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PTSD Seen in Deployed Medical Personnel


 

ATLANTA— Medical personnel returning from combat deployment experience rates of posttraumatic stress disorder only slightly below those of returning soldiers, a study has shown.

Nearly 16% of medical personnel from one U.S. military hospital who had been deployed to the setting of large-scale, ongoing, armed conflict reported symptoms consistent with posttraumatic stress disorder (PTSD) in a voluntary, anonymous survey, said Tonya T. Kolkow, M.D., of Naval Medical Center San Diego. Whether a consequence of their exposure to battle scenes and wounded soldiers or a concern for their own safety and potential injury, “these individuals experience rates of PTSD somewhat comparable with that of returning soldiers who have engaged in battle,” she said. Previous studies have estimated that 15%–20% of combat troops returning from war experience PTSD.

“Medical personnel who provide care in the field and in field hospitals comprise a unique group of individuals with their own distinct trauma exposure,” Dr. Kolkow said in a poster presentation at the annual meeting of the American Psychiatric Association.

“Their training and experience with combat situations is likely to be more limited than that of military operational personnel, while their experience with exposure to illness, trauma, and death may be more extensive,” she noted.

To better understand the effects of war on medical personnel, including physicians, nurses, enlisted medical technicians, and other health care workers, who are assigned within the combat theater, Dr. Kolkow and her colleagues provided a voluntary, anonymous, Internet-based questionnaire to the medical staff of a major U.S. military hospital that has deployed a high number of personnel to support U.S. military efforts in Iraq and Afghanistan. Staff members were asked to participate regardless of whether they had been deployed to a combat zone.

The survey included questions about demographics, prior trauma experience, traumatic exposure, and emotional reactions during deployment, and rates of mental health care use before and after deployment. A total of 310 surveys were completed, including 102 from individuals who were deployed the previous year.

The investigators used the 17-item National Center for PTSD Checklist of the Department of Veterans Affairs (PCL-17) to detect PTSD symptoms and the depression scale of the Patient Health Questionnaire-9 to assess the presence of depressive symptoms.

In their PTSD assessments, “we used two case definitions—a broad screening definition in which respondents were scored as positive for PTSD if they endorsed DSM-IV criteria and a strict screening definition that required the same distribution of symptoms along with a PCL-17 symptom severity score of 50 or higher, indicating a significant level of distress,” Dr. Kolkow noted.

Of those who had been deployed to combat areas within the previous year, 15.7% met the broad PTSD criteria, 8.8% met the more conservative criteria, and 4.9% met criteria for probable depression.

While there was no association between combat deployment and presence of depression, deployment to a combat zone was significantly associated with the presence of both the broad and strict PTSD criteria after controlling for demographic variables,” Dr. Kolkow said.

Individuals at greatest risk for developing PTSD included those who were directly exposed to combat; those who were fired upon by opposition forces; and those who reported experiencing significant fear for their own safety, anxiety, and helplessness during deployment, Dr. Kolkow said.

In the sample as a whole, ages younger than 35 years and the absence of a college degree were significant risk factors for the presence of PTSD. Those findings probably are likely reflective of the fact that the younger, less educated health care providers typically had more combat exposure, she said.

More research is needed to evaluate the psychological impact of combat deployment on medical personnel and to provide direction in addressing their mental health needs, Dr. Kolkow said.

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