1 15 1 https://www.nal.usda.gov/exhibits/speccoll/files/original/1a0bf05df109281eff2c486dcfb15fc4.pdf d669c4eba5fc1f64cf6ddacac31262ea PDF Text Text Item ID Number °1837 Author True, William Ray Corporate Author Roport/Artido TltlO Typescript: Prevalence Odds Ratios for Stress Symptomology Among Vietnam Veterans from a Major Health Survey Journal/Book Title Year 1986 Month/Day Juno Color Number of Images 21 Alvin L Youn filed this item 9 under "Vietnam Veterans Twin Study." Item includes cover letter from William R. True ot Alvin L. Young, June 26, 1986. Wednesday, July 11, 2001 Page 1838 of 1870 �Medical Center St. Louis, MO 63125 Veterans Administration J u n e 26, 1986 Alvin L. Young, LTCOL, USAF, Ph.D. Senior Policy Analyst for the Life Sciences Executive Office of the President Office of Science and Technology Policy Room 5005, New Executive Office Building Washington, D.C. 20506 Dear Alvin: I really enjoyed seeing you in Washington, and thanks again for lunch. I'm gratified that this project is finally coming to show some results for all the time and effort that has gone into it. We also owe you so much for your significant assistance throughout. I wanted to get your schedule for your St. Louis trip. Please have your secretary give us a call as I'd love to take you to one of our fun Italian restaurants on the hill, former home of Yogi Berra and Joe Garagiola. My growing bride will join us, eating for two. I'm enclosing a copy of the paper I gave last week at the Society for Epidemlological Research in Pittsburgh. It got some press which was fun. Best wishes. I'll look forward to seeing you. Sincerely, William R.- True, Ph.D., M.P.H. Research Anthropologist (151A-JB) cc: Reply Refer To: Seth Eisen, M.D. 65 7/151A JB �Prevalence Odds Ratios for Stress Symptomology Among Vietnam Veterans from a Major Health Survey William Ray True, Ph.D., M.P.H. Research Anthropologist Psychiatry Service (151A-JB) VA Medical Center St. Louis MO 63125 Jack Goldberg, Ph.D. Epidemiologist Cooperative Studies Coordinating Center Hines VA Medical center Hines IL 60141 Seth A. Eisen, M.D. Medical and Research Services VA Medical Center St. Louis MO 63125 Presented at the Society for Epidemiological Research June 18-20, 1986 Pittsburgh PA �I. Introduction Many research s t u d i e s (Figley, 1978) have suggested t h a t p a r t i c i p a t i o n in the V i e t n a m War is c o r r e l a t e d w i t h psychological difficulties presently reported by Vietnam U n d e r a c h i e v e m e n t in e d u c a t i o n a l and employment spheres veterans. (Egendorf et a l . , 1981)/ m a r i t a l and p e r s o n a l i t y problems, and d r u g a n d / o r d r i n k i n g problems are j u s t a few e x a m p l e s of symptom c l u s t e r s which have been a t t r i b u t e d to the c o n f l i c t . Although the Vietnam War, like other wars, left with feelings of danger, combatants loss, helplessness, and d i s r u p t i o n (Laufer, 1985; Y a g e r , 1984), many i n v e s t i g a t o r s h a v e c o n c l u d e d t h a t the V i e t n a m e x p e r i e n c e was u n i q u e and t h e r e f o r e w o r t h y of special r e s e a r c h e f f o r t s . I n c o n t r a s t w i t h other w a r s , v e t e r a n s point out t h a t they l e f t the war zone as i n d i v i d u a l s r a t h e r t h a n as members of m i l i t a r y u n i t s , f a c e d b r o a d - b a s e d o p p o s i t i o n at home t o t h e i r p a r t i c i p a t i o n , s u f f e r e d the f r u s t r a t i o n s "limited war m e n t a l i t y , " and had to deal w i t h an a b r u p t t r a n s i t i o n f r o m a w a r t i m e to a c i v i l i a n e n v i r o n m e n t . of a The issue is f u r t h e r complicated by the perception shared by many v e t e r a n s t h a t e x p o s u r e t o H e r b i c i d e Orange a n d other p o t e n t i a l