ABSTRACT
This article describes the development and validation of the Race-Related Stressor Scale (RRSS), a questionnaire that assesses exposure to race-related stressors in the military and war zone. Validated on a sample of 300 Asian American Vietnam veterans, the RRSS has high internal consistency and adequate temporal stability. Hierarchical regression analyses revealed that exposure to race-related stressors accounted for a significant proportion of the variance in posttraumatic stress disorder (PTSD) symptoms and general psychiatric symptoms, over and above (by 20% and 19%, respectively) that accounted for by combat exposure and military rank. The RRSS appears to be a psychometrically sound measure of exposure to race-related stressors for this population. Race-related stressors as measured by the RRSS appear to contribute uniquely and substantially to PTSD symptoms and generalized psychiatric distress.
Subject(s)
Asian/psychology , Combat Disorders/psychology , Personality Inventory/statistics & numerical data , Prejudice , Veterans/psychology , Combat Disorders/diagnosis , Humans , Male , Middle Aged , Psychometrics , Reproducibility of Results , Stress, Psychological/complications , Vietnam , WarfareABSTRACT
This article addresses theoretical principles and clinical descriptions of the phenomenon of race-related stress and trauma experienced by Asian American Vietnam veterans. A conceptual model of race-based stress is presented, comprised of five principles, by which to understand mental health difficulties that can arise in regard to race-based stressors. The model describes (a) the relationship between life threat and physical similarity to the "enemy," (b) the relationship between fear and prejudice, (c) dehumanization as it impacts race hate and combat indoctrination, (d) additive life threat related to exploitation of one's physical similarity to the "enemy," and (e) race-based remorse. The article delineates factors affecting treatment seeking and disclosure of race-based stresses, guidelines for interviewing veterans about race-related events and ethnic self-worth, and the harmful effects of race hate.
Subject(s)
Acculturation , Asian/psychology , Combat Disorders/diagnosis , Veterans/psychology , Attitude to Death , Combat Disorders/psychology , Combat Disorders/therapy , Fear , Humans , Male , Prejudice , Psychotherapy , VietnamABSTRACT
There is a paucity of studies on Outward Bound Experiences (OBE) with adult psychiatric populations and, more notably, with trauma victims. This study evaluates the efficacy of OBE as an adjunct to specialized inpatient PTSD treatment with survivors of chronic combat-related PTSD (N = 219) at two Veterans Administration Medical Centers. On several measures of PTSD and general adaptation, results showed that the five-day OBE did not differ from standard treatment of PTSD survivors. Two other issues were addressed: identification of successful and non-successful subjects as a result of OBE, and exploration of objective versus subjective measures among this chronic group. Finally, as a post-study analysis, inferred curative components of the OBE were discussed as each appeared to impact on the participants.
Subject(s)
Camping , Combat Disorders/therapy , Patient Admission , Patient Care Team , Psychotherapy, Group , Veterans/psychology , Adult , Cohort Studies , Combat Disorders/psychology , Combined Modality Therapy , Humans , Male , Middle Aged , Personality Inventory , Treatment Outcome , VietnamABSTRACT
The American Lake VA Post-Traumatic Stress Disorder (PTSD) Treatment Program provides intensive inpatient treatment for war-related PTSD and associated conditions. As part of a substantial outreach effort to American Indians (AI) in the Northwest U.S., the program significantly modified its admission criteria and treatment to be more clinically and culturally relevant. An all-AI cohort, and then a group that was 50% AI, were admitted. Highlighted are lessons learned regarding: treating "traditional" versus more "assimilated" AI veterans; culture-specific additions of building and utilizing a sweatlodge on the hospital grounds, hiring an AI spiritual leader as a clinical advisor, and promoting attendance at weekend Pow-Wows; the relevance of the "regular" treatment components; and the need for regular debriefings about counter-transference dynamics among staff.
Subject(s)
Combat Disorders/therapy , Indians, North American/psychology , Patient Admission , Veterans/psychology , Cohort Studies , Combat Disorders/psychology , Combined Modality Therapy , Countertransference , Humans , Male , Medicine, Traditional , Northwestern United States , Patient Care Team , VietnamABSTRACT
An evaluation study is reported about an unprecedented in vivo activity: Huey helicopter rides in the inpatient treatment of post-traumatic stress disorder among Vietnam veterans. A pre- and post-ride attitude survey (N = 45) and clinical observations revealed a series of salient outcomes, including the provocation of pre-existing traumatic memories and pre-flight concerns, profound in-flight reactions, post-flight triggering of intrusive, painful memories, the enhancement of peer group bonding and remembrance of positive war associations, and the desensitization to helicopters and other military stimuli. Theoretical and clinical implications are elaborated.
