Introduction
Posttraumatic stress disorder (PTSD) refers to a serious anxiety disorder that can occur after one is exposed to any circumstance that causes psychological trauma. Indeed, the situation that an individual is exposed to may involve a risk of death to the person or another person. In addition, it may encompass the person’s or another person’s physical, emotional or sexual integrity, denying the individual’s capability to cope (Harbertson et al., 2013). In fact, PTSD is categorized as an anxiety disorder. It is characterized by aversive anxiety-related occurrences, behaviors, and emotional reactions that come up following exposure to emotionally traumatic experience. The symptom of Posttraumatic stress disorder can be manifested months after exposure to the traumatic experience. Nevertheless, posttraumatic stress disorder can take weeks or years before it is manifested (Pless Kaiser, Proctor, & Vasterling, 2016). The characteristics of Posttraumatic stress disorder remain for longer than a month. In essence, this differentiates Posttraumatic stress disorder from other stress-related disorders such as acute stress disorder. The persisting symptoms of Posttraumatic stress disorder lead to interruptions of one or more aspects of an individual’s life.
Harbertson et al., (2013) posit that posttraumatic stress disorder has remained a common problem among soldiers returning from deployment. Interest in this area has increased since the start of the 1980s. Beginning from that time, various researchers have investigated several elements of the mental disorder. The research has emanated in a huge body of literature on the topic. Much of the research has concentrated on the impact of traumatic events in life on the mental stability of the affected person, mostly soldiers who have been deployed in combat and experienced some form of trauma. The studies have also culminated in a lot of controversy around the causes and effects of PTSD. Among the most significant aspects of the studies have been the effects of the traumatic effects on war veterans (Vyas et al., 2016). Psychiatrists have suggested in the past that stressing or traumatizing incidents can lead to major stress-related symptoms even in well-adjusted persons. Among soldiers returning from deployment, interest in the disorder has increased as more cases are being reported. Stress among returning soldiers is diverse and so is the prevalence of posttraumatic stress disorder.
Individuals with the disorder re-experience the traumatic events and may react by keeping away from situations, people, or any other thing that might remind them of the traumatic incidents. Avoidance and Hyperarousal are widespread symptoms of PTSD, which can be easily recognized in soldiers returning from war. While the symptoms of the disorder have been presented since people began to experience traumatic situations, it has been grouped as a disorder only in the 1980s. Nevertheless, it has been known by other terms before the coining of the term posttraumatic stress disorder, even at the time of the American Civil War. Soldiers were argued to suffer from “soldier’s heart” during the American Civil War. Even at the time of the World War I, soldiers were seen to suffer symptoms that could be characterized as those of PTSD (Vyas et al., 2016). In this case, the soldiers were said to have “combat fatigue.” On the other hand, the “Gross stress reaction” was the term that was used for PTSD during the Second World War. The term “post-Vietnam syndrome” was developed during the Vietnam War in reference to the symptoms that were consistent with the disorder. It was after the Vietnam War that the term posttraumatic disorder was used.
Modern research has correctly classified PTSD according to the mental health symptoms. Thus, it is currently possible to recognize the individuals suffering from the disorder depending on the symptoms they exhibit, and especially after traumatic events such as war. Hourani et al., (2016) suggest that there are considerable rates of PTSD among soldiers returning from war, although comparative studies between soldiers who deploy and those who do not are rare. One of the primary reasons for the difference, in the few studies that have been carried out, is the fact that posttraumatic stress disorder emanates from exposure to events that cause psychological trauma. Such are many incidents during deployment because the soldiers are normally exposed to war and deaths of civilians and other soldiers. On the contrary, the soldiers who are not deployed are less likely to experience such incidents and thus, less likely to suffer from PTSD.
Statement of the Problem
Research interest in the area of PTSD has been on the increase at the beginning of the 1980s based on the increase in the number of people suffering from the mental health condition. Various aspects of the disorder have been studied and mostly focused on the biological and other causes of PTSD. For example, as a psychological disorder, research has focused on the identification of the genes, which might play a role in the fear and anxiety related to the disorder (Renshaw et al., 2011). Traumatic events are the primary causes of PTSD, leading to the interest in the research on the effects of war on soldiers. In the current world, there are an increasing number of military actions and interventions both within national borders and in other foreign countries. Novaco et al. (2012) argue that the aftermath of war is normally more painful than the war itself. Soldiers returning from military operations are faced with countless problems among them, PTSD.