l y toxic substances while in V i e t n a m c a u s e d the physiologic disorders they believe psychological and t h e y a r e n o we x p e r i e n c i n g ( W a d e , 1979; Holden, 1 9 7 9 ) . While c o n s i d e r a b l e research a t t e n t i o n has been directed t o w a r d s u n d e r s t a n d i n g t h e long-term p s y c h o l o g i c a l health effects and physical of the Vietnam W a r , the relationship remains �Vietnam Veterans 3 incompletely defined. Many clinical studies have had no control groups, inadequate definition of outcomes, attention to confounding factors. and insufficient Four relatively large scale epidemiological studies do exist which examine the relationships between Vietnam service and subsequent health status. Slide 1 Although t h e s e s u r v e y s c o n s t i t u t e an i m p r e s s i v e body of knowledge, some l i m i t a t i o n s u p o n t h e i r interpretation Only the H a r r i s (1980) s t u d y is based on n a t i o n a l sampling t e c h n i q u e s . exist. probability Robins (1974) and Card (1983) both selected p r e s u m a b l y u n b i a s e d samples based upon c h r o n o l o g i c a l c r i t e r i a : Robins used Army examinations positive drug screens study. 'Legacies...') servicemen with 1971 a n d w i t h d r u g - f r e e s o l d i e r s f r o m t h e same Card selected veterans follow-up identify leaving V i e t n a m in September, matched these subjects group; to from The Egendorf the 1974 P r o j e c t T a l e n t study (referred to as i s p o t e n t i a l l y biased b e c a u s e p a r t i c i p a n t s w e r e selected u s i n g an u n u s u a l "snowball" sampling t e c h n i q u e in w h i c h a contacted household r e f e r r e d the study personnel to other v e t e r a n s m e e t i n g study c r i t e r i a . Further, objectives, employed. the research projects had different thereby accounting for Thus, the variety of research methods s t u d i e s d e f i n e d c o n t r o l groups a s V i e t n a m o r n o n - V i e t n a m e x p e r i e n c e d s o l d i e r s , a l t h o u g h t h e r e was considerable �Vietnam Veterans 4 non-Vietnam experienced s o l d i e r s / a l t h o u g h t h e r e was c o n s i d e r a b l e v a r i a t i o n i n levels o f w a r t r a u m a e n c o u n t e r e d . c o n t r o l groups were d e f i n e d as n o n - v e t e r a n s . Card study, comparisons were made reasons for not being Alternatively For example, in the with non-veterans, whose i n t h e m i l i t a r y w o u l d t h e m s e l v e s have complicated any analysis of t h i s q u e s t i o n . The analysis research of r e p o r t e d here is a major study, the based on the Survey of commissioned by the V e t e r a n s A d m i n i s t r a t i o n . secondary Veterans II, The s t u d y was Slide 2 conducted in 1979 by the Census Bureau of the Department of Commerce on the Current Population identified themselves serving since 1917. Era sub-sample Survey respondents who had as veterans of the U.S. Armed Forces From this study sample of 11,230, a Vietnam of 2,452 was identified and interviewed. This group was divided between 1,036 Vietnam theater and 1,416 Vietnam Era veterans. II. Epidemiological Analysis of the SOV II This sample is particularly important because it was studied in 1979, a t i m e p r e c e e d i n g the d e v e l o p m e n t of the major controversy about Agent Orange and the considerable surrounding that issue. litigation Therefore the SOV II was an important benchmark sample against which other current surveys may be compared. �Vietnam Veterans 5 The a n a l y s i s of the e f f e c t s was performed of war service in t h i s sample with Mantel-Haenszel p r e v a l e n c e odds ratios c o n t r o l l i n g for age, race, length of s e r v i c e , year of release Slide 3 from service, years of education