt with these study issues in a sample of 311 men and women who were associated with the Gulf war 1.

Numerous dissimilarities were experienced in deployment stressor contacts and results derived from differential relations normally recommended more unconstructive impacts of deployment experiences for on duty females and NG/R men. The probable role of unit consistency in elucidating these findings is also discussed.

Assessment and Critique

The above study follows the approach less implemented by many researchers whereby the impact and extent of PTSD is measured and compared between men and women in the armed forces. This approach gives the study a unique distinction in the sense that it allows the researcher to aptly see the impact of posttraumatic experiences and the coping techniques for men and women during and after their experience at war. Of course PTSD is experienced differently by every individual, male and female, and thus this study is an excellent collection of the varied extent that PTSD exists in war veterans, male and female.

Reflection

The above study will add another profound comparative depth to this proposed study as it will allow the study to have different form of comparative analysis. This differentiation of comparisons will help the researcher better understand the extent of PTSD as well as understand the various ways that it can impact women as well. The approach towards understanding PTSD amongst the female combatants is a rare investigation as most PTSD studies have concentrated on the impact on male combatants, which is why this is a very important study to consider.

Article 4: 'Personal, Family, and Multiple Barriers of Long-Term Welfare Recipients' by Taylor and Barusch (2004)

Summary

This piece of writing reports the outcome of an in detail, descriptive investigation of long-term welfare beneficiaries. An arbitrary sample of 284 respondents was chosen and all of them had gotten public support for as a minimum 36 months, was interviewed.

The findings of the study showed that the individual barriers to self-reliance, as well as there were physical health problems that put off work then there were other issues like stern domestic aggression, educational deficits, substance abuse. The learning disabilities, child behavior problems, generalized anxiety disorder, posttraumatic stress disorder, and clinical depression were also a part of the findings.

The findings also illustrated and highlighted the multifaceted, constant, and numerous problems faced by these people and proposed that for some welfare recipients, lifelong monetary supports and social services may be in regulation. Proposition for strategy and programming are also discussed.

Assessment and Critique

This study is a great approach towards understand the afterlife of war veterans and the obstacles that they face in the normal structures of society especially being part of the welfare or recuperation systems. Very rarely do studies actually consider the norms of life when studying the war veterans and the PTSD and focus primarily on the life after the treatment for PTSD has been received and they are in the recovery system.

Reflection

The above study will again give a new depth to the study and give it a beginning-middle-end perspective as the study will be able to incorporate the personal attributes of the war veterans before the experience of war, PTSD developed during war, the treatment for PTSD and the life after the treatment is complete. This study will help the proposed study complete the last stage of understanding the life after the treatment for PTSD is complete.

Article 5: 'Together in Pain: Attachment-Related Dyadic Processes and Posttraumatic Stress Disorder' by Ein-Dor and colleagues (2010)

Summary

An actor-partner interdependence modeling was used by Ein-Dor, Tsachi; Doron, Guy; Mikulincer, Mario; Solomon, Zahava; Shaver and Phillip R. To discover relations between attachment-related dyadic procedures, posttraumatic stress disorder (PTSD) in war veterans, and secondary traumatic stress (STS) in their wives.

The study basically revolves around the sample of 157 Israeli couples of which 85 previous prisoners of warfare and their wives and a contrast group of 72 veterans not held imprisoned and their wives filled up a self report scale that actually took under consideration the attachment uncertainty and PTSD signs.

The findings suggested that the attachment anxiety was linked with the severity of their own and their spouses' PTSD and STS for both the groups. Avoidant attachment was linked with PTSD and STS solely in couples that incorporated a past captive of warfare.

A multifaceted pattern of relations including avoidant attachment was seen in the actor-partner analyses of these people. The investigation showed that attachment-related dyadic procedures have a very important part in the growth and maintenance of PTSD in traumatized veterans and STS in their wives.

Assessment and Critique

This research was an extensive and in-depth research in a twofold way. First, it was a comparative analysis of two forms of veterans -- one who had been captives in Israel and the other who had not been captives; second it also compares the impact made on the spouses of the affected veterans and their coping strategies and lifestyles. These two perspectives gave this study a very strong approach for not only highlighting how PTSD affected two different kinds of war veterans as well as how their lives and the changes in their lives affect the lives of their families and spouses in particular.

Reflection

The above study will add a great dimension to this proposed study because it will be give great depth to the comparative analysis being done in the study as well as bring in a new perspective of how spouses copes with the changes that are brought about with the development and extent of PTSD.

Article 6: 'Being a Wife of a Veteran with Posttraumatic Stress Disorder' by Dekel and colleagues (2005)

Summary

Dekel, Rachel; Goldblatt, Hadass; Keidar, Michal; Solomon, Zahava; Polliack and Michael illustrated the results from the qualitative investigation exploring the marital opinion of nine housewives of the veteran and post traumatic stress disorder people. The data was gathered from conducting a semi-structured interview session with the participants using the approach of in depth focus group.

According to the results lives of these women actually revolved around the illness of their husbands and they had to face continues tension between the fusion with their husbands and their own individuality and sovereignty.

