Post-Traumatic Stress Disorder in War Veterans - Term Paper Example

Post-Traumatic Stress Disorder (PTSD) in War Veterans Name Institution Abstract The socio-political problems, such as terrorism and incidences of warfare that burden the Australian society show that the Australian war veterans have been found to be at high risk of PTSD. Globally, the problem is, however, older, and goes back in history to the American Civil War (1861-1865) and the Franco-Prussian War (1870-1871). The findings of the studies of Australian veterans related with those of the American and New Zealand veterans. It is established that war veterans with long-term health problems are at high risk of PTSD. Additionally, PTSD affects a spectrum of long-term mental health disorders, physical health, as well as social functioning problems among both female and male veterans, although the males are more vulnerable. It also leads to high unemployment rates, family breakups, and violence among the veterans. There is also a link of the occurrence of PTSD in traumatised veterans to family dysfunction and symptoms in their children, such as self-esteem. There is an increased role of women in warfare. Male veterans are more prone to PSTD than the female veterans are, and, therefore, require different needs. There is also need to address PTSD and related psychiatric disorders of war zone exposure among the veterans, based on their gender differences. There is a need for inclusion of families in the veteran PTSD treatment programmes. Brief historical overview of the development of the PTSD diagnosis in war veterans Introduction The stresses resulting from traumatic events trigger a range of physiopathological and psycho-emotional outcomes. The Post-traumatic stress disorder (PTSD) refers to a type of psychiatric disorder resulting from witnessing or experiencing traumatic or distressing events. The PTSD has significant psychobiological correlates that potentially impair an individual’s normal everyday life (Marvasti and Fuchsman, 2012). In respect to the current problems, such as contact with particular environmental toxins, terrorism and incidences of warfare, which burden the Australian society, Australian war veterans have been found to be at high risk of PTSD (Davidson and Mellor, 2001; Fuchsman, 2008; Marvasti and Fuchsman, 2012). Indeed, Australian participation in the Vietnam War in 1965 and subsequent cases of psychiatric casualty rate of around 50 per 100,000 per year for close to 10 years underscored the need for a study of PTSD in war veterans (Boman, 1985). Hence, PTSD is a severe public health concern that calls for enhanced modes of treatment intervention. Historical overview of the development of the PTSD diagnosis in war veterans While posttraumatic stress disorder (PTSD) is often viewed to be a comparatively new concept of diagnosis since it was initially described based on the name in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), its concept is significantly older. According to Friedman (2013), the early evocative accounts of disorders related to stress, which are connected to the history of war globally. An early example is provided by Stephen Crane’s pensive accounts of the reaction of the Civil War veterans after the war. The account of psychological symptoms after the military trauma goes back in history to the ancient times. One of these instances was the American Civil War (1861-1865) and the Franco-Prussian War (1870-1871), which marked the beginning of formal medical efforts in order to resolve the problems that the military Veterans who participated in the combat faced. There are also links to the railroad accidents, which provided an understanding of the trauma-related conditions (Friedman, 2013). Before the U.S. military attempts, an Austrian physician Josef Leopold (1761) is said to have written about cases of "nostalgia" in combatants. This included those who were experiencing military trauma, where some soldiers complained that they missed home, felt sad, as well as had anxiety and problems with sleeping. Such description of symptoms of PTSD created a model of psychological injury, which survived into the Civil War. In another case, Jacob Mendez Da Costa of the United States conducted a study on the Civil War soldiers who exhibited such "cardiac" symptoms and portrayed it as overstimulation of the nervous system of the heart. They were later dubbed "Da Costa's Syndrome." European documents of the "railway spine” also supported the idea that physical injury contributed to PTSD-like symptoms (Friedman, 2013). The increase in the number of railway travels also led to increased railway accidents, where diagnosis of injured passengers indicated problems to the central nervous system. A case in point is Charles Dickens who, in 1865, was involved in a rail accident recorded symptoms of sleeplessness and anxiety due to trauma. Later in the 20th century or 1919 precisely, President Wilson declared November 11 the first observance of Armistice Day, immediately after the end of the World War I. During the War, treatment differed. While some soldiers only received a few days' rest before they returned to active combat, those with chronic or severe symptoms were subjected to "electrotherapy" (shock) or “hydrotherapy" (water) (Friedman, 2013). Psychological