. "INDEX." Gulf War and Health: Volume 6. Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress. Washington, DC: The National Academies Press, 2008.
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Gulf War and Health, Volume 6: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress
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INDEX
A
Accidental death, 237–247
primary studies, 237–241, 245–247
PTSD and, 242–243
secondary studies, 241–242
ACR. See American College of Rheumatology
ACTH. See Adrenocorticotrophic hormone, corticotropin
Adrenocorticotrophic hormone (ACTH). See Corticotropin
Afghanistan. See Operation Enduring Freedom
Age, and PTSD, 88
Agent Orange, 115, 117–119, 127, 201, 214, 216, 218, 318
Air Force cohorts, 136, 147, 149, 161, 251–253
Alcohol abuse or dependence, 8, 55, 57, 83, 86, 89, 144–145, 150, 158–163, 224, 238, 243, 250–251, 289, 291, 319
Alcohol Use Disorder Identification Test (AUDIT), 158, 161–162
Allostasis, 54–55
Allostatic load and overload, 49–50, 54–56
Alternate Family Violence Measure, 289
American College of Rheumatology (ACR), 222, 226–227, 255
American Indian veterans. See Race and ethnicity
American Psychiatric Association (APA), 76, 85
Amygdala, importance in stress response, 51–53, 57–58, 60–61, 65, 98–100
Animal studies, 18–19, 58–59, 96–97
Anticipation of deployment to a war zone, a deployment–related stressor, 36
Antisocial personality disorder, 145, 161, 284, 289, 300, 306
Anxiety disorders, 2, 7, 12, 30, 35, 51, 53, 84, 86, 88–89, 91, 100, 144–157, 193, 253, 257, 308–309, 319.
See also Generalized anxiety disorder
Anxiety Sensitivity Index (ASI), 149
APA. See American Psychiatric Association
Army cohorts, 34, 79, 118, 125–126, 142–144, 147, 158, 167, 229, 237, 241, 253, 287
female, 38
ASI. See Anxiety Sensitivity Index
Assault. See Sexual assault and harassment
Assessment of the strength of evidence, 25–26
biologic plausibility, 26
consistency of association, 26
dose–response relationship, 25
specificity of association, 26
strength of an association, 25
temporal relationship, 25
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AUDIT. See Alcohol Use Disorder Identification Test
Auditory-Verbal Learning Test, 169
Australian troops, 79–80, 88–89, 91–92, 123–124, 134, 146, 150, 152, 163, 180, 185, 199, 216, 231–233, 248–249, 253, 256, 287, 318
Autoimmune diseases, 63, 137, 217–218
B
Barsky Amplification Scale, 149
Bed nucleus of the stria terminalis (BNST), 51–53, 61
Bias, in identifying and evaluating the literature, 24
Biologic plausibility, in assessing the strength of evidence, 26
Birth defects, 12
and miscarriage, 229–231
primary studies, 229–231
secondary studies, 231
Birth Defects Monitoring Programs, 229
Black veterans. See Race and ethnicity
Blood lipids, 193
concentrations of, 188
BMI. See Body-mass index
BNST. See Bed nucleus of the stria terminalis
Body-mass index (BMI), 61–62, 138, 188–189
Brain function, 60–61
and anxiety and fear, 61
and memory and cognition, 60–61
in stress response, 60–61
Brain-gut axis
and IBS, 64–65, 204
in stress response, 64–66
Brain-imaging techniques, 60
Brain’s role in stress response, 50–56, 60–61
allostatic load and overload, 54–56
gastrointestinal (GI) and brain-gut axis, 64–66
hypothalamus-pituitary-adrenal axis, 53–54
importance of the amygdala, 51–53
reticular activating system, 51
Brief Life Stress Questionnaire, 224
Brief Symptom Inventory, 151
British troops. See United Kingdom troops
C
C-reactive protein, 58, 64
CAGE scale, 158
California Verbal Learning Test (CVLT), 168–169
Canadian troops, 36, 79, 123, 136, 148, 162, 176, 225, 248, 250, 318
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Cancer, 117–132
all cancers, 118–125
Gulf War, 120–123
PTSD and, 125–126
skin cancer, 124–125
testicular cancer, 123–124
Vietnam War, 118–120
CAPS. See Clinician-Administered PTSD Scale
Cardiovascular diseases, 183–196
blood lipid concentrations, 188
cardiovascular symptoms, 183–184, 191–192
heart disease, 186–187
hypertension, 184–186, 189–190
PTSD and, 188–193
Cardiovascular reactivity, PTSD and, 190–191
Cardiovascular system, in stress response, 63–64
Career Development Study (CDS), 285–286
Case-control studies, 21–22
Casualty Information System, 239
Categories of association, 4–5, 26–28.
