The Effects of Adverse Childhood Experiences on Post-Traumatic Stress Disorder in Post 9/11 Combat Veterans

Objective: To determine whether Adverse Childhood Experiences (ACE) predict the development of Post-Traumatic Stress Disorder (PTSD) among post 9/11 combat veterans who served in Iraq or Afghanistan. Rationale: PTSD is a diagnosis found among a high percentage of combat veterans who experience trauma while deployed. As recent research shows, trauma during childhood can affect and increase the trauma related to deployment and combat. This research study expands upon the current literature that demonstrates a relationship between childhood trauma and trauma experienced among combat veterans while deployed, as the results may benefit military branches in improving mental health services to service members. The researcher hypothesizes that combat veterans’ ACE scores will be positively correlated with their PTSD scores. Method: A total of 51 veterans were recruited via email at a Midwest liberal arts college. Participants were also recruited via the researcher’s Facebook friends and from various Veterans of Foreign Wars (VFWs) organizations in Iowa. Veterans answered various demographic questions and completed two questionnaires: 1) the Adverse Childhood Experience questionnaire to obtain their overall ACE score; and 2) the PCL-M to obtain a total PTSD symptom severity score. Results: A Spearman’s Rho correlation was calculated, revealing a significant, moderately strong, positive relationship between veterans’ ACE scores and their total PTSD symptom severity scores. Conclusion: ACEs remain an important contributor to the development of PTSD among post 9/11 combat veterans. These results justify a need for the Department of Defense to conduct ACE screenings before military recruits are deployed to combat zones. BACKGROUND Prevalence of PTSD ▪ Approximately 11-20% of Operations Enduring Freedom and Iraqi Freedom veterans will have PTSD in a given year (“How Common is PTSD,” 2016). Overview of Adverse Childhood Experiences ▪ Between 1995 and 1997, Dr. Vincent Felitti and his research team discovered a connection between childhood trauma and health complications later in life. They found that the higher the number of ACEs an individual has, the more likely they are to have health complications later in life (Felitti et al., 1998). ▪ They identified ten main categories of childhood trauma: physical, sexual, and emotional abuse; physical and emotional neglect; and household dysfunction, identified as divorce, substance abuse, domestic violence, incarcerated family member, and mental illness (Felitti et al., 1998). ACEs and PTSD ▪ Compared to veterans who were not deployed, research shows that both male and female soldiers are significantly more likely to screen positive for PTSD post-deployment if they reported exposure to more than one category of childhood adversity (Cabrera et al., 2007; LeardMann et al., 2010; Gahm et al., 2007). ▪ Childhood physical neglect, prior exposure to violence, and childhood physical abuse among deployed male Marines and veterans were the greatest predictors of PTSD symptoms (LeardMann et al., 2010; Phillips et al., 2010; Fritch et al., 2010). ▪ Childhood physical abuse among female veterans were the greatest predictors of PTSD symptoms (Mercado et al., 2015). ACEs, Depression, and Anxiety Disorders ▪ Controlling for combat experiences, one study found that male soldiers were more likely to screen positive for depression if they reported exposure to two or more categories of childhood adversity (Cabrera et al., 2007). ▪ Among female patients at VA hospitals, researchers found that childhood physical abuse was a greater predictor of poorer health and greater depressive symptoms (Mercado et al., 2015). ▪ A history of childhood adversity was associated with new-onset depression and depressed affect postdeployment for soldiers that had no prior history of PTSD or depression (Rudenstine et al., 2015; Gahm et al., 2007; Shen et al., 2012; Dube et al., 2001). ACEs and Alcohol/Substance Use ▪ Navy recruits who were victimized as children were more likely to use alcohol than non-abused drinkers (Trent et al., 2007). ▪ In a study of men beginning military training, 14.8% were identified as early drinkers, which correlated with their ACEs (Young et al., 2006). ▪ Active duty personnel were at increased odds of substance use after deployment to Iraq or Afghanistan (Shen et al., 2012). ACEs and Suicide ▪ Childhood adversity among service members who reported prior suicide attempts was significantly higher compared with personnel who did not report any suicide attempts (Skopp et al., 2011), and male veterans from Iraq/Afghanistan who had pre-military stressors were found to be at an increased risk for suicide (Carroll et al., 2017). METHOD REBECCA BROWN University of Northern Iowa, Department of Social Work, Cedar Falls, Iowa SELECTED REFERENCES THE PRESENT STUDY CONCLUSIONS ▪ The researcher’s hypothesis was confirmed as a statistically significant relationship between veterans’ ACE scores and their total PTSD symptom severity scores was found despite combat experience. ▪ Past research shows a relationship between ACEs and PTSD among combat veterans. This study supports and extends this literature by showing a significant correlation between veterans’ ACE scores and their total PTSD symptom severity scores. ▪ This study could be improved by having a larger, more diverse sample size. Future studies should include more Air Force veterans, along with an evenly distributed number of the other military service branches. ▪ Future studies should use the updated PCL-5 questionnaire that corresponds to the DSM-5 to assess for PTSD symptoms. ▪ Overall, ACEs remain an important contributor to the development of PTSD among post 9/11 combat veterans despite war-related stressors. The results of this study justify a need for the Department of Defense to conduct ACE screenings before military recruits are deployed to combat zones. THE EFFECTS OF ADVERSE CHILDHOOD EXPERIENCES ON POST-TRAUMATIC STRESS DISORDER IN POST 9/11 COMBAT VETERANS