well-being of war veterans and impact on their civilian life Previous scholarly researches that investigated how war veterans readjust have showed that PTSD is an outcome of exposure to combat among Australian, American, or New Zealand war veterans. An early study by MacDonald et al. (1995) concluded that veterans were at high risk of PTSD. The researchers had examined war veterans in the New Zealand and concluded that war veterans with PTSD were further at high risk of a spectrum of long-term mental health disorders, physical health, as well as social functioning problems. The study confirmed that war veterans in New Zealand and the United States suffered the same consequences due to the combat experiences, which led higher prevalence of family breakdowns, and unemployment. Later studies have also brought evidence showing the prevalence of PTSD on war veterans. Like MacDonald et al. (1995), a later study in Australia by Davidson and Mellor (2001) confirmed that PTSD affected a spectrum of long-term mental health disorders, physical health, as well as social functioning problems. Both studies served to validate findings of an earlier research paper by Boman (1985), which forms one of the seminal researches on veteran PTSD in Australia. In the study, Boman (1985) indicated that war veterans had impulsive acting-out behaviour due to alcohol influences, which led to domestic crisis, marital discord and high rate of criminal conviction due to assault, fraud and murder. A related study by Kinney (2015) was more comprehensive. Kinney (2015) examined the US military personnel who participated in combats in Afghanistan and Iraq wars. In his review, Kinney (2015) argued that Afghan War and Iraqi War veterans differed significantly from the Vietnam War veterans when it comes to their clinical statuses. His findings suggested that diagnosis with substance abuse disorders was not recurrent in the Afghan War and Iraqi War veterans compared to the Vietnam War marines, soldiers, veterans, and sailors. Despite this, the Afghan War and Iraqi War veterans were highly susceptible to aggressive behaviour compared to Vietnam veterans. In both cases, such behaviours affected their social lives, particularly their relationship with their families. This also confirms that PTSD affects a spectrum of long-term mental health disorders, physical health, as well as social functioning problems. Kinney’s (2015) comparative research further shows that the Persian Gulf War female veterans tended to suffer from greater medical difficulties  compared to the Afghan War and Iraqi War female veterans, particularly in respect to the general cognitive disability and drug dependence and abuse. The findings further showed that male war veterans tended to be more often diagnosed with alcohol dependence and abuse, and medical problems, compared to the female veterans. Conversely, the male soldiers were less frequently identified with anxiety disorders. The results confirm findings by an earlier study by Fontana et al. (2010) of the female veterans of the Iraq/Afghanistan war, which established that female soldiers were less likely to be married or be employed due to mood disorders. The fact that military personnel who return from combats to civilian life, experience severe mental and physical issues, demonstrate that their families are at high risk of breakdown. When the findings by Boman (1985) and that of Balfour et al. (2014) are taken into perspective, it becomes clear that the two groups of scholars made similar findings, which only suggests that the same findings are still experienced two decades later. Balfour et al. (2014) established that more than 18.5% of military personnel who returned from combats, and attempt to adjust to civilian life tended to experience mental health issues that led to breakdown of their families, events of homelessness and unemployment. Balfour et al. (2014) argued that nearly 4000 Australian soldiers who had returned home between 1999 and 2009 suffered from PTSD. From the review, it can be argued that in an era where Australian military personnel tend to be exposed to combats, such as the Afghanistan and Iraq War, the traumatic event stressors by war veterans have been given less attention, and that strategies to overcome these stressors, more than two decades later, are still not in place. At the same time, veterans who report subjective traumatic exposure and experience higher rates of stressors are more likely to show poorer mental and physical health outcomes, engage in violent behaviours, become highly dependent on drugs and report higher rate of unemployment and family breakdown. Australian research with research from overseas From a survey of literature, it is clear that most studies on veterans PTSD have been done in the United States, although there has also been a large body of literature generated in Australia. In all, only a handful of studies have been conducted outside the United States and Australia. In an earlier study in Australia, Boman (1985) examine the Australian veterans who had participated in the Vietnam War alongside the United States. He suggests that the psychiatric rate was nearly 50 per 100,000 each year, showing that seminal studies in Australia were interested in determining the prevalence of PTSD, among war