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Table Cross sectional and longitudinal studies examining

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Table Cross sectional and longitudinal studies examining Powered By Docstoc
					Table	
  1:	
  Cross-­‐sectional	
  and	
  longitudinal	
  studies	
  examining	
  prevalence	
  of	
  mental	
  health	
  problems	
  and	
  distress	
  among	
  soldiers	
  who	
  had	
  been	
  deployed	
  to	
  
peacekeeping	
  missions.	
  	
  
Author	
                                    Mission	
                       Sample	
                      Design	
                                                        Main	
  conclusions	
  
                                                                                                             a       b
                                                              US	
  solders:	
  2,114	
  men,	
        CS ;	
  SR 	
  
                                       Yugoslavia,	
                                                                       Longer	
  deployments	
  and	
  first	
  time	
  deployments	
  associated	
  with	
  increased	
  
Adler	
  2005	
                                               1,225	
  women	
                                                                 c
                                            Hungary	
                                                                      risk	
  for	
  PTSD 	
  and	
  depressive	
  symptoms	
  in	
  men	
  but	
  not	
  women.	
  
                                                              	
  
                                                                                                                                                    d
                                                              1187	
  deployed	
  vs.	
  669	
         CS;	
  SR	
         Probable	
  PTSD :	
  11%	
  for	
  veterans	
  vs.	
  3.9%	
  for	
  controls.	
  PTSD	
  symptoms	
  
Asmundson	
  2002	
                         Multiple	
        non-­‐deployed	
  Canadian	
                                 had	
  a	
  negative	
  influence	
  on	
  service	
  members’	
  health	
  through	
  direct	
  and	
  
                                                              veterans	
                                                   indirect	
  paths	
  (i.e.,	
  through	
  depression,	
  and	
  alcohol	
  use).	
  
                                                                                                       CS;	
  SR	
         Probable	
  PTSD:	
  16%	
  in	
  veterans	
  vs.	
  9%	
  in	
  controls.	
  Serving	
  in	
  Bosnia	
  
                                                              145	
  UK	
  service	
  members	
  
Baggaley	
  1999	
                           Bosnia	
                                                                      associated	
  with	
  PTSD.	
  	
  No	
  difference	
  between	
  groups	
  on	
  overall	
  level	
  of	
  
                                                              and	
  234	
  era	
  controls	
  
                                                                                                                           psychopathology.	
  
                                                              452	
  Italian	
  service	
              CS;	
  SR	
  
Ballone	
  2000	
                            Bosnia	
                                                                      No	
  increase	
  in	
  self-­‐reported	
  distress	
  between	
  cases	
  and	
  controls.	
  	
  
                                                              members	
  vs.	
  166	
  controls	
  
                                                                                                        e
                                                                                                       L ;	
  SR	
  &	
    Described	
  stressors	
  at	
  each	
  of	
  the	
  phases	
  of	
  deployment.	
  Overall	
  
                                                                                                               f
Bartone	
  1998	
                      Yugoslavia	
           128	
  US	
  soldiers	
                  INT 	
              summarized	
  stressors	
  of	
  peacekeeping	
  as:	
  1)	
  isolation,	
  2)	
  ambiguity,	
  3)	
  
                                                                                                                           powerlessness,	
  4)	
  boredom,	
  and	
  5)	
  threat	
  and	
  danger.	
  
                                                                                                       CS;	
  SR	
         Prior	
  to	
  deployment,	
  approximately	
  74%	
  of	
  reported	
  a	
  lifetime	
  history	
  of	
  a	
  
Bolton	
  2001	
                             Bosnia	
         2947	
  US	
  soldiers	
                                     potentially	
  traumatic	
  event	
  and	
  6%	
  had	
  probable	
  PTSD	
  (witnessing	
  injury	
  
                                                                                                                           was	
  the	
  most	
  common	
  traumatic	
  event).	
  	
  
                                                                                                       CS;	
  SR	
         Individual’s	
  perceptions	
  of	
  homecoming	
  reception	
  were	
  positively	
  
Bolton	
  2002	
                            Somalia	
         1,023	
  US	
  soldiers	
  
                                                                                                                           associated	
  with	
  lower	
  levels	
  of	
  PTSD	
  symptoms	
  
                                                                                                       CS;	
  SR	
         Self-­‐disclosure	
  of	
  deployment	
  stressors	
  with	
  family/friends	
  were	
  
Bolton	
  2003	
                            Somalia	
         426	
  US	
  soldiers	
  
                                                                                                                           associated	
  with	
  lower	
  PTSD	
  symptoms.	
  