Subject(s)
Aircraft , Stress Disorders, Post-Traumatic/therapy , Veterans , Warfare , Attitude , Evaluation Studies as Topic , Humans , Male , Memory , Stress Disorders, Post-Traumatic/psychology , United States , VietnamABSTRACT
Clinical, milieu, and patient management psycho-social interventions are identified and discussed concerning medical and psychiatric evacuees from a war zone. The acute psychological state of evacuees, specific areas of inquiry from the onset of becoming a casualty through initial hospitalization stateside, and interventions to address psychological aspects of being wounded or a psychiatric evacuee are highlighted. Issues and dynamics to address with the families, to include clinical experiences with families of Vietnam, Panama, and Gulf War military returnees are described, as well as specific risk factors for Operation Desert Storm families and personnel. Distinctive stressors faced by women, national guard and reserves, and ethnic minority personnel in Operation Desert Storm are identified. Finally, complications and recommendations concerning the appropriate diagnoses for psychiatric evacuees, and the stressors faced by the health care provider, are presented. Specific recommendations by veterans who themselves were evacuated from Vietnam are described in the veterans' own words.
Subject(s)
Family , Military Personnel , Stress Disorders, Post-Traumatic/therapy , Transportation of Patients , Wounds and Injuries/therapy , Hospitals, Military , Humans , Middle East , Risk Factors , Stress, Psychological/therapy , United States , United States Department of Veterans Affairs , Veterans , Vietnam , WarfareABSTRACT
War-related PTSD frequently presents as a dual disorder. Questions have been raised about whether the MMPI-PTSD subscale developed by Keane, Malloy, and Fairbank (1984) is identifying a separate PTSD syndrome or is a measure of generalized distress common to various diagnostic categories, including substance abuse. In this study, veterans with PTSD with and without substance abuse were compared to veterans with substance abuse only on the MMPI-PTSD subscale (n = 22 in each of the four categories). Results support the ability of the test to distinguish between groups of veterans with PTSD and those with substance abuse only. The findings lend indirect support to the validity of a distinct PTSD symptom cluster.
Subject(s)
Alcoholism/diagnosis , Combat Disorders/diagnosis , Hospitalization , MMPI/statistics & numerical data , Substance-Related Disorders/diagnosis , Alcoholism/psychology , Alcoholism/rehabilitation , Combat Disorders/psychology , Combat Disorders/rehabilitation , Follow-Up Studies , Humans , Male , Psychometrics , Substance-Related Disorders/psychology , Substance-Related Disorders/rehabilitationABSTRACT
Eight patients with combat-induced chronic posttraumatic stress disorder (PTSD) receiving long-term alprazolam therapy for anxiety or depression (maximum dose of 2-9 mg/day for 1-5 years) had alprazolam therapy withdrawn. Most of the patients underwent gradual medication withdrawal. All patients had a prior history of alcohol abuse or benzodiazepine dependence. During withdrawal, all patients had severe reactions including anxiety, sleep disturbance, rage reactions, hyperalertness, increased nightmares, and intrusive thoughts; and 6 of the 8 patients had homicidal ideation. As a result of this report, the authors suggest that the potential for severe withdrawal reactions, even with gradual tapering, should be considered before prescribing alprazolam therapy for this group of patients.
Subject(s)
Alprazolam/adverse effects , Combat Disorders/drug therapy , Stress Disorders, Post-Traumatic/drug therapy , Substance Withdrawal Syndrome/etiology , Adult , Anxiety Disorders/drug therapy , Anxiety Disorders/psychology , Benzodiazepines , Combat Disorders/psychology , Depressive Disorder/drug therapy , Depressive Disorder/psychology , Homicide , Humans , Male , Rage , Substance Withdrawal Syndrome/diagnosis , Substance-Related Disorders/complicationsABSTRACT
Previously we reported that abstaining chronic alcoholic men demonstrated significantly more nighttime hypoxemia than a control group. Here, we report a replication employing a larger sample of abstaining chronic alcoholics and a more appropriate control group than that used in the previous study. Forty-seven males, 48.4 +/- 1.7 years of age (mean +/- SEM), reporting 24.8 +/- 1.5 years of heavy alcohol use, comprised the abstaining alcohol group. Thirty-five age- and weight-matched males, 50.3 +/- 1.7 years were the control group. The alcohol group had significantly more nighttime oxygen desaturations below 90% than did the control group (16.9 +/- 3.3 vs. 6.2 +/- 1.4, F = 7.8, p less than 0.01), with significantly higher percentages of individuals in the alcohol group manifesting more than 10 or 20 oxygen desaturations below 90%. Regression analyses within the alcohol group revealed that severity of alcohol abuse, but not age, body mass index, days abstinent, or smoking significantly predicted levels of nighttime hypoxemia. These results confirm our original observation of increased nighttime hypoxemia in abstaining chronic alcoholic men and suggest that long-term alcohol abuse may be a risk factor for development of sleep apnea.