See also Summary of findings regarding the association between deployment to a war zone and specific health and psychosocial effects
in identifying and evaluating the literature, 26–28
inadequate/insufficient evidence to determine whether an association exists, 5, 27
limited but suggestive evidence of an association, 4, 27
limited/suggestive evidence of no association, 5, 28
sufficient evidence of a causal relationship, 4, 27
sufficient evidence of an association, 4, 27
CCEP. See Comprehensive Clinical Evaluation Program
CDC. See Centers for Disease Control and Prevention
CDS. See Career Development Study
Centers for Disease Control and Prevention (CDC), 118, 124, 127, 133, 142–143, 158, 168, 174–177, 185, 187, 193, 237, 248, 251–253
Central nervous system (CNS), 53, 59, 65–66, 207, 210, 225
CES. See Combat Exposure Scale
CFS. See Chronic fatigue syndrome
Chalder fatigue scale, 176
CHD. See Coronary heart disease
Chemical stressors, deployment-related, 39
Child Behavior Checklist, 285, 293
Childhood Physical Punishment Scale, 293
Children, psychosocial effects of parents’ deployment on, 285–286, 291–293
Children’s Depression Inventory, 292
Chronic fatigue syndrome (CFS), 86–87, 174–178, 253
case definition of, 174
primary studies, 175
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PTSD and, 176–177
secondary studies, 175–176
Chronic obstructive pulmonary disease (COPD), 197, 201
Chronic stress, 6, 13, 15, 52–57
brain function, 60–61
cardiovascular system, 63–64
endocrine system, 61–62
gastrointestinal system and brain-gut axis, 64–66
and health, 59–66
immune and inflammatory responses, 62–63
Chronic widespread pain (CWP), 222–228, 255–257.
See also Fibromyalgia
primary studies, 222–224
PTSD and, 226, 256–257
secondary studies, 224–226
Chronicity of stressors, 57
CIDI. See Composite International Diagnostic Interview
Clinical features, of PTSD, 76–77
Clinician-Administered PTSD Scale (CAPS), 76, 138, 226, 291, 309
CNS. See Central nervous system
Cognition, 60–61
Cohort studies, 20–21
Combat exposure, 28, 33–34, 42, 81
and PTSD risk, 88, 90, 92–93
Combat Exposure Index, 145
Combat Exposure Scale (CES), 117, 224, 253, 305, 317
Expanded, 146, 224
Committee on Gulf War and Health: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress,
approach to its charge, 2–3, 14–15
interpretation of its charge, 2, 13–14
Comorbidity, and PTSD, 78, 84–85
Composite International Diagnostic Interview (CIDI), 23, 76, 142, 147
Comprehensive Clinical Evaluation Program (CCEP), 181, 223
Conclusions, 317–320
about cancer, 126–127
about cardiovascular diseases, 193–194
about chronic fatigue syndrome, 177
about chronic stress and health, 66
about deployment-related stressors, 43
about digestive system disorders, 209–210
about employment, 309–310
about endocrine diseases, 139–140
about fibromyalgia and chronic widespread pain, 226–227
about gastrointestinal (GI) effects, 209–210
about homelessness, 301–302
about incarceration, 306
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about marital and family conflict, 293–294
about neurobehavioral and neurocognitive effects, 170
about neurobiology, 100
about psychiatric disorders, 152
about reproductive effects, 233
about respiratory system diseases, 200–201
about skin disorders, 218–219
about sleep disturbances, 182
about substance-use disorders, 162–163
about suicide and accidental death, 243–244
about symptom reporting, 257–258
quality of the studies, 317–318
summary of, 7–9, 318–320
Conflict Tactics Scale (CTS), 287–288
Confounding factors, 21
in identifying and evaluating the literature, 24
Consistency of association, in assessing the strength of evidence, 26
Continuous Performance Test, 169
Controllability, modifying the stress response, 59
COPD. See Chronic obstructive pulmonary disease
