Table 1.
Prevalence Estimates of Combat-Related PTSD
| Country | Study Year | Study Design | Participants (Sample Size) | Assessment Instruments | (Lifetime) Current Prevalence |
|---|---|---|---|---|---|
| US | NVVRS, 1990 | retrospective., assessed 11–12 yrs post-return | Vietnam veterans, males (1,200) | MISS-PTSD (SR), MMPI-PTSD (SR), SCID-III-R (CI); PTSD from DSM-III-R | (30.9%) 15.2% |
| US | VES, 1988 | retrospective, assessed 11–12 yrs post-return, telephone | Vietnam era, males (2,490 VV; 1,972 NVV) | MMPI-PTSD (SR), DIS-3A (CI) | (15.2%) 2.2% |
| US | Eisen et al., 2004 [26] | retrospective, assessed 17yrs pot- return | Vietnam veterans, males, twin registry (8,169) | DIS-III-R (based on DSM-III-R criteria) | (10%) 4.5% |
| US | Dohrenwend et al., 2006 [2] | retrospective review | Original NVVRS sample data (1,200) | as per NVVRS | (18.7%) 9.1% |
| US | Thompson et al., 2006 [28] | retrospective review | Original NVVRS and VES sample data (1,200; 2,490) | as per NVVRS & VES | NVVRS=2.9% VES=2.6% |
| US | Goldberg et al., 1990 [49] | retrospective, 15yrs post deployment, MZ twin pairs, males postal/telephone | Vietnam veterans, males, twin registry (2,092) | PCL (SR) | 16.8% VV, 5.0% NVV |
| Australia | O’Toole et al., 1996 [61] | retrospective assessed 20–25 yrs post-deployment | Vietnam veterans, males (641) | MISS-PTSD (SR) AUSCID (SR) | (20.9%) 11.6% |
| US | Iowa Persian Gulf Study Group, 1997 [32] | retrospective, assessed 4–5 yrs post deployment, cross sectional, telephone | 1990 PGW veterans (1,896); era veterans not deployed to PGW (1,799) | PCL-M(SR) | PGWV=1.9% Era Non-GWV=0.8% |
| US | Barrett et al., 2002 [29] | as per Iowa Persian Study group sample, Review of data | 1990 PGW veterans (1,889); era veterans not deployed to PGW (1,793) | PCL-M (SR) | 1.09% |
| US | Kang et al., 2003 [34] | retrospective, cross sectional, postal, assessed 5–6 yrs post- deployment | 1990 PGW veterans (11,441); era veterans not deployed to PGW (9,476) | PCL- (SR) | PGW =10.1%; Era Non-GW =4.2% |
| US | Wolfe, Proctor et al., 1999 [39] | retrospective, cross sectional, assessed 3–6 yrs post | 1990 PGW veterans (204), sampled from Louisiana & Massachusetts bases; era veterans not deployed to PGW (48) | CAPS (CI) SCID (CI) MISS-PTSD (SR) | PGWV= Approx 6.3% (approx 7.35%); Era Non-GWV = not reported |
| US | Wolfe, Erikson et al., 1999 [37] | prospective, assessed 5 days post deployment (T1) and recontacted 2 yrs later (T2) | 1990 PGW veterans, males & females, from Massachusetts base (2,942) | MISS-PTSD (SR) | T1 GWV= 3%; T2 GWV = 8% |
| US | Gray et al., 2002 [31] | based on Seabee Health Study 1997–1999 Retrospective, cross sectional, postal | 1990 PGW veterans, Seabees compared to US era veterans not deployed to Gulf (3,831 GWV; 4,933 deployed elsewhere Era Seabee; 3,104 non-deployed Seabees) | PTSD screen from DSM-IV (SR) | GWV= 3.04%, Era= 0.61; Non- deployed = 0.71 |
| US | Stretch et al., 1993 [35] | retrospective, cross sectional assessed 2 yrs post-deployments, postal | 1990 PGW veterans compared to non- deployed era veterans residing in Hawaii/Pennsylvania (1,524 GWV; 2,512 NGW) | WRAIR algorithm | 8.6% GWV, 1.6% NGW |
| Canada | Goss-Gilroy et al., 1998 [142] | retrospective, assessed 6yrs post- deployment, postal | 1990 PGW, males & females, compared to deployed elsewhere (3,113 GWV; 3,439 NGV) | PCL-R (SR) | OR=2.69 (95% CI 1.59–4.26) |
