The Health of Former Prisoners of War Results from the Medical Examination Survey of Former POWs of World War II and the Korean Conflict (1992) / Chapter Skim
Currently Skimming:
5 Examination of Basic Research Questions
5 Examination of Basic Research Questions
Pages 43-70
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 43... ...
, highlighted the need to focus attention first and foremost on psychiatric morbidity. The 1984-1985 results, however, could not provide any real evidence regarding underlying diagnoses for example, whether the elevated depressive symptoms were associated with a diagnosis of major depression or with, perhaps, posttraumatic stress disorder (PTSD)
|
From page 44... ...
Question E, like others already discussed, was framed with findings from the 1984-1985 follow-up in mind, which had shown that malnourished WW II prisoners of the European theater had significantly elevated depressive symptoms compared with other European prisoners. The malnourished group, however, had not been included in Beebe's 1967 follow-up; consequently, less was known about their physical health in detail.
|
From page 45... ...
Based on previous studies of this cohort, it was expected that psychiatric sequelae would continue to persist. The preliminary findings in Chapter 4 clearly support that expectation: all POW groups had appreciably higher lifetime prevalence rates of depression and PTSD, and there is even the suggestion that schizophrenia might be found at a higher rate among POWs than among corresponding controls.
|
From page 46... ...
PTSD, the Mississippi PTSD scale, was also administered as part of the examination, and Table 5.A.2 displays the prevalence rates of current PTSD based on data from that scale. In contrast to Table 5.A.1, rates are appreciably higher for all POW groups, relative to their corresponding controls.
|
From page 47... ...
As noted earlier, the CES-D scale was administered by mail in the 198~1985 survey whose results showed depressive symptom prevalence rates roughly three to five times higher among POWs than in other studies of comparable populations. The data in Table 5.A.3 are in line with those of the earlier survey, showing apparently similar rates of depressive symptoms, and all POW groups show appreciably higher levels of depressive symptoms than their respective controls.
|
From page 48... ...
PWP WP PWE PWEM WE PWK WK Symptom N=172 N=95 N=120 N=60 N=40 N=264 N=185 Somatization 1.148a 0.839 1.000a 1.254a 0.446 1.402a 1.031 Depression 1.048a 0.634 0.868a 1.128a 0.431 1.314a 0.820 Phobia 0.468a 0.195 0.309 0.503a 0.141 0.705a 0.375 Obsession 1.308a 0.810 1.054 1.324a 0.704 1.479a 0.971 Anxiety 0.889a 0.434 0.706a 0.940a 0.325 l.l95a 0.726 Paranoia 0.863a 0.489 0.663 o.9oOa 0.379 1.197a 0.772 Interpersonal sensitivity 0.852a 0.468 0.665a O.919a 0.285 1.188a 0.676 Hostility 0.740a 0.444 0.602a 0.870a 0.248 1.168a 0.715 Psychoticism 0.611a 0.331 0.453 0.643a 0.253 0.846a 0.490 More items 1.084a 0.744 o.9o3a 1.239a 0.548 1.350a 0.900 Global symptom index 9.049a 5.385 7.209a 9.723a 3.757 11.863a 7.444 Positive symptom distress index 0.190 0.169 0.167 0.192a 0.152 0.213a 0.185 POOP, prisoner of war, Pacific theater, WW II; PWE, prisoner of war, European theater, WW II; PWEM, prisoner of war, malnourished, European theater, WW II; PWK, prisoner of war, Korean conflict; WP, war veteran, Pacific theater, WW II; WE, war veteran, European theater, WW II; WK, wounded war veteran, Korean conflict. aAppreciable difference between POW and control group scores.
|
From page 49... ...
Psychiatric morbidity is appreciably higher in WW II prisoners of the Pacific theater and those of the Korean conflict compared with former WW II POWs of the European theater, as observed in earlier follow-ups of these same groups. QUESTION B What differences, if any, will there be between psychiatric morbidity assessed by interviewer versus questionnaire?
|
From page 50... ...
9 2 14 76b POOP, prisoner of war, Pacific theater, WW II; PWE, prisoner of war, European theater, WW II; PWEM, prisoner of war, malnounshed, European theater, WW II; PWK, prisoner of war, Korean conflict; WP, war veteran, Pacific theater, WW II; WE, war veteran, European theater, WW II; WK, wounded war veteran, Korean conflict; PTSD, posttraumatic stress disorder; SCID, Structured Clinical Interview for DSM-III-R. aNot a noteworthy (see text)
|
From page 51... ...
6 3 6 83a POOP, prisoner of war, Pacific theater, WW II; PWE, prisoner of war, European theater, WW II; PWEM, prisoner of war, malnourished, European theater, WW II; PWK, prisoner of war, Korean conflict; WP, war veteran, Pacific theater, WW II; WE, war veteran, European theater, WW II; WK, wounded war veteran, Korean conflict; PTSD, posttraumatic stress disorder; SCID, Structured Clinical Interview for DSM-III-R. Current examination data are limited to unresolved conditions.
|
From page 52... ...
