No description available.

No description available.

No description available.

No description available.

No description available.

No description available.

This study was conducted to identify gaps in existing knowledge regarding impacts of combat-related PTSD on the spouse and to gain an understanding of the lived experience of Appalachian Spouses of combat veterans with PTSD. A systematic literature review was conducted to identify research and findings on the impacts of combat-related PTSD on spouses of veterans and a qualitative study was conducted to gain an understanding of the lives of Appalachian spouses of combat veterans with PTSD. The systematic review identified 16 qualitative studies conducted between 1988 and 2016 in five countries spanning five wars. Regardless of the country of study or the war, the spouses experienced problems dealing with the symptoms of PTSD, emotional distress, impacts to relationships and caregiver burden. The systematic literature review revealed limited information on minority or underserved populations. Qualitative interview data from ten Appalachian spouses of combat veterans with PTSD were examined to gain an understanding of their lives. Data were obtained from semi-structured interviews. Findings indicate Appalachian Vietnam veteran spouses experience similar problems dealing with the veteran’s symptoms of PTSD, relationship problems, mental health problems and caregiver burden. The veterans in this study were not diagnosed with PTSD until later in life so they spent the majority of their life without knowledge or treatment for the illness. The women in this study expressed concerns that government and society have marginalized Vietnam veterans. This research highlights the need for outreach and PTSD education for Vietnam veterans and their spouses. Future research is recommended to expand the body of knowledge on the impacts of PTSD on the spouse with particular attention to other cultures, minority and underserved populations.

The purpose of this quantitative study was to examine whether the post-deployment screening instrument currently utilized to assess active-duty Marines for symptoms of PTSD upon their return from a combat deployment can be solely relied upon to accurately assess for PTSD. Additionally, this study sought to compare the number of Marines who have sought trauma-related mental health treatment based on their answers on the Post-Deployment Health Assessment (PDHA) to the number who have sought trauma-related mental health treatment based on their answers on their PTSD Checklist - Military Version (PCL-M). The participants in this study were comprised of a sample of active-duty Marines that had recently returned from a combat deployment. A quantitative secondary data analysis used Item Response Theory (IRT) to examine the answers provided by the participants on both the PDHA and PCL-M. Both instruments proved to be effective when assessing symptoms of PTSD and the participants identified as having symptoms of PTSD were referred for mental health services as required. According to the results, more Marines were identified as having symptoms of PTSD using both assessment instruments (PDHA and PCL-M) compared to those identified using just the PDHA. The result was a better understanding of predictors of Marines who may later develop PTSD. The results of this study can also assist the Marine Corps with its post-deployment screening for symptoms of PTSD which in turn can provide appropriate mental health referrals for Marines if deemed appropriate.

This thesis presents an eclectic mix of studies which consider laterality in the context of previous findings of increased prevalence of Posttraumatic Stress Disorder (PTSD) in male combat veterans with non-consistent right hand preference. Two studies extend these findings not just to civilian populations and women, but to left handers and find that left, rather than mixed, handedness is associated with increased prevalence of PTSD in both general population and clinical samples, and to severity of symptoms in the former. To examine issues relevant to the fear response in healthy populations, a movie excerpt is shown to be theoretically likely to target the emotion of fear and to generate subjective and physiological (skin conductance) responses of fear. The film is used as a laboratory analogue of fear to examine possible differences in left and right handers in memory (for events of the film) and in an emotional Stroop paradigm known to produce a robust and large effect specifically in PTSD. According to predictions based on lateralisation of functions in the brain relevant to the fear response, left handers show a pattern of enhanced memory for visual items and poorer memory for verbal material compared to right handers. Immediately after viewing the film, left handers show an interference effect on the Stroop paradigm to general threat and film words and increased response latency compared to right handers, approaching performance of previously reported clinical samples with PTSD. A novel non-word Stroop task fails to show these effects, consistent both with accounts of interference as language processing effects and compromised verbal processing in PTSD. Unexpected inferior performance of females in memory for the film, contrary to previous literature, may also be amenable to explanations invoking compromised left hemisphere language functions in fear situations. In testing one theory of left handedness as due to increased levels of in utero testosterone, the 2D:4D (second to fourth digit ratio) provides mixed evidence in two samples. A possible association of more female-like digit ratios in males with PTSD is a tentative finding possibly relevant to sex differences in prevalence of PTSD. A critique of existing and inadequate theoretical accounts of handedness concludes the thesis and proposes a modification of the birth stress hypothesis to one specifically considering peri-natal trauma to account for the above findings. This hypothesis remains to be empirically tested.

Depression and post-traumatic stress disorder are common psychiatric comorbidities related to stress. These conditions are frequently treated with antidepressants such as selective serotonin reuptake inhibitors (SSRI’s). However, there are individual differences in susceptibility to stress-induced psychopathologies and response to antidepressants. Therefore, there is a need to identify biologic factors that predict vulnerability to stress and response to treatment. Furthermore, few studies have examined the neural correlates of antidepressant treatment response in a stress-susceptible animal model. This dissertation had three specific aims: 1) to characterize behavioral predictors of stress vulnerability by studying three dimensions of temperament (reward dependence, novelty-specific activity and harm avoidance) before stress exposure using a stress-susceptible rat strain, 2) to identify the neural network effects of response and non-response to SSRI treatment using a stress-susceptible animal model, and 3) to determine the neurophysiologic correlates of helplessness susceptibility. This was examined via measurement of regional brain metabolic capacity and functional connectivity within relevant neural circuits, and measurements of corticosterone and heart rate. These effects were studied in rats that underwent inescapable shock exposure followed by escape testing. Holtzman rats showed greater predisposition to helpless behavior following inescapable shock compared to Sprague Dawley and Long-Evans strains. Also, increased activity in a novel environment and low heart rate appeared to be markers of helplessness susceptibility in Holtzman rats. Limbic-cortical network effects were identified that distinguished between responders and non-responders to antidepressant treatment in the Holtzman strain. Finally, hypermetabolism of the lateral habenula and a less interactive prefrontal-limbic cortex were identified in subjects with higher susceptibility towards helplessness within the Holtzman strain. Similar findings have been reported with other depression animal models and human neuroimaging studies. These findings support that the helpless dimension of mood disorders can be accurately modeled with the Holtzman rat strain and confirm that the lateral habenula and prefrontal cortex are key regions mediating the helpless phenotype and response to SSRI treatment. / text