at discharge, rank, draftedenlisted, and branch of service. Test-based Confidence Intervals are presented in lieu of significance levels. In this analysis, the controlling variables were adjusted for simultaneously. Further analysis of the specific associations of the individual potential confounding variables with the outcome measures is now in progress. The survey did not include questions about preservice risk factors or youthful liability measures which have been shown to be important in other studies. Questions as they were stated on the questionnaire took the following form: "Since your LAST release from active military service, have you...had any problems with your physical health? /alternatively/. . .had frightening dreams or nightmares?" items asked for overall prevalence The during the years since discharge, and there was no probe for timing of the item. The question concerning Vietnam service was phrased as follows: Were you stationed in Vietnam, Laos, or Cambodia; in the waters in or around these countries; or fly in missions over these areas? The prevalence odds ratios for psychiatric symptom outcomes �Vietnam Veterans 6 revealed increased prevalence odds ratios for those exposed to in-country Vietnam Duty. The striking elevation in prevalence Slide 4 odds ratios for nightmares was the strongest outcome in the study, and this nearly four-fold increase did not diminish with adjustment. Although sufficient data are not available to make a presumptive diagnosis of Post-Traumatic Stress Disorder, we looked at the evidence relevent to this diagnosis. Nightmares, for example, along with confusion, are specifically included in the Diagnostic and S t a t i s t i c a l Manual III (APA, 1980) as contributing to the diagnosis of Post-Traumatic Stress Disorder. Depression and guilt both have also been included in clinical descriptions of post-traumatic stress symptomatology 1979). (Helzer, Another feature of the clinical presentation of troubling d r e a m s are n i g h t terrors, which are often accompanied by retrograde amnesia, therefore causing the symptom to be commonly under-reported. Consequently, we suspect that although these findings are quite dramatic, they may still understate this troubling symptomology. Slide 5 These psychological outcomes, including Troubled Memories, Psychological Problems, and Temper Control also contribute to the �Vietnam Veterans 7 Post Traumatic Stress Disorder diagnosis. The diagnosis itself encompasses two different domains of symptoms, intrusive imagery and numbing. intrusive symptoms, such as the psychological outcomes displayed, suggest the re-experiencing of the original trauma. This may occur through hyper-reactivity to environmental stimuli such as startle responses to backfires, i r r a t i o n a l feelings and actions upon seeing an oriental face, or disturbing dreams. Numbing suggests constricted affect, feelings of estrangement, deliberate efforts to avoid feelings and activities which may directly or indirectly resonate with the original trauma. Thus, for example, a veteran may avoid sports in spite of personal interest because the emotional closeness of the team may recall the esprit of the platoon, which may have been d e c i m a t e d in combat. In these data, life goal indecision suggests a reflection of the numbing symptomology. General Problem Outcomes suggest more of the areas Slide 6 included in the numbing aspect of the Post Traumatic Stress Disorder diagnosis, although in this study, they do not appear to be important. Outcomes relating to job, school and family would suggest these difficulties. These findings are increased with measurement of the combat exposure. Combat was measured with an additive scale for all �Vietnam Veterans Slide 7 Vietnam veterans and was grouped for this analysis levels: none, low, medium, and