4 3 15 114b POOP, prisoner of war, Pacific theater, WW II; PWE, prisoner of war, European theater, WW II; PWEM, prisoner of war, maloounshed, European theater, WW II; PWK, prisoner of war, Korean conflict; WP, war veteran, Pacific theater, WW II; WE, war veteran, European theater, WW II; WK, wounded war veteran, Korean conflict; PTSD, posttraumatic stress disorder. Current examination data are limited to unresolved conditions.
|
From page 53... ...
4 4 7 64a POOP, prisoner of war, Pacific theater, WW II; PWE, prisoner of war, European theater, WW II; PWEM, prisoner of war. malnourished, European theater, WW II; PWK, prisoner of war, Korean conflict; WP, war veteran Pacific theater, WW II; WE, war veteran, European theater, WW II; WK, wounded war veteran, Korean conflict; PTSD, posttraumatic stress disorder; SCID, Structured Clinical interview for DSM-III-R.
|
From page 54... ...
5 13 11 ll5a POOP, prisoner of war, Pacific theater, WW II; PWE, prisoner of war, European theater, WW II; PWEM, prisoner of war, malnourished, European theater, WW II; PWK, prisoner of war, Korean conflict; WP, war veteran, Pacific theater, WW II; WE, war veteran, European theater, WW II; WK, wounded war veteran, Korean conflict. Current examination data are limited to unresolved conditions.
|
From page 55... ...
8 8 21 POOP, prisoner of war, Pacific theater, WW II; PWE, prisoner of war, European theater, WW II; PWEM, prisoner of war, malnourished, European theater, WW II; PWK, prisoner of war, Korean conflict; WP, war veteran, Pacific theater, WW II; WE, war veteran, European theater, WW II; WK, wounded war veteran, Korean conflict; CES-D, Center for Epidemiologic Studies depression scale. Current examination data are limited to unresolved conditions.
|
From page 56... ...
Also, the earlier data were coded to the seventh revision of the International Classification of Diseases and Injuries, which necessitates the use of broad diagnostic categories when making comparisons with the 1984-1985 data, which were coded to the ninth revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM)
|
From page 57... ...
Another, less suitable way to look at changes over time is to compare lifetime prevalence rates from the examination with current prevalence rates from the same source, again considering current conditions to be those that are still unresolved. Earlier, Table 4.2 displayed lifetime prevalence rates for all medical conditions in broad ICD rubrics.
|
From page 58... ...
bFactors influencing health status and contact with health services. rent prevalence rates in a similar fashion.
|
From page 59... ...
of Current Medical Conditions by ICD Rubrics and Study Group ICD Rubric PWP PWE PWEM PWK WP WE WK Infectious diseases 22.8 18.3 19.3 27.7 29.6 7.4 20.4 Malignant neoplasms 4.0 2.1 4.8 2.9 1.9 3.7 3.9 Benign neoplasms 11.6 12.0 10.8 10.1 20.4 11.1 9.7 Diabetes mellitus 14.8 13.4 12.1 12.5 18.5 7.4 10.7 Other endocrine diseases 44.8b 47.2 50.6 43.1 66.7b 70.4 48.5 Blood diseases 12 4b 9 9 7.2 11.5b 25.9b 14.8 2l.4b Psychoses 15.2b 11.3 l8.lb 1g.lb 3.7b o.ob s 8b Neuroses 87.6b 82.4b 86.8b 9o.ob 74.1b 63.0b 80.6b Nervous system 31.2b 12.0 20.5 2l.lb 9.3b 11.1 7.8b Sense organs 83.6 82.4 84.3 85.1 85.2 74.1 80.6 Heart disease 56.0 56.3 56.6 46.6 57.4 63.0 50.5 Cerebrovascular disease 1.6 1.4 2.4 2.2 0.0 0.0 2.9 Hypertension and other circulatory diseases 75.2 64.1 77.1 63.2 63.0 66.7 61.2 Acute respiratory 4.8 2.8 6.0 2.9 9.3 3.7 2.9 Chronic respiratory 57.6 54.9 57.8 52.7 53.7 44.4 44.7 Digestive 74.4b 70.4 74.7 8l.6b 57.4b 70.4 58 3b Urogenital 46.4 35.2 37.4 29.7 44.4 25.9 32.0 Skin 64.8 62.0 73.5 . 64.2 70.4 63.0 62.1 Musculoskeletal 92.8 84.5 89.2 90.0 85.2 77.8 84.5 Congenital conditions 6.8 4.2 3.6 5.2 3.7 3.7 2.9 Symptoms and ill-defined conditions 97.2 93.7 98.8 98.ob 98.2 100.0 92.2b Injury and poisoning 26.4 26.8 21.7 26.7 22.2 18.5 18.5 V-codesC 3o.8b 46.5 42.2 49.3 46.3b 55.6 54.4 Number of exams 250 142 83 408 54 27 103 POOP, prisoner of war, Pacific theater, WW II; PWE, prisoner of war, European theater, WW II; PWEM, prisoner of war, malnourished, European theater, WW II; PWK, prisoner of war, Korean conflict; WP, war veteran, Pacific theater, WW II; WE, war veteran, European theater, WW II; WK, wounded war veteran, Korean conflict.
