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Understanding the Neuropsychological Consequences of Deployment Stress: A Public Health Framework

Published online by Cambridge University Press:  17 November 2010

Jennifer J. Vasterling*
Affiliation:
Psychology Service and VA National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
Susan P. Proctor
Affiliation:
Military Performance Division, US Army Research Institute for Environmental Medicine, Natick, Massachusetts Research Service, VA Boston Healthcare System, Boston, Massachusetts Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
*
Correspondence and reprint requests to: Jennifer J. Vasterling, Psychology (116), VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. E-mail: jennifer.vasterling@va.gov

Abstract

Complaints of neuropsychological dysfunction have emerged among subsets of military personnel after almost every major deployment involving western nations in recent history. Although deployments have been characterized by a range of neural risk factors, psychological stress is common to most prolonged deployments. This review uses a public health framework to address associations between deployment-related stress and neuropsychological performance. Specifically, the review covers mechanisms by which deployment-related psychological stress may affect neuropsychological functioning, considers the advantages and disadvantages of approaching the question from a public health perspective, and discusses how epidemiological research may sort out questions regarding course, cause, and effect. (JINS, 2011, 17, 000–000)

Type
Short Reviews
Copyright
Copyright © The International Neuropsychological Society 2010

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Footnotes

Disclaimer: The content of this article does not necessarily reflect the position or policy of the U.S. government, and no official endorsement should be inferred.

