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PTSD AND SUICIDE FOLLOWING WAR
When one or more members of a family are traumatized,
the entire family can suffer from posttraumatic symptoms. Unfortunately,
this may go unrecognized by the family, friends, and professionals. A
cycle of posttraumatic victimization and fragmentation of family
integrity can lead to disastrous consequences. The posttraumatic phases
leading to such a destructive outcome can potentially involve events like a young adult child's suicide, combat trauma and loss, or a child's witness of parental suicide. Treatment of the traumatized families may include psychoeducational, psychodynamic, systemic, behavioral, and spiritual interventions.
Trauma has an big impact on both individuals and society as a whole. According to Davidson (2000), recognition of the extent of this impact by the medical profession has been relatively slow. However, with growing appreciation of the prevalence of trauma exposure in civilian as well as combat populations, the true scale of trauma-related psychiatric consequences is beginning to emerge. Reports suggest that more than 60% of men and 51% of women
experience at least one traumatic event in their lifetimes. Of these, 8%
and 20%, respectively, fall victim to PTSD indicating that more women
are at risk for developing PTSD. Individuals experience severe
psychiatric stress that is compounded by significant comorbid illness.
This impacts critically upon quality of life resulting in grave
functional and emotional impairment. Additionally, there is a detrimental
cost to society with high financial and social consequences from the
significantly elevated rates of hospitalization, suicide attempts and
alcohol abuse (Davidson, 2000). Davidson, Hughes, Blazer, & George, (1991) examined posttraumatic stress disorder (PTSD) among
2,985 Ss (aged 18-95 yrs) in a community. Based on responses to the
Diagnostic Interview Schedule, the lifetime and six month prevalence figures
for PTSD were 1.3% and 0.44%, respectively. Compared with non-PTSD Ss,
those with PTSD had significantly greater job instability, family
history of psychiatric illness, parental poverty, experience of child
abuse, and parental separation or divorce before age 10 years. PTSD was
associated with greater psychiatric comorbidity, attempted suicide,
social phobia, obsessive-compulsive disorder, generalized anxiety, and
major depression. Compared with acute cases, chronic PTSD was
accompanied by more social phobia and somatization disorder, impairment
of subjective social support, and greater likelihood of physical attack
with regard to initiating trauma.
Amir, Kaplan, Efroni & Kotler (1999) examined the relationship between suicide risk and coping styles in 46 Ss with posttraumatic stress disorder (PTSD) (mean age 39.21 yrs) as compared with 42 Ss with non-PTSD anxiety disorders
(mean age 42.45 yrs) and 50 healthy controls. Ss completed the Suicide
Risk Scale (SRS) and the Albert Einstein College of Medicine Coping
Styles Questionnaire based on the R. Plutchik (1991) model of emotions.
The PTSD Ss scored significantly higher than the two control groups on the
SRS. In the PTSD group, suicide risk was significantly negatively
correlated with the coping styles of mapping, minimization, and
replacement and positively correlated with the coping style of
suppression. Coping styles significantly explained the variance in the
SRS scores for all three groups. The cognitive map of PTSD patients highly
resembles other populations with high suicide risk. Amir et al's (1999) results suggest that clinicians treating victims of traumatic events should focus on problem-solving therapies in order to help these patients deal less rigidly with everyday stresses and decrease suicide risk.
Ferrada-Noli, Asberg, Ormstad, Lundin & Sundbom (1998) assessed the prevalence of posttraumatic stress disorder (PTSD) and psychiatric comorbidity, the incidence of suicidal behavior among refugees with a history of exposure to severe trauma, and the possible difference between the different diagnoses with respect to modes of suicidal behavior. 149 adult refugees with severe traumatic
experiences underwent PTSD diagnoses and an assessment of suicidal
behavior. PTSD prevalence was 83% in all cases in which a principal
psychiatric diagnosis was established. A significant over-representation
of suicidal behavior was found in Ss with PTSD compared with non-PTSD
Ss. No difference was found with respect to the total prevalence of
suicidal behavior between depressed and nondepressed PTSD subgroups.
Nondepressed PTSD patients showed an increased frequency of suicide
attempts, but decreased frequency of suicide thoughts, relative to
depressed-PTSD patients.