Coping strategies, and PTSD, 89–90
Coronary heart disease (CHD). See Heart Disease
Corticotropin, 52–53, 58, 64, 96
Corticotropin-releasing hormone (CRH), 52–53, 58, 64, 96–98, 208
Cortisol, 53–54, 58–61, 96–97, 100
Course, of PTSD, 81–84
CRH. See Corticotrophin-releasing hormone
Cross-sectional studies, 22
CTS. See Conflict Tactics Scale
CVLT. See California Verbal Learning Test
CWP. See Chronic widespread pain
Cytokines, 54, 62
D
Da Costa syndrome, 183
Danish troops, 41, 167, 188, 198, 215, 232–233, 248–249, 318
Demographics of military populations, 12–13
Department of Defense (DoD)
Mental Health Advisory Team, 241, 283
Solider and Marine Well-Being Survey, 34
Task Force on Domestic Violence, 287
Deployment-related stressors, 2, 5–6, 13, 31–47, 115
anticipation of deployment to a war zone, 36–37
conclusions, 43
environmental and chemical stressors, 39
impacts on families and children, 292–293
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living conditions, 38
military sexual assault and harassment, 37–38
noncombat stressors, 35
peacekeepers, 40–41
Reserve and National Guard troops, 39–40
stressors during combat, 32–35
women, 41–43
Depressive disorders, 51, 55–56, 91–92, 142–157, 193, 257, 319.
See also Major depressive disorder;
Psychiatric Disorders
Developmental history, and PTSD, 88–89
Diabetes, 133–135
primary studies, 133
secondary studies, 134–135
Diagnosis, of PTSD, 76–77
Diagnostic and Statistical Manual of Mental Disorders (DSM), 7, 76–77, 81, 84–85, 142, 158, 256
diagnostic criteria for PTSD, 77
Diagnostic Interview Schedule (DIS), 142, 217, 242
Digestive system disorders, 204–213
primary studies, 205–206
PTSD and, 208–209
secondary studies, 207–208
DIS. See Diagnostic Interview Schedule
Disability, and PTSD, 85–86
DoD. See Department of Defense
Dose-response relationship,
in assessing the strength of evidence, 4, 25
of cancer and PTSD, 125
of combat and PTSD, 92, 94
of early life stress and PTSD, 58
of exposure to war-zone stressors and PTSD, 144, 150
of sex and PTSD, 87
of skin disorders and PTSD, 216
Drug abuse or dependence, 8, 84, 86, 158–163, 238–239, 243, 251, 320
DSM. See Diagnostic and Statistical Manual of Mental Disorders
E
Early-life stress
modifying the stress response, 58
and PTSD, 88–89
Employment, 308–311
Endocrine diseases, 133–141
diabetes, 133–135
obesity, 138–139
PTSD and, 137–138
thyroid disease, 135–137
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Endocrine system in stress response, 61–62
insulin resistance and glucose intolerance, 62
obesity, 61–62
Environmental stressors, 6, 39, 49, 197
Epidemiologic studies, 7, 17–22
case-control studies, 21–22
cohort studies, 20–21
cross-sectional studies, 22
Ethnicity. See Race and ethnicity
Evaluation criteria, 3–4
primary studies, 3
secondary, or support, studies, 4
Evaluation of the literature, 17–29
Evidence, assessment of the strength of, 25–26
Evidence types, 18–22
animal studies, 18–19
epidemiologic studies, 19–22
F
Fear conditioning, in the neurobiology of PTSD, 97–98
Fertility difficulties, 231–232
primary studies, 231–232
secondary studies, 232
Fibromyalgia and chronic widespread pain, 222–228
primary studies, 222–224
PTSD and, 226
secondary studies, 224–226
“Fight or flight” stress response, 6, 14, 49, 51–52, 54
G
GAD. See Generalized anxiety disorder
Gastrointestinal (GI) effects, 204–213, 251
primary studies, 205–206
PTSD and, 208–209
secondary studies, 207–208
in stress response, 64–66
General symptoms and signs, 248–250, 259
PTSD and reporting of, 250–251
Generalized anxiety disorder (GAD), 144–152, 169, 180
Genes, modifying the stress response, 56–58
GI. See Gastrointestinal (GI) effects
Glucocorticoids, 60
receptors of, 53–54, 96
Glucose intolerance, 62
Graves disease, 137, 139.
