Guide Coping with War-Induced Stress: The Gulf War and the Israeli Response

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She also provides a unique insight into the role of Israel's mental health professionals during the war. Men and Women at War. Children in the Line of Fire.

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Holocaust Survivors in the Gulf War. The Evacuees. Soldiers in Restraint. Mental Health Professionals in the Public Arena. Customer Reviews Average Review. The rates of hospitalization per person-years were 9. Fontana et al. Studies of Vietnam veterans Bremner et al.

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Kulka et al. Black et al. During the s, however, active-duty military personnel aged were at greater risk for hospitalization for a mental disorder than older veterans Hoge et al. Seal et al. The risk of having a diagnosis of PTSD or any mental health diagnosis decreased with increasing age. Compared with veterans 40 years and older, the relative risk for PTSD was 8.

Developmental History and Early-Life Stress Numerous epidemiologic studies of Vietnam and Gulf War veterans and of civilians have found that childhood trauma from physical or sexual abuse is a risk factor for PTSD, regardless of later combat exposure.

Coping with War-Induced Stress: The Gulf War and the Israeli Response

The strongest evidence of the impact of early-life stress comes from large studies of Vietnam veterans Fontana and Rosenheck a; Kulka et al. A history of child abuse contributed nearly as much to the risk of having PTSD as did military sexual trauma although combat exposure was twice as likely to contribute to the risk of PTSD Fontana and Rosenheck a.

King et al. Childhood sexual and physical abuse is common in Gulf War and Vietnam veterans seeking treatment for psychiatric disorders including PTSD, with studies that assessed this endpoint. Psychiatric History Having been diagnosed previously with a psychiatric disorder increases the likelihood of PTSD after exposure to a traumatic event. People with a history of a psychiatric disorder may have an increased likelihood of engaging in risky behavior which increases the likelihood of their exposure to traumatic events and their potential for PTSD or other stress-related disorders.

Someone with a pre-existing psychiatric disorder who is exposed to wartime trauma may respond ineffectively to the traumatic event because of pre-existing symptoms, inadequate coping styles, low social support, and poor self-esteem, all of which increase the likelihood of PTSD or related disorders. A study of Gulf War veterans by Black et al. The overall likelihood of postwar anxiety disorders was increased by a factor of 4 range, 2. A study of Australian Gulf War veterans by Ikin et al. They found that Those findings highlights that a substantial portion of military personnel may enter combat at increased risk for a psychiatric disorder on the basis of psychiatric history alone.

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Hardiness, Coping Strategies, and Sense of Control The occurrence and severity of stress-related health effects are not solely the result of interaction of physiologic processes with a threatening environment. Those characteristics are determined or modulated by the action of life experiences on genetic makeup. Dolan and Adler adapted the definition of hardiness in a military population to mean the degree to which military personnel are committed to and feel a sense of control over their work experiences.

They surveyed U. Army soldiers during and after a 6-month peacekeeping mission in Kosovo.

Military hardiness was correlated with psychologic but not physical health during and after deployment. Among soldiers who experienced high levels of deployment stressors, those with. Studies of deployed Gulf War veterans have found that hardiness was protective against the adverse effects of combat stress and stressful life events and that the level of hardiness was a significant predictor of health outcomes Bartone Those with greater hardiness reported fewer physical symptoms than those with lower hardiness regardless of the intensity of the combat exposure or the reported level of stressful life events.

For military personnel with long exposure to war-zone stressors, hardiness and perceived social support may gradually diminish, and the diminution can result in deterioration of physical health Taft et al. The types of physiologic changes seen in animals after exposure to uncontrollable stressors have also been observed in humans see Chapter 4 for a discussion of the animal studies. In a prospective study of Gulf War veterans all military reservists , Benotsch et al. Conversely, coping with stress through avoidance increased significantly between the two times.

The 1991 Gulf War a BBC production

Storzbach et al. Coping strategies are also associated with ability to respond to stressors. In a study of Vietnam combat veterans, positive coping strategies were found to protect against the development of PTSD symptoms Wolfe et al. Vaillant found that avoidant behavior was also a major predictor of a downward trajectory in life in a civilian population. It has been shown in other stressful circumstances that ineffective coping strategies, especially avoidant or passive coping as opposed to active problem-solving strategies, predict adverse mental-health outcomes Arata et al.

