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The Relationship Between Trauma Exposure, Somatic Symptoms, and Mental Health in Australian Defence Force Members Deployed to the Middle East Area of Operations

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The Relationship Between Trauma Exposure, Somatic Symptoms, and Mental Health in Australian Defence Force Members Deployed to the Middle East Area of Operations The Relationship Between Trauma Exposure, Somatic Symptoms, and Mental Health in Australian Defence Force Members Deployed to the Middle East Area of Operations Thesis submitted for the degree of Doctor of Philosophy by Kristin Graham Dip Ap Sc (Pod) B(Hons) Psych Sc March 2019 School of Population Health Faculty of Health Sciences The UniversityUniversity of ofAdelaide Adelaide, Australia Centre for TraumaticAustralia Stress Studies Faculty of Health and Medical Sciences School of Medicine Title The Relationship Between Trauma Exposure, Somatic Symptoms, and Mental Health in Australian Defence Force Members Deployed to the Middle East Area of Operations Author Kristin Graham Institute Centre for Traumatic Stress Studies (CTSS) Publisher Centre for Traumatic Stress Studies (CTSS) Submitted Published ISBN Academic advisors Professor Alexander McFarlane AO, Centre for Traumatic Stress Studies Dr Miranda Van Hooff, Centre for Traumatic Stress Studies Dr Amelia Searle, Centre for Traumatic Stress Studies Assessment committee Centre for Traumatic Stress Studies University of Adelaide Level 1 / Helen Mayo North 30 Frome Road ADELAIDE SA 5000 E-mail: [email protected] webpage: https://health.adelaide.edu.au/ctss/ TABLE OF CONTENTS Reader navigation & overview ................................................................ 1 1.1 Navigation ................................................................................................................. 2 1.2 Overview ................................................................................................................... 2 Introduction .............................................................................................. 5 2.1 Overview ................................................................................................................... 6 2.2 Physical symptoms .................................................................................................... 7 Physical symptom terminology.............................................................................. 9 Factors that influence symptom experience and reporting .................................... 9 Physical symptoms and the medical specialties ................................................... 10 2.3 Association between physical and psychological symptoms .................................. 11 2.3.1 Posttraumatic stress disorder ........................................................................................ 13 2.4 History of physical symptoms and associated syndromes ...................................... 13 2.4.1 Physical symptoms before World War I .............................................................. 14 2.4.2 Wartime History .................................................................................................. 18 2.4.3 Somatisation in the Diagnostic and Statistical Manual of Mental Disorders ....... 20 2.5 Physical and psychological symptoms: The modern military context .................... 24 2.5.1 Physical symptoms following military deployment............................................. 25 2.5.2 Posttraumatic stress disorder following deployment ........................................... 27 2.5.3 Physical symptoms and posttraumatic stress disorder in the military.................. 28 2.6 Risk factors for physical symptoms and PTSD ....................................................... 29 2.6.1 Deployment trauma .............................................................................................. 32 2.7 Theorised mechanisms for the link between trauma and symptoms ....................... 35 2.8 Recent military deployment research ...................................................................... 38 2.8.1 Reflections on deployment research............................................................................. 41 2.9 Thesis aims, hypotheses, and structure ................................................................... 44 Methodology............................................................................................ 46 3.1 Data Sources ............................................................................................................ 47 3.2 Thesis samples ........................................................................................................ 48 3.2.1 Chapter 4, 5, & 6 sample: MEAO Census Study ......................................................... 48 3.2.2 Chapter 7 sample: MEAO census and MHPWS Studies ..................................... 49 3.2.3 Chapter 8 sample: MEAO Prospective Study ...................................................... 51 3.3 Measures ................................................................................................................. 52 3.3.1 Psychological measures ................................................................................................ 52 3.3.2 Health symptom checklist (HSC) ................................................................................. 55 3.3.3 Trauma measure ................................................................................................... 58 Page | iv TABLE OF CONTENTS 3.4 How the symptom profiles were developed for Chapters 4 and 5 .......................... 59 The relationship between traumatic deployment exposures and physical and psychological symptom profiles......................................................................... 60 4.1 Abstract ................................................................................................................... 63 4.2 Introduction ............................................................................................................. 64 4.3 Method .................................................................................................................... 67 4.3.1 Participants ................................................................................................................... 67 4.3.2 Measures ....................................................................................................................... 67 4.3.3 Data Analysis ................................................................................................................ 70 4.4 Results ..................................................................................................................... 71 4.5 Discussion ............................................................................................................... 78 4.6 Supplementary material .......................................................................................... 83 Dimensions of distress: Posttraumatic stress and physical symptoms as discrete and overlapping outcomes following traumatic deployment exposures . 85 5.1 Abstract ................................................................................................................... 88 5.2 Introduction ............................................................................................................. 89 5.3 Method .................................................................................................................... 91 5.3.1 Study design and participants ....................................................................................... 91 5.3.2 Measures ....................................................................................................................... 92 5.4 Results ..................................................................................................................... 95 5.4.1 Multivariate multinomial logistic regression models ................................................... 97 5.5 Discussion ............................................................................................................. 101 5.6 Supplementary material ........................................................................................ 105 Identifying health symptoms in deployed military personnel and their relationship to probable PTSD ............................................................................... 108 6.1 Abstract ................................................................................................................. 111 6.2 Introduction ........................................................................................................... 112 6.3 Method .................................................................................................................. 114 6.3.1 Study design and participants ..................................................................................... 114 6.3.2 Measures ..................................................................................................................... 115 6.3.3 Statistical analysis ....................................................................................................... 117 6.4 Results ................................................................................................................... 119 6.4.2 Psychological test scores ............................................................................................ 121 6.4.3 Traumatic deployment exposure ................................................................................. 121 6.5 Discussion ............................................................................................................. 126 6.6 Supplementary material ........................................................................................ 130 Page | v The value of physical symptoms
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