See also Endocrine diseases;
Thyroid disease
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Graves registration, 13, 35
Grooved Pegboard Test, 169
Gulf War, 1, 5, 32, 35, 38–43, 79, 82–83, 88–89, 92, 115, 120–121, 125–127, 318
demographics, 12–13
living conditions, 37–38
prevalence of PTSD in, 79, 82–83, 87–88
Gulf War Health Registry, 253
Gulf War illness, 122, 179, 205, 224.
See also Unexplained illness
H
Harassment. See Sexual assault and harassment
Hardiness, and PTSD, 89–90
Hawaiian Vietnam Veterans Project (HVVP), 87
Health effects, 115–260
assessment of as an inclusion criterion, 23
cancer, 117–132
cardiovascular diseases, 183–196
chronic fatigue syndrome, 174–178
digestive system disorders, 204–213
endocrine diseases, 133–141
fibromyalgia and chronic widespread pain, 222–228
gastrointestinal effects, 204–213
neurobehavioral and neurocognitive effects, 167–173
organization of chapter, 115–117
psychiatric disorders, 142–157
reproductive effects, 229–236
respiratory system diseases, 197–203
skin disorders, 214–221
sleep disturbances, 179–182
substance-use disorders, 158–166
suicide and accidental death, 237–247
symptom reporting, 248–260
Heart disease, 183–184, 186–187, 189, 192–194
primary studies, 186–187
secondary studies, 187
Heart rate, PTSD and, 63, 188–191
Hispanic veterans. See Race and ethnicity
Hodgkin’s lymphoma, 118–119
Homeless Chronically Mentally Ill Veterans Program, 300
Homelessness, 299–303
primary studies, 299–300
secondary studies, 300–301
Homeostasis, 54
HPA. See Hypothalamus-pituitary-adrenal axis
HVVP. See Hawaiian Vietnam Veterans Project
Hypertension, 183–186
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primary studies, 184–185
PTSD and, 189–190
secondary studies, 185–186
Hypothalamus-pituitary-adrenal (HPA) axis, 50, 53–54, 58, 65, 96–97, 218
alterations in the neurobiology of PTSD, 96–97
in stress response, 53–54
I
IBS. See Irritable bowel syndrome
ICD. See International Statistical Classification of Diseases and Related Health Problems
Immune responses, in stress response, 62–63
Inadequate/insufficient evidence to determine whether an association exists, 5, 9, 27, 320
Incarceration, 304–307
Inclusion criteria, 23
health-effect assessment, 23
in identifying and evaluating the literature, 23
methodologic rigor, 23
primary studies, 23
secondary studies, 23
Inflammatory responses, in stress response, 62–63
Insulin resistance, 62
International Statistical Classification of Diseases and Related Health Problems (ICD), 115, 122, 136, 149, 186, 193, 238, 243–244, 248, 251, 254
Intimate partner violence, 287–291
primary studies, 288–290
secondary studies, 290–291
Iowa Persian Gulf Study Group cohort, 42, 122, 125, 148–149, 159, 200, 217, 223–225, 248, 254, 304
Iraq. See Operation Iraqi Freedom
Irritable bowel syndrome (IBS), 64–65, 204–213
K
Korean War, 3, 7, 14, 17, 31, 84, 91, 100, 117, 126, 137, 139, 181, 192, 194, 208, 210, 218–219, 249–250, 300, 318
prevalence of PTSD in, 80–81
L
Limitations of veteran studies, 5, 217–218
in identifying and evaluating the literature, 28
Limited but suggestive evidence of an association, 4, 8, 27, 319–320
Limited/suggestive evidence of no association, 5, 9, 28, 320
Liver cancer, primary, 118–119
Living conditions, as deployment-related stressors, 38
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M
Magnetic resonance imaging (MRI), 99
