Posttraumatic stress disorder and depression in soldiers with combat experiences

Aim. To compare psychological, medical, and trauma-related variables in veterans with combat-related post-traumatic stress disorder (CR-PTSD) comorbid with depression and veterans with CR-PTSD only. Method. Out of 402 Croatian veterans recruited during expert evaluation for war-related compensation claims, 346 met the criteria for CR-PTSD: 97 for CR-PTSD only and 249 for PTSD comorbid with other diagnoses (77 comorbid with depression). To reach diagnosis, psychiatrists used clinical interview based on DSM-IV criteria, interview with family and friends, previous medical documentation, and Hamilton Rating Scales for Depression and Anxiety. An independent psychologist used a structured psychological interview Mississippi CR-PTSD scale, Watson's PTSD criteria, Minnesota Multiphasic Personality Inventory-version 201, and trauma questionnaire based on the Harvard Questionnaire. Results. Out of 402 soldiers, 13.9% did not meet the criteria for PTSD or other psychiatric diagnosis, 61.9% met the criteria for comorbid diagnoses, and 24.2% for PTSD only. The PTSD group with depression did not differ from PTSD-only group in combat experience, number of traumatic events, age, length of employment, sick leave, education, or marital status (chi-square test, p=0.121-0.672). The two groups differed in pre-trauma factors, such as mental disturbances before combat experiences (p=0.003), positive family history of psychiatric illness (p=0.008), primary major depression (p=0.012), and the number of hospital admissions (p=0.002). Conclusion. Different assessment methods in expert examination of combat-experienced soldiers with PTSD for compensation-related purposes are needed to establish the final diagnosis and avoid possibility of factitious disorder or malingering. Combat ability assessment should include assessment of previous psychiatric disturbances of soldiers and their families.