Elsevier

Clinical Psychology Review

Volume 29, Issue 8, December 2009, Pages 727-735
Clinical Psychology Review

Posttraumatic stress disorder and quality of life: Extension of findings to veterans of the wars in Iraq and Afghanistan

https://doi.org/10.1016/j.cpr.2009.08.006Get rights and content

Abstract

The wars in Iraq and Afghanistan—Operation Iraqi Freedom and Operation Enduring Freedom, or OEF/OIF—have created unique conditions for promoting the development of psychological difficulties such as posttraumatic stress disorder (PTSD). PTSD is an important outcome because it can affect quality of life, impairing psychosocial and occupational functioning and overall well-being. The literature on PTSD and quality of life in OEF/OIF Veterans is at an early stage, but the consistency of the evidence is striking. Our review indicates that the findings on PTSD and quality of life in OEF/OIF veterans are comparable to findings obtained from other war cohorts and from nonveterans as well. Even though the duration of PTSD in OEF/OIF Veterans is much shorter than in Vietnam Veterans, for example, those with PTSD in both cohorts are likely to experience poorer functioning and lower objective living conditions and satisfaction. The review ends with discussion of the implications of the evidence for research and clinical practice.

Section snippets

What is quality of life?

Quality of life is defined as physical, mental, and social well-being (World Health Organization, 1948). Over the past few decades, quality of life has gained recognition as an important component of health (e.g., Gladis et al., 1999, Kaplan, 2003, Katschnig, 2006). In contrast with the traditional biomedical model, the outcomes model of healthcare places value not only on increasing life expectancy (or quantity of life), but also helping patients to feel better about the quality of their lives

The impact of PTSD on the three components of quality of life

PTSD is associated with impaired quality of life among both Veterans and nonveterans. A recent meta-analysis of quality of life in anxiety disorders (Olatunji et al., 2007) found large effect sizes for PTSD across multiple domains. In order to examine the effects of PTSD on quality of life in OEF/OIF Veterans, we searched the Published International Literature on Traumatic Stress database (PILOTS), an electronic index of literature on traumatic stress that indexes articles using a controlled

Clinical implications for treating OEF/OIF Veterans

The growing evidence showing that PTSD is related to impaired quality of life in OEF/OIF Veterans has implications for clinical practice. One question is whether treating PTSD can improve quality of life. There have been no randomized clinical trials of treatment in OEF/OIF Veterans, but evidence from other cohorts supports this assumption. With few exceptions (Glynn et al., 1999, Schnurr et al., 2003), studies have shown that both psychotherapy (e.g., Cloitre et al., 2002, Ehlers et al., 2003,

Knowledge gaps

There is a need for more research on the relationship between PTSD and quality of life in OEF/OIF Veterans. Most studies of quality of life in this cohort have focused on functioning, so there is a particular need for investigations of how PTSD relates to social–material conditions and life satisfaction. Other priorities are longitudinal studies and clinical trials to determine whether PTSD treatment improves quality of life.

Population surveys can help us understand the breadth of the impact of

Conclusions

Our review indicates that the findings on PTSD and quality of life in OEF/OIF Veterans are comparable with findings obtained from other war cohorts and from nonveterans. This literature on is at an early stage, but the consistency of the evidence is striking. Even though the duration of PTSD in OEF/OIF Veterans is much shorter than in Vietnam Veterans, for example, those with PTSD in both cohorts are likely to experience poorer functioning and lower objective living conditions and satisfaction.

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