veterans. Consistent with studies in the United States, Bolman (1985) showed that violence and drug abuse were linked to veteran PTSD. Indeed, the study concluded that the PTSD prevalence in the United States (43%) is similar to that of Australia (40%). Bolman (1985) examined 25 Vietnam veterans using a controlled study. The small study sample implies a weakness of the study, as the study is less generalisable. Such a limited sample size suggests that the findings are merely propositions that require further validation before broader generalization. Additionally, since it is restricted to Australia, the results may never be completely transferable in other countries. No interventions are suggested. Balfour et al. (2014) also concentrated on Australian veterans, by focusing on the Veterans Transition Program (VTP), an innovative programme imported from Canada. Unlike his predecessor Bolman (1985), Balfour’s et al. (2014) scope of study was broader as it looked at PTSD prevalence, as well as the therapeutic options for war veterans. Balfour’s et al. (2014) findings are in agreement with related studies, which confirmed the prevalence of PTSD among war veterans. They found that many Australian participated in the VTP showed positive outcomes. However, the program needs greater involvement of family members. The need for inclusion of families is further supported by a related study in Australia by Waller et al. (2012), which studied the adjustment of children of war veterans. Waller et al. (2012) linked the occurrence of posttraumatic stress disorder (PTSD) in trauma survivors with family dysfunction and symptoms in their children, such as self-esteem. Overall, Waller et al. (2012) examined 50 children, between the ages 16 and 30 years, of 50 male Vietnam War veterans. Again, unlike the American studies, the researchers recommended that support be given to families of war veterans. However, the small study sample of 50 children makes the study less generalisable. Waller et al. (2012) conducted two cross-sectional studies of the Australian Defence Force were used to study the operational stressors and physical and mental health that Australian Defence Force personnel report.1704 participants in Bougainville peacekeeping and 1333 participants in East Timor peacekeeping participated in the study. Like the American and New Zealand studies, the key stressors identified included separation and ‘work frustration’. The study concluded that there is a need for strategies for treating those exposed to traumatic events, as well as other stressors on while deployed on military missions. The large study sample makes the findings highly generalisable. In a study by MacDonald (1995) that was done in New Zealand, the research focused on mental and physical health effects of PTSD on New Zealand, war veteran. Consistent with overseas studies, a large fraction of veterans in Zealand was found to suffer from depression, anxiety, and severe somatic symptoms. An underlying weakness of the study is its failure to estimate the number of Zealand veterans with PTSD. MacDonald (1995) used document analysis to review past studies in New Zealand. He established that war veterans who develop long-term mental health problems are at a greater risk of developing PTSD. These findings are consistent with studies in Australia (Davidson and Mellor, 2001; Fuchsman, 2008; Marvasti and Fuchsman, 2012). It could, however, be reasoned that since the study was based on systematic review of literature, the study's potential weakness is that may not be practicable, as no follow up study was done to validate the results. Kinney (2014) also did another comprehensive systematic review of literature to compare PTSD severity among Afghan/Iraq and Vietnam War veterans in the United States. Unlike Australian studies that focused on integrating both genders, Kinney’s (2014) strength was in separating the male and female veterans, from which he established that the implications of gender disparity between female and male war veterans might be adequately sufficient to support the idea that mixed-gender programs or independent programs for women be initiated. The weakness of the study is that no follow up study was conducted, which makes it worthwhile to argue that while the data may be appealing, it is only significant, as it rationalises a reason for further research on the findings. Still, Fontana et al. (2010) also studied war veterans in the United States, and classified them in terms of males and females. The study recommended that the Department of Veterans Affairs (VA) should take charge of addressing (PTSD) and related psychiatric disorders of war zone exposure among the veterans based on their gender differences, as well as increase the role of women through evaluation of their treatment programs in respect to the needs of female veterans. The findings may, however, not be practicable, as no follow up study was done. Fontana et al. (2010) also supported the need for specialized intervention programs for PTSD where consideration is given to program design and planning aimed at addressing female and male severity differences in each program that treats female veterans. Fontana et al. (2010) is more valid as a follow up study was conducted. What the two studies in the United States show is that