Ferrada-Noli, Asberg & Ormstad (1998) studied whether relationships exist between the type of torture stressors and suicidal ideation. The hypothesis they tested was that the nature of the torture methods would be reflected in the content of posttraumatic self-destructive ideation. 65 adult refugees who had been assessed with both diagnoses of posttraumatic stress disorder (PTSD) and
suicidal behavior underwent psychiatric diagnoses and suicidal behavior
assessment. Results showed a clear association between the mode of
torture and preferred suicidal strategy. Among PTSD patients with a
history of torture, an association was seen between the torture methods
that the victim had been exposed to, and the suicide method used in
ideation or attempts. Blunt force applied to the head and body was
associated with jumping from a height or in front of trains, water
torture with drowning, or sharp force torture with methods involving
self-inflicted stabbing or cutting. These suggested relationships between main stressors and content of suicidal ideation.
Youth
PTSD symptoms have been reported in children who have watched TV coverage related to Halloween, wars, industrial disasters, and terrorist bombings.
Duggal, Berezkin, Gennady & Vineeth (2002) report the case of an 11-yr-old boy who developed posttraumatic stress disorder (PTSD) along with major depression after watching on TV the terrorist attacks on the World Trade Center. The
boy was in the 7th grade in a boarding school. Overwhelmed by the events, he impulsively decided to commit suicide, but was prevented from it. This case demonstrates that a child who is exposed to traumatic events on TV can develop PTSD symptoms. It has implications for media personnel, teachers, parents, and clinicians.
Carter & Brooks (1991) discussed survivorship in children and adolescents. They
addressed directly the myth that children cannot truly experience mourning
because of their developmental age or more specifically their incomplete
understanding of death. They utilized research and case illustrations to help us understand what it is like for these young survivors, including that they themselves now become at greater risk for suicide.
Brent, Moritz, Bridge, Perper et al (1996) examined the long-term impact of exposure to suicide on 166 friends of adolescent suicide victims and 175 unexposed community controls (aged 21-23 yrs) up to three years after the suicide. Ss completed the Schedule for Affective Disorders and Schizophrenia for School-Age Children. The incidence of suicide attempts was comparable between groups over the entire follow-up period, despite higher rates of
baseline and incident psychopathology in the exposed Ss. An increased
incidence of depression and anxiety was found in friends that was most
marked in the first six months of follow-up. An increased incidence of
posttraumatic stress disorder (PTSD) in exposed Ss was found. Those
exposed Ss who knew the suicide plans of the suicide victim were at the
greatest risk for depression and PTSD over the entire course of
follow-up.
Brent, Perper, Moritz, Liotus et al (1995) examined the predisposing factors to posttraumatic stress disorder (PTSD) in 146 peers of 26 adolescent suicides. Eight Ss (mean age 20.1) who developed PTSD after exposure to suicide were
compared to the remaining 138 Ss (mean age 18.2 yrs). PTSD Ss were more
likely to have had a history of substance abuse, agoraphobia, and
suicide attempts. PTSD Ss were also more likely to have developed a
new-onset depression (NOD), to have more severe grief, and to have been
closer to the suicide victim. The eight PTSD Ss were also compared to 38 Ss
who developed NOD but not PTSD. PTSD Ss were more likely to have had
past substance abuse; suicide attempts; family history of panic
disorder; history of parent-child disruption and loss; and symptoms of
intrusive visual images, hypervigilance, and avoidance of reminders.
In summary, children may appear more resilient in their response and recovery from disaster or trauma. However, the research and literature suggest they are at risk for PTSD, depression and anxiety disorders as well as possible developmental delays as a result. Children will follow the leads of their parents, cultural/ethnic groups and belief systems. One of the least studied areas of PTSD and one that deserves more attention involves the responses of children of various ages and developmental levels and their risk for developing posttraumatic problems.
Vietnam Veterans
In our current decade, the Vietnam War (1963-1973) still haunts
the American conscience, not only because of the 57,939 Americans who
lost their lives, but also due to a much larger number (up to 1.5
million by some estimates), who returned with war-induced Post-Traumatic
Stress Disorder (PTSD), a delayed stress syndrome responsible for a wide
array of psychological and social problems. However, despite the
centrality of the Vietnam veteran to American views on war and despite
the oft-repeated claim that the psychological problems of the Vietnam
veteran are unique in American history, there has been no serious
attempt to place these problems into any meaningful historical context.
