Post-Traumatic Stress Disorder: Rate of Occurrence in a Solder/Woman versus Civilian/Man

Abstract

 Post-traumatic stress disorder (PTSD) is an anxiety disorder which people develop after experiencing trauma. The current criteria used for determining PTSD in the DSM-IV is inaccurate and increases the difficulty when diagnosing the disorder. PTSD in solders is higher than in civilians and higher in women than men. The continuous exposure to combat increases the risk of developing PTSD for soldiers whereas civilian’s minimal exposure to continuous traumatic experiences minimizes PTSD prognosis. The nature of violent trauma women are exposed to make them more susceptible to suffer from PTSD whereas men are exposed to different types of trauma and hence are less susceptible to suffer from PTSD.  Survey questionnaires based on the PTSD Screening and Diagnostic Scale (PSDS) will be distributed among a specific population and made available online. A correlational study to measure the correlation between frequency of trauma and PTSD will be conducted to include a minimum of 500 randomly selected participants. The data will be analyzed using a scatter plot and the Statistical Package for the Social Sciences (SPSS). 

Introduction

 Post-traumatic stress disorder (PTSD) is primarily an anxiety disorder which persons develop after experiencing various type of trauma, both directly and indirectly. It is a mental illness that can target anyone at any age. Treatment to this illness includes psychotherapy which is known as talk therapy as well as medication. Different research indicates that family and friend support have a positive impact on the success of this therapy. The therapy is based on a person to person’s need, including various forms which target symptoms or social problems. 

People often deals with stress in various forms. However PSTD diagnosis has shown that there are individual differences regarding the capacity to cope with catastrophic stress (Friedman, 2001). While some people do not develop PTSD after a traumatic events others cannot cope ending up developing symptoms of PTSD. Symptoms often manifest in forms of avoidance, flashbacks, and hyper arousal. PTSD cannot be diagnosed until it has been established that the patient has been exposed to trauma and has met the stress criterion. PTSD can only be diagnosed based on symptoms due to lack of test available to detect this illness (Foa, Keane, & Friedman, 2000). The Traumatic exposure leading to PTSD are inclusive of: abuse, rape, torture, assault, genocide, terrorism as well as war among others. Persons with mental illness are more likely to develop PTSD. 

Persons suffering from PTSD are often treated through psychotherapy which is primarily a form of talk therapy. The primary focus of therapy is cognitive behavioral therapy (CBT) which includes exposure therapy, stress inoculation training as well as cognitive restructuring. CBT aids patients understand and change how they view their trauma and its effects (Bisson & Andrew , 2007). Another form of treatment is Eye Movement Desensitization and Reprocessing (EMDR). EMDR aids patients to change the reaction of traumatic memories. PTSD can also be treated with medication or a combination of therapy and medication. The medications offered for PTSD are known as Selective Serotonin Reuptake Inhibitors (SSRI’s). SSRI’s are a type of antidepressants (Foy, 1992). These medications are effective for some people and help decrease feelings such as sadness and worry. Treatment can occur on a one on one basis or a group setting. 

Statement of the Problem

 Currently the criteria used for determining PTSD is DSM-IV, which is being re-examined for the accuracy in the criterion used to diagnose this disorder and should be updated for the proposed DSM-V. It is crucial to develop the right criteria for determining PTSD so patients are not misdiagnosed. PTSD can only be diagnosed based on symptoms due to lack of tests available to detect this disorder (Hinton & Lewis-Fernandez, 2011). Patients are treated through psychotherapy such as cognitive behavioral therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) as well as with medications like selective serotonin reuptake inhibitors (SSRIs). A study based on the Acceptance and Action Questionnaire (AAQ) shows that although over 50% of adults have experienced a traumatic event only 6.8% develop PTSD symptoms (Kubany, Leisen, Kaplan, & Kelly, 2000). The conclusions gathered from this research suggests that it supports the idea that experimental avoidance is increased in people with PTSD, and are important in the onset of the disorder. Having the proper DSM classification for diagnosis is imperative to properly diagnose patients so the disorder does not go untreated. 

According to the (National Institute of Mental Health. , 2010), 80% of the United States populations have experienced a trauma but although many have been exposed to trauma only a small percentage, less than 10% meet the current criteria for PTSD. Results show that exposure to trauma were higher in men with 92.2%, than women with 87.1%. But the risk for PTSD was higher in women with 13.0% than in men with 6.2%. Since the Vietnam War the study of PTSD in veterans has increased. Levels of PTSD among our veterans have greatly increased over the years and it’s attributed to the recent wars overseas. PTSD among combat veterans is at 15% versus PTSD among civilians which is at 4 %, which is a great difference. Multiple combat tours increase exposure to trauma therefore increasing their likelihood of developing PTSD symptoms. Because soldiers are more likely to develop PTSD rather than civilians it is important to increase the resources offered to military personnel after returning from war in order to detect and treat PTSD disorders more accurately. 

