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Aims: The relationship between alcohol consumption, cigarette smoking and post-traumatic stress disorder (PTSD) was studied in 147 male former members of the civilian resistance against the Nazi occupation of Holland during World War II. Methods: The subjects were interviewed at home. Measures included rating of current PTSD and a self-report measure of smoking and alcohol use. Results: The weekly alcohol consumption reported by veterans was substantially below that of the general population. Furthermore, there was no significant difference in self-reported alcohol consumption between veterans with and without current PTSD. Cigarette smoking, however, was more prevalent in those with current PTSD. Conclusions: The absence in these veterans of a correlation between PTSD and alcohol consumption is contrary to the results of most studies on this subject. It may be related to the exclusion from organized resistance activities of people prone to the over-consumption of alcohol. It is hypothesized that, in trauma survivors, current substance use is associated with peri-traumatic patterns of psychological tension-reduction modes.

The Self-rating Inventory for Posttraumatic Stress Disorder of 22 items was developed for use with populations without identified traumatic experiences. The inventory has been used extensively in survey research in The Netherlands. This paper examines the psychometric properties. In four different groups (trauma and psychiatric patients, elderly Dutch subjects, former peacekeepers, and medical students) internal consistency, test-retest reliability, concurrent and discriminant validity, and sensitivity and specificity are analyzed. The inventory showed good internal consistency, test-retest reliability, concurrent and discriminant validity, and high sensitivity and specificity. It appears to be valuable for survey research on posttraumatic stress in nonselected populations. As a screening device, high sensitivity for PTSD symptoms is evident even when the traumatic event has not been defined.

Immediately after a severe bus accident a program in preventing posttraumatic stress disorder was started by the Community Mental Health Centre (RIAGG). Six months after the accident, 17 subjects (42.5%) were investigated with regard to posttraumatic stress disorder. Almost 18% appeared to satisfy the DSM-IV criteria. Another subject was considered to be a borderline case. The correlations among measures of intrusion, avoidance, and hyperarousal suggest that subjects with high scores on hyperarousal are at risk for posttraumatic stress disorder.

In this study, 680 male and 144 female Dutch Resistance veterans of World War II were evaluated on Posttraumatic Stress Disorder, trait anxiety, and depression. Approximately 27% of these men and 20% of these women showed current Posttraumatic Stress Disorder. Resistance veterans, as a group, appeared comparable to the controls from Dutch validation studies on trait anxiety and depression. Gender differences were not observed. Veterans with current PTSD symptoms scored higher on trait anxiety and depression than the remaining veterans and were comparable on trait anxiety and depression to psychiatric patients. Correlational analyses showed that there was a strong association between trait anxiety and depression. Posttraumatic Stress Disorder correlated highly with trait anxiety and depression.

The present study reports on the development of a Dutch PTSD scale based on the DSM-III criteria for PTSD. Test-retest reliability was .91. The scale showed an internal consistency with a coefficient alpha of .88. Factor analysis on a large sample of Resistance veterans (N = 967) yielded six factors, which represent intrusive thoughts, physiological reactions, detachment, rage, active confrontation, and guilt.

In this study, 147 Dutch Resistance veterans from WW II are evaluated on psychometric instruments for anxiety, depression and anger. Resistance veterans appeared to be more anxious, depressive and angry on these instruments compared to controls from the validation studies of the respective instruments. Veterans currently suffering from PTSD (56%) were significantly more anxious, depressed, and angry than veterans without PTSD. With respect to staying in Nazi concentration camps, which is an extremely severe stressor, and in which half of the veterans were imprisoned, no difference on the three instruments was found. Anxiety, depression and anger were observed to be highly interrelated in PTSD. The close interrelationship between anxiety and depression, anxiety and danger, and depression and anger mediated by way of anxiety is, however, not unique for traumatized subjects. It is argued that for Resistance veterans only the intrusive reminiscences of the stressful events discriminate this constellation of symptoms from subjects with an anxious-depressive symptomatology.

The extraordinary trauma experienced by Resistance veterans from World War II (WW II) and other veterans may be associated with an increased incidence of posttraumatic stress disorder (PTSD) and somatic morbidity, including cardiovascular disease (CVD). This study explored some relationships between current PTSD and CVD risk factors in 147 male Dutch WW II Resistance veterans. They were compared to 65 same-aged male patients with a recent myocardial infarction and 79 surgical patients. Of these subjects, WW II Resistance veterans scored highest on CVD risk factors (i.e., angina pectoris, type A behavior, life stressors, and vital exhaustion), except smoking. Fifty-six percent of these veterans were currently suffering from PTSD. They reported CVD risk factors, in particular type A behavior and vital exhaustion, more often than veterans without PTSD; they also reported more premorbid adverse living conditions. These data suggest that early sensitization to environmental stressors may be associated with a high prevalence of current PTSD and excess CVD risk factors in subjects exposed to extraordinary war-time trauma and that this may lead to vital exhaustion.

In order to estimate the present occurence of Post Traumatic Stress Disorder (PTSD) in Dutch World War II Resistance veterans, 147 male resistance veterans, aged 60 to 65 years, were assessed by means of the SCID and by means of a clinical rating based on DSM-III. According to the SCID ratings, 56% of the sample investigated was identified as currently suffering from PTSD. This study demonstrates that participation in the Resistance in the Netherlands during World War II has a life-long impact. Although 44% of the subjects did not meet the criteria for current PTSD, only 4% did not show any symptoms of PTSD at all

As a first step in a nation-wide study about psychiatric complaints in Dutch Resistance veterans, a feasibility study was conducted to test the instruments. The complaints of eight war victims, aged 61 to 73, were analyzed by means of questionnaires, a psychiatric survey, and a life history interview. All subjects met the DSM-III-R criteria for PTSD, with symptoms ranging from mild to very severe. The occurrence of manifest PTSD differed considerably over the years. Highly prevalent complaints included sleep disturbances, anxiety, and vital exhaustion. An increase in psychiatric complaints was often positively associated with the occurrence of stressful life events.

The Self-rating Inventory for Posttraumatic Stress Disorder is a 22-item self-report questionnaire to give a diagnosis for PTSD based on DSM–IV criteria. Originally, the questionnaire was standardized with trauma survivors and psychiatric patients. Here test-retest reliabilities with 90 medial students are reported for 15 (.79) and 19 days (.97). As expected, the stability was slightly less for 34 days (.60)

At present it is generally accepted that extensive war traumata can cause permanent damage to a person’s mental and physical health. However, the precise nature of the associations between traumatic war experiences and subsequent disorders remains uncertain.

A group of 24 Dutch World War II Resistance veterans with a documented traumatic war history and a (partially) positive diagnosis of current posttraumatic stress disorder (PTSD) was studied. This special group of war victims is characterised by chronicity, suffering from intractable posttraumatic complaints for decades. They were treated with fluvoxamine (Fevarin), a selective serotonin reuptake inhibitor with antidepressive and anxiolytic properties. The study was designed as an open-ended, outpatient pilot study, with a treatment period of 12 weeks. Results of clinical examination, and questionnaires investigating PTSD, depression, sleeping problems, anxiety, and vital exhaustion indicate that a significant number of the subjects improved with respect to their PTSD symptomatology, and their symptoms of anxiety and vital exhaustion. However, at the end of the study, quantitative improvement was modest. The results indicate that treatment with fluvoxamine may offer alleviation of chronic PTSD symptoms