Nor, despite over 50,000 books having been written on the subject over
the past 130 years, has there yet been any attempt to investigate the
psychological and related readjustment problems of veterans of the
American Civil War. Dean (1996) attempts to place the problems of
Vietnam veterans into a meaningful historical context by investigating
the psychological problems of soldiers and veterans of the American
Civil War (1861-1865). Insane asylum and federal pension records bearing
on the readjustment problems of Civil War veterans were closely analyzed,
and reveal that Civil War soldiers and veterans experienced a wide array
of mental problems, from depression, anxiety, flashbacks, and cognitive
disorders (loss of concentration and memory), to resulting social
pathologies such as suicide, alcoholism, and domestic violence. Hence,
the Vietnam veteran was not unique in American history in this respect.
However, Dean also rejects as simplistic the post-Vietnam
tendency to view all American veterans as neglected and badly treated.
Rather, he suggests that war is a complex phenomenon. While some soldiers are devastated by the attendant hardships and danger, others are strengthened by the
experience. Additionally, views of war and the veteran are culturally
conditioned.
Employing a multidisciplinary approach that merges military, medical, and social history, Dean (1997) draws on individual case analyses and quantitative methods to trace the reactions of Civil War veterans to combat and death. He seeks to determine whether exuberant parades in the North and sectional adulation in the South helped to wash away memories of violence for Civil War veterans. His study reveals and supports his previous study that Civil War veterans experienced severe persistent psychological problems such as depression, anxiety, and flashbacks with resulting behaviors such as suicide, alcoholism, and domestic violence. By comparing Civil War and Vietnam veterans, Dean demonstrates that Vietnam vets did not suffer exceptionally in the number and degree of their psychiatric illnesses. The politics and culture of the times, he argues, were responsible for the claims of singularity for the suffering Vietnam veterans as well as for the development of the modern concept of posttraumatic stress disorder (PTSD).
Farberow, Kang & Bullman (1990) examined potential risk factors for suicide from
records of 175 Vietnam veterans (VVs) or non-VVs who committed suicide
or died from motor vehicle accidents (MVAs). No military service factor
was associated with suicide. Characteristics of VV suicides were not
substantially different from non-VV suicides with respect to known
demographic risk factors. The psychological profiles of VV suicides were
also similar to non-VV suicides in most instances. Symptoms related to
posttraumatic stress disorder (PTSD) were observed more frequently among
suicide than MVA cases. However, suicides were not associated with
specific combat experiences or military occupation. The extent of combat
experience in Vietnam was not a good predictor of suicide death.
Hendin & Haas (1991) investigated factors predictive of suicide among
Vietnam combat veterans with posttraumatic stress disorder (PTSD). 100
veterans were confirmed by means of a structured questionnaire and 5
clinical interviews as having had combat experience in Vietnam and as
meeting the Diagnostic and Statistical Manual of Mental Disorders
(DSM-III) criteria for PTSD. 19 Ss had made a postservice suicide
attempt, and 15 more had been preoccupied with suicide since the war.
Five factors were significantly related to suicide attempts: guilt about
combat actions, survivor guilt, depression, anxiety, and severe PTSD.
Logistic regression analysis showed that combat guilt was the most
significant predictor of both suicide attempts and preoccupation with
suicide.
Bryant (1998) studied the pattern of calls to an after-hours crisis telephone service for Vietnam veterans over a 9-week period. Not including prank and administrative calls, 274 calls were made to the service. Domestic conflict, substance abuse, traumatic memories, depression and anger at government represented the major problems requiring counseling. Crisis intervention was required for 18% of calls because of suicide threats or threatened violence to others. The survey findings indicate that telephone counseling can be an appropriate means to provide support for many veterans who may avoid conventional counseling agencies.
Bullman & Kang (1994) evaluated whether an association exists between
posttraumatic stress disorder (PTSD) and traumatic deaths among Vietnam
veterans from the Agent Orange Registry (AOR). 4,247 Ss with and 12,010
Ss without a diagnosis of PTSD were followed for vital status from the
date they received their AOR physical and psychiatric evaluation until
their date of death or August 16, 1990, whichever was earlier. Mortality
risk was calculated using the Cox proportional hazards model. Ss with
PTSD were more likely than Ss without PTSD to die from suicide and from
accidental poisoning. Ss with PTSD and additional mental disorders had a
greater risk of dying from suicide, motor vehicle accidents, and other
accidents than Ss with PTSD and no comorbid mental disorder. Both groups
of veterans had increased risk of deaths due to external causes when
compared with the US population.