Research Questions

 During the course of this study the following questions will be promptly addressed. What are the statistical differences between developing PTSD after exposure to war as a soldier versus other types of trauma as a civilian? What are the differences in developing PTSD symptoms as a female versus a male? What makes a soldier more vulnerable to PTSD? What makes a female more likely to develop symptoms of PTSD after trauma? 

In the event that correlation is found between the variables, it suggests that agencies should provide and make easily available the resources necessary to diagnose and treat individuals who are at higher risk of developing the PTSD disorder. 

Hypotheses

 It is believed that continuous exposure to combat increases the risk of developing PTSD for soldiers whereas civilian’s minimal exposure to continuous traumatic experiences minimizes PTSD prognosis. Due to the nature of violent trauma women are exposed to, they are more likely to develop PTSD whereas men are exposed to different types of trauma and hence less likely to develop PTSD. 

Literature Review

 Research by Thompson, Arnkoff, and Glass, (2011) focused on mindfulness- and acceptance-based theories of psychopathology indicates that avoidance to trauma creates vulnerability to the disorder whereas acceptance to the exposure of trauma will increase resilience. The theories focus on the risk and increased resilience of PTSD after being exposed to trauma. The research main focus is subjects such as avoidance, dissociation, acceptance and mindfulness of the symptoms of PTSD. Research shows that although over 50% of adults have experienced a traumatic event only 6.8% develop PTSD symptoms. This research uses the Acceptance and Action Questionnaire (AAQ), it is a self-report measure designed to assess experiential avoidance (Thompson, Arnkoff, & Glass, 2011). The questionnaire consists of two versions, one includes 16 items of measure the other 9 items of measure. The 16 item version has a focus of two factors, mindfulness/acceptance and values-based action. The 9 item version focuses on only one factor, psychological flexibility. The conclusions gathered from this research study indicate that avoidance increases symptoms of PTSD and its importance in the onset of the disorder. The results of the AAQ implicate that there is a relationship between PTSD, avoidance and other symptoms developed after trauma experiences.

An epidemiologic study was conducted and the evidence suggests that not all who have experienced trauma will develop PTSD. There has been various studies conducted which indicate that female victims are more vulnerable to PTSD. Breslau (2009) conducted a study with a focus on eliminating the factors that differentiate women from men, and their greater risk of developing PTSD after experiencing trauma. Some differences include types of traumatic events, anxiety and depression. According to this study it shows that 80% of the United States populations have experienced a trauma. Although many have been exposed to trauma only a small percentage, less than 10% meet the criteria for PTSD. A consistent finding across epidemiologic studies is the higher PTSD prevalence in women compared with men (Breslau, 2009). This research was based on the 1990 census in Detroit. A sample of 2,181 persons 18 to 45 years of age in the main metropolitan statistical area was used along; the sample was selected by using random digit dialing method. The survey included a list of 19 events separated into 4 categories which included assaultive, direct injury, learned trauma, and unexpected death of a loved one. The results showed that exposure to trauma were higher in men (92.2%) than women (87.1%) but the risk of PTSD was higher in women (13%) than in men (6.2%). The evidence suggests that the percentage sex difference is due to the woman’s higher risk of PTSD after exposure to a violent assault. 

A study based its research on the hypothesis that psychological treatment can reduce traumatic stress symptoms in individuals with PTSD. The purpose of this study was to perform a systematic review of randomized controlled trials of all psychological treatments (Bisson, 2009). The participants used in this study included adults who have had PTSD symptoms for a minimum of 3 months. The data was analyzed using Review Manager Software. There were a total of thirty-three studies included. Bisson, (2009) indicates that individual trauma focused cognitive-behavioral therapy (TFCBT), eye movement desensitization and reprocessing (EMDR), stress management and group TFCBT are effective in the treatment of PTSD. Treatments which are not focused on trauma are not as effective in reducing PTSD symptoms. The evidence suggests that individual TFCBT and EMDR are more successful than stress management in the treatment of PTSD. Evidence suggests that these forms of therapy should be made available to individuals with PTSD because they show the best evidence of success. Current psychological treatment options have a high dropout rate. Some implications of this research suggest that further trials need to be conducted in consideration of boundary issues as well as EMDR trails. A comparison of treatments from one another is vital to this research. 

According to The National Center for PTSD, PTSD very common among civilians and soldiers, although the rate is higher for soldiers. Studies have discovered that soldier’s prevalence to PTSD who fought in the Iraq war was at a rate of 13.8 % versus civilian’s lifetime prevalence of PTSD at 6.8 %. There is a significant difference in the statistics among soldiers and civilians. Insufficient research has been conducted in this field and the importance of it is imperative to diagnosing and treating military service members with this disorder. There are various risks associated with individuals not receiving proper treatment for PTSD. Individuals may stay in a continuous hyper aroused state, prolonging damage to the brain. They may experience irritability and anxiety which can interfere with their daily family life and work. Suicide and homicide are also among the risks factors. 