scholars in the United States appreciate that women today play a significant role in the armed forces, and, therefore, the interventions should consider their different levels of risks to PTSD while recommending treatment. Marvasti and Fuchman (2012) examined the effects of war and combat on American veterans. His findings are consistent with Australian findings that war veterans are at high risk of PTSD. Marvasti and Fuchman (2012) found that the severity of PTSD on veterans depended on the intensity of combat, where those who serve more than one tour are more prone to PTSD. In consistency with studies in Australia, the study highlighted problems with self-esteem and self-image, as well as lack of confidence among the veterans. However, Marvasti and Fuchman (2012) only used systematic review of literature or document analysis, which makes it less authentic, unless a follow-up study is done. Findings: Implication on intervention The PTSD affects a spectrum of long-term mental health disorders, physical health, as well as social functioning problems among both female and male veterans, although the males are more vulnerable. The underlying consequences on war veterans include higher prevalence of family breakdowns, and unemployment. This implies that the families of the war veterans are also prone to PTSD. There is a need for inclusion of families in the veteran PTSD treatment programmes, as there is a link of the occurrence of PTSD in traumatised veterans to family dysfunction and symptoms in their children, such as self-esteem. There is also a need to address PTSD and related psychiatric disorders of war zone exposure among the veterans based on their gender differences, as well as increase the role of women through evaluation of their treatment programs in respect to the needs of female veterans. There is a need to initiate mixed-gender programs or independent programs for treatment of female war veterans. There is, therefore, a need for specialized intervention programs for PTSD where consideration is given to program design and planning aimed at addressing female and male severity differences in each program that treats female veterans. Conclusion The war veterans in Australia, especially those who experience long-term mental health problems, are at high risk of PTSD. These findings are consistent with findings derived from studies in the United States and Australia. From the literature review, it is established that the Australian military personnel who are exposed to the traumatic event stressors by warfare have been given less attention. In fact, strategies to overcome these stressors are still not in place. Similarly, female veterans have been given less priority. At the same time, veterans’ family members who report more subjective traumatic exposure and experience higher rates of stressors are more likely to show poorer mental and physical health outcomes, engage in violent behaviours, become highly dependent on drugs and report higher rate of unemployment and family breakdown. Therefore, there is also need to address PTSD and related psychiatric disorders of war zone exposure among the veterans based on their gender differences. There is a need for inclusion of families in the veteran PTSD treatment programmes. References Balfour, M., Westwood, M., & Buchanan, M. J. (2014).Protecting into emotion: therapeutic enactments with military veterans transitioning back into civilian life. Research in Drama Education, 19, 165-181. doi: 10.1080/13569783.2014.911806 Boman, B. (1985).Psychiatric disturbances among Australian Vietnam veterans. Military Medicine, 150, 77-79. Davidson, A. C., & Mellor, D. J. (2001). The adjustment of children of Australian Vietnam veterans: is there evidence for the transgenerational transmission of the effects of war-related trauma? Australian & New Zealand Journal of Psychiatry, 35, 345-351. doi: 10.1046/j.1440-1614.2001.00897.x Fontana, A. Rosenheck, R. & Desai, R. (2009). Female Veterans of Iraq and Afghanistan Seeking Care from VA Specialized PTSD Programs: Comparison with Male Veterans and Female War Zone Veterans of Previous Eras. Journal of Women’s Health 19(4), 1-7 Friedman, M. (2013). History of PTSD in Veterans: Civil War to DSM-5. PTSD: National Center for PTSD. Retrieved: Fuchsman, K. (2008). Traumatized Soldiers. The Journal of Psychohistory 36(1), 73-83 Kinner, W. (2015). Comparing PTSD Among Returning War Veterans. Journal of Military and Veterans' Health 20(3), 1-5 MacDonald, C., Chamberlain, K. & Long, N. (1996). Posttraumatic Stress DIsorder (PTSD) and its Effects in Vietnam Veterans: The New Zealand Experience. New Zealand Journal of Psychology 24(2), 63-68 Marvasti, J. A., & Fuchsman, K. A. (2012).Impact of war and combat on veterans.In J. A. Marvasti (Ed.), War trauma in veterans and their families: Diagnosis and management of PTSD, TBI and comorbidities of combat trauma (pp. 5-22). Springfield, Illinois, USA: Charles C Thomas Publisher, Ltd. Waller, M., Treloar, S. A., Sim, M. R., McFarlane, A. C., McGuire, A. C. L., Bleier, J., & Dobson, A. J. (2012). Traumatic events, other operational stressors and physical and mental health reported by Australian Defence Force personnel following peacekeeping and war-like deployments. BMC Psychiatry, 12, 88-98. doi: 10.1186/1471-244X-12-88 Read More

