title: The effect of enemy combat tactics on PTSD prevalence rates: A comparison of Operation Iraqi Freedom deployment phases in a sample of male and female veterans.
abstract: Research suggests that the nature of combat may affect later development of posttraumatic stress disorder (PTSD) in combat veterans. Studies comparing rates of PTSD across different conflicts indicate that the use of asymmetric or guerilla-style tactics by enemy fighters may result in higher rates of PTSD among U.S. military personnel than the use of symmetric tactics, which mirror tactics used by U.S. forces. Investigations of the association between enemy combat tactics and PTSD across conflicts were limited because of cohort effects and a focus on male veterans. The current study examined rates of PTSD diagnosis in a sample of male and female veterans deployed to Operation Iraqi Freedom (OIF), a conflict with 3 distinct phases marked by varying enemy tactics.
  
  
  
  Participants were 738 veterans enrolled in Project VALOR (Veterans' After-Discharge Longitudinal Registry) who deployed once to OIF. Participants completed a clinician interview as well as self-report measures.
  
  
  
  Male veterans deployed during the OIF phase marked by asymmetric tactics were more than twice as likely to be diagnosed with PTSD as those deployed during the other 2 phases, even after controlling for extent of combat exposure, demographic characteristics, and other deployment-related risk factors for PTSD. Differing rates of PTSD across the 3 OIF phases were not observed among female participants.
  
  
  
  The nature of combat (specifically, asymmetric enemy tactics) may be a risk factor for the development of PTSD among males. Factors other than enemy tactics may be more important to the development of PTSD among females. (PsycINFO Database Record
authors.affiliation: Veterans Affairs Boston Healthcare System.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Green
authors.affiliation: Veterans Affairs Boston Healthcare System.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Bovin
authors.affiliation: Veterans Affairs Boston Healthcare System.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Erb
authors.affiliation: Veterans Affairs Boston Healthcare System.
authors.forename: Mark
authors.initials: M
authors.lastname: Lachowicz
authors.affiliation: Veterans Affairs Boston Healthcare System.
authors.forename: Kaitlyn R
authors.initials: KR
authors.lastname: Gorman
authors.affiliation: New England Research Institutes.
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Rosen
authors.affiliation: Veterans Affairs Boston Healthcare System.
authors.forename: Terence M
authors.initials: TM
authors.lastname: Keane
authors.affiliation: Veterans Affairs Boston Healthcare System.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marx
mesh_terms: D000328:Adult; D003130:Combat Disorders / Q000523:psychology*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D014728:Veterans / Q000523:psychology*