Past research has not extensively covered the area of how the disorder can be identified among the soldiers, with the aim of differentiating treatment approaches for the mental health condition than others suffered by all the soldiers. The little research done on identifying the diseases tends to concentrate on the signs and symptoms of the disorder as experienced by soldiers who deploy. The approach is ineffective given the fact that most of the symptoms become evident during the advanced stages of the PTSD (Vyas et al., 2016). Thus, the focus of the current research will be answering the question, how can we identify PTSD among soldiers who deploy as opposed to those who do not. It is necessary to provide a better understanding of the reasons why some soldiers have the mental disorder while others do not. Researchers have suggested that within the human mind, memories are created and keep replaying, which are possibly the basis of PTSD among soldiers.
Conceptual Framework
From the topic of this research, the independent variables are the factors that cause PTSD among soldiers, while the dependent variable is the PTSD. Researchers have suggested that the main factors behind posttraumatic stress disorder are physical or emotional trauma, or sometimes both. Posttraumatic stress disorder is more likely to be as a result of physical or emotional trauma resulting from human acts such as sexual assault, terrorist attack, and combat as compared to trauma that results from natural calamities (Harbertson et al., 2013). Potential factors behind trauma include firsthand experience, or witnessing, psychological, physical or sexual assault. In addition, going through or witnessing situations that can be categorized as life-threatening, such as accident, physical abuse, diseases, and being involved in works, which expose one to warfare like military or disasters such as soldiers and emergency service workers expose one to PTSD.
Whichever the war or battle one looks at there are very many cases of Posttraumatic stress disorder that have been reported. All through history, it has been realized that exposure to military experiences can negatively affect the psychological health of the people involved in such experiences. As a matter of fact, Posttraumatic stress disorder historically emanates from the interpretation of the impact of combat on soldiers. The categorization of symptoms that are currently referred to as posttraumatic stress disorder has been defined in the past as “combat fatigue,” “shell shock,” or “war neurosis” (Hourani et al., 2016). From this point of view, researchers have developed a particular interest in investigating the rate of posttraumatic stress disorder among military veterans. Levels of Posttraumatic stress disorder in Vietnam, Persian Gulf, and Iraq war veterans have been investigated.
Many psychologists hold that even though the war is normally painful at the battlefield; its aftermath is normally tougher. The long-term effects of the war are far much more painful than what is experienced on the battlefield. War victims require long-term care due to the physical as well as the psychological impacts of war. According to research, war brings about several problems, including the spread of diseases such as tuberculosis as well as highlighting of other health problems like heart conditions and asthma. For instance, many people were affected by trench foot after the First World War (Mayo et al., 2013). In fact, the disease was caused by the wet, cold, and unsanitary conditions during the war. All these health complications affect victims of the war long after the battle is over. Some of the diseases are not curable; hence, victims are forced to live with the conditions for the rest of their lives. In essence, the situation is much more painful than the war itself.
Relevance of the Study
It is important to provide research evidence related to the identification of PTSD, for more effective intervention in terms of prevention and even treatment for the soldiers. There have been various ways used by experts in the identification of the disorder. Mayo et al., (2013) argue that the treatment of PTSD has focused on the use of psychotherapy and medication or both. However, the treatment is done the same for soldiers without considerations of the underlying causes of the disorder. Indeed, just because someone is a soldier does not make him or her susceptible to PTSD, the underlying cause could be the experience of traumatic experiences mostly in combat. There are others who have to live with the mental health condition due to a lack of effective ways of recognizing it. Thus, development of effective means of identifying the disorder as early as possible will be the basis for effective intervention and care for those with the disorder (Harbertson et al., 2013). The findings from this study will inform better policies regarding timely diagnosis, treatment, and care for those with the disorder, especially immediately soldiers come back from combat. As such, it will be beneficial for the soldiers, the general population, as well as for the physiotherapists because they will be better placed to identify the PTSD cases early and give the right treatment.
Indeed, the results from the study will provide experts and the affected with the necessary resources to identify the affected persons and provide treatment before the symptoms get worse. In addition, the results of the study will be beneficial at the policy level, as it will inform policies geared towards making life better for the war veterans (Pless Kaiser, Proctor, & Vasterling, 2016). Mental health problems are among the primary concerns of the veterans as it affects their ability to integrate effectively into their societies. The problem also affects their families and relatives because they interfere with their relationships. Thus, providing solutions to the problems, as early as possible, will be beneficial to the society in general since the affected veterans are a part of the larger community and need to reintegrate effectively after taking part in combat.