Major depressive disorder (MDD), 7, 76, 84–86, 91–92, 96, 142–157, 189, 226, 243, 253, 309
Marine cohorts, 34, 79, 119, 253
Marital and family conflict, 283–298
deployment impacts on families and children, 291–293
intimate partner violence, 287–291
primary studies, 284–286
secondary studies, 286–287
MDD. See Major depressive disorder
Memory, 53, 60–61, 167–169, 248–249
Mental Health Advisory Team (MHAT), DoD, 31, 34–35, 92, 241, 283
Meta-analysis, 18, 91, 98, 190, 193, 255, 258
Methodologic rigor, as an inclusion criterion, 23
MHAT. See Mental Health Advisory Team
MI. See Myocardial infarction
Military sexual assault and harassment, 37–38
Military status, and PTSD, 91
Minnesota Multiphasic Personality Inventory (MMPI), 137, 189, 256
Miscarriage
primary studies, 229–231
secondary studies, 231
Mississippi Scale for Combat-Related PTSD, 81, 180, 189, 191–192, 309
MMPI. See Minnesota Multiphasic Personality Inventory
Modifiers of the stress response, 56–59
controllability, 59
early-life stress, 58
genes, 56–58
Motor-vehicle accidents, 238–241
MRI. See Magnetic resonance imaging
Multisymptom-based medical conditions, 2, 12, 251–254
Myocardial infarction (MI), 58, 189, 193
N
NART. See National Adult Reading Test
Nasal cancer, 118–119
Nasopharyngeal cancer, 118–119
National Adult Reading Test (NART), 167
National Child Abuse and Neglect Data System, 293
National Comorbidity Survey (NCS), 78, 83–84, 158–161, 189, 290, 309
National Crime Victimization Survey, 287
National Death Index, 123, 237–238, 240
National Family Violence Re-Survey, 287
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National Guard troops, 13, 32, 35, 39–40, 79, 83, 122, 124, 146, 148, 159–160, 176–177, 224–225, 251–252.
See also Reservists
deployment-related stressors for, 39–40
National Health Interview Surveys, 242
National Health Survey of Gulf War Era Veterans and Their Families, 38, 133, 147, 175, 185, 198, 206, 215, 222
National Law Center on Homelessness and Poverty, 299
National Survey of Homeless Assistance Providers, 300
National Survey of the Vietnam Generation (NSVG), 143, 284–285, 288–290, 308
National Vietnam Veterans Readjustment Study (NVVRS), 33, 78, 80, 84–85, 87–88, 92, 117, 143–144, 158–159, 162, 180, 182, 251, 284–285, 288, 291, 293–294, 299, 305, 308–309, 318
Naval Mobile Construction Battalions (Seabees), 134, 136, 148, 175, 179, 184–185, 198–200, 205, 209
Navy cohorts, 43, 91, 147, 179, 253
NCS. See National Comorbidity Survey
Neurobehavioral and neurocognitive effects, 167–173
primary studies, 167–168
PTSD and, 168–170
secondary studies, 168
Neurobiology of PTSD, 94–100
fear conditioning, 97–98
HPA-axis alterations, 96–97
neuroimaging studies, 99–100
sleep disturbances, 98–99
startle reflex, 98
sympathetic nervous system alterations, 94–96
Neurocognition Deployment Health Study, 167
Neuroimaging studies, in the neurobiology of PTSD, 99–100
NHL. See Non-Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma (NHL), 118–119, 126–127
Noncombat stressors, deployment-related, 2, 13, 31, 35
Normative Aging Study, 80, 90, 189, 192, 250, 318
NSVG. See National Survey of the Vietnam Generation
NVVRS. See National Vietnam Veterans Readjustment Study
O
Obesity, 61–62, 138–139
Obsessive-compulsive disorder, 145–147
OEF. See Operation Enduring Freedom
OIF. See Operation Iraqi Freedom
Operation Desert Shield, 11, 13, 32
Operation Desert Storm, 1, 11, 13, 32
