Research Article
Combat, dissociation, and posttraumatic stress disorder in Australian Vietnam veterans
Brian I. O'Toole,
Richard P. Marshall,
Ralph J. Schureck,
Matthew Dobson,
Corresponding Author
Brian I. O'Toole
Department of Public Health and Community Medicine, University of Sydney, Sydney, Australia and School of Community Medicine, University of New South Wales
School of Community Medicine, University of New South Wales, New South Wales 2052 AustraliaSearch for more papers by this authorRichard P. Marshall
Psychiatric Epidemiology Research Unit, Australian National University, Canberra, Australia
Search for more papers by this authorRalph J. Schureck
Institute of Psychiatric Evaluation, Sydney, Australia
Search for more papers by this authorMatthew Dobson
Centre for Education and Research on Aging, Concord Hospital, Sydney, Australia
Search for more papers by this authorBrian I. O'Toole,
Richard P. Marshall,
Ralph J. Schureck,
Matthew Dobson,
Corresponding Author
Brian I. O'Toole
Department of Public Health and Community Medicine, University of Sydney, Sydney, Australia and School of Community Medicine, University of New South Wales
School of Community Medicine, University of New South Wales, New South Wales 2052 AustraliaSearch for more papers by this authorRichard P. Marshall
Psychiatric Epidemiology Research Unit, Australian National University, Canberra, Australia
Search for more papers by this authorRalph J. Schureck
Institute of Psychiatric Evaluation, Sydney, Australia
Search for more papers by this authorMatthew Dobson
Centre for Education and Research on Aging, Concord Hospital, Sydney, Australia
Search for more papers by this authorAbstract
The specificity of various wartime stressors for different posttraumatic stress disorder (PTSD) symptoms is inconsistently reported in the literature. Combat, wounding, and peritraumatic dissociation have not been assessed together in their effects on each of the various PTSD symptom clusters. This cohort study of a random sample of male Australian Army Vietnam veterans yielded psychiatric assessments of 641 subjects. PTSD measures comprised symptom criteria for reexperiencing, numbing and avoidance, hyperarousal, and PTSD diagnosis both lifetime and current within the past month. Logistic regression is used to examine the effects of combat, wounding, and peritraumatic dissociation together on PTSD. Combat experiences comprised four components derived from a principal components analysis of combat experiences: direct combat exposure, exposure to death and injury, exposure to civilian death and injury, and exposure to mutilation. Each was differentially related to reexperiencing, avoidance, hyperarousal, and PTSD diagnosis. Being wounded was not related to lifetime or current PTSD and peritraumatic dissociation was related to all diagnostic components of PTSD in the presence of other variables.
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