Hypothesis
Many people have experienced traumatic events in their life, which have negative effects on their life, including suffering from PTSD. Research has indicated that approximately 8% of individuals in the United States will suffer from this mental condition at some point in their life (Ghaffarzadegan, Ebrahimvandi, & Jalali, 2016). Compared to the general population, people who have experienced combat have more chances of experiencing PTSD. Therefore, the reality is a serious concern for the most affected individuals and generates critical questions among mental health care providers on the most effective ways of identifying PTSD and the most effective ways of dealing with the problem. Given the reality that PTSD results from experiencing a traumatic incident, the hypothesis for this study is that soldiers who deploy or experience combat are more vulnerable to suffering the mental health problem than those who do not deploy or experience combat.
Summary
The use of signs and symptoms has been the conventional way of identifying individuals with PTSD, and this is somewhat ineffective as some of the symptoms become evident in the advanced stages of the disorder. Thus, developing other means to identify the mental health problem in a timely manner is better for more effective treatment and management. Towards this end, the purpose of the current study is to establish the effects of war on veterans, by comparing the prevalence of PTSD among those who have deployed and those who have never deployed. Identifying the symptoms of the disorder in those who have deployed is critical to establishing the disorder’s trajectory promptly for the purpose of effective treatment. Most of the veterans suffer from the disorder for a long time before the problem is established and addressed. Thus, realizing the signs of the disorder by comparing the two groups is important. Therefore, the need for timely diagnoses and treatment makes the study necessary.
Methodology
This section discusses the actual implementation of the study. It contains a discussion of the methods and the research design that will be used in collecting the data. The part also includes the participants who will take part in the study and the settings within which the study will be carried out. The section also contains the measures and procedures, which will be used in the study.
Research Design
Previous studies have applied different methods of collecting data to inform the reality of PTSD. The methods applied depend on the nature of the study. The study will use a blended research design, in which case different research methods will be applied in carrying out the study. Data will be collected both qualitatively and quantitatively using various data collection tools and procedures. The collected data will be brought together to test the hypothesis. As such, the detailed collection of the data will also provide details findings, conclusions, and lead to policy and future research recommendations.
For the quantitative data, surveys will be carried out which will provide numerical data such as the prevalence rate of PTSD among the soldiers who deploy and the soldiers who have never deployed. The data will be geared at testing the hypothesis, with the aim of finding ways of identifying PTSD in at-risk populations, soldiers. In fact, to collect the qualitative data, the study will use interviews and observations. In fact, this approach will provide data in the form of narratives to identify the factors that put the soldiers at risk of suffering from PTSD (Hourani et al., 2016). The narratives will also provide an understanding of the circumstances unique to combat that make the soldiers who deploy to suffer from the mental health problem while those who do not deploy might not be affected. Observations will be necessary to differentiate between the behaviors of the affected soldiers against the unaffected ones. All the collected data will be analyzed to come up with ways of identifying PTSD among different at-risk individuals, thus the soldiers who deploy (Ghaffarzadegan, Ebrahimvandi, & Jalali, 2016). The use of the diverse methods of collecting data, is due to the diversity of the participants, in terms of age and other demographic factors, as well as the need to collect as detailed data as possible. Application of the diverse methods of data collection is also necessary to bring about the whole picture of the reality of PTSD from diverse sources.
Evidently, the current study is a primary research, which means that primary data will be collected to fill the gaps identified in previous studies. The research is being done to test the formulated hypothesis. The study uses a deductive approach to research, which means that it begins with the formulation of the hypothesis, which will then be tested using the data that will be collected and analyzed. The top-down approach begins with the development of the hypothesis leading to the general conclusions. The primary rationale for such a study is to make it possible for the researcher to have a focus on a specific issue, in this case, PTSD among soldiers who deploy.
Participants
For the current study, the population of interest will be soldiers in the United States. The soldiers are the most at risk of suffering PTSD because of the experience with war. However, as hypothesized, not all soldiers face the same realities because while some are exposed to war, others are not. The soldiers who do not deploy might suffer some traumatizing events, but not as severe as those experienced by the soldiers who deploy. Thus, the participants will be divided into two groups, one of the soldiers who has been deployed at some point in their career and the other one of the soldiers who has never been deployed. The experimentation group will be that of the war veterans, those who have ever deployed. The control group will be that of the soldiers who have never been involved in any war in the course of their career. In essence, this form of study is critical to establishing the possible factors that underlie PTSD as experienced by the soldiers who deploy.