| UK | Unwin et al., 1999 [73] | retrospective, cross sectional postal | 1990 PGW veterans, males compared to non- deployed era veterans, compared to era veterans deployed to Bosnia peacekeeping (3,284 GWV; 1,815 Bosnian vets; 2,408 era vets) | MISS-PTSD | GWV= 13.2%, Bosnia deployed = 4.7%, Era=4.1% |
| Canada | Statistics Canada, 2003 [60] | retrospective, interview, random selection from total deployed forces | Canadian Regular Forces, males & females (5,000 regulars, 3,000 reservists) | CIDI (CI) | (7.2%) 2.8%; reserves (4.7) 1.2%; >3 tours (10.3%); > 3 tours 4.7% |
| UK | Toomey et al., 2007 [36] | regular UK personnel, postal, assessed T1 = 3–4 yrs post- deployment and T2 = 10 yrs later | 1990 PGW veterans (subset of Kang et al 2000) (4,762) | CAPS ( CI) PCL-C (SR) | 3.7% |
| UK | Lee et al., 2002 [64] | consecutive serving + former serving, cross sectional | Post-1993, all branch UK regular forces veterans (3,000) | Clinician Assessment | 12% |
| Australia | Ikin et al., 2004 [62] | retrospective, mailed plus interview, all deployed ADF personnel to GW | 1990 PGW veterans (1,381) | CIDI (CI) | 5.4% |
| UK | Jones et al., 2006 [65] | retrospective, postal, random sample | active, past-deployed, all units (2,873) | PCL (SR), GHQ-12 (SR) | 2.5% |
| UK | Hotopf et al., 2006 [20] | retrospective, random, postal and sub-sample in-person | 2003 Iraq War (4,722 OIF; 5,500 OIF era) | PCL-C (SR) | 4% |
| UK | Brown et al., 2007 [21] | postal, random | as per Hotopf et al., 2006 (3,936 regulars, 796 reservists) | PCL-C (SR), GHQ-12 (SR) | 4%= regulars, 6%= reservists |
| UK | Iversen et al., 2008 [22] | retrospective regular personnel, postal | OIF (4,762) | PCL-C (SR) | 3.7% |
| US | Hoge et al., 2004 [18] | cross-sectional, longitudinal, pre- post | OIF/OEF active deployed (2,530 pre deployment; 3,671 post-deployment) | routine post- deployment (SR) | post-OIF = 15.6%(army), 17.1%(marine), post-OEF=11.2% |
| US | Hoge et al., 2006 [17] | cross sectional, pre-post, Army & Marines | OIF/OEF/other active deployed (303,905) | routine post- deployment (SR) | OIF=9.8%; OEF = 4.7%; Other = 2.1% |
| US | Seal et al., 2007 [19] | prospective, 2001–2005, all deployed personnel | OEF/OIF veterans enrolled at VA (103,788) | VA diagnosis on files (CI) | 13% |
| US | Smith et al., 2008 [56] | prospective cohort analysis, deployed personnel | OIF/OEF/other active duty and Reserve/National Guard deployed (50,184) | PCL-C (SR) | 7.6–8.7% |
Note: US = United States; UK = United Kingdome; NVVRS = National Vietnam Veterans Readjustment Survey; MISS-PTSD = Mississippi Scale for posttraumatic stress disorder; SR = self report; MMPI-PTSD = Minnesota Multiphasic Personality Inventory, PTSD subscale; SCID = Structured Clinical Interview for DSM; CI = clinical interview; DSM = Diagnostic and Statistical Manual; VES = Vietnam Experience Study; VV = Vietnam veteran; NVV = Vietnam era veteran, did not serve in Vietnam; DIS = Diagnostic Interview Schedule; MZ = monozygotic twins; PCL = PTSD Checklist; AUSCID = Australian Version Structured Clinical Interview for DSM-IIIR; PGW = Persian Gulf War; GW = Gulf War era veteran, did not serve in Gulf War; ADF = Australian Defence Force; CAPS = Clinician Administered PTSD Scale; PCL-C = PTSD Checklist-Civilian; CIDI = Composite International Diagnostic Interview; GHQ-12 = General Health Questionnaire – 12; OIF = Operation Iraqi Freedom; OEF = Operation Enduring Freedom (Afghanistan); VA= Department of Veterans Affairs; WRAIR = Walter Reed Army Institute of Research.