                                                                                                       CS;	
  SR	
         PTSD	
  symptom	
  severity	
  was	
  associated	
  with	
  exposure	
  to	
  warzone	
  stress.	
  
Bolton	
  2006	
                            Somalia	
         522	
  US	
  soldiers	
  
                                                                                                                           But,	
  this	
  association	
  was	
  modest.	
  
                                                                                                       L;	
  SR	
          Pre-­‐deployment	
  personality	
  traits	
  	
  (negativism	
  and	
  psychopathology)	
  were	
  
                                                              572	
  male	
  Dutch	
  service	
  
Bramsen	
  2000	
                      Yugoslavia	
                                                                        significantly	
  associated	
  with	
  post-­‐deployment	
  PTSD	
  symptoms	
  even	
  after	
  
                                                              members	
  
                                                                                                                           adjustment	
  of	
  number	
  of	
  stressors	
  during	
  deployment.	
  	
  	
  
                                                              US	
  161	
  soldiers	
  mid-­‐          L;	
  SR	
  
                                                                                                                           Military	
  hardiness	
  was	
  associated	
  with	
  being	
  engaged	
  in	
  meaningful	
  work	
  
Britt	
  2001	
                              Bosnia	
         deployment	
  and	
  post-­‐
                                                                                                                           during	
  deployment	
  and	
  deriving	
  benefits	
  from	
  deployment.	
  
                                                              deployment	
  	
  
                                                                                                       L;	
  SR	
          Soldiers	
  reporting	
  higher	
  levels	
  of	
  engagement	
  in	
  their	
  work	
  were	
  less	
  
Britt	
  2003	
                              Bosnia	
         1181	
  US	
  soldiers	
  
                                                                                                                           likely	
  to	
  display	
  distress	
  in	
  the	
  context	
  of	
  higher	
  work	
  stress,	
  less	
  sleep	
  and	
  
Author	
                             Mission	
                     Sample	
                      Design	
                                                Main	
  conclusions	
  
                                                                                                              family	
  stress.	
  
                                                     40	
  Italian	
  peacekeepers	
         CS;	
  SR	
      Peacekeepers	
  had	
  significantly	
  higher	
  levels	
  of	
  anxiety.	
  The	
  two	
  groups	
  did	
  
Di	
  Nicola	
  2007	
             Afghanistan	
  
                                                     vs.	
  120	
  era	
  controls	
                          not	
  differ	
  on	
  PTSD	
  and	
  depression	
  symptoms.	
  
                                                                                             CS;	
  SR	
      Planful	
  problem	
  solving	
  and	
  seeking	
  social	
  support	
  were	
  associated	
  with	
  
Dirkzwager	
  2003	
                 Multiple	
      733	
  Dutch	
  peacekeepers	
  
                                                                                                              lower	
  PTSD	
  symptoms.	
  
                                                                                             CS;	
  SR	
      Probable	
  PTSD	
  prevalence	
  5.6%.	
  Higher	
  rates	
  of	
  PTSD	
  symptoms	
  among	
  
                                                     3481	
  Dutch	
                                          peacekeepers	
  deployed	
  to	
  Bosnia	
  in	
  comparison	
  to	
  Cambodia.	
  	
  PTSD	
  
Dirkzwager	
  2005	
                 Multiple	
  
                                                     peacekeepers	
                                           associated	
  with	
  lower	
  level	
  of	
  education,	
  exposure	
  to	
  traumatic	
  events,	
  
                                                                                                              perceived	
  meaninglessness	
  of	
  the	
  mission,	
  no	
  control	
  over	
  situation.	
  
                                                                                             CS;	
  SR	
      Military	
  hardiness	
  (scale	
  assessing	
  military-­‐specific	
  commitment,	
  
Dolan	
  2006	
                      Kosovo	
        629	
  US	
  soldiers	
                                  challenge,	
  and	
  control.	
  	
  Military	
  hardiness	
  moderated	
  the	
  impact	
  of	
  
                                                                                                              deployment	
  stress	
  on	
  post-­‐deployment	
  depressive	
  symptoms.	
  
                                                     1132	
  male	
  Canadian	
              CS;	
  SR	
      PTSD	
  and	
  depressive	
  symptoms	
  were	
  associated	
  with	
  health	
  service	
  use	
  
Elhai	
  2007	
                      Multiple	
  
                                                     veterans	
                                               intensity.	
  
