Post-Traumatic Stress Disorder and Social Support in Men and Women Combat Veterans: A Literature Review

This literature review critically analyses the available literatures on the advent of post-traumatic stress disorder in men and women and establishes a link between the available social-support for the victims. The paper aims to answer the research question: ‘Is there an evidence based relationship between the available social support strategies and the men and women combat veterans affected with Post Traumatic Stress Disorder?’

Running head: RESEARCH QUESTION AND LITERATURE REVIEW
RESEARCH QUESTION AND LITERATURE REVIEW
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Introduction:
Post-Traumatic Stress Disorder, abbreviated as PTSD has been defined as the mental
health disorder developed by individuals on being exposed to a devastating natural calamity,
war or a sexual-assault experience (Alisic et al., 2014). It is believed to affect the life of
individuals witnessing the life-threatening incident deeply. The consequences of the life-
threatening incidents often lead to the development of stress, trauma, anxiety, Depression and
in extreme cases might even lead to the mental health impairment (Bisson et al., 2013). It has
been observed that post-traumatic disorder can affect individuals at any age and even lead to
cognitive impairment. The worst victims can be categorized as the children and the women as
society perceives them to be the most vulnerable target audience. The effect of trauma is deep
and at the same time persists for a long period of time and sometimes can even last a life time
(Mithoefer et al., 2013).This paper would critically analyse the available literatures on the
advent of post-traumatic stress disorder in men and women and would try to establish a link
between the available social-support for the victims. The literature review would then aim to
correlate the two elements and provide a supportive framework to answer the research
question: ‘Is there an evidence based relationship between the available social support
strategies and the men and women combat veterans affected with Post Traumatic Stress
Disorder?’ The paper would delve deeper into the central theme of post-traumatic stress
disorders and critically analyse the literatures present in favour of the topic and carry out an
extensive review of the literatures and synthesise the findings so as to develop a critique and
synthesis of the subject.
Literature Review:
Post traumatic disorder is seen to affect the lives of the men and women veteran
combats to a great extent. In alignment to this perspective, a study conducted by Chen et al.,

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(2015) involved the meta-analysis of thirty two articles in order to understand the social
behaviour exhibited by the veteran combats. The findings of the study revealed that the
veteran combats find it extremely difficult to socialize with positive vibes on account of
being exposed to gruesome sights that include the sight of dead bodies on regular basis.
Along with the study also revealed that a number of social determinant factors such as low
income, lack of proper education and proper infrastructure to avail counselling sessions post
trauma episode also plays a major role in determining the quality of life of the veteran
combats. Research papers have also reported a hike in the advent of post-traumatic disorder
in the war veterans. A qualitative study was conducted on the Kosovo regiment soldiers who
had participated in the Albanian battle and the data was collected on the basis of the
demographical statistics available. Surprisingly, the study revealed a hike in the number of
patients suffering from post-traumatic disorder which clearly indicates that due to the lack of
social support and feasible compensation schemes, there is a rise in post-traumatic
complications in the war veterans. The research study comprised of a sample size of 150
participants, out of which the findings revealed that 47.3% of the war veterans had already
developed acute stress disorder caused due to the drastic effect of the war. The research
conducted by Han et al., (2014) suggests that post deployment due to the lack of accessibility
of any counselling session to minimise the effect of the war experience the soldiers often
show the manifestation of symptoms that are related to the post-traumatic stress disorder. The
research was conducted on the basis of qualitative analysis of the data obtained on comparing
a sample size of 835 American Battalion and 173 civil guard soldiers pre and post
deployment. The key findings revealed that due to the unavailability of ample social support
or counselling help-cells there was a rise in the manifestation of symptoms of PTSD among
the deployed soldiers. In order to understand the criticality and access the pattern of the
manifestation of the PTSD symptoms, a quantitative analysis was carried out by Andersen et

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al., (2014). The study was solely designed to trace the initial phases of the PTSD symptoms
in soldiers who had been deployed after a period of two and a half years and the assessment
of risk factors was done in compliance with the six PTSD check-list factors. The research was
carried out with the consideration of a sample size that comprised of 743 soldiers who were
deployed in the year of 2009 in Afghanistan. The findings of the research revealed six
trajectories and the identification of vulnerabilities prior to deployment and stressors after the
deployment. The findings of the research study point towards the fact that due to absence of
adequate social support the soldiers face life-threatening complications and depressive
symptoms. Research evidences as furnished by the study conducted by Nash et al., (2015)
aimed at accessing the reasons that contribute to the development of PTSD symptoms in 867
American soldiers who were recruited and deployed to Afghanistan post 7 months of their
recruitment. The factors that contributed heavily in the development of PTSD symptoms
were analysed with the help of qualitative semi-structured interviews and survey responses of
the soldiers. The survey responses highlighted three important factors that affected the
severity of the PTSD symptoms in the combats and the factors that were listed were mainly
the absence of social support, the segregation and the avoidance to provide counselling in any
form to the sufferers. Scientific research factors as stated by Sripada et al., (2016) also states
that there is an acute negligence in providence of social support to the veterans and that
directly leads to the cause of PTSD. The research was carried out after conducting a thorough
analysis on the medical reports of the PTSD patients and the report of 742 veteran patients
were analysed. The results revealed that the effect of PTSD in the veterans were primarily on
account of lack of access to any social support system. This makes it evident that due to the
inappropriate providence of social support and education related to the harsh effects of PTSD,
there has been a rise in the PTSD cases. According to Melanie et al., (2018), it has been
reported that there is a high incidence of suicidal tendencies in veterans who are affected with

