Peterson Alan L, Baker Monty T, Moore Cpt Brian A, Hale Willie J, Joseph Jeremy S, Straud Casey L, Lancaster Cynthia L, McNally Richard J, Isler William C, Litz Brett T, Mintz Jim
University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.
South Texas Veterans Health Care System, 7400 Merton Minter Boulevard, San Antonio, TX.
Mil Med. 2019 Jan 1;184(1-2):e133-e142. doi: 10.1093/milmed/usy147.
Limited research has been conducted on the impact of deployment-related trauma exposure on post-traumatic stress symptoms in military medical personnel. This study evaluated the association between exposure to both combat experiences and medical duty stressors and post-traumatic stress symptoms in deployed military medical personnel.
U.S. military medical personnel (N = 1,138; 51% male) deployed to Iraq between 2004 and 2011 were surveyed about their exposure to combat stressors, healthcare stressors, and symptoms of post-traumatic stress disorder (PTSD). All participants were volunteers, and the surveys were completed anonymously approximately halfway into their deployment. The Combat Experiences Scale was used as a measure of exposure to and impact of various combat-related stressors such as being attacked or ambushed, being shot at, and knowing someone seriously injured or killed. The Military Healthcare Stressor Scale (MHSS) was modeled after the Combat Experiences Scale and developed for this study to assess the impact of combat-related healthcare stressors such as exposure to patients with traumatic amputations, gaping wounds, and severe burns. The Post-traumatic Stress Disorder Checklist-Military Version (PCL-M) was used to measure the symptoms of PTSD.
Eighteen percent of the military medical personnel reported exposure to combat experiences that had a significant impact on them. In contrast, more than three times as many medical personnel (67%) reported exposure to medical-specific stressors that had a significant impact on them. Statistically significant differences were found in self-reported exposure to healthcare stressors based on military grade, education level, and gender. Approximately 10% of the deployed medical personnel screened positive for PTSD. Approximately 5% of the sample were positive for PTSD according to a stringent definition of caseness (at least moderate scores on requisite Diagnostic and Statistical Manual for Mental Disorders criteria and a total PCL-M score ≥ 50). Both the MHSS scores (r(1,127) = 0.49, p < 0.0001) and the Combat Experiences Scale scores (r(1,127) = 0.34, p < 0.0001) were significantly associated with PCL-M scores. However, the MHSS scores had statistically larger associations with PCL-M scores than the Combat Experiences Scale scores (z = 5.57, p < 0.0001). The same was true for both the minimum criteria for scoring positive for PTSD (z = 3.83, p < 0.0001) and the strict criteria PTSD (z = 1.95, p = 0.05).
The U.S. military has provided significant investments for the funding of research on the prevention and treatment of combat-related PTSD, and military medical personnel may benefit from many of these treatment programs. Although exposure to combat stressors places all service members at risk of developing PTSD, military medical personnel are also exposed to many significant, high-magnitude medical stressors. The present study shows that medical stressors appear to be more impactful on military medical personnel than combat stressors, with approximately 5-10% of deployed medical personnel appearing to be at risk for clinically significant levels of PTSD.
关于部署相关创伤暴露对军事医务人员创伤后应激症状的影响，相关研究有限。本研究评估了作战经历和医疗任务压力源暴露与部署的军事医务人员创伤后应激症状之间的关联。
对2004年至2011年期间部署到伊拉克的美国军事医务人员（N = 1138；51%为男性）进行了调查，询问他们接触作战压力源、医疗保健压力源以及创伤后应激障碍（PTSD）症状的情况。所有参与者均为志愿者，调查在他们部署大约一半时间时匿名完成。作战经历量表用于衡量接触各种与作战相关压力源的情况及其影响，如遭到攻击或伏击、被射击以及知晓有人受重伤或死亡。军事医疗保健压力源量表（MHSS）以作战经历量表为蓝本，为本研究开发，用于评估与作战相关的医疗保健压力源的影响，如接触创伤性截肢、开放性伤口和严重烧伤患者。创伤后应激障碍检查表 - 军事版（PCL - M）用于测量PTSD症状。
18%的军事医务人员报告接触到对他们有重大影响的作战经历。相比之下，报告接触到对他们有重大影响的特定医疗压力源的医务人员数量是前者的三倍多（67%）。在根据军衔、教育水平和性别自我报告的接触医疗保健压力源方面发现了统计学上的显著差异。大约10%的部署医务人员PTSD筛查呈阳性。根据严格的病例定义（在必需的《精神障碍诊断与统计手册》标准上至少为中度分数且PCL - M总分≥50），样本中约5%的人PTSD呈阳性。MHSS分数（r(1,127) = 0.49，p < 0.0001）和作战经历量表分数（r(1,127) = 0.34，p < 0.0001）均与PCL - M分数显著相关。然而，MHSS分数与PCL - M分数的统计学关联比作战经历量表分数更大（z = 5.57，p < 0.0001）。对于PTSD阳性评分的最低标准（z = 3.83，p < 0.0001）和严格标准的PTSD（z = 1.95，p = 0.05）也是如此。
美国军方为与作战相关的PTSD预防和治疗研究提供了大量资金投入，军事医务人员可能会从许多这些治疗项目中受益。虽然接触作战压力源使所有军人都有患PTSD的风险，但军事医务人员也接触到许多重大的、高强度的医疗压力源。本研究表明，医疗压力源对军事医务人员的影响似乎比作战压力源更大，约5 - 10%的部署医务人员似乎有临床显著水平PTSD的风险。
