Alcoholism, Depressive Disorder, Post-traumatic Stress Disorder
Conditions
Keywords
post-traumatic stress disorder, depressive disorder, alcoholism, Longitudinal studies, readjustment
Brief summary
Functional recovery is of the utmost importance to evaluate in our returning Operation Enduring and Iraqi Freedom Veterans so that we can better understand their needs and experiences during the readjustment process from warzone to civilian life. Although most soldiers are resilient, concerning rates of PTSD (12-20%) and depression (14-15%) have been found, and as many as 24-35% report drinking more alcohol than they intended (Hoge et al., 2004). The current study proposes to follow returning Veterans for a one-year period to evaluate factors that influence the readjustment process and functional impairment. This information should guide the development of early intervention and treatment programs to help recovery.
Detailed description
The proposed longitudinal study aims to better understand the functioning of returning Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) OEF/OIF Veterans over time and to identify potentially malleable resilience factors associated with higher levels of functioning. A total of 300 returning OEF/OIF Veterans will be followed for a one-year period. Veterans will complete a baseline assessment, followed by three follow-up assessments (two self-report assessments mailed at 4- and 8-months post-baseline and a one-year in-person follow-up assessment that repeats many of the baseline clinician-administered assessments). Multiple functional outcomes will be evaluated, including occupational, family, social, and physical functioning. The specific aims include: 1) identifying whether a dose-response relationship exists between level of exposure to stressors (pre-deployment, deployment-related, and post-deployment) and functioning over time; 2) examining whether potentially malleable resilience factors predict higher levels of functioning in returning Veterans over time; 3) examining whether psychopathology predicts lower levels of functioning in returning Veterans over time; 4) testing the theoretical model that psychopathology partially mediates the effects of stress, social support, coping, and neurocognition on functioning over time; 5) examining whether changes in the use of healthy coping strategies, social support, post-deployment stress, and psychopathology predict changes in functioning over time; and 6) exploring whether stress, social support, coping, neurocognition, and psychopathology have differential effects on specific aspects of functioning (e.g., occupational, family, social, and physical functioning) over time. The long-term aim of this research is to develop evidence-based early intervention and treatment programs designed to assist returning OEF/OIF Veterans with achieving optimal functioning when reintegrating into civilian life. In keeping with the VHA's goal of operationalizing principles of recovery and rehabilitation in treatment planning, this research should provide a platform of empirical data to assist with the further development of meaningful early intervention and treatment programs to assist OEF/OIF Veterans with the post-war readjustment process over time.
Interventions
None listed
Sponsors
Study design
Eligibility
Inclusion criteria
To be eligible, participants must be: * enrolled returning OEF/OIF Veteran within CTVHCS; * English-speaking Veterans; * able to comprehend and sign the informed consent form; * able to complete the structured interviews and self-report assessments; * willing to be contacted for follow-up assessments; * deemed stable on psychotropic medications and in psychotherapy.
Exclusion criteria
Veterans will be excluded if they: * plan to relocate out of the Central Texas area within four months of protocol initiation; * meet criteria for a diagnoses of schizophrenia, other psychotic disorders, or bipolar disorder; * report current hallucinations or delusions that are clearly not trauma-related; or * report current suicidal or homicidal risk warranting crisis intervention.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| World Health Organization Disability Assessment Schedule II (WHODAS II) | one year | Participants complete the WHODAS II at baseline, 4 months, 8 months, and 12 months. The WHODAS II measures general disability related to multiple domains (i.e., understanding and communicating, getting around, self care, getting along with people, life activities, work/school, participation in society). Total scores range from 1 (no disability) to 5 (extreme/cannot do), with higher scores indicating more impairment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Inventory of Psychosocial Functioning (IPF) | one year | 80-item self-report measure of psychosocial functioning across multiple domains (e.g., family, social, day-to-day activities). Items are rated on a 7-point scale ranging from 0 (never) to 6 (always). Lower scores indicate more positive outcomes. |
| Quality of Life Scale (QLS) | one year | Quality of life measure of functioning scored on a 1 (delighted) to 7 (terrible) scale. Scores are summed with higher scores indicating lower quality of life. Total scores range from 16 - 112. |
| Clinician Administered PTSD Scale (CAPS-5) | one year | Total scores reflecting PTSD symptom severity. Scores ranging from 0-136 (higher score = more severe). |
Countries
United States
Participant flow
Pre-assignment details
A total of 345 participants were consented into the study, after which final eligibility was determined during the baseline assessment (see inclusion/exclusion criteria). Of the 345 enrolled, 309 met inclusion criteria and were deemed eligible for follow-up in the longitudinal study.