But one more thing that this study revealed was that these wives were pretty positive about their marriage and they identified how it granted them the strength and courage to cope up with the situation.

Assessment and Critique

The study was a good in-depth look into the lives of the spouses primarily as opposed to the war veterans. This is not a rare approach but the lifestyle and sacrifices of the spouses could be further studied in the future. The study provided a detailed look into the psyche of the spouses and the responsibilities that they feel are added onto them if and when, upon return from war, their husbands suffer from PTSD.

Reflection

The above study will further support this proposed study to make accurate analyses and conclusions on the impact that the lives of war veterans suffering from PTSD makes on their families, in particular their spouses. The study will hence get a more detailed look into both the influence of PTSD on the lives of the war veterans as well as their spouses.

Article 7: 'Posttraumatic Stress Disorder: A Treatable Public Health Problem' by Salvatore (2009)

Summary

The research focuses on how the PTSD levels have risen a lot more drastically after the war on terror began in 2001. The research highlights the importance of the role of the clinicians and the necessary balance between providing good and sufficient care and not providing enough care to the war veterans returning from the excursions in Afghanistan and Iraq. The research suggests the use of eye movement desensitizing and reprocessing (EMDR) as an effective method to counter PTSD symptoms and syndrome n returning combatants. The benefits and effects of EMDR are also discussed thoroughly.

Assessment and Critique

This study is also a very important study for those looking to understand recuperation methods and therapies for returning war veterans so as to ensure a quick identification and recovery from PTSD. This study also offers some effective and successful therapeutic strategy of EMDER for clinicians so that they can effectively counter PTSD syndrome.

Reflection

The above study will add a great dimension to this proposed study as well because it will provide scientific and therapeutic support for the treatment of PTSD amongst war veterans. Furthermore, literature from this study will also help in giving this study a new perspective of EMDR in leading the recovery for PTSD.

Article 8: 'Posttraumatic Stress Disorder and Marital Adjustment: The Mediating Role of Forgiveness' by Solomon, Dekel and Zerach (2009)

Summary

This particular study basically investigated the impact of war imprisonment on posttraumatic stress symptoms and marital modification amongst the Prisoners of War (POWs) from the Yom Kippur War. It was imagined that men's thinking about the level of clemency mediate the link between the posttraumatic symptoms and marital modification. For the study, sample was of 157 Israeli veterans who were further divided into three major groups that were 21 POWs with Posttraumatic Stress Disorder (PTSD), 58 former POWs without PTSD, and 70 were control veterans. It can be seen from the findings of the study that the POWs who were former showed lesser level of marital contentment clemency than veterans in the other 2 groups. Additionally, men's discernment of level of clemency mediated the association between their posttraumatic symptoms and their marital modification. The hypothetical and clinical implications of these results are also discussed.

Assessment and Critique

The above study provides an in-depth look into how and why the PTSD syndrome can affect the marital relations of war veterans. It does a thorough comparison of three different groups which makes its investigation even more accurate and detailed. The study also provides great theoretical support for medical processes and therapies that can be used to understand how some therapies can be more effective for a certain PTSD patient and not for others.

Reflection

The above study will provide this proposed study with great theoretical and medical support for all the therapies suggested which will strengthen the reliability and validity of the research method that will be employed in this proposed study.

Article 9: Posttraumatic Stress Disorder or Midlife Crisis in Vietnam Veterans?

Summary

The authors analyzed the link between individual world presumptions and their emotional distress levels. They link these to the PTSD and found that a number of symptoms are related to veterans suffering from PTSD persistent intrusive distressing recollection of trauma; recurrent distressing dreams of war events; and even feelings that the event is currently taking place in the present. The authors also view problems veterans face during their midlife crisis. They conclude that PTSD has a strong link to emotions distress and marital problems and that further studies need to be carried out to determine the depth and breadth of the problem.

Assessment and Critique

This study provided good additional data to the domain of veterans and signs of emotional distress in relation to PTSD. These two aspects are pretty much interdependent as the positive emotions of a war veteran could lead to low levels of PTSD and the opposite also stands true. So, this study did provide a good look into the inner world of war veterans as well as the personal perceptions and opinions of war veterans.

Reflection

The above study will also add a profound dimension to this proposed study as it will link two important aspects of self-perception/self-worth of war veterans and their emotional levels with the extent of PTSD that they experience. This particular approach will link the medical and theoretical foundations already established in this study with some more psychological perceptions and the impact that PTSD has on them.

Article 10: 'No One Leaves Unchanged: Insights for Civilian Mental Health Care Professionals Into the Military Experience and Culture' by Coll, Weiss and Yarvis (2011)

Summary

This article basically explains the military culture, way of life and understanding. The reason behind this is to show a bit clearer picture of the services offered by civilian clinicians. The service members trained into such an impactful environment are common to experience the adjustment issues and so the councilors should be ready to help them at every step of the reintegration process.

In addition, this piece of writing shows a small number of the main mental health issues that are common in war veterans, particularly for those coming back from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF).

The article also highlights the treatment modalities applied for both within and from outside of the military. Realistic healing suggestions for clinicians with modest or no information of the military are also discussed. The main purpose is to instruct and prepare civilian mental health doctors to manage culturally sensitive avoidance and interference services to meet the exclusive needs of these people.