The presence of posttraumatic stress disorder (PTSD) as
a risk factor for suicide or other traumatic deaths should result in
higher mortality rates for these causes among patients with PTSD than
among those with no diagnosis of PTSD. The trauma of exposure to
combat in Vietnam may adversely affect not only the psychological health
of Vietnam veterans but their physical well-being as well. Bullman & Kang (1997) report the results of a study of Vietnam veterans in which the primary objective was to determine whether there is a significant association between the presence of PTSD and the risk of traumatic deaths among these veterans. They hypothesized that traumatic deaths such as accidental drug overdoses, motor vehicle accidents, and suicides would be elevated among patients with PTSD, compared with a similar group of Vietnam veterans who were not diagnosed with PTSD. The study group consisted of 4,247 male veterans with PTSD. The comparison group consisted of 12,010 male veterans with no clinical diagnosis. Veterans with PTSD had a two- to fourfold increased risk for external causes of death compared with non-PTSD veterans. Attempted suicide and preoccupation with suicide among military veterans suggests that guilt over actions in combat was the most significant factor distinguishing veterans with posttraumatic stress disorder.
Fontana, Rosenheck & Brett (1992) extended the understanding of war zone stressors by specifying the psychological meaning of traumas and by examining the extent to which this specification adds to the ability to account for
the severity of current symptoms of posttraumatic stress disorder
(PTSD). Eleven traumas were organized in terms of four roles that veterans
played in the initiation of death and injury; namely, target, observer,
agent, and failure. The relationships of these roles to current
symptomatology were examined in combination with a set of objective
measures of war zone stressors. Ss were 1,709 Vietnam theater veterans.
Results suggest that having been a target of others' attempts to kill or
injure was related more uniquely than any other roles to symptoms of
PTSD. On the other hand, having been an agent of killing and having been
a failure at preventing death and injury were related more strongly than
other roles to general psychiatric distress and suicide attempts.
Fontana & Rosenheck (1995) investigated the etiology of attempted suicide using
both retrospective and prospective data from 402 Vietnam veterans who
were receiving treatment in the Department of Veterans Affairs
Posttraumatic Stress Disorder (PTDS) Clinical Teams Program. The
applicability of a community-based model to the treatment-seeking sample
was assessed. The community-based model achieved a very high fit with
reasonably good parsimony with the treatment-seeking data. Causal paths
in the treatment-seeking sample mirrored those in the community sample
in that psychiatric symptoms (including PTSD) were the sole factors
contributing directly to attempted suicide. Traumatic military
experiences played a substantial role, but only indirectly as they
contributed to the development of psychiatric symptoms.
Data from the National Vietnam Veterans Readjustment
Study were used to develop an etiological model of attempted suicide
among a community sample of 1,198 male Vietnam veterans. In a 3-step
process, Fontana & Rosenheck (1995) used structural equation modeling to develop a model that they refined, cross-validated, and then specified in terms of its replicable paths. The final model possessed highly satisfactory fit
and parsimony. General psychiatric disorders (GPDs) were the sole
factors contributing directly to attempted suicide. GPDs were in part
products of both non-military and military traumas, most specifically
participation in abusive violence. Substance abuse and posttraumatic
stress disorder (PTSD) were related to attempted suicide bivariately but
not when considered in conjunction with GPDs. Among pre-military risk
factors, family instability contributed to attempted suicide indirectly
through its influence on GPDs.
Freeman, Keesee, Thornton, Gillette et al (1995) hypothesized that suicide attempts in 14 combat veterans with chronic posttraumatic stress disorder (PTSD) represent impulsive, aggressive, and self- destructive acts, and therefore these Ss would exhibit a more frequent history of other aggressive and
impulsive acts relative to their 16 peers who had not made suicide
attempts in the past. Findings did not support the hypothesis. The two
groups appeared to engage in impulsive, violent behaviors with weapons at
a similar frequency. There were no significant differences between the
groups in terms of reported PTSD symptom severity and histories of
alcohol abuse, substance abuse, and combat exposure. The only
substantial difference between groups lay in their reported current
dissociative symptoms.