Operation Enduring Freedom (OEF), 1–3, 6–7, 11–14, 28, 31, 33, 39, 40, 43, 88, 93, 100, 150–151, 248, 255, 258, 283
prevalence of PTSD in, 79
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Operation Iraqi Freedom (OIF), 1–3, 6–7, 11–14, 28, 31–35, 38–40, 43, 79, 88, 94, 100, 150–151, 167, 191, 208, 241, 243, 248, 255, 257–258, 283
prevalence of PTSD in, 79
P
Panic disorder, 84, 95, 97, 145–149
Parental Problems Index (PPI), 285
PB. See Pyridostigmine bromide
PDHA. See Postdeployment health assessment
Peacekeepers, deployment-related stressors for, 35, 40–41
and health effects, 162, 167, 170, 180, 188, 215, 232–233, 249–250
and psychosocial effects, 287, 290
Persian Gulf War Veterans Act, 1, 12
Phobias, 146–148, 150
Physical injury, and PTSD, 93–94
Postdeployment health assessment (PDHA), 150–151
Posttraumatic stress disorder (PTSD), 2–3, 5–8, 12, 15, 18, 23, 28, 31, 35, 43, 51, 59–60, 75–113, 116, 118, 137–140, 142–152, 159, 162, 168–170, 176–183, 188–194, 205, 208–210, 249–250, 283–294, 299, 304–305, 308–309, 317–319
and cancer, 125–126, 132
and cardiovascular disease, 192–193
and cardiovascular reactivity, 190–191
and cardiovascular symptoms, 191–192
and chronic fatigue syndrome, 176–177
and chronic pain, 256–257
and comorbidity, 84–85
conclusions, 100
course of, 81–84
diagnosis and clinical features, 76–77
and digestive system disorders, 208–209
and disability, 85–86
and endocrine diseases, 137–139
and fibromyalgia and chronic widespread pain, 226
and gastrointestinal effects, 208–209
and general symptom reporting, 250–251
and heart rate, 188–189
and hypertension, 189–190
and neurobehavioral and neurocognitive effects, 168–170
and neurobiology, 94–100
and prevalence, 78–81
and reproductive effects, 233
and respiratory system diseases, 200
risk and protective factors for, 86–94
and skin disorders, 216–218
and sleep disturbances, 180–182
and substance-use disorders, 162
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and suicide and accidental death, 242–243
and unexplained illness, 254–255
PPI. See Parental Problems Index
Prevalence of PTSD, 78–83
in the Gulf War, 79
in the Korean War, 80–81
in Operation Enduring Freedom and Operation Iraqi Freedom, 79
in U.S. military populations, estimated, 82–83
in the Vietnam War, 80
in World War II, 80–81
Proinflammatory cytokines, 54, 62
Propranolol, 95–96
Protective factors for PTSD. See Risk and protective factors
Psychiatric disorders, 142–157.
See also Posttraumatic stress disorder;
Substance-use disorders
primary studies, 142–147
secondary studies, 148–151
Psychiatric history, and PTSD, 89
Psychosocial effects, 8, 283–319
employment, 308–311
families and children, 291–293
homelessness, 299–303
incarceration, 304–307
intimate partner violence, 287–291
marital and family conflict, 283–298
PTSD. See Posttraumatic stress disorder
Pyridostigmine bromide (PB), 39
R
Race and ethnicity, and PTSD, 87–88, 305
Random error, in identifying and evaluating the literature, 24–25
Rapid-eye-movement (REM) sleep, 51, 98–99, 181
RAS. See Reticular activating system
rCBF. See Regional cerebral blood flow
Recommendations, 321
Regional cerebral blood flow (rCBF), 99
REM. See Rapid-eye-movement sleep
Reproductive effects, 229–236
birth defects and miscarriage, 229–231
fertility difficulties, 231–232
PTSD and, 233
sexual dysfunction, 232–233
Reservists, 11, 31, 39–40.