Assessment and Critique

This study is also a very important study for those looking to understand recuperation methods and therapies for returning war veterans so as to ensure a quick identification and recovery from PTSD. This study also offers some effective and successful therapeutic strategies for clinicians, military and non-military, so that they can understand the impact that PTSD can have on an individual and don't underestimate it in any way.

Reflection

The above study will add a great dimension to this proposed study as well because it will provide scientific and therapeutic support for the treatment of PTSD amongst war veterans. Furthermore, literature from this study will also help in giving this study a new perspective and look into the role of the clinicians in the recovery process of the veterans. This is a very important aspect because the role of the therapists and clinicians is instrumental in the recovery process of the war veterans.

Synthesis

Conclusion

The 10 studies assessed and reviewed above used either induction or deduction as their research approach. In line with Trochim (2006), there are two fundamental approaches towards research: the first is deductive and the second is inductive. Deductive reasoning, also referred as the "top-down" tactic, works from the more wide-ranging purpose to the more specialized aim. The inductive reasoning also referred to as the "bottom-up" tactic, works the opposite way i.e. It starts off from having specialized aims and then expands them into generalized as well as widespread practices and notions. Both forms of research approaches were used with survey questionnaire and interviews so as to decipher the issues related to PTSD.

Similarly, the timeline of a research study is directly linked with its format. There are primarily two primary formats of a research study with regards to timeline:

1) cross-sectional and

2) longitudinal studies.

In a cross-sectional study the concentration of the researcher is restricted within a single time-frame i.e. The researcher only acquires a segment of the whole phenomenon he/she is measuring or studying. However, in a longitudinal study the concentration spreads over a larger spectrum of time i.e. A lot more dependent and independent variables are included and modifications that take place over time are also noted before coming to concrete conclusions (Trochim, 2006). For the research studies summarized above, with the time frame available to the researcher, the longitudinal format was used in all the 10 studies.

As far as data collection is concerned, there are two kinds of data collection strategies: 1) quantitative, which is basically numeric representation and breakdown of all the data: and 2) qualitative, which involves distinct intangible dimensions and can incorporate videos, photographs, sound recordings etc. The latter is far more widespread then the former. In the studies specified above, the researchers utilized both the numerically proven statistical analysis (i.e. quantitative data), as well as, qualitative data analysis (interviews). Some studies whether qualitative or quantitative utilized one or a mixture of the following methodologies so as to gather their data/information:

1. Survey: which may involve both questionnaire and interviews

2. Structured interview

3. Semi-structured interview

4. Unstructured interview

5. Questionnaire (Trochim, 2006).

The authenticity or validity of a study is what lies behind its failure or success. Even the smallest level of illegitimacy can create the whole research a drowned effort. For any kind of data the validity lays in the depth, integrity and capacity of the information collected along with the targeted sample and the impartial strategy employed by the researcher. In the studies summarized above, the researcher utilized the survey method (questionnaire and semi-structured interviews) with the same process for all subjects in the sample. This ensured that the dissimilarities present in the responses are personal genuine: hence the methodology cannot be disapproved for being subjective or impartial in any way (Trochim, 2006).

According to Saunders et al. (2012), in order to reduce the chances of getting inappropriate answers, a researcher must consider to what extent the research would be feasible and strong while designing out the research structure.

Reliability can be classified as the probability of other researches studies arriving at the same inference when computing with similar devices and using similar methods. In reality, issues of reliability demonstrate dilemmas and problems in both precision and accuracy of the measuring/calculating device being used in the study (Bouma, 2004).

Adhering to this point-of-view, Saunders et al. (2012) reveals the issues of bias, which is linked with reliability and can be classified into two types. The first is the researcher bias where observations, tone as well as body language of the researcher may produce bias and the subject may react different to the questions (Saunders et al., 2012). In the studies summarized above, focus was given to both planning and designing of the survey so that they do not impose the researcher's viewpoint and beliefs. Moreover, the researchers made efforts to build their trust with the subjects so that reliability and validity doubts can be minimized.

The second type of bias is classified as the respondent's bias which is mainly triggered by views about the researcher (Saunders et al., 2012). In the studies summarized above, despite the fact that the researcher made efforts to build trust prior to taking the survey, it was obvious that the subjects were aware about the delicate nature of certain questions and may have decided not to reveal and answer certain questions. In addition, it can also be argued the subjects did not answer the questions with precision and accuracy and may have attempted to exaggerate their answers and give a positive picture.

To conclude one can point out that it has been more than a decade since the terrorist attacks on the United States, service males and females are coming back from battle zone in Iraq and Afghanistan with terrible injuries to both mind and body. DoD and VA leaders are confronted with the difficult obstacle of recovering these servicemen and females with undetectable retrieval in addition to noticeable injuries. How can their care be enhanced? Which ingenious methods could avoid PTSD prior to exposure to a distressing occasion? Which therapies could enhance management of PTSD for service participants, veterans, and their households in the short-term and long-term? Responding to these essential concerns will be vital to enhancing the look after the country's injured warriors.