Freeman & Moore (2000) compared various features of chronic combat-related
posttraumatic stress disorder (PTSD) patients with and without a history
of suicide attempt (HSA) to improve the assessment of suicide risk in
this patient population. Ss were 109 veterans with chronic PTSD; 32 Ss
(mean age 51.2 yrs) with a HSA and 77 Ss (mean age 50.9 yrs) without a
HSA. Ss completed series of tests which included: 36-question Short Form
general health survey, Brief Symptom Inventory, Mississippi Scale,
Addiction Severity Index, Dissociative Experiences Scale, and an
abbreviated form of the Wechsler Adult Intelligence Scale-Revised
(WAIS-R). Ss were also interviewed. Ss with a HSA differed from Ss
without a HSA in clinician-administered and self-reported measures of
psychopathology and tests of intelligence. Ss with an HSA produced higher
IQ scores on a short form of the WAIS-R than did their counterparts. Additionally, the suicide attempt group reported significantly more severe
symptoms of depression, anxiety, and PTSD. Ss with a HSA also related
higher levels of alexithymia and lower levels of vitality and physical
and mental health than did their counterparts. The suicide attempt group
did not differ from their counterparts in terms of combat exposure,
pain, dissociation, or histories of alcohol or other substance abuse.
Goodale (1999) addressed the observation of a higher
incidence of suicidal behavior among the Vietnam Veterans who have
developed Post-Traumatic Stress Disorder, as well as the additional
clinical observation of elevated levels of aggression and anger. The
inquiry was developed with its foundation firmly established in the
psychodynamic theories of suicide. The primary clinical objective of
this study was to identify the specific elements of both anger and PTSD
symptoms which might assist the clinician in predicting an elevated risk
of suicidal behaviors. The specific grouping variables of interest were
a history of suicidal behavior and current suicidality. A MANOVA
indicated no significant interaction between these two variables.
However, current suicidality was significant and therefore the
discriminant analysis was run using this variable collapsed across
history of behavior. The discriminant analysis produced a significant
discriminant function consisting of numbing the only significant
variable of the MANOVA, as well as those variables which displayed a
trend, the Beck Depression score, trait anger and anger expression/anger
held in. The inclusion of these last three variables created the most
parsimonious function. However this function misclassified 84% of the
suicidal group as not suicidal, thus exhibiting that the high hit rate
for the non-suicidal group was the reason for the significance.
Pre-military experiences, childhood victimization and other traumatic experiences contribute to post-military adjustment problems. Hiley-Young, Blake, Abueg, Rozynko et al (1995) studied the impact of childhood victimization and other premilitary factors on war zone abusive violence with 177 Vietnam combat veteran inpatients. Premilitary and military variables were also examined in relation to postmilitary variables, including violence and
posttraumatic stress disorder (PTSD), using the Vietnam Era Stress
Inventory, and the MMPI. Statistical analyses showed that none of the
premilitary variables predicted war zone violence. However, high combat
exposure did predict war zone abusive violence and PTSD. In addition,
participation in war zone violence predicted postmilitary violence to
self, spouse, and others. Although high rates of childhood victimization
and high levels of combat exposure were found, neither predicted
postmilitary violence, criminal activities, drug/alcohol problems, or
suicide attempts. Low childhood adjustment ratings and school
suspensions predicted adult alcohol abuse and drug abuse, respectively.
In summary, the above cited studies identify a number of variables that should be considered when reviewing the adjustment of Iraq War combat veterans when they return to civilian life or rotate assignments back. These include the extent of combat experience and types of combat experiences. Combat guilt was found in a number of previous studies to be a strong predictor of suicide attempts and preoccupation with suicide. However, the extent of combat experience in at least one study was found to not be a good predictor of suicide. Problem areas identified which should be assessed for in returning military include depression, anger, guilt about combat actions, survivor guilt, anxiety,domestic conflicts, substance abuse, traumatic memories and others. It is likely that these problems may not manifest themselves immediately. It is also likely that those who were exposed to more severe circumstances (e.g. losing a close buddy in combat or as a prisoner) will be more at risk. Individual levels of resilience are likely to vary for a variety of reasons.