Sampling will be necessary to ensure that sufficient numbers of individuals in each group are achieved. Sampling methods are necessary for any study and can be under the aspect of probability or non-probability. The former applies a sampling frame in obtaining the sample, while the latter does not use the sampling frame. The current study will apply random sampling of the soldiers to each of the two groups. The use of random sampling is critical to ensuring the validity of the study; hence, achieve generalization. Based on the nature of the current research, random sampling method will be used to draw a sample from the population under study. The list of soldiers from which the sample will be selected will have individuals aged between 19 and 35 years. One of the inclusion criteria is the necessity to be a soldier and within the identified age bracket. Individuals outside this group will be excluded. The soldiers will be both male and female and from all ethnic groups in the country, though not necessarily in the same number. A sample of 50 soldiers who have deployed at some point in their career and 50 soldiers who have never deployed will be used to carry out the research.
Setting
It is critical that the settings of the research be carefully considered due to the sensitive nature of the study. The soldiers should be interviewed in their familiar settings and the presence of professional counselors. Thus, the research will be carried out in a clinical setting. The selected setting is an army base that has a medical facility for the soldiers. All the interviews and other aspects of the research will be carried out at the facility.
Measures
To test the hypothesis for this research, the researcher will carry out a face-to-face interview with the 10 soldiers who have been deployed in war and 10 who have never been deployed. The choice of the 10 soldiers out of the 50 in each group is because of the complexity involved in interviewing a huge number of participants. To collect data from such a number a survey will be more effective. Questionnaires will also be developed and given out to the 100 soldiers, 50 who have been deployed, and 50 who have not been deployed. The focus of the questions in the questionnaires and those used in the interviews will be on the effects of post-traumatic stress disorder on the returning soldiers. During the interview, the interviewee will seek to identify the returning soldiers who have been diagnosed with symptoms associated with PTSD. Most of the data for the research will be obtained from primary literature on research carried out by the government and individuals into the effects of post-traumatic stress disorder in returning soldiers.
Procedures
The interviews will be carried out in the clinical setting and go hand in hand with the observation of the participants. The interviews will be carried out using an interview schedule, which will contain more elaborate, but similar questions as those in the structured questionnaire. The importance of this aspect is to ensure more elaborate and detailed answers to the research questions. The questions will be related to the factors underlying PTSD among soldiers. The responses from the soldiers will be audio-recorded for later analysis. The questionnaires will be given to the soldiers to fill the required information, and they will be later collected for analysis. Each interview session will last for 30, while the questionnaires will be given on a day before the interviews and collected the following day, which is the day the interviews will be conducted. The questionnaires will be expected to have all the required information although this might not be necessarily the case. Nonetheless, the data that will be provided in terms of responses will be analyzed to test the hypothesis and come up with conclusions.
Proposed Analysis Plan
Data from the questionnaires and the responses to the interview schedule will be analyzed to provide conclusions, policy, and future research recommendations. Triangulation method will be used as the basis for data analysis. The method of analysis explores complementary and validity enhancing the credibility of the findings. Thus, data will be analyzed differently depending on its nature. Data from the surveys will be analyzed using a statistical method, the Statistical Package for Social Sciences (SPSS). On the other hand, the data from the interviews and observations will be analyzed using discourse analysis. The model proposed by Gee (2010) will be used for the discourse analysis where the common themes will be identified to come up with the findings. The descriptive qualitative design will be used where findings are described as they occurred in the area of study (Creswell, 2013). The data will provide important findings to answer the research questions. Reliability and validity will be assured through utilization of consistent measurement tools, critical references from literature, and the connection of study findings with what is already known in the literature on the topic.
Errors of Type I and type II are some of the errors that will be taken into account in this investigation. Type I errors suggest the rejection of a correct hypothesis while the error of type II is accepting a false null hypothesis. However, the errors cannot be avoided but can be minimized by using a larger sample as it is more representative of the population. Statistical power is the likelihood that an investigation will detect a consequence if in fact there is an effect to be detected. A high statistical power usually leads to minimizing type II error and helps the researchers estimate the parameters required to achieve the desired power of the study (Creswell, 2013).