Methods

 The study used in this research will be a correlational study to measure the correlation between frequency of trauma and PTSD. The descriptive research will consist of survey research to gather all quantitative information through questionnaires. It’s hypothesized that the frequency of exposure to trauma increases the chances of developing PTSD symptoms. A scatter plot will be designed to show visually the relationship between variables. The developmental design used in this study will be a cross-sectional study used to gather a sample of various age groups and compared the frequencies of trauma exposure, background in military and developing PTSD. In this study the independent variable is trauma and the dependent variable is PTSD. This study will focus on how multiple exposures to trauma affect the likelihood of being diagnosed with PTSD. 

Sample

 The study will use probability sampling. Due to the specific population the study requires such as only individuals who are in a position in which they are likely to experience or be exposed to trauma the study will consist of proportional stratified sampling. After identifying the various populations a random sample will be taken from each section to build the data sample. Because the study is focused on a particular section of the population it is not guaranteed that all members of the population will be selected to use in the sample. There data will be separated into two groups; both men and women with an age range from 18-65. The first group will include current military personnel and military veterans. The second group will consists of civilians, with a focus on groups such as police officers, firefighters, and domestic abuse victims whom all have been exposed to a trauma. 

Instruments

 This study will employ two ways of distributing questionnaires, mailed questionnaires and online questionnaires. Survey research will be used to collect data through 10-15 minute self-report questionnaires. The questionnaire will be simple to read and to respond to by using clear and simple language. Clear instructions will be provided in order to explain how to use the Likert Scale. The first questionnaire will be the PTSD Screening and Diagnostic Scale (PSDS) a 4 part, 38 item questionnaire based on a rating scale such as the Likert scale, which will be used to determine if the willing participants have PTSD. The second questionnaire will inquire about demographics, amount of trauma the participants have experienced and if they have been diagnosed with PTSD. Question samples are: Bad dreams or nightmares about the event(s)? Where you extremely afraid at any time during the event(s)? Included in our packet will be the 2 questionnaires, a letter of inquiry which will emphasize the importance of the study along with a self-addressed envelope with return postage. A debriefing form will be sent out to all participants who return the questionnaire including the research results. The online questionnaires will be uploaded to an online commercial website that distributes surveys. The advantages of using data collection over the internet are the extensive number of possible participants and easy distribution process. 

Data Collection

 During the collection of data for this research, a minimum of 5,000 questionnaires distributed due to the low return rates on surveys. They will be divided into the four subject groups, military and civilian as wells as women and men. The surveys will be sent out to various military units in Fort Irwin Army Post, VA Loma Linda Healthcare Center, Police and Fire Stations in San Bernardino County, women shelters, mental health clinics and the San Bernardino County Department of Behavioral Health. A pilot test will be conducted to check the validity of the questionnaire. The pilot test will be conducted at a facility in Fort Irwin Army Post in which both military and civilian personnel work. Included in the pilot test will be a response section at the end, in an effort to gather information regarding the participant’s thoughts about the questionnaire. The online questionnaires will be distributed through email invitations. The advantage features of online questionnaires are participant communication through email, tabulated results, statistics are analyzed and downloaded. 

Analysis

 Once all the data have been collected and analyzed, a visual representation of the data will be developed on a scatter plot to show the correlation between variables. The participants (soldier/civilian) as well as (women and men) will be represented on the vertical axis which is the ordinate, and the number of trauma exposure will be represented on the horizontal axis, the abscissa. If the variables are unrelated the dots will be scattered all over the graph whereas if they are related they will form an elliptical shape which will show correlation between the variables. Data will be inputted into a spreadsheet to better sort, recode, graph, and search. Using a spreadsheet will benefit when manipulating the data and variables to show correlation among variables. Interpretation of the data and calculations will be accurate and produced quickly. The data will be analyzed using the Statistical Package for the Social Sciences (SPSS). Online questionnaire are cost effective and will acquire a large sample size. The sampling will be a concern and a pre-questionnaire will be included to stream the participants benefit to the study. If the participant is approved the regular questionnaire will be available for them to complete, if not they will be thanked for their participation thus far and no further action will be necessary. This research will use inferential statistics to test the hypothesis. In order to decrease the probability of a Type I and Type 2 error the study will use a large sample, maximize both reliability and validity, and use a parametric statistic such as the t-test. When testing the hypothesis the study will conduct a t-test. Using the t-test as the statistical procedure will help determine if there is a statistical significance between the two variables. 

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