See also National Guard troops
deployment-related stressors for, 39–40
Respiratory system diseases, 197–203
primary studies, 197–199
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PTSD and, 200
secondary studies, 199–200
Reticular activating system (RAS), in stress response, 51–52
Rey-Osterrieth Complex Figure Drawing Test, 168–169
Risk and protective factors for PTSD, 86–94
age, 88
combat exposure, 92–93
developmental history and early-life stress, 88–89
hardiness, coping strategies, and sense of control, 89–90
physical injury, 93–94
psychiatric history, 89
race and ethnicity, 87–88
sex, 86–87
social support, 91–92
socioeconomic status and military status, 91
Rome Criteria, for functional GI disorders, 204
S
Schedule for Affective Disorders and Schizophrenia-Lifetime Version, 243
SCID. See Structured Clinical Interview for DSM
Seabee Health Study, 186
Seabees. See Naval Mobile Construction Battalions
Self-reports, 4, 23, 28, 33, 41, 79, 116, 120, 122, 124–126, 133–138, 146–150, 167, 175–176, 183–187, 197–201, 205–207, 214–217, 222, 224–226, 229, 231–232, 242, 250–258, 288, 292, 305, 317–318
of sleep disturbance, 179–180
Sense of control, and PTSD, 89–90
Serotonin, 56–59, 94
Sex, and PTSD, 86–87
Sexual assault and harassment, military, 37–38
Sexual dysfunction, 232–233
Shell shock, 75
Skin cancer, 124–125, 131
Skin disorders, 214–221
primary studies, 214–215
PTSD and, 216–218
secondary studies, 215–216
Sleep disturbances, 98–99, 179–182
in the neurobiology of PTSD, 98–99
PTSD and, 180–182
self-reports of, 179–180
Social Isolation Index, 285
Social support, and PTSD, 91–92
Socioeconomic status, and PTSD, 91
Soft-tissue sarcoma, 118–119
Soldier and Marine Well-Being Survey, DoD, 34.
See also Mental Health Advisory Team
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Somatoform pain disorder, 150, 256
Specificity of association, in assessing the strength of evidence, 26
Spouse/Partner Interview, of the National Vietnam Veterans Readjustment Study, 284–285
Standard Family Violence Measure, 289
Startle reflex, in the neurobiology of PTSD, 98
Strength of association, in assessing the strength of evidence, 25
Strength of evidence, assessment of, 25–26
Stress response, 6, 13–14, 49–74
central role of the brain, 50–56
chronic stress and health, 59–66
conclusions, 66
modifiers of the stress response, 56–59
pathways of, 52
physiologic changes during, 50
Stressors experienced by U.S. forces
anticipation of deployment to a war zone, 36–37
chronicity of, 56–57
deployment-related, 5–7, 11, 13–15, 31–47
during combat, 32–35
environmental and chemical, 39
living conditions, 38
military sexual assault and harassment, 37–38
noncombat, 35
Structured Clinical Interview for DSM (SCID), 23, 76, 80, 92, 142, 144, 146, 149–150, 181, 189, 191, 284–285, 291, 305
Substance-use disorders, 60, 84, 89, 149, 158–166.