                                                                                             CS;	
  SR	
      Two-­‐thirds	
  of	
  those	
  with	
  PTSD	
  sought	
  help.	
  	
  Gender,	
  lower	
  military	
  rank,	
  
Fikretoglu	
  2007,	
  2008,	
  
                                     Multiple	
      8441	
  Canadian	
  military	
                           lifetime	
  trauma	
  exposure,	
  PTSD	
  severity	
  and	
  comorbid	
  depression	
  were	
  
2009	
  
                                                                                                              associated	
  with	
  service	
  use.	
  	
  
                                                     1307	
  US	
  men,	
  197	
             CS;	
  SR	
      Combat	
  and	
  sexual	
  harassment	
  associated	
  with	
  PTSD	
  symptoms	
  in	
  both	
  
Fontana	
  2000	
                    Somalia	
  
                                                     women	
                                                  men	
  and	
  women.	
  
                                                     66	
  Australian	
                      L;	
  INT	
      PTSD	
  symptoms	
  were	
  more	
  severe	
  among	
  peacekeepers	
  than	
  Vietnam	
  
Forbes	
  2005	
                      Africa	
       peacekeepers	
  and	
  63	
                              veterans.	
  	
  At	
  three	
  months	
  follow-­‐up,	
  no	
  differences	
  in	
  treatment	
  
                                                     Vietnam	
  controls	
                                    outcomes.	
  
                                                     1040	
  US	
  soldiers,	
  	
           L;	
  SR	
       6.5%	
  of	
  the	
  sample	
  had	
  delayed	
  onset	
  Probable	
  PTSD.	
  War	
  zone	
  traumatic	
  
Gray	
  2004	
                       Somalia	
       1	
  and	
  18	
  months	
  after	
                      events	
  exposure	
  and	
  perceived	
  meaningfulness	
  of	
  the	
  mission	
  were	
  
                                                     deployment	
                                             associated	
  with	
  symptom	
  course.	
  
                                                     1201	
  UK	
  service	
                 CS;	
  SR	
      Talking	
  about	
  peacekeeping	
  experiences	
  was	
  associated	
  with	
  lower	
  
Greenberg	
  2003	
                   Bosnia	
  
                                                     members	
                                                distress.	
  Most	
  peacekeepers	
  make	
  use	
  of	
  informal	
  support	
  networks.	
  
                                                     1198	
  UK	
  service	
                 CS;	
  SR	
      Deploying	
  without	
  an	
  established	
  peer	
  group	
  was	
  not	
  associated	
  with	
  
Greenberg	
  2008	
                  Multiple	
  
                                                     members	
                                                PTSD	
  symptoms.	
  
                                                     25	
  Dutch	
  peacekeepers	
           CS;	
  Int	
  
                                                                                                              Neuropsychological	
  testing	
  revealed	
  significantly	
  lower	
  levels	
  of	
  learning,	
  
                                                     with	
  PTSD	
  vs.	
  to	
  25	
  
Geuze	
  2009	
                      Multiple	
                                                               immediate	
  and	
  delayed	
  memory	
  among	
  PTSD	
  veterans	
  compared	
  to	
  those	
  
                                                     peacekeepers	
  without	
  
                                                                                                              without	
  PTSD.	
  
                                                     PTSD	
  
Author	
                       Mission	
                                 Sample	
                             Design	
                                        Main	
  conclusions	
  
                              Western	
                   119	
  UN	
  service	
  members	
               CS;	
  SR	
      21%	
  reported	
  moderate	
  levels	
  of	
  stress.	
  Distress	
  due	
  to	
  climate	
  
	
  Han	
  2001	
  
                            Sahara	
  Desert	
            from	
  23	
  countries	
                                        adaptation,	
  homesickness	
  and	
  interpersonal	
  conflicts.	
  
                                                          2	
  049	
  UK	
  service	
                     CS;	
  SR	
  
                                                                                                                           Highest	
  level	
  of	
  PTSD	
  symptoms	
  among	
  Gulf	
  and	
  Bosnia	
  Veterans	
  (13.2%).	
  