high. into four The psychiatric outcomes and combat show the increased prevalence odds ratios for Slide 8 higher levels of combat. over a nine-fold Again, Nightmares for high combat shows increase. Prevalence odds ratios for all psychiatric symptoms show highly significant combat effects with the Test for Trend. Similar findings are shown for the psychological outcomes. Slide 9 Troubled memories show almost an eight fold increase, and all outcomes save Life Goal indecision demonstrate clear stepped increases with combat. All trends are highly significant. Of the General Problem Outcomes, Physical Health shows Slide 10 increased Prevalence Odds Ratios and highly significant trend with combat. This finding is interesting although we cannot �Vietnam Veterans 9 determine whether the health problems were the result of injuries from the war itself, or related to the indirect stresses of combat as these might be hypothesized or increased risk-taking. to affect physical health The other outcomes show modest but consistent increases and significant trend. Evidence has been presented of the presence of traumatic stress symptomology for a randomly selected sample of veterans studied in 1979, a time preceding recent increases in the political sensitivities surrounding the issue of the effects of the Vietnam War. That these symptoms are magnified by combat exposures follows clinical experience and other research already conducted. �Vietnam Veterans 10 References American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders III (DSM-III). Washington, D.C.; 1980. Card, J.J.: Lives After Vietnam: The personal impact of military service. Lexington, Mass.: D.C. Heath, 1983. Egendorf, A., Kadushin, C., Laufer, R.S., Rothbart, C., and Sloan, L.: Legacies of Vietnam: Comparative adjustment of veterans and their peers, a study conducted for the Veterans Administration, submitted to the Committee on Veterans' Affairs, U.S. House of Representatives, 1981. Figley, C.R., ed.: Stress Disorders Among Vietnam Veterans: Theory, Research and Treatment. New York: Brunner/Mazel, 1978. Harris, L. and Associates, Inc.: Myths and Realities: A Study of A t t i t u d e s Toward Vietnam Era Veterans. Conducted for the Veterans Administration, Washington, D.C., 1980. Helzer, J.E., Robins, L.N., Wish, E., and Hesselbrock, M. : Depression in Vietnam veterans and civilian controls. Am J Psychiatry 1979; 136:526-529. t Holden, C.: Agent Orange furor continues to build. 24:770-772. Science 1979; L a u f e r , R.S.: War Stress and T r a u m a : the Vietnam Veteran Experience. Presented at the American Sociological Association Meetings, San Francisco, CA 1982. J Health Soc Behavior, 1985. Robins, L.N., Davis, D.H., Goodwin, D.W.: Drug use by U.S.Army enlisted men in Vietnam: A Follow-up on their return home. Am J Epidemiology 1974 (April); 99(4):235-249. Veterans Administration, Reports and Statistics Service, Office of the Controller, 1979 National Survey of Veterans II, Summary Report, 1980. Wade, N.: Viets and vets fear herbicide health effects. 1979; 25:817. Science Yager, T., Laufer, R., and Gallops, M.: Some problems associated with war experience in men of the Vietnam generation. Arch Gen Psychiatry 1984; 41:327-333. �Table 1 Vietnam Veteran Surveys Study Question Population N Controls Robins, 1974 Post service drug use Army enlisted leaving VN 9/71 495 drug 470 drug Legacies of Vietnam, 1981 War effects Strat prob sample: 10 sites 350 VN 363 VN Prob sample 1176 VN Harris, 1980 War effects 629 Veterans 1388 VN 4073 Veterans Card, 1979 War effects Project Talent 500 VN 500 VN 500 Veterans SOV II, 1979 War effects CPS 1036 VN 1416 VN �Table 2 Study Sample Survey of Veterans II (1979) Sponsored by Reports and Statistics Service Veterans Administration Central Office Conducted by Bureau of Census Commerce Department February to April 1979 Sample size: 11,230 male veterans (Military Service since 1917) Bureau of Census Current Population Sample (CPS) �Table 3 Potential Confounding Vnrinblon Age at time of Survey Race Length of Service Year of Release Years of Education Rank Drafted - Enlisted Branch of Service �Table 4 Prevalence Odds Ratios for Psychiatric Symptom Outcomes and Service in Vietnam Unadjusted 95% C.I. Adjusted 95% C.I. Nightmares 3.69 2.91-4.68 3.78 2.85-5.02 Confusion 1.53 1.22-2.19 1.82 1.39-2.39 Depression 1.43 1.20-1.70 1.65 1.35-2.01 Guilt 1.37 1.12-1.68 1.42 1.12-1.81 �Table 5 Prevalence Odds Ratios for Psychological Outcomes and Service in Vietnam Unadjusted 95% C.I. Adjusted 95% C.I. Troubled Memories 3.31 2.64-4.14 3.52 2.69-4.61 Psychological Problems 1.66 1.29-2.13 1.75 1.30-2.35 Temper Control 1.72 1.39-2.12 1.78 1.38-2.29 Life Goal Indecision 1.43 1.18-1.73 1.53 1.22-1.90 Sleeping Problems 1.51 1.22-1.87 1.46 1.13-1.87 �Table 6 Prevalence Odds Ratios for General Problem Outcomes and Service in Vietnam Unadjusted 95% C.I. Adjusted 95% C.I. Physical Health 1.42 1.16-1.75 1.30 1.10-1.68 Drug or Drinking 1.58 1.08-2.37 1.81 1.18-2.79 Finding Job 1.29 1.07-1.56 1.36 1.09-1.71 Holding Job 1.43 1.02-2.07 1.57 1.05-2.36 Inadequate Pay 1.19 1.01-1.41 1.18 .97-1.44 Family Trouble 1.26 1.01-1.57 1.27 .97-1.65 Legal Trouble 1.07 .74-1.56 1.27 .81-1.99 School Trouble 1.05 .71-1.55 1.10 .69-1.79 �Table 7 Combat Scale 1 Artillery Unit which fired on the enemy 2 Flew missions over Vietnam/ Laos, and/or Cambodia 3 Stationed at a forward observation post 4 Received incoming fire (artillary, rockets, or mortars) 5 Encountered enemy mines or booby traps 6 Received sniper or sapper fire 7 Ambushed by enemy 8 Engaged the Vietcong, Guerilla, or unidentified troups in a firefight 9 Engaged the North Vietnamese Army or other organized military forces in a firefight Combat Scale equals sum of positive responses to any of the above. There are two groups: Non-Vietnam and Vietnam (Combat Scale 0 to 9) �Table 8 Prevalence Odds Ratios for Psychiatric Symptom Outcomes and Combat Scale Combat Level Non-VN None Low Med High Test for Trend Nightmares 1.00 1.54 2.27 5.47 9.31 203.333*** Confusion 1.00 1.21 1.26 1.85 2.24 22.811*** Expression 1.00 1.13 1.12 1.97 2.05 29.938*** en I II 1,00 .97 1.00 1.77 2 . 2 .1, 22.533*** *** |> < .00 �Table 9 Prevalence Odds Ratios for Psychological Outcomes and Combat Scale Combat Level Test for Trend Non-VN None Low Med Troubled Memories 1 .00 1.68 1.92 7.74 7.94 188.331*** Psychological Problems 1 .00 1. 04 1 .39 1. 93 2 .72 28. 737*** Temper Control 1 .00 1. 05 1 .46 2. 17 2 .75 43. 049*** Life Goal Indecision 1 .00 1. 42 1 .28 1. 70 1 .52 13. 683*** Sleep Problems 1 .00 1. 09 1 .03 1. 90 3 .02 35. 931*** *** p < .001 High �Table 10 Prevalence Odds Ratios for General Problem Outcomes and Combat Scale Combat Level Non-VN None Low Med High Test for Trend Physical Health 1.00 .92 1.04 2.18 2.17 26.821*** Drug or Drinking 1.00 .66 1.58 2.07 1.82 8.836** Finding Job 1.00 1.17 1.13 1.52 1.62 11.165** Holding Job 1.00 1.05 1.32 1.70 1.78 6.459** Inadequate Pay 1.00 .97 1.15 1.46 1.22 6.382** Family Trouble 1.00 .77 1.12 1.69 1.65 11.047** Legal Trouble 1.00 .67 .98 1.96 1.21 .904 School Trouble 1.00 .58 .91 1.59 1.18 .881 ** p < .01 *** p < .001 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 068 Folder The folder containing the original item. 1837 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource True, William Ray Jack Goldberg Seth A. Eisen Date A point or period of time associated with an event in the lifecycle of the resource 1986-06-01 Title A name given to the resource Typescript: Prevalence Odds Ratios for Stress Symptomology Among Vietnam Veterans from a Major Health Survey Subject The topic of the resource Vietnam Experience Twin Study PTSD ao_seriesIII