See also Alcohol abuse or dependence;
Drug abuse or dependence;
Psychiatric disorders
primary studies, 158–160, 164–166
PTSD and, 162
secondary studies, 160–162
Sufficient evidence of a causal relationship, 4, 8, 27, 319
Sufficient evidence of an association, 4, 8, 27, 319
Suicide, 237–247
ideation, 148, 151
primary studies, 237–241
PTSD and, 242–243
secondary studies, 241–242
Summary of findings regarding the association between deployment to a war zone and specific health and psychosocial effects, 8–9, 319–320
inadequate/insufficient evidence to determine whether an association exists, 9, 320
limited but suggestive evidence of an association, 8, 319–320
limited/suggestive evidence of no association, 9, 320
schematic depiction of, 15
sufficient evidence of a causal relationship, 8, 319
sufficient evidence of an association, 8, 319
Sympathetic nervous system alterations, in the neurobiology of PTSD, 94–96
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Symptom reporting, 248–260
chronic pain, 255–256
general symptoms and signs, 248–250
PTSD and chronic pain, 256–257
PTSD and general symptom reporting, 250–251
PTSD and unexplained illness, 254–255
unexplained illness, 251–254
T
T3. See Triiodothyronine
T4. See Thyroxine
Task Force on Domestic Violence, DoD, 287
Temporal relationship, in assessing the strength of evidence, 25
Test of Memory Malingering (TOMM), 168
Testicular cancer, 123–124, 131
Thyroid disease, 135–137
primary studies, 135–136
secondary studies, 136–137
Thyroid-stimulating hormone (TSH), 133, 135–136, 138–139
Thyrotropin. See Thyroid-stimulating hormone
Thyroxine (T4), 135–136, 138
TOMM. See Test of Memory Malingering
Trauma. See Posttraumatic stress disorder
Triiodothyronine (T3), 135–136, 138
TSH. See Thyroid-stimulating hormone
Types of evidence, in identifying and evaluating the literature, 18–22
U
UK. See United Kingdom troops
UN. See United Nations
Unexplained illness, 90, 251–254, 257–260
PTSD and, 254–255
United Kingdom (UK) troops, 36, 75, 79, 121, 123, 135, 167, 175, 180, 184, 214–216, 222, 225–226, 232–233, 241, 248, 318
United Nations (UN), 40–41, 188, 250
University of Pennsylvania Smell Identification Test, 169–170
V
VES. See Vietnam Experience Study
VET. See Vietnam-Era Twin Registry
Veteran studies, limitations of, 5, 28, 317–318
Veterans Health Study, 137, 192, 217, 251
Veterans Programs Enhancement Act, 1, 12
Vietnam-Era Twin Registry (VET), 134, 145, 159, 163, 191, 207
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Vietnam Experience Study (VES), 80, 87, 118, 133, 135, 137, 142, 158, 161–162, 168–169, 185, 187, 193, 197, 215–218, 229, 231–233, 237–238, 243, 248, 284, 318
Vietnam War, 6, 13, 31, 33, 35, 40–41, 81, 86, 88, 91–95, 97, 100, 115, 117–120, 127, 139, 162, 194, 201, 210, 214, 216, 218–219, 231, 237–239, 248–250, 256–257, 284, 289–291, 293, 300, 308–309, 318
demographics, 13
prevalence of PTSD in, 80
Violent Behavior Index, 293
W
WAIS-R. See Wechsler Adult Intelligence Scale-revised
“War neurosis,” 75
WCST. See Wisconsin Card Sorting Test
Wechsler Adult Intelligence Scale-revised (WAIS-R), 168–169
Wisconsin Card Sorting Test (WCST), 168–169
Women, 13, 33, 38, 41–43, 137–140, 222, 248
cancer, 117, 120, 123
cardiovascular disease, 186
comorbidity and disability, 84–86
deployment-related stressors for, 41–43
employment, 308
fibromyalgia and chronic pain, PTSD and, 226, 256
gastrointestinal effects, PTSD and, 209
homelessness, 299, 301
marital and family conflict, 284–285, 287–288
prevalence of PTSD in, 78
psychiatric disorders, 144–146, 149
PTSD risk and protective factors, 86–87, 91
reproductive effects, 230–231
respiratory diseases, PTSD and, 200
substance abuse, 158–159, 161–162
suicide and accidental death, 139–140
symptom reporting, PTSD and, 250–251
in the Vietnam war, 80–82
World Health Organization, 78, 158
World Mental Health Survey, 78
World War I, 75, 183
World War II, 7, 13, 31, 33, 41, 75, 83–85, 90–91, 93–94, 137–138, 181, 189, 192, 208, 218–219, 249–250
prevalence of PTSD in, 80–81
Y
Yohimbine, 95
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