                                                          members	
  vs.	
  1785	
  era	
  
Hotopf	
  2003a,b	
  	
          Bosnia	
                                                                                  Overall	
  no	
  increase	
  in	
  risk	
  of	
  PTSD	
  symptoms	
  among	
  service	
  members	
  
                                                          controls	
  vs.	
  570	
  Gulf	
  &	
  
                                                                                                                           deployed	
  only	
  to	
  Bosnia	
  (4.4%)	
  vs.	
  controls	
  (4.5%),	
  
                                                          Bosnia	
  veterans	
  
                                                                                                          L;	
  SR	
       Self-­‐perceived	
  job	
  control	
  and	
  active	
  coping	
  style	
  impacted	
  on	
  the	
  level	
  of	
  
Ippolito	
  2005	
              Kosovo	
                  638	
  US	
  service	
  members	
  
                                                                                                                           psychological	
  distress.	
  	
  
                                                          1,086	
  Swedish	
  service	
                   CS;	
  SR	
  
                                                                                                                           No	
  difference	
  in	
  psychiatric	
  morbidity.	
  Combat	
  veterans	
  more	
  prone	
  to	
  
Kettner	
  1972	
  	
            Congo	
                  members,	
  and,	
  1,242	
  
                                                                                                                           accidents.	
  
                                                          controls	
  
                                                          1046	
  Dutch	
                                 CS;	
  SR	
      Dutch	
  peacekeepers	
  do	
  not	
  have	
  higher	
  rates	
  of	
  psychological	
  distress	
  
Kllaassens	
  2008	
           Multiple	
  
                                                          peacekeeping	
  veterans	
                                       than	
  the	
  Dutch	
  general	
  population	
  10-­‐25	
  years	
  post-­‐deployment.	
  
                                                                                                          L;	
  SR	
       Baseline	
  trait	
  anxiety	
  and	
  insomnia	
  predicted	
  postdeployment	
  
Larsson	
  2008	
               Kosovo	
                  44	
  Swedish	
  peacekeepers	
  
                                                                                                                           posttraumatic	
  symptoms.	
  
                                                                                                          CS;	
  SR	
      Probable	
  PTSD	
  8%.	
  War	
  zone	
  stressors	
  and	
  negative	
  aspects	
  of	
  
Litz	
  1997a,b	
                                         3,461	
  US	
  service	
                                         peacekeeping	
  predicted	
  PTSD.	
  Experiencing	
  the	
  military	
  mission	
  as	
  
                                Somalia	
  
Orsillo	
  1998	
                                         members	
                                                        rewarding/positive	
  protected	
  against	
  PTSD.	
  Military	
  pride	
  and	
  cohesion	
  
                                                                                                                           are	
  associated	
  with	
  lower	
  distress	
  	
  
                                                                                                          L;	
  SR	
       Self-­‐reported	
  anxiety	
  and	
  distress	
  was	
  highest	
  at	
  pre-­‐deployment	
  and	
  at	
  
                               Multiple	
  
MacDonald	
  1998,	
                               	
  	
  	
  	
  277	
  New	
  Zealand	
  service	
                      the	
  follow-­‐up	
  period	
  in	
  comparison	
  with	
  during	
  deployment.	
  	
  Self-­‐
                               missions	
  
1999	
                                             members	
                                                               reported	
  depression	
  was	
  highest	
  at	
  mid-­‐deployment	
  and	
  6	
  months	
  follow-­‐
                                1992	
  
                                                                                                                           up.	
  
                                                          203	
  US	
  service	
  members	
               L;	
  SR	
       Exposure	
  to	
  traumatic	
  events	
  associated	
  with	
  post-­‐deployment	
  PTSD	
  
Maguen	
  2004	
                Kosovo	
  
                                                   	
                                                                      symptoms	
  and	
  depressive	
  symptoms,	
  but	
  not	
  problem	
  drinking.	
  
                                Kosovo,	
                 203	
  Kosovo	
  personnel,	
                   L;	
  SR	
       Following	
  deployment,	
  5%-­‐9%	
  of	
  peacekeepers	
  reported	
  need	
  for	
  mental	
  
Maguen	
  2006	
  
                                Bosnia	
                  105	
  Bosnia	
  reservists	
                                    health	
  treatment.	
  	
  
                                                          Norwegian	
  service	
                          CS;	
  SR	
      Service	
  members	
  that	
  had	
  prematurely	
  been	
  repatriated	
  had	
  the	
  highest	
  
                                                          members	
  –	
  888	
  veterans,	
                               levels	
  of	
  probable	
  PTSD	
  (16%	
  vs.	
  5%	
  in	
  veterans).	
  	