References

Arnsten, A.F.T. (2009). Stress signaling pathways that impair prefrontal cortex structure and function. Nature Neuroscience, 10, 410422.CrossRefGoogle ScholarPubMed
Bartone, P.T., Adler, A., Vaitkus, M.A. (1998). Dimensions in psychological stress in peacekeeping operations. Military Medicine, 163, 587593.CrossRefGoogle ScholarPubMed
Bearden, C.E., Jasinska, A.J., Freimer, N.B. (2009). Methodological issues in molecular genetic studies of mental disorders. Annual Review of Clinical Psychology, 5, 4969.CrossRefGoogle ScholarPubMed
Brenner, L.A., Ladley-O’Brien, S.E., Harwood, J.E.F., Filley, C.M., Kelly, J.P., Homaifer, B.Y., Adler, L.E. (2009). An exploratory study of neuroimaging, neurologic, and neuropsychological findings in veterans with traumatic brain injury and/or posttraumatic stress disorder. Military Medicine, 174, 347352.CrossRefGoogle ScholarPubMed
Brewin, C.R., Kleiner, J.S., Vasterling, J.J., Field, A.P. (2007). Memory for emotionally neutral information in posttraumatic stress disorder: A meta-analytic investigation. Journal of Abnormal Psychology, 116, 448463.CrossRefGoogle ScholarPubMed
Bryant, R.A., O’Donnell, M.L., Creamer, M., McFarlane, A.C., Clark, C.R., Silove, D. (2010). The psychiatric sequelae of traumatic inquiry. American Journal of Psychiatry, 167, 312320.CrossRefGoogle Scholar
Constans, J.I. (2005). Information-processing biases in PTSD. In J.J. Vasterling & C.R. Brewin (Eds.), Neuropsychology of PTSD: Biological, cognitive, and clinical perspectives pp. (105130). New York: Guilford Press.Google Scholar
David, A.S., Farrin, L., Hull, L., Unwin, C., Wessely, S., Wykes, T. (2002). Cognitive functioning and disturbances of mood in UK veterans of the Persian Gulf War: A comparative study. Psychological Medicine, 32, 13571370.CrossRefGoogle ScholarPubMed
Feder, A., Nestler, E.J., Charney, D.S. (2009). Psychobiology and molecular genetics of resilience. Nature Neuroscience, 10, 446457.CrossRefGoogle ScholarPubMed
Friedl, K.E., Grate, S.J., Proctor, S.P. (2009). Neuropsychological issues in military deployments: Lessons observed in the DoD Gulf War Illnesses Research Program. Military Medicine, 174, 335346.CrossRefGoogle ScholarPubMed
Friedman, A., Kaufer, D., Shemer, J., Hendler, I., Soreq, H., Tur-Kaspa, I. (1996). Pyridostigmine brain penetration under stress enhances neuronal excitability and induces early immediate transcriptional response. Nature Medicine, 2, 13821385.CrossRefGoogle ScholarPubMed
Garfinkel, S., Liberzon, I. (2009). Neurobiology of PTSD: A review of neuroimaging findings. Psychiatric Annals, 39, 370372, 376–381.CrossRefGoogle Scholar
Gilbertson, M.W., Paulus, L.A., Williston, S.K., Gurvits, T.V., Lasko, N.B., Pitman, R.K., Orr, S.P. (2006). Neurocognitive function in monozygotic twins discordant for combat exposure: Relationship to posttraumatic stress disorder. Journal of Abnormal Psychology, 115, 484495.CrossRefGoogle ScholarPubMed
Gilbertson, M.W., Shenton, M.E., Ciszewski, A., Kasai, K., Lasko, N.B., Orr, S.P. Pitman, R.K. (2002). Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma. Nature Neuroscience, 5, 12421247.CrossRefGoogle ScholarPubMed
Gilbertson, M.W., Williston, S.K., Lynn, A.P., Lasko, N.B., Gurvits, T.V., Shenton, M.E., Orr, S.P. (2007). Configural cue performance in identical twins discordant for posttraumatic stress disorder: Theoretical implications for the role of hippocampal function. Biological Psychiatry, 62, 513520.CrossRefGoogle ScholarPubMed
Hyams, K.C., Wignall, S., Roswell, R. (1996). War syndromes and their evaluation: From the U.S. Civil War to the Persian Gulf War. Annals of Internal Medicine, 125, 398405.CrossRefGoogle Scholar
Jones, E., Hodgins-Vermaas, R., McCartney, H., Everitt, B., Beech, C., Poynter, D., Wessely, S. (2002). Post-combat syndromes from the Boer War to the Gulf War: A cluster analysis of their nature and attribution. British Medical Journal, 324, 17.CrossRefGoogle Scholar
Karl, A., Schaefer, M., Malta, L.S., Dorfel, D., Rohleder, N., Werner, A. (2006). A meta-analysis of structural brain abnormalities in PTSD. Neuroscience and Biobehavioral Reviews, 30, 10041031.CrossRefGoogle ScholarPubMed
King, D.W., King, L.A., Gudanowski, D.M., Vreven, D.L. (1995). Alternative representations of war zone stressors: Relationships to posttraumatic stress disorder in male and female Vietnam veterans. Journal of Abnormal Psychology, 104, 184196.CrossRefGoogle ScholarPubMed
Lange, R.T., Iverson, G.L., Rose, A. (2010). Depression strongly influences postconcussion symptom reporting following mild traumatic brain injury. [Epub ahead of print].Google Scholar
Maguen, S., Vogt, D.S., King, L.A., King, D.W., Litz, B.T. (2006). Posttraumatic growth among Gulf War I veterans: The predictive role of deployment-related experiences and background characteristics. Journal of Loss and Trauma, 11, 373388.CrossRefGoogle Scholar
Marx, B.P., Brailey, K., Proctor, S.P., MacDonald, H.Z., Graefe, A.C., Amoroso, P.J., Vasterling, J.J. (2009). Association of time since deployment, combat intensity and posttraumatic stress symptoms with neuropsychological outcomes following Iraq War deployment. Archives of General Psychiatry, 66, 9961004.CrossRefGoogle ScholarPubMed