Participants by arm
| Arm | Count |
|---|---|
| OEF/OIF/OND Veterans Operations Enduring Freedom, Iraqi Freedom and New Dawn Veterans | 309 |
| Total | 309 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | ineligible at baseline assessment | 36 |
| Overall Study | Lost to Follow-up | 23 |
| Overall Study | Withdrawal by Subject | 9 |
Baseline characteristics
| Characteristic | OEF/OIF/OND Veterans |
|---|---|
| Age, Continuous | 38.81 years STANDARD_DEVIATION 9.81 |
| Sex: Female, Male Female | 100 Participants |
| Sex: Female, Male Male | 209 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 2 / 309 |
| serious Total, serious adverse events | 28 / 309 |
Outcome results
World Health Organization Disability Assessment Schedule II (WHODAS II)
Participants complete the WHODAS II at baseline, 4 months, 8 months, and 12 months. The WHODAS II measures general disability related to multiple domains (i.e., understanding and communicating, getting around, self care, getting along with people, life activities, work/school, participation in society). Total scores range from 1 (no disability) to 5 (extreme/cannot do), with higher scores indicating more impairment.
Time frame: one year
Population: A total of 345 participants were enrolled, of which 309 were deemed eligible. Analyses are conducted with the total sample N = 309, followed over time. Sample sizes vary over time due to attrition and missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| OEF/OIF/OND Veterans | World Health Organization Disability Assessment Schedule II (WHODAS II) | Baseline | 1.87 units on a scale | Standard Deviation 0.69 |
| OEF/OIF/OND Veterans | World Health Organization Disability Assessment Schedule II (WHODAS II) | 4 months | 2.03 units on a scale | Standard Deviation 0.77 |
| OEF/OIF/OND Veterans | World Health Organization Disability Assessment Schedule II (WHODAS II) | 8 months | 2.07 units on a scale | Standard Deviation 0.78 |
| OEF/OIF/OND Veterans | World Health Organization Disability Assessment Schedule II (WHODAS II) | 12 months | 1.88 units on a scale | Standard Deviation 0.73 |
Clinician Administered PTSD Scale (CAPS-5)
Total scores reflecting PTSD symptom severity. Scores ranging from 0-136 (higher score = more severe).
Time frame: one year
Population: Sample sizes differ across time points due to attrition and missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| OEF/OIF/OND Veterans | Clinician Administered PTSD Scale (CAPS-5) | Baseline | 29.71 score on a scale | Standard Deviation 27.49 |
| OEF/OIF/OND Veterans | Clinician Administered PTSD Scale (CAPS-5) | 12 months | 34.29 score on a scale | Standard Deviation 30.94 |
Inventory of Psychosocial Functioning (IPF)
80-item self-report measure of psychosocial functioning across multiple domains (e.g., family, social, day-to-day activities). Items are rated on a 7-point scale ranging from 0 (never) to 6 (always). Lower scores indicate more positive outcomes.
Time frame: one year
Population: Sample sizes differ due to attrition and missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| OEF/OIF/OND Veterans | Inventory of Psychosocial Functioning (IPF) | Baseline | 2.51 score on a scale | Standard Deviation 1.25 |
| OEF/OIF/OND Veterans | Inventory of Psychosocial Functioning (IPF) | 12 months | 2.33 score on a scale | Standard Deviation 1.19 |
Quality of Life Scale (QLS)
Quality of life measure of functioning scored on a 1 (delighted) to 7 (terrible) scale. Scores are summed with higher scores indicating lower quality of life. Total scores range from 16 - 112.
Time frame: one year
Population: Sample sizes differ due to attrition and missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| OEF/OIF/OND Veterans | Quality of Life Scale (QLS) | Baseline | 76.33 score on a scale | Standard Deviation 17.46 |
| OEF/OIF/OND Veterans | Quality of Life Scale (QLS) | 4 months | 73.04 score on a scale | Standard Deviation 20.2 |
| OEF/OIF/OND Veterans | Quality of Life Scale (QLS) | 8 months | 72.38 score on a scale | Standard Deviation 20.6 |
| OEF/OIF/OND Veterans | Quality of Life Scale (QLS) | 12 months | 77.59 score on a scale | Standard Deviation 18.31 |