IRAQ WAR CLINICIAN GUIDE

lraa War Clinician Guide 176 Appendix I
depressive reactions, and psychoticlike states. Formal diagnostic criteria, however,
do not exist.
CSRs may not necessarily share many features with PTSD, but they are
strongly predictive of subsequent MSD. Among Israeli soldiers who fought in
the 1982 Lebanon War, IrGD prevalence was dramatically higher among those
who had sustained a CSR mmparcd with soldiers who had notP Ln the CSR
group, prevalence estimates were 62% 1 year after the war, 56% 2 years after,
and 43% 3 years aftec l-, 2-, and 3-year estimates for the nonCSR group, which
was comparable to the CSR group in both demographic background and warzone
exposure, were 14% 17%, and 11%.
PREVALENCE
Estinlates of 1?SD prevalence among military veterans vary markedly as a
function of the sample and methods used, even in the same war cohort. Few
studies of military veterans have used the rigorous sampling methods necessary
to derive epidemiolop,inlly sound prevalence estimates.
Vletnam and Vietnam-Era Veterans
1%e most methodologically adequate study of F13D in the Viebanl cohort
estimated the current prevalence in male Vietnam veterans to be just over 15%P
This shdy, known as the National Viebam Veterans Readjustment Study
(NVVa), also estimated the current prevalence of PTSD in female Vietnam
veterans to be 8.5%; current estimates for veterans who served outside of the
Viemam theater were 2.5% in men and 1.1% in women. Current lYI3D was
dramatically higher in men and women with high war-zone exposure: 35.8%in
men and 17.5% in women. Lrfetime MSD among Vietnam veterans was estimated
to be 30.9% in men and 26.9% in women.
In the NWRS. currcnt PTSD was hieher " amone black; 127.9%) . and Hisoanits
(20.6%). Ih;ln among wl,iles (13 i%).Bmause in.lividuaI$ exposed to high war
?one strcs.5 n.cro ~nuil,(nor.! likely tu drvvlop PTSD rhan ihoje cxpoxd to lu~v
or nlodrrale stres avd 12c1111*1 black and tllspanic reteritwi aerc otuch mure
likely to have had higher war-ronc exposure, ilwas n%essary to control for this
vaiiable. It also was necessary to control for predisposing factors that might
confound ethnicitv , (such . as childlrood and familv backeround factors. . . orcmililay
fa~tors, and nlill~ory factors). \Vhen this mu~ti\,a;~lte analysis tvas p'rformed,
the increased prev~lcncc among blacks !%,as ckp1ainr.d by their grc.,ter
amount of combat exposure rrlat~vc to\\htres. in ronlral, the diffcrrnrehrt~vwn
whites and Hispanic; was only partially explained by increased cxposure anlong
Hispanin.
An important aspect of Kulka et al's" study is that they estimated the
prevalence of partial PTSD, a subdiagnostic constellation of symptoms that was
associated lvitlr signifirant impainnent, e.g., having the suflicient number of B
(re-experiencing) and D (hyperarousal) symptoms, an insufficient number of C
(avoidance/numbing) synrptoms, and cotnorbid alcohol abuse or dependence
(\rlliclr might by intcrpreled as rclvted to the C symptom cluster) (as per DSM-
Ill-R). Among male theater veterans, lifctime and current prevalence of partial
P'ISD were 22.5% and 11.1%; conrparable estimates for fenmle theater veterans
were 21.2% and 7.8%. Kulkn et al note that the combined full and partial lifetime
P P
DEPARTMENT OF VETERANS AFFAIRS
NATIONAL CENTER FOR PTSD