Content area
Full Text
(ProQuest: ... denotes non-USASCII text omitted.)
Introduction
There is a consistent body of research showing that exposure to combat is associated with an increased risk of post-deployment psychiatric injury (Kulka et al. 1990; Lee et al. 1995). After the recent conflict in Iraq, high rates of post-traumatic stress disorder (PTSD) have been reported in US combat troops (Hoge et al. 2006). UK personnel returning from Iraq have a lower prevalence of PTSD than their US counterparts but there is a clear association between combat role and increased risk of PTSD (Hotopf et al. 2006). PTSD is a major concern to the military because of the considerable disability and co-morbidity associated with the disorder (Zatzick et al. 1997; Kessler, 2000), which have implications for the individual affected, for the employer, and for society in general. More research is needed to understand modifiable factors in the military environment that reduce the risk of PTSD.
The introduction of the diagnostic category of PTSD in 1980 stated that war trauma alone was a sufficient cause of long-term disorder (APA, 1980). Like its predecessors, that view was too absolute, and since 1980 there has been a gradual re-exploration of the importance of individual factors associated with PTSD. Meta-analyses have identified several risk factors for PTSD in both the military and the general population.
In terms of pre-trauma vulnerability factors, Brewin et al. (2000) have identified factors such as previous psychiatric history, early childhood adversity and a family history of mental illness as independent risk factors for PTSD. Other individual factors such as low education, previous trauma, female gender, ethnic minority status and younger age have also been shown to be associated with PTSD in both the military (Riddle et al. 2007) and the general population (Brewin et al. 2000; Ozer et al. 2003). Several authors report that degree of exposure to potentially traumatic events and severity of trauma are associated with risk of PTSD (Brewin et al. 2000; Hoge et al. 2004). Objective degree of trauma exposure may, however, be less predictive of PTSD than the individuals' appraisals of the trauma and its aftermath (Ehlers & Clark, 2000). Such appraisals have been shown to predict PTSD over and above objective trauma severity (Halligan et al. 2003) and perceived threat...