Marx, B.P., Doron-Lamarca, S., Proctor, S.P., Vasterling, J.J. (2009). The influence of pre-deployment neurocognitive functioning on post-deployment PTSD symptom outcomes among Iraq-deployed Army soldiers. Journal of the International Neuropsychological Society, 15, 840852.CrossRefGoogle ScholarPubMed
Milad, M.R., Orr, S.P., Lasko, N.B., Chang, Y., Rauch, S.L., Pitman, R.K. (2008). Presence and acquired origin of reduced recall for fear extinction in PTSD: Results of a twin study. Journal of Psychiatric Research, 42, 515520.CrossRefGoogle ScholarPubMed
Mollica, R.F., Lyoo, I.K., Chernoff, M.C., Bui, H.X., Lavelle, J., Yoon, S.J., Renshaw, P.F. (2009). Brain structural abnormalities and mental health sequelae in South Vietnamese ex-political detainees who survived traumatic brain injury and torture. Archives of General Psychiatry, 66, 12211232.CrossRefGoogle ScholarPubMed
Morgan, C.A. III, Doran, A., Steffian, G., Hazlett, G., Southwick, S.M. (2006). Stress-induced deficits in working memory and visuo-constructive abilities in Special Operations soldiers. Biological Psychiatry, 60, 722729.CrossRefGoogle ScholarPubMed
Morgan, C.A. III, Rasmusson, A.M., Wang, S., Hoyt, G., Hauger, R.L., Hazlett, G. (2002). Neuropeptide-Y, cortisol, and subjective distress in human exposed to acute stress: Replication and extension of previous report. Biological Psychiatry, 15, 136142.CrossRefGoogle Scholar
Morilak, D.A., Barrera, G., Echevarria, D.J., Garcia, A.S., Hernandez, A., Ma, S., Petre, C.O. (2005). Role of brain norephinephrine in the behavioral response to stress. Progress in Neuropharmacology and Biological Psychiatry, 29, 12141224.CrossRefGoogle Scholar
Nash, W.P. (2007). The stressors of war. In C.R. Figley & W.P. Nash (Eds.), Combat stress and injury: Theory, research, and management pp. (1131). New York: Routledge/Taylor & Francis Group.Google Scholar
Nelson, L.A., Yoash-Gantz, R.E., Pickett, T.C., Campbell, T.A. (2009). Relationship between processing speek and executive functioning performance among OEF/OIF veterans: Implications for postdeployment rehabilitation. Journal of Head Trauma Rehabilitation, 24, 3240.CrossRefGoogle Scholar
Parslow, R.A., Jorm, A.F. (2007). Pretrauma and posttrauma neurocognitive functioning and PTSD symptoms in a community sample of young adults. American Journal of Psychiatry, 164, 509515.CrossRefGoogle Scholar
Proctor, S.P., Heaton, K.J., Dos Santos, K.D., Rosenman, E.S., Heeren, T. (2009). Prospective assessment of neuropsychological functioning and mood in US Army National Guard personnel deployed as peacekeepers. Scandinavian Journal of Work and Environmental Health, 35, 349360.CrossRefGoogle ScholarPubMed
Sauro, M.D., Jorgensen, R.S., Pedlow, C.T. (2003). Stress, glucocorticoids, and memory: A meta-analytic review. Stress, 6, 235245.CrossRefGoogle ScholarPubMed
Shin, L.M., Liberzon, I. (2010). The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology, 35, 169191.CrossRefGoogle ScholarPubMed
Southwick, S.M., Davis, L.L., Aikins, D.E., Rasmusson, A., Barron, J., Morgan, C.A. (2007). Neurobiological alterations associated with PTSD. In M.J. Friedman, T.M. Keane & P.A. Resick (Eds.), Handbook of PTSD: Science and practice pp. (166189). New York: Guilford Press.Google Scholar
Street, A., Vogt, D., Dutra, L. (2009). A new generation of women veterans: Stressors faced by women deployed to Iraq and Afghanistan. Clinical Psychology Review, 29, 685694.CrossRefGoogle ScholarPubMed
Sutker, P.B., Vasterling, J.J., Brailey, K., Allain, A.N. (1995). Memory, attention, and executive deficits in POW survivors: Contributing biological and psychological factors. Neuropsychology, 9, 118125.CrossRefGoogle Scholar
Tanielian, T., Jaycox, L.H. (Eds.). (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica: RAND Corporation.Google Scholar
Toomey, R., Kang, H.K., Karlinsky, J., Baker, D.G., Vasterling, J.J., Alpern, R., Eisen, S.A. (2009). Mental health of US Gulf War veterans 10 years after the war. British Journal of Psychiatry, 190, 385393.CrossRefGoogle Scholar
Vasterling, J.J., Proctor, S.P., Amoroso, P., Kane, R., Heeren, T., White, R.F. (2006). Neuropsychological outcomes of Army personnel following deployment to the Iraq War. Journal of the American Medical Association, 296, 519529.CrossRefGoogle Scholar
Vasterling, J.J., Proctor, S.P., Friedman, M.J., Hoge, C.W., Heeren, T., King, L., King, D.W. (2010). PTSD symptom increased in Iraq deployed soldiers: Comparison with nondeployed soldiers and associations with baseline symptoms, deployment experiences, and postdeployment stress. Journal of Traumatic Stress, 23, 4151.CrossRefGoogle ScholarPubMed
Yehuda, R. (2009a). Stress hormones and PTSD. In Post-traumatic stress disorder: Basic science and clinical practice pp. (257275). Totowa, NJ: Humana Press.CrossRefGoogle Scholar
Yehuda, R. (2009b). Status of glucocorticoid alterations in post-traumatic stress disorder. Annals of the New York Academy of Science, 1179, 5669.CrossRefGoogle ScholarPubMed