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Post-traumatic stress disorder in combat veterans

Masters, Kim J., MD, FACP, DFAPA, DFAACAP

Journal of the American Academy of PAs: November 2018 - Volume 31 - Issue 11 - p 11
doi: 10.1097/01.JAA.0000546487.96721.81
Commentary

Kim J. Masters is an adjunct assistant professor in the Department of Psychiatry and Department of Physician Assistant Studies at Wake Forest University in Winston-Salem, N.C., an affiliate assistant professor in the PA program at the Medical University of South Carolina in Charleston, a professor in the PA program at A.T. Still University in Mesa, Ariz., and a consultant for Three Rivers Midlands Campus Residential Treatment Center in West Columbia, S.C. The author has disclosed no potential conflicts of interest, financial or otherwise.

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The article on post-traumatic stress disorder (PTSD) in combat veterans in this issue (page 21) is a critical addition to clinicians' armamentarium in the assessment, treatment, and management of PTSD in combat-exposed veterans. The article highlights the extent of PTSD, the evidence-based treatments, and the unique position of physician assistants (PAs) to engage with military patients. Thirty percent of PAs have some military experience, and in 2010 almost 2,010 PAs were employed in the VA hospital system.

The article also is an invitation to engage PAs in PTSD assessments and treatment. In the role of first contact with many patients and their families, PAs can form treatment alliances and work for effective treatments. One approach is to engage patients and their support systems in public health prevention measures.

  • Primary prevention efforts or preventing PTSD. Adverse childhood events, particularly childhood sexual abuse, domestic violence, bullying, and homelessness, are well known as causes of adverse consequences during life, including an increase in suicide and a shortened life span.1,2 Primary care providers who screen patients for adverse childhood events can devise effective treatment strategies and reduce patients' risk for PTSD.

PAs also can work with the military and civilian networks to support strategies and programs to reduce the high rate of sexual harassment and assault of women in the military (affecting 31% of women in the military in one study).3

  • Secondary prevention efforts to mitigate PTSD symptomatology in patients who are diagnosed. This issue's article presents many treatment options. Additional treatments could include dealing with moral injury issues, which occur when a person's core beliefs are contravened by his or her actions. Several new treatment protocols target the moral crisis raised by conflicts such as killing a child to protect oneself and one's comrades.4
  • Tertiary prevention to prevent PTSD symptoms from distressing others in the affected person's family and community. Family members of veterans diagnosed with PTSD respond to how information about the trauma is shared, which in turn affects economic and social well-being and relationships with family, friends, neighbors, and other members of the community. PTSD symptoms can be compounded by survivor guilt and comorbid traumatic brain injury and combat-related physical injuries. PAs, especially those in primary care or at Veterans Affairs facilities, are well positioned to understand the role of the family in PTSD treatments and to be aware of cultural and community issues and resources.5,6

In every sense, this article is a clarion call for PA involvement in PTSD treatments, not only those of combat veterans, but those in the community who come to primary care and psychiatric clinics with the wounds from violence, assault, sexual abuse, school bullying, and homelessness. By all means, get involved either through your own practice, through discussions with colleagues, with grand round presentations, at national PA meetings, through speaking in public forums, or through writing articles for your local community, in public media, and in professional journals.

In summary, PAs are well positioned to provide leadership on PTSD awareness, diagnosis, and treatment. It ensures continual challenges in caring for patients because new instances are an hourly occurrence, and their traumatic effects potentially lifelong.

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REFERENCES

1. Centers for Disease Control and Prevention. Adverse childhood experiences. http://www.cdc.gov/violenceprevention/acestudy/index.html. Accessed August 8, 2018.
2. National Council of Juvenile and Family Court Judges. Adverse childhood experience questionnaire. http://www.ncjfcj.org/sites/default/files/Finding%20Your%20ACE%20Score.pdf. Accessed August 8, 2018.
3. Lofgreen AM, Carroll KK, Dugan SA, Karnik NS. An overview of sexual trauma in the US military. Focus. 2017;15:411–419.
4. Held P, Klassen BJ, Zalta AK, Pollack MH. Understanding the impact and treatment of moral injury among military service members. Focus. 2017;15:399–405.
5. Lester P, Rauch P, Loucks L, Sornborger J, Ohye B. Posttraumatic stress disorder and military-connected families: the relevance of a family centered approach. Focus. 2017;15:420–428.
6. Brofenbrenner's bioecologic model of development. http://www.learning-theories.com/bronfenbrenners-bioecological-model-bronfenbrenner.htm. Accessed August 8, 2018.
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