SOCIAL STATUS AND POST TRAUMATIC STRESS DISORDER IN US V

本研究的主要目的是解释不同社会地位的越战美国退伍军人的创伤后应激障碍（PTSD）和共病发生率的差异，这些社会地位包括性别、民族/种族背景和父母的社会经济地位（SES）。具体目的包括测试关于暴露于环境战区压力源的首要性的其他假设，先前的个人倾向的作用，以及与不同社会地位相关的内源性文化因素的影响。这些测试的数据来自国家越南退伍军人再适应研究（NVVRS）。NVVRS由三角研究所（RTI）进行，以响应国会的授权，调查美国退伍军人的创伤后应激障碍和其他心理问题。这项研究从1984年开始，在全国范围内对3016名越战老兵、其他越战老兵和非老兵进行了抽样调查，在接下来的几年里，这项密集的数据收集工作一直在继续。这些退伍军人的样本是从军事记录中抽取的，并详细采访了他们参军前的生活、军事经历和战后生活，以及各种各样的心理症状和问题。此外，对343名剧院退伍军人和93名时代退伍军人进行了深入的研究诊断检查，由经验丰富的临床医生进行。这些子样本诊断包含了研究中关于PTSD发病和病程的唯一数据，迄今为止，研究结果的报告都集中在更大样本中的当前PTSD。目前PTSD（战后15到20年）在男性战区退伍军人中占15.2%，是时代对比样本的6倍。与非西班牙裔白人（13.7%）相比，西班牙裔美国人（27.9%）和非洲裔美国人（20.6%）的持续性或复发性PTSD发病率尤其高。当父母的社会经济地位（SES）得到控制时，这些民族/种族差异会减少，但不会消失。在女性戏剧退伍军人中，主要是非西班牙裔白人护士，目前8.5%的PTSD发病率大大低于男性。绝大多数患有创伤后应激障碍的男性和女性戏剧退伍军人都被诊断出患有其他伴随的精神疾病。造成这些性别和种族/民族差异的原因尚不清楚。拟议的研究将几乎完全集中在诊断的子样本上，以便研究群体差异的其他解释，因为这些假设适用于创伤后应激障碍和共病障碍的初始发病和病程。根据NVVRS数据，制定了利用现有措施和开发新措施的计划，并使用描述性统计、图形方法、逻辑和高斯多元回归进行各种统计分析。长期目标是增加对人类如何适应或无法适应逆境和压力的认识，并为这个国家生活中的历史性事件做出贡献。

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.