  Level	
  of	
  stress	
  during	
  
Mehlum	
  2002	
               Lebanon	
  
                                                          323	
  repatriated,	
  485	
                                     service,	
  perceived	
  lack	
  of	
  meaningfulness	
  of	
  the	
  mission,	
  and	
  stressful	
  life	
  
                                                          controls	
                                                       events	
  after	
  the	
  service	
  were	
  associated	
  with	
  probable	
  PTSD.	
  
                                South	
                   888	
  Norwegian	
  service	
                   CS;	
  SR	
      44%	
  of	
  service	
  members	
  reported	
  increased	
  alcohol	
  consumption	
  during	
  
Mehlum	
  1999	
  
                               Lebanon	
                  members	
                                                        deployment.	
  Exposure	
  to	
  combat	
  exposure	
  was	
  associated	
  with	
  self-­‐
Author	
                          Mission	
                       Sample	
                    Design	
                                                Main	
  conclusions	
  
                                                                                                           medication	
  with	
  alcohol.	
  
                                                     211	
  male	
  Norwegian	
           CS;	
  SR	
  
                                                                                                           UN	
  observers	
  had	
  significantly	
  elevated	
  levels	
  of	
  distress	
  and	
  PTSD	
  
Mehlum	
  2006	
                 Lebanon	
           peacekeepers,	
  187	
  
                                                                                                           symptoms	
  than	
  peacekeepers.	
  
                                                     Norwegian	
  observers	
  
                                                                                          L;	
  SR	
       No	
  significant	
  change	
  on	
  level	
  of	
  mental	
  distress	
  over	
  time.	
  	
  Exposure	
  to	
  
                                                     316	
  Swedish	
  Service	
  
Michel	
  2003	
                   Bosnia	
                                                                traumatic	
  events	
  during	
  deployment	
  and	
  post-­‐deployment	
  stressful	
  
                                                     members	
  
                                                                                                           events	
  associated	
  with	
  distress.	
  
                                                                                          L;	
  SR	
       9.5%	
  of	
  the	
  cohort	
  met	
  criteria	
  for	
  at	
  least	
  one	
  probable	
  personality	
  
                                                     516	
  Swedish	
  service	
                           disorder.	
  The	
  presence	
  of	
  a	
  probable	
  personality	
  disorder	
  at	
  baseline	
  was	
  
Michel	
  2005	
                   Bosnia	
  
                                                     members	
                                             associated	
  with	
  increased	
  distress	
  at	
  one	
  year	
  follow-­‐up,	
  greater	
  
                                                                                                           likelihood	
  of	
  reporting	
  traumatic	
  events	
  during	
  deployment.	
  
                                                     130	
  Canadian	
  veterans	
        CS;	
  INT	
     The	
  association	
  between	
  PTSD	
  and	
  pain	
  was	
  fully	
  mediated	
  by	
  comorbid	
  
Poundja	
  2006	
                Multiple	
  
                                                     attending	
  clinic	
                                 depression.	
  
                                                                                          CS;	
  SR	
      Probable	
  PTSD	
  and	
  depression	
  higher	
  among	
  those	
  with	
  multiple	
  
                                                                                                           deployments	
  compared	
  to	
  those	
  with	
  one	
  deployment	
  and	
  no	
  
Richardson	
  2006,	
                                1,016	
  Canadian	
  male	
  
                                 Multiple	
                                                                deployments.	
  	
  Younger	
  age,	
  and	
  not	
  being	
  married	
  was	
  associated	
  with	
  
2007	
                                               service	
  members	
  
                                                                                                           PTSD.	
  Probable	
  PTSD	
  was	
  associated	
  with	
  increased	
  medical	
  and	
  specialist	
  
                                                                                                           care	
  utilization.	
  
                                                     125	
  Canadian	
  soldiers	
        CS;	
  INT	
     PTSD	
  and	
  depression	
  symptom	
  severity	
  were	
  associate	
  with	
  lower	
  quality	
  
Richardson	
  2008	
             Multiple	
  
                                                     attending	
  clinic	
                                 of	
  life.	
  
                                                                                          CS;	
  INT	
     Exposure	
  to	
  peacekeeping	
  operations,	
  combat	
  exposure	
  and	
  witnessing	
  
                                                     8,441	
  Canadian	
  service	
  
                                                                                                           atrocities	
  were	
  associated	
  with	
  an	
  increased	
  likelihood	
  of	
  PTSD	
  and	
  other	
  
Sareen	
  2007,	
  2008	
        Multiple	
          members	
  (population-­‐
                                                                                                           mental	
  disorder.	
  Approximately	
  20%	
  of	
  cases	
  of	
  PTSD	
  were	
  attributable	
  to	
  
                                                     based	
  sample)	
  
                                                                                                           peacekeeping	
  operations.	
  