|
From page 60... ...
bFactors influencing health status and contact with health services. there were fewer noteworthy current POW-versus-control differences than lifetime differences.
|
From page 61... ...
of Self-Reported Medical Conditions Treated from the 198~1985 Questionnaire for All POW Groups, by ICD Rubrics ICD Rubric Reported Rate Infectious diseases Cancer Benign neoplasms Diabetes mellitus Other endocrine diseases Blood diseases Psychoses Neuroses Nervous system Sense organs Heart disease Cerebrovascular disease Hypertension and other circulatory diseases Acute respiratory Chronic respiratory Digestive Urogenital Skin Arthritis Other musculoskeletal Congenital conditions Symptoms and ill-defined conditions Injury and poisoning V-codesb 2.5 4.1 0.4 4.4 5.3 0.4 0.6 9.0 2.7 8.7 15.5 1.1 26.9 0.3 7.8 11.7 4.6 4.6 13.1 10.7 0.05 23.1 3.1 14.9 aCoded to the ninth revision, International Classification of Diseases, Clinical Modification. bFactors influencing health status and contact with health services.
|
From page 62... ...
Comparing these two sets of rates, one sees that in general the prevalence rates for unresolved conditions are equal to or greater than the rates for medical conditions in the findings and laboratory sections of the exam. This apparently higher rate is most striking for psychoses, neuroses, and nervous system conditions; only the unresolved acute respiratory conditions have a notably lower rate.
|
From page 63... ...
of Medical Conditions Denved from the Findings and Laboratory Sections of the Medical Examination and Statements of Unresolved Medical Conditions, by ICD Rubnca Prevalence Findings and Lab Unresolved ICD Rubric Conditions Conditions Infectious diseases 24.8 22.0 Cancer 9.8 3.5 Benign neoplasms 7.7 11.1 Diabetes mellitus 8.1 13.2 Other endocrine diseases 36.2 46.4 Blood diseases 7.5 10.3 Psychoses 2.5 15.9 Neuroses 48.1 86.7 Nervous system 9.1 21.2 Sense organs 67.6 83.9 Heart disease 43.9 53.9 Cerebrovascular disease 3.9 1.9 Hypertension 48.5 69.9 Acute respiratory 19.6 4.1 Chronic respiratory 44.8 55.8 Digestive 71.2 75.3 Urogenital 32.2 37.2 Skin 44.8 66.1 Arthritis 57.7 74.8 Other musculoskeletal 63.7 78.9 Congenital conditions 2.5 5.0 Symptoms and ill-defined conditions 88.3 96.9 Injury and poisoning 22.9 25.4 V-codesb 3.0 42.2 Number of exams 883 883 aCoded to the ninth revision, International Classification of Diseases, Clinical Modification. bFactors influencing health status and contact with health services.
|
From page 64... ...
It is not surprising, therefore, that V-codes were reported more frequently on a questionnaire than in the findings/laboratory section of the medical examination. Nor is it surprising that self-reporting was most complete (i.e., comparability ratios
|
From page 65... ...
aCoded in ninth revision, International Classification of Diseases, Clinical Modification. bFactors influencing health status and contact with health services.
|
From page 66... ...
These data showed few striking differences between PWEM and PWE, although in general, lifetime prevalence rates across all ICD rubrics were higher for PWEM than for PWE; the only noteworthy difference in PWEM and PAVE rates is for "other endocrine disease" (which includes nutritional deficiencies)
|
From page 67... ...
There are five diagnostic categories in which PWEM lifetime prevalence rates appreciably exceed those of PWE. Aside from dysentery, beriberi, and frozen feet these three are presumably elevated as a result of prison camp medical history the rates of peripheral nerve disease and gastroenteritis are appreciably elevated.
|
From page 68... ...
In summary, the answer to question E must be that there is some evidence of differences in physical findings between the malnourished WW II European theater prisoners and all other European theater POWs. Looking first at the broad ICD disease groups, one sees an appreciably higher lifetime prevalence rate of other endocrine diseases (which include the nutritional disorders)
|
From page 69... ...
Physical findings are not nearly as sinking, and earlier differences among POW groups may have lessened over the past 25 years. The special group of malnourished WW II European theater pnsoners, however, exhibits not only elevated prevalence rates of conditions clearly linked with their earlier captivity, such as dysentery and benben, but also some apparently longer-term aftereffects, such as gastroententis and peripheral nerve disease.
|
From page 70... ...
In Williams T (ed.) , Post-traumatic Stress Disorders: A Handbook for Clinicians.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.