Questionnaire can better identify complex post-traumatic stress disorder in veterans


Military mental health services should urgently adopt an internationally recognised trauma questionnaire to better diagnose and treat veterans with complex post-traumatic stress disorder, a new study with Charles Darwin University (CDU) has revealed.

The study tested the validity and reliability of the International Trauma Questionnaire (ITQ) to distinguish between post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) in mental health support-seeking, former-serving veterans of the Australian Defence Force (ADF).

The study also aimed to estimate the proportion of ADF veterans meeting the criteria for CPTSD or PTSD.  Currently specialist military health services routinely screen and treat PTSD, but do not assess and design services for CPTSD.

Lead author and CDU Professor in Mental Health Dan Bressington said this was problematic because although the two disorders share some features, CPTSD is a more debilitating disorder than PTSD and it has been argued that CPTSD requires a different therapeutic approach to treat it effectively.

A total of 174 participants completed the ITQ with most being male, aged under 35 and had been enlisted full-time in the Army. The participants were recruited from a specialist primary care service and were seeking mental health support.

Professor Bressington said questionnaire results revealed 51.4 per cent of participants met diagnostic criteria for CPTSD, while only 9.1 per cent met the diagnostic requirements for PTSD.

“The results of this study indicate that the ITQ can effectively and reliably distinguish between PTSD and CPTSD within primary care samples of ADF veterans,” Professor Bressington said.

“Given that the occurrence of CPTSD was five times higher than PTSD in this cohort, the ITQ should be considered for routine use in specialist military health services.”

“We also found that those meeting diagnostic requirements for CPTSD were more likely to have served in the military for 15 years or longer, had a history of more traumatic life events and had the highest levels of depression, anxiety and stress symptoms.”

Professor Bressington said with high levels of psychological distress recorded among service members transitioning back to civilian life, the study results reinforced the need for the provision of effective CPTSD interventions and should be used to help inform the planning of trauma-related treatment resources, assessments and interventions.

“Ultimately, this may improve engagement with services, the efficacy of treatment and reductions in dropout rates, thereby improving the well-being of veterans and the quality of life of their families.”

The study was led by CDU alongside Maynooth University in Ireland, Veteran Medical in Perth, Ulster University in Ireland, The Hong Kong Polytechnic University, RMIT University in Melbourne, King’s Centre for Military Health Research in London, and Edinburgh Napier University in Edinburgh.

ICD-11 post-traumatic stress disorder and complex post-traumatic stress disorder in mental health support-seeking former-serving Australian defence force veterans was published in the Australian & New Zealand Journal of Psychiatry.