Validity
The validity of the study is a critical element that should be considered in this study. Given that most of the empirical studies lack reliability and validity, it is important to ensure that the current one does not fall under this category. Thus, the sampling method is critical in ensuring the reliability of the current study. In addition, it is necessary to ensure that the data collection method ensures validity. Use of random sampling is one of the ways of guaranteeing that the study is reliable. It is necessary to confirm that the appropriate sample size is used in the study, that biases are avoided, and that the researcher is not in any way influencing the outcome of the study.
Randomization is an effective way of making certain that the current study has the validity required. In clinical settings, randomized trials work by assigning selected cases to either a control or treatment group. Indeed, the individuals who are assigned to either of the two groups are randomly selected using a list of the possible cases from the population. Randomization has the primary goal of producing groups that are comparable in relation to the characteristics of the participants, including gender and age. The groups are comparable from the beginning of the study. In fact, where the outcomes show considerable differences between the two groups, then there is confidence in stating that the intervention works better on one than the other.
In the case of the current study, randomization to ensure reliability and validity of the study will be ensured in the selection of the participants. The two groups will be made up of soldiers who have been deployed (in one group) and those who have never been deployed (in the second group). Both genders will be included in the two groups, which will be made up of soldiers between the ages of 19 and 35. Performing the study in the form of a randomized controlled study will be critical in ensuring that the study has reliability and validity. In addition, it will be possible to ensure validity in the tools that will be used in collecting the data, questionnaires, and interview schedules. The research tools will be developed using standardized approaches to ensure that they are valid. Through randomization and the validity of the research tools, it will be possible for the researcher to achieve both internal and external validity.
Strengths and Limitations
The current study has some strengths. One of them is the use of the clinical settings within an army base. The use of such settings will ensure that the soldiers are being interviewed in a setting where they feel comfortable to respond to the questions. The setting will not be manipulated, a situation that might interfere with the responses given by the soldiers. Use of expert counselors during data collection will prevent the possibility of bias in the study. There is no chance of manipulation of the setting or responses by the researcher. The other strength of the study is in the use of the random sampling of the participants in each group, experimentation, and control. Use of random sampling will ensure reliability and validity of the study. It will also allow for the generalizability of the findings of the study to other similar settings. The use of a sample of 100 soldiers, 50 for each group suggests an additional strength of the study. The sample is sufficient for the needs of such a study.
However, the study has a number of limitations that should be addressed in future research as they influence the effectiveness of the research. One of the limitations is the assumption that the soldiers who have never been deployed have also never experienced such traumatic events in their lives that could result in PTSD. It is possible for all soldiers to have suffered such incidents even away from the battlefield. It is also assumed that the soldiers will cooperate with the researcher and provide all the information required, which is not necessarily the case in mental health situations. Some soldiers might have suffered very traumatic events that they are not prepared to recount even in the presence of a counselor. Such cases might hinder the effectiveness of the study.
References
Creswell, J. W. (2013). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications.
Gee, J, P. (2010). An Introduction to Discourse Analysis: Theory and Method. London: Routlegde
Ghaffarzadegan, N., Ebrahimvandi, A., & Jalali, M. S. (2016). A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans. Plos ONE, 11(10), 1-17
Harbertson, J., Grillo, M., Zimulinda, E., Murego, C., Cronan, T., May, S., & … Shaffer, R. (2013). Prevalence of PTSD and depression, and associated sexual risk factors, among male Rwanda Defense Forces military personnel. Tropical Medicine & International Health, 18(8), 925-933
Hourani, L., Tueller, S., Kizakevich, P., Lewis, G., Strange, L., Weimer, B., & … Spira, J. (2016). Toward Preventing Post-Traumatic Stress Disorder: Development and Testing of a Pilot Predeployment Stress Inoculation Training Program. Military Medicine, 181(9), 1151-1160
Mayo, J. A., MacGregor, A. J., Dougherty, A. L., & Galameau, M. R. (2013). Role of Occupation on New-Onset Post-Traumatic Stress Disorder and Depression Among Deployed Military Personnel. Military Medicine, 178(9), 945-950.
Pless Kaiser, A., Proctor, S. P., & Vasterling, J. J. (2016). Consistency of Reporting for Stressful Life Events Among Nondeployed Soldiers. Journal Of Clinical Psychology, 72(10), 1088-1098.
Vyas, K. J., Fesperman, S. F., Nebeker, B. J., Gerard, S. K., Boyd, N. D., Delaney, E. M., & … Johnston, S. L. (2016). Preventing PTSD and Depression and Reducing Health Care Costs in the Military: A Call for Building Resilience Among Service Members. Military Medicine, 181(10), 1240-1247
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