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PTSD. The researchers have critically evaluated and tried to trace the root cause for the
dearth of suicidal tendencies in veterans being affected with PTSD. The nature of incidence
and dearth of suicidal tendencies in the veterans were analysed using the CAPs and PHQ-9
scale and the sample size considered for this study comprised of a total of 746 veterans. The
results pin pointed towards the fact that the suicidal tendency in the veteran men and women
combats were high because of the lack of social support. In relation to the change in
behavioural pattern of the combats who have been reported to be suffering from PTSD, it has
been suggested by Headquarters (2015) in his study, that special focus should be put on the
mental status of the women serving in the army. Women serving in the military have been
reported to be victims of a number of harsh situations which includes cases of sexual assault,
suffering, depression and anxiety (Admon et al., 2013). The cases of the emotional suffering
have been reported by both men and women and thus the results of the research study
suggests that steps must be taken to refine the concept of social support in the military camps
so as to avoid the incidences of PTSD patients. Studies reveal that the most common change
in the behavioural pattern of the victims suffering from PTSD is the withdrawal from society.
This change in behaviour is not perceived in a positive manner by the peer group and family
members of the victim and often leads to emotions of anger and impatience. However Smith
et al., (2018) in their study state that it is important to provide space to the victims so that
they are able to deal with the stress and in addition to this social support and immediate
interventions can be provided by the immediate family members and family. Interventions
that could be provided would include monitoring minimal rhythmic exercises, motivating the
patients to take up a hobby in order to harbour positive thoughts and also maintaining a
friendly and compassionate relationship with them would heavily contribute in effectively
treating the negativity associated with developing PTSD. According to the study conducted
by Mayo (2018), PTSD has been associated with serious mental disturbance in individuals

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who have witnessed life threatening incidents. The most challenging part that has been
qualitatively identified in this research comprises of the individuals to not being able to stop
visualising the happenings of the disaster again and again. The incident generates an
extensive negative impact that seeps down extremely deep within the patients experiencing
the mishap. At the same time, it has been said the patients develop severe changes in their
respective behavioural pattern such as turning aloof from the society and developing a lot of
aggression among themselves. The symptoms associated with the development of PTSD
range from mild to severe and can even harbour self-harm or suicidal thoughts in individuals
going through it. Hence, it is pivotal to administer therapeutic interventions in terms of
professional support and support from family members so as to minimise the drastic effect of
the symptoms.
Literature Gap:
On critically carrying out a review on the literatures it is evident that the researchers
have mainly focused on carrying out research to identify the onset of PTSD and identify the
initial symptoms associated with the disorder. The papers have also significantly revealed an
existing relationship between the manifestations of PTSD in veterans primarily due to the
lack of an efficient social support system (Yehuda et al., 2015). However, a major literature
gap has been noticed in terms of devising appropriate interventions and inclusion of social
support facilities in war camps so as to provide immediate support to the victims.
Additionally it should also be stated that the literature review critically synthesizes the central
idea of all the available literatures that predict an existing relationship between the incidence
of PTSD and lack of social support measures (Trimble, 2013). Therefore, to summarize the
concept of the key findings of the research it can be said that there is ample amount of scope
for the researchers to research on the manner in which the social support system can be
efficiently enhanced for the victims who have witnessed acute devastation in some form.

