Social Psychiatry
Bruce P. Dohrenwend, Ph.D., Chief
of Psychiatric Research
Arthur L. Whaley, Ph.D., Research
Scientist V
There are two main research projects in the department. One is a three-year study of post-traumatic stress disorder (PTSD) in U.S. veterans of the war in Vietnam; it began at the end of September 1999 and is supported by grants from the National Institute of Mental Health (NIMH) and from an anonymous private foundation. The other is a five-year study of the conceptualization and measurement of major stressful events over the life course that will start officially in February 2001 with support from an NIMH grant. Dr. Dohrenwend is Principal Investigator on both studies, which involve interdisciplinary collaboration with colleagues from the Department of Psychiatry and the School of Public Health at Columbia University.
Vietnam Study
The purpose of the Vietnam study is to investigate hypotheses about differences in pre-war vulnerability/protective factors and exposure to war-zone stressors that may lead to different rates of PTSD onset, and differences in post-war experiences that may contribute to differences in PTSD persistence and recurrence in groups of Vietnam veterans defined by gender, ethnic/racial status, and socioeconomic background. The data come from the National Vietnam Veterans Readjustment Study (NVVRS) conducted by the Research Triangle Institute (RTI) with funds from the Veterans Administration.
The main focus of the present research is on an intensively studied subsample consisting of 343 veterans who served in Vietnam (Theater veterans) and 93 veterans who served at the same time outside Vietnam (Era veterans). All 436 members of the subsample were interviewed as part of the National Survey of the Vietnam Generation (NSVG) which included the entire Theater sample (1632) and Era sample (716). In addition to participating in the detailed NSVG interview, the 436 subsample members were interviewed and psychiatrically diagnosed by doctoral level clinicians; the diagnostic interviews were tape-recorded. Independent diagnoses based on reviews of over 50 of these tape recordings by psychiatrists and clinical psychologists on our study team agree well with the original diagnoses of PTSD and most of the co-morbid disorders.
Analyses of some of the data available on members of the diagnosed subsample were reported at the November 2000 annual meeting of the International Society for the Study of Traumatic Stress (ISTSS) in San Antonio. Among the preliminary results reported were the following:
(1) Overwhelmingly, first onsets of PTSD for male Theater veterans are war-related. For women, mainly nurses, first onsets for a substantial minority appear to be unrelated to their experiences in Vietnam but, rather, follow experiences in either their pre-war or post-war lives.
(2) There appear to be gender differences and, among males, ethnic/racial differences in the types of PTSD symptoms most likely to be associated with a persistent course of PTSD.
(3) Most research on the aftermath of the Vietnam war has focused on psychopathology and other dysfunctional consequences. Against this background, it is striking to find that 15 to 20 years after the war when the present data were collected, 52 % of the male Theater veterans and 69% of the female Theater veterans said that the effects of the war on their lives at present were mainly positive, with less than 10% in either group saying that the effects were mainly negative. The nature and implications of these mainly positive appraisals are being investigated.
While these preliminary analyses are continuing, however, our efforts during the past year have been concentrated on developing measures of pre-war, war-zone, and post-war traumatic and other major events. This work is labor-intensive and involves the construction of narratives of events from interview data and from military records in the context of the history of military operations over the 11 years of the war (19641975). The main analyses await the completion of these measures during the second year of the grant.
Conceptualization and Measurement of Major Stressful Life Events
Over the Life Course
Over the Life Course
Powerful research designs and statistical methods for studying the roles of heredity and environment in the etiology of psychiatric disorders have outstripped our ability to measure the relevant variables . The conceptualization and measurement of major stressful life events as important environmental variables is a case in point. The research will address problems with even the best of the self-report checklist approaches and with the more labor-intensive interview and rating approaches. It will involve review and analysis of the literature on case studies of individual events varying from those in extreme situations such as exposure to combat to more usual events such as spousal bereavement, divorce, unemployment, child abuse and neglect, and rape. The resulting measures will be tested on already existing event narratives collected with our SEPARATE approach in five case/control studies of various types of disorder, including schizophrenia, major depression, and PTSD.
Other Research
Dr. Whaley is continuing his write-up
of data analyses from his NIMH-supported Culturally-Sensitive Diagnostic
Interview Research Project. He is also working on grant applications to
examine the implications of disagreements between chart and research diagnoses
for treatment issues in his sample of hospitalized African-American psychiatric
patients.
From left to right, Dr. Arthur Whaley, Dr. Bruce Dohrenwend, and Dr. Roberto Lewis-Fernández