In addition to a positive coping style, a perception that some benefit derives from military experience is associated with reduced potential for adverse health effects after combat exposure. Lee et al. Aldwin et al. The majority of veterans responded with positive comments about their military service for example, a sense of mastery, enhanced self-esteem, and effective coping , and there was a linear relationship between perceived benefits and combat exposure. Similar results were seen by Jennings et al. Wisdom also correlated positively with perception of benefits of military experience and with positive coping strategies.

Department of Health and Human Services Not surprisingly, similar relationships are apparent in veteran populations. Low military rank enlisted personnel vs officers is also associated with greater risk of a stress-related disorder Black et al. Two studies found that being an officer or being college-educated reduced the risk of developing anxiety or depressive disorders after deployment by at least half Black et al. Slusarcick et al.

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Navy hospital ship during the Gulf War, junior enlisted health-care providers had the highest levels of depression followed by junior officers, senior enlisted, and senior officers, in that order. By occupation, corpsmen were the most depressed, and physicians the least. However, Ikin et al. Social Support Social support has been linked to favorable mental-health outcomes Bland et al. Studies have shown that good social support is a protective factor against the onset of PTSD Benotsch et al.

Two meta-analyses found that lack of social support was the factor most strongly associated with the development of PTSD after a traumatic event for veterans of the Vietnam War and the Gulf War Benotsch et al. Vietnam veterans with low levels of social support 10 years after the war had more symptoms of PTSD than those with high levels of social support; and when combined with high levels of combat exposure, those with low social support had far more symptoms of PTSD Barrett and Mizes The role of social-support networks in the Vietnam-Era Adjustment Survey was explored in nursing and combat personnel Stretch , ; Stretch et al.

The rates of PTSD were highest in men and women who had lacked positive social supports from family, friends, and society in general. Hispanic Vietnam veterans who were highly symptomatic for PTSD expressed fewer social contacts, more adverse social encounters, and smaller family and social networks Escobar et al. One study, conducted in , explored the burden of war and social bonding in veterans of World War II and the Korean War. Painful memories of war and symptoms of stress in later life were diminished through involvement with a supportive community of service mates and partners Elder and Clipp Prospective studies reveal a downward spiral: as PTSD symptoms worsen, veterans lose more social support, the lack of which in turn exacerbates their PTSD symptoms Benotsch et al.

Those studies all showed that low social support increased the risk of depression and other psychiatric disorders, such as generalized anxiety disorder. Most findings regarding social support come from studies of homecoming support, whether given by family, friends, or community. Few studies have specifically investigated social support during the period of deployment to a war zone.

The lack of studies of the role of social support during deployment is an important gap because U. The committee notes that it is difficult to determine whether low social support leads to mental-health sequelae, psychiatric problems reduce social support, or the relationship is indirect with other variables, such as the association of personality with both social support and other psychopathology.

Combat as a deployment- related stressor was discussed in Chapter 3. PTSD appears to be associated with intensity and length of combat exposure. Studies of veterans from the Vietnam War and the Gulf War have confirmed a dose-response relationship between level of combat exposure and likelihood of PTSD. The prevalence of lifetime combat-related PTSD was When the prevalence of lifetime or current PTSD based on the SCID was compared with responses to a item combat index, there was a linear dose-response relationship with increasing combat exposure.

A dose-response relationship between PTSD and exposure to war-zone stressors was established.

The evolution of the emergency mental health system in Israel - from the 1980’s until today

Current as of war-related PTSD was diagnosed in 0. Longer and more intense combat exposure is associated with a greater prevalence of current PTSD. One study of male twins discordant for serving in Vietnam found more PTSD symptoms in the Vietnam veterans than in their twins who did not serve in Vietnam, even 15 years after the war Goldberg et al. Roy-Byrne et al. Over the year followup, the number of PTSD. One study of Marines and soldiers deployed to OIF found that the number of veterans who screened positively for PTSD months after their return increased linearly with the number of reported firefights with the enemy: 4.