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Conclusion:
Therefore to conclude, it must be acknowledged that Post-Traumatic disorders in
individuals witnessing a traumatic incident is extremely heart-wrenching. The scenario in
context of the men and women veterans is even worse as they have to deal with a number of
circumstances such as sexual assault, drastic effect of war and sight of death on a regular
basis. The synthesis of the literatures reviewed reveal that due to lack of social support in
terms of counselling help and proper education to combat post-traumatic stress, the scenario
have been witnessed to be even more degenerating. Negative effects such as suicidal
tendencies, inflicting self-harm and tremendous aggression have been reported to exist in
individuals exposed to post-traumatic stress disorders. In light of seriousness of the situation,
it must be mentioned that the women and the children who witness a war condition in most of
the cases are reported to be intellectually disabled and at the same time also found to be
impaired with respect to their cognitive behaviour and life-long depression. These urgent
conditions of emergency call for immediate measures to be designed in order to incorporate
support systems to effectively help the individuals in need. In addition to raising the quality
of life it would also help in preventing further incidences of PTSD in men and women
veterans and their loved ones because individuals irrespective of their background and
environment deserve to lead a healthy standard of living both in terms of physical and mental
well-being.

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References:
Admon, R., Milad, M. R., & Hendler, T. (2013). A causal model of post-traumatic stress
disorder: disentangling predisposed from acquired neural abnormalities. Trends in
cognitive sciences, 17(7), 337-347.
Alisic, E., Zalta, A. K., Van Wesel, F., Larsen, S. E., Hafstad, G. S., Hassanpour, K., & Smid,
G. E. (2014). Rates of post-traumatic stress disorder in trauma-exposed children and
adolescents: meta-analysis. The British Journal of Psychiatry, 204(5), 335-340.
Andersen, S. B., Karstoft, K. I., Berteslen, M., & Madsen, T. (2014). Latent Trajectories of
Trauma Symptoms and Resilience: the 3-Year Longtudinal Prospective USPER Study
of Danish Veterans Deployed in Afghanistan. The Journal of Clinical Psychiatry,
1001-1008.
Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological
therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane
Database Syst Rev, 12.
Chen, X., Yang, G., Tang, B., Liu, Y., Kang, P., Wang, M., & Zhang, L. (2015). A Meta-
Analysis of Risk Factors for Combat Related PTSD among Millitary Personel and
Veterans . plus One, Online.
Danuza, T., Arenliu, A., & Masten, R. (2014). Post Traumatic Stress Disorder and Social Su-
pport in the Veterans of the War in Kosovo Post Traumatic Stress Disorder and Social
Su-pport in the Veterans of the War in Kosovo. Strokovni prispevki, 75-83.
Han. C, S., FrankCastro, O.Lee, L., E.Charney, M., P.Marx, B., Brailey, K., . . . J.Vasterling,
J. (2014). Military unit support, postdeployment social support, and PTSD symptoms

10RESEARCH QUESTION AND LITERATURE REVIEW
among active duty and National Guard soldiers deployed to Iraq. Journal of Anxiety
Disorders, 446-453.
Headquarters, T. S. (2015). Healing the Hidden Wounds of War. Retrieved from The Soldiers
Project: https://www.thesoldiersproject.org/female-veterans-ptsd/
Mayo, C. S. (2018, July 06). Post-traumatic stress disorder (PTSD). Retrieved from Mayo
Clinic: https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-
disorder/symptoms-causes/syc-20355967
Melanie, A. B., Mary, W. A., Thomas, C. N., Shira, M., Thomas, M. J., & Beth, C. E. (2018).
Posttraumatic stress disorder, depression, and suicidal ideation in veterans: Results
from the mind your heart study. Psychiatry Research, 224-230.
Mithoefer, M. C., Wagner, M. T., Mithoefer, A. T., Jerome, L., Martin, S. F., Yazar-
Klosinski, B., ... & Doblin, R. (2013). Durability of improvement in post-traumatic
stress disorder symptoms and absence of harmful effects or drug dependency after 3,
4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term
follow-up study. Journal of Psychopharmacology, 27(1), 28-39.
Nash, W. P., Boaso, A. M., Steenkamp, M. M., Larson, J. L., Lubin, R. E., & Litz, B. T.
(2015). Posttraumatic stress in deployed Marines: Prospective trajectories of early
adaptation. Journal of Abnormal Psychology, 155-171.
Smith, M., & Robinson, L. (2018, July). Effects of PTSD on Family – National Center for
PTSD. Retrieved from Helpguide.org: https://www.helpguide.org/articles/ptsd-
trauma/helping-someone-with-ptsd.htm

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Sripada, R. K., Lamp, K. E., Defever, M. B., Venners, M. M., & Rauch, S. A. (2016).
Perceived Social Support in Multi-era Veterans With Posttraumatic Stress Disorder.
The Journal of Nervous and Mental Disease, 317-320.
Trimble, M. R. (2013). Post-traumatic stress disorder: History of a concept. In Trauma and
its wake (pp. 31-39). Routledge.
Yehuda, R., Hoge, C. W., McFarlane, A. C., Vermetten, E., Lanius, R. A., Nievergelt, C.
M., ... & Hyman, S. E. (2015). Post-traumatic stress disorder. Nature Reviews Disease
Primers, 1, 15057.