SOCIAL STATUS AND PTSD IN U.S. VIETNAM VETERANS

美国越南退伍军人的社会地位和创伤后应激障碍

• 批准号: 6186134
• 负责人: BRUCE P DOHRENWEND
• 金额: $ 38.22万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-09-28 至 2002-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6186134
• 关键词: African American; Hispanic Americans; behavioral /social science research tag; caucasian American; clinical research; disease /disorder onset; disease /disorder proneness /risk; education; environmental stressor; epidemiology; gender difference; human data; interview; mental disorder diagnosis; military personnel; nurses; occupations; posttraumatic stress disorder; psychological stressor; racial /ethnic difference; relapse /recurrence; social status; socioeconomics; veterans; war /peace

The broad objective is to explain differences in rates of Post-Traumatic Stress Disorder (PTSD) and comorbid disorders in U.S. Vietnam veterans from different social statuses indicated by gender, ethnic/racial background, and parental socioeconomic status (SES). The specific aims involve tests of alternative hypotheses about the primacy of exposure to environmental war- zone stressors, the role of antecedent personal predispositions, and the influence of endogenous cultural factors associated with the differing social statuses. The data for these tests come from the National Vietnam Veterans Readjustment Study (NVVRS). The NVVRS was conducted by the Research Triangle Institute (RTI) in response to a Congressional mandate to investigate PTSD and other psychological problems in the U.S. veterans. The study of nationwide samples of 3,016 Vietnam Theater veterans other Vietnam Era veterans, and non-veterans began in 1984, and the intensive data collection continued over the next several years. The veteran samples were drawn from military records and interviewed in detail about their premilitary lives, their military experiences, and their lives following the war as well as a wide variety of psychological symptoms and problems. In addition, a subsample of respondents consisting of 343 Theater veterans and 93 Era veterans were given intensive research diagnostic examinations by experienced clinicians. These subsample diagnoses contain the only data in the study on onset and course of PTSD, and reports of results of the study thus far have focused on current PTSD in the larger samples. The rate of current PTSD (present 15 to 20 years after the war) was 15.2 percent in male Theater veterans, six times as high as for the Era comparison sample. This rate of persistent or recurrent PTSD was especially high in Hispanics (27.9 percent) and African-Americans (20.6 percent) compared to nonHispanic whites (13.7 percent). These ethnic/racial differences are reduced but do not disappear when parental socioeconomic status (SES) is controlled. Among female Theater veterans, mainly nonHispanic white nurses, the 8.5 percent rate of current PTSD is substantially lower than for males. Very large majorities of both male and female Theater veterans with current PTSD were diagnosed with other concomitant psychiatric disorders. The reasons for these gender and racial/ethnic differences are unknown. The proposed study will focus almost exclusively on the diagnosed subsample in order to investigate alternative explanations of the group differences as the hypotheses apply to initial onset and to course of PTSD and comorbid disorders. Plans are set forth for utilizing existing measures and developing new ones necessary for the task from the NVVRS data, and for a variety of statistical analyses using descriptive statistics, graphical methods, and logistic and Gaussian multivariate regression. The long term goal is to increase knowledge of how humans adapt or fail to adapt to adversity and stress, and to contribute to the account of an historic event in the life of this nation.

其广泛目标是解释不同社会地位的美国越战老兵的创伤后应激障碍(PTSD)和共病障碍发生率的差异，这些社会地位由性别、民族/种族背景和父母社会经济地位(SES)指示。具体目标包括测试关于暴露于环境战区应激源的首要地位、先天个人倾向的作用以及与不同社会地位相关的内生文化因素的影响的替代假设。这些测试的数据来自国家越南退伍军人调整研究(NVVRS)。NVVRS是由三角研究所(RTI)根据国会的授权进行的，调查美国退伍军人的创伤后应激障碍和其他心理问题。对全国3016名越战退伍军人、其他越战时期退伍军人和非退伍军人的研究始于1984年，密集的数据收集工作在接下来的几年里继续进行。这些退伍军人样本来自军事记录，详细采访了他们的军前生活、军事经历、战后生活以及各种心理症状和问题。此外，由343名战区退伍军人和93名退伍军人组成的小样本受访者接受了经验丰富的临床医生的密集研究诊断检查。这些小样本诊断包含关于创伤后应激障碍发病和病程的研究中唯一的数据，到目前为止，研究结果的报告集中在较大样本中的当前创伤后应激障碍。在男性战区退伍军人中，目前的创伤后应激障碍(指战后15至20年)的比率为15.2%，是时代比较样本的6倍。与非西班牙裔白人(13.7%)相比，西班牙裔(27.9%)和非裔美国人(20.6%)的持续性或复发性创伤后应激障碍的比率尤其高。当父母的社会经济地位(SES)受到控制时，这些族裔/种族差异会缩小，但不会消失。在女性剧院退伍军人中，主要是非西班牙裔白人护士，目前8.5%的创伤后应激障碍发生率大大低于男性。绝大多数患有创伤后应激障碍的男性和女性退伍军人都被诊断出患有其他伴随的精神障碍。造成这些性别和种族/族裔差异的原因尚不清楚。这项拟议的研究将几乎完全集中在诊断出的亚样本上，以调查对群体差异的替代解释，因为假设适用于最初的发病以及创伤后应激障碍和共病障碍的过程。提出了利用现有措施和根据NVVRS数据开发新的必要措施的计划，以及使用描述性统计、图形方法以及Logistic和高斯多元回归进行各种统计分析的计划。长期目标是增加关于人类如何适应或未能适应逆境和压力的知识，并为描述这个国家生活中的一个历史性事件做出贡献。