According to Friedman (2013), the early evocative accounts of disorders related to stress, which are connected to the history of war globally. An early example is provided by Stephen Crane’s pensive accounts of the reaction of the Civil War veterans after the war. The account of psychological symptoms after the military trauma goes back in history to the ancient times. One of these instances was the American Civil War (1861-1865) and the Franco-Prussian War (1870-1871), which marked the beginning of formal medical efforts in order to resolve the problems that the military Veterans who participated in the combat faced.

There are also links to the railroad accidents, which provided an understanding of the trauma-related conditions (Friedman, 2013). Before the U.S. military attempts, an Austrian physician Josef Leopold (1761) is said to have written about cases of "nostalgia" in combatants. This included those who were experiencing military trauma, where some soldiers complained that they missed home, felt sad, as well as had anxiety and problems with sleeping. Such description of symptoms of PTSD created a model of psychological injury, which survived into the Civil War.

In another case, Jacob Mendez Da Costa of the United States conducted a study on the Civil War soldiers who exhibited such "cardiac" symptoms and portrayed it as overstimulation of the nervous system of the heart. They were later dubbed "Da Costa's Syndrome." European documents of the "railway spine” also supported the idea that physical injury contributed to PTSD-like symptoms (Friedman, 2013). The increase in the number of railway travels also led to increased railway accidents, where diagnosis of injured passengers indicated problems to the central nervous system.

A case in point is Charles Dickens who, in 1865, was involved in a rail accident recorded symptoms of sleeplessness and anxiety due to trauma. Later in the 20th century or 1919 precisely, President Wilson declared November 11 the first observance of Armistice Day, immediately after the end of the World War I. During the War, treatment differed. While some soldiers only received a few days' rest before they returned to active combat, those with chronic or severe symptoms were subjected to "electrotherapy" (shock) or “hydrotherapy" (water) (Friedman, 2013).

Psychological well-being of war veterans and impact on their civilian life Previous scholarly researches that investigated how war veterans readjust have showed that PTSD is an outcome of exposure to combat among Australian, American, or New Zealand war veterans. An early study by MacDonald et al. (1995) concluded that veterans were at high risk of PTSD. The researchers had examined war veterans in the New Zealand and concluded that war veterans with PTSD were further at high risk of a spectrum of long-term mental health disorders, physical health, as well as social functioning problems.

The study confirmed that war veterans in New Zealand and the United States suffered the same consequences due to the combat experiences, which led higher prevalence of family breakdowns, and unemployment. Later studies have also brought evidence showing the prevalence of PTSD on war veterans. Like MacDonald et al. (1995), a later study in Australia by Davidson and Mellor (2001) confirmed that PTSD affected a spectrum of long-term mental health disorders, physical health, as well as social functioning problems.

Both studies served to validate findings of an earlier research paper by Boman (1985), which forms one of the seminal researches on veteran PTSD in Australia. In the study, Boman (1985) indicated that war veterans had impulsive acting-out behaviour due to alcohol influences, which led to domestic crisis, marital discord and high rate of criminal conviction due to assault, fraud and murder. A related study by Kinney (2015) was more comprehensive. Kinney (2015) examined the US military personnel who participated in combats in Afghanistan and Iraq wars.

In his review, Kinney (2015) argued that Afghan War and Iraqi War veterans differed significantly from the Vietnam War veterans when it comes to their clinical statuses.

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