                                                                                          CS;	
  SR	
      Mental	
  health	
  condition	
  remained	
  stable	
  before,	
  during	
  and	
  after	
  
                                                     339	
  Self-­‐Defense	
  Force	
  
Sawamura	
  2008	
            Golan	
  Heights	
                                                           deployment	
  with	
  little	
  variation	
  in	
  mental	
  health	
  conditions	
  influenced	
  by	
  
                                                     members	
  	
  
                                                                                                           deployment	
  period.	
  
                                                                                          CS;	
  SR	
      Veterans	
  with	
  comorbid	
  Probable	
  PTSD	
  and	
  depression	
  used	
  more	
  health	
  
                                                     473	
  Canadian	
  
Stapleton	
  2006	
              Multiple	
                                                                care	
  resources	
  in	
  the	
  past	
  year	
  than	
  did	
  those	
  with	
  either	
  PTSD	
  or	
  
                                                     peacekeeping	
  veterans	
  	
  
                                                                                                           depression	
  alone.	
  	
  
                                                                                          L;	
  SR	
       Baseline	
  negative	
  affect	
  traits	
  also	
  appear	
  to	
  interact	
  with	
  the	
  number	
  of	
  
                                                     138	
  male	
  Brazilian	
  
Souza	
  2008	
                     Haiti	
                                                                stressful	
  situations	
  experienced	
  during	
  deployment	
  to	
  increase	
  the	
  
                                                     service	
  members	
  
                                                                                                           likelihood	
  of	
  post-­‐deployment	
  self-­‐reported	
  PTSD	
  symptoms.	
  
Author	
                                      Mission	
                         Sample	
                          Design	
                                                      Main	
  conclusions	
  
                                                                                                               CS;	
  SR	
          The	
  majority	
  of	
  stress	
  was	
  perceived	
  to	
  be	
  due	
  to	
  frustrations	
  with	
  the	
  
                                              Multiple	
  
Thomas	
  2006	
                                                  342	
  UK	
  service	
  members	
                                 occupational	
  role	
  of	
  being	
  a	
  peacekeeper,	
  although	
  many	
  peacekeepers	
  
                                       	
  
                                                                                                                                    found	
  their	
  role	
  fulfilling.	
  
                                                                     UK	
  service	
  members:	
                   CS;	
  SR	
  
                                                                                                                                       Although	
  Gulf	
  war	
  veterans	
  were	
  significantly	
  more	
  likely	
  to	
  be	
  distressed	
  
                                                                     3284	
  Gulf	
  war	
  veterans,	
  
                                                                                                                                       compared	
  to	
  Bosnia	
  peacekeepers	
  and	
  controls,	
  Bosnia	
  peacekeepers	
  did	
  
Unwin	
  1999	
                                  Bosnia	
            1815	
  Bosnia	
  veterans,	
  
                                                                                                                                       not	
  have	
  an	
  increased	
  risk	
  of	
  probable	
  PTSD	
  or	
  GHQ	
  caseness	
  compared	
  
                                                                     2408	
  controls	
  
                                                                                                                                       to	
  controls	
  
                                                                     	
  
                                                                     117	
  Australian	
  soldiers	
               CS;	
  SR	
         Self-­‐reported	
  distress	
  increased	
  in	
  veterans	
  compared	
  to	
  controls.	
  
Ward	
  1997	
                                  Somalia	
  
                                                                     and	
  77	
  controls	
                                           	
  
a                                             b                                                                                                                                                       c
     CS-­‐	
  Cross-­‐sectional	
  design,	
   SR-­‐	
  Main	
  outcomes	
  are	
  based	
  on	
  self-­‐report	
  measures	
  that	
  are	
  not	
  designed	
  for	
  delineating	
  diagnosis,	
   PTSD-­‐	
  Posttraumatic	
  Stress	
  
                   d                                                                                                             e                                 f
Disorder,	
   Probable	
  PTSD	
  –	
  High	
  likelihood	
  for	
  PTSD	
  based	
  on	
  self-­‐report	
  measures;	
   L-­‐	
  Longitudinal	
  design;	
   INT-­‐	
  Interview	
  based	
  assessment	
  of	
  mental	
  
disorders.	
  
	
  

				
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