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REFERENCES
Amir, Marianne, Kaplan, Z., Efroni, R. & Kotler, M. (Mar-Apr 1999). Suicide risk and coping styles in posttraumatic stress disorder patients. Psychotherapy & Psychosomatics, Vol 68(2), pp.76-81. Journal URL: http://www.karger.ch/journals/pps/pps_jh.htm
Brende, Joel O. & Goldsmith, Richard (Sum 1991). Post-traumatic stress disorder in families. Journal of Contemporary Psychotherapy, Vol 21(2), pp.
115-124. Journal URL: http://www.wkap.nl/journalhome.htm/0022-0116
Brent, David A., Moritz, Grace, Bridge, Jeff, Perper, Joshua et al. (May 1996).
Long-term impact of exposure to suicide: A three-year controlled follow-up.
Journal of the American Academy of Child & Adolescent Psychiatry, Vol 35(5), pp. 646-653. Journal URL: http://www.jaacap.com/
Brent, David A., Perper, Joshua A., Moritz, Grace, Liotus, Laura et al. (Feb 1995). Posttraumatic stress disorder in peers of adolescent suicide
victims: Predisposing factors and phenomenology. Journal of the American Academy of Child & Adolescent Psychiatry, Vol 34(2), pp. 209-215. Journal URL: http://www.jaacap.com/
Bryant, Richard A. (Jul 1998). An analysis of calls to a Vietnam veterans' telephone counselling service. Journal of Traumatic Stress, Vol 11(3), pp. 589-596. Journal URL: http://www.wkap.nl/journalhome.htm/0894-9867
Bullman, Tim A. & Kang, Han K. (1997). Posttraumatic stress disorder and the risk of traumatic deaths among Vietnam veterans. In Fullerton, Carol S. (Ed); Ursano, Robert J. (Ed); Posttraumatic stress disorder: Acute and long-term responses to trauma and disaster. Progress in psychiatry series, No. 51. pp. 175-189.
Bullman, Tim A. & Kang, Han K. (Nov 1994). Posttraumatic stress disorder and the risk of traumatic deaths among Vietnam veterans. Journal of Nervous & Mental Disease, Vol 182(11)[1344], pp. 604-610. Journal URL: http://www.jonmd.com/
Carter, Bonnie Frank & Brooks, Allan (1991). Child and adolescent survivors of suicide. In Leenaars, Antoon A. (Ed); Life span perspectives of
suicide: Time-lines in the suicide process. pp. 231-258.
Davidson, J. R. T. (2000). Trauma: The impact of post-traumatic stress disorder. Journal of Psychopharmacology, Vol 14(2,Suppl1), pp. S5-S12.
Davidson, Jonathan R., Hughes, Dana, Blazer, Dan G., George, Linda K. (Aug 1991). Post-traumatic stress disorder in the community: An epidemiological study. Psychological Medicine, Vol 21(3), pp. 713-721. Journal URL: http://uk.cambridge.org/journals/psm/
Dean, Eric T. Jr. (1997). Shook over hell: Post-traumatic stress, Vietnam, and the Civil War. Harvard Univ Press, xi, 315 pp.
Dean, Eric Thomas, Jr. (Dec 1996). In evident mental commotion: Post-Traumatic Stress and the American Civil War. Dissertation Abstracts International Section A: Humanities & Social Sciences, Vol 57(6-A), pp. 2640.
Duggal, Harpreet S., Berezkin, Gennady, John & Vineeth (May 2002). PTSD and TV viewing of World Trade Center. Journal of the American Academy of Child & Adolescent Psychiatry, Vol 41(5), pp. 494-495. Journal URL: http://www.jaacap.com/
Farberow, Norman L., Kang, Han K. & Bullman, Tim A. (Jan 1990). Combat experience and postservice psychosocial status as predictors of suicide in Vietnam veterans. Journal of Nervous & Mental Disease, Vol 178(1), pp.
32-37. Journal URL: http://www.jonmd.com/
Ferrada-Noli, Marcello, Asberg, Marie, Ormstad, Kari, Lundin, Tom & Sundbom, Elisabet (Jan 1998). Suicidal behavior after severe trauma. Part 1: PTSD diagnoses, psychiatric comorbidity and assessments of suicidal behavior.
Journal of Traumatic Stress, Vol 11(1), pp. 103-112. Journal URL: http://www.wkap.nl/journalhome.htm/0894-9867
Ferrada-Noli, Marcello, Asberg, Marie & Ormstad, Kari (Jan 1998). Suicidal behavior after severe trauma. Part 2: The association between methods of torture and of suicidal ideation in posttraumatic stress disorder.
Journal of Traumatic Stress, Vol 11(1), pp. 113-124. Journal URL: http://www.wkap.nl/journalhome.htm/0894-9867
Fontana, Alan & Rosenheck, Robert (Jun 1995). An etiological model of attempted suicide among Vietnam theater veterans: Prospective generalization to a treatment-seeking sample. Journal of Nervous & Mental Disease, Vol 183(6), pp. 377-383. Journal URL: http://www.jonmd.com/
Fontana, Alan & Rosenheck, Robert (Jan 1995). Attempted suicide among Vietnam veterans: A model of etiology in a community sample. American Journal of Psychiatry, Vol 152(1), pp. 102-109. Journal URL: http://ajp.psychiatryonline.org/
Fontana, Alan, Rosenheck, Robert & Brett, Elizabeth (Dec 1992). War zone traumas and posttraumatic stress disorder symptomatology. Journal of Nervous & Mental Disease, Vol 180(12), pp. 748-755. Journal URL: http://www.jonmd.com/
Freeman, Thomas W. & Moore, William M. (Jul 2000). A comparison of chronic combat-related posttraumatic stress disorder (PTSD) patients with and without a history of suicide attempt. Journal of Nervous & Mental Disease, Vol 188(7), pp. 460-463. Journal URL: http://www.jonmd.com/
Freeman, Thomas W., Keesee, Nichole, Thornton, Carolyn, Gillette, Gregory et al (Oct 1995). Dissociatve symptoms in posttraumatic stress disorder subjects
with a history of suicide attempts. Journal of Nervous & Mental Disease, Vol 183(10), pp. 664-666. Journal URL: http://www.jonmd.com/
Goodale, Peggy Ann (April 1999). Anger profile of suicidal inpatient Vietnam veterans. (posttraumatic stress disorder). Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 59(10-B), pp. 5577.
Hendin, Herbert (Jan 1992). "PTSD and risk of suicide": Reply. American Journal of Psychiatry, Vol 149(1), pp. 143. Journal URL: http://ajp.psychiatryonline.org/
Hendin, Herbert & Haas, Ann P. (May 1991). Suicide and guilt as manifestations of PTSD in Vietnam combat veterans. American Journal of Psychiatry, Vol 148(5), pp. 586-591. Journal URL: http://ajp.psychiatryonline.org/
Hiley-Young, Bruce, Blake, Dudley David, Abueg, Francis R., Rozynko, Vitali et al (Jan 1995). Warzone violence in Vietnam: An examination of premilitary, military, and postmilitary factors in PTSD in-patients. Journal of Traumatic Stress, Vol 8(1), pp. 125-141. Journal URL: http://www.wkap.nl/journalhome.htm/0894-9867
Plutchik, Robert (1991). The Emotions, Revised Edition. University Press of America; Revised Edition edition.
To search for books on disasters and disaster mental
health topics, leaders, leadership, orgainizations,
crisis intervention, leaders and crises, and related
topics and purchase them online, go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
RECOMMENDED READING
by Eric T., Jr. Dean
Editorial Reviews
Eric T. Dean Jr., a lawyer whose interest in the Civil War prompted him to return to school to obtain a Ph.D. in history, makes a unique contribution to Civil War studies with his research on the psychological effects of the war on its veterans. Digging through the pension records of Civil War vets, Dean documents the great number who, suffering from severe psychological problems triggered by intense combat experience, were dutifully provided with disability pensions by the U.S. government. Dean's central thesis--that these veterans provide a mirror for the experiences of their counterparts in Vietnam a century later--is supported with lucid reasoning. Of particular interest are the many stories of intense Civil War combat and its psychological aftereffects, including many cases of Civil War veterans committed to asylums well into the 1890s--case studies seldom found in standard histories which offer painful testimony to the war's enormous impact on the nation. --Robert McNamara
Additional Readings at: Terrorism and Stress in the search engine. Also try looking here for Psychology and Terrorism.
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
Rocky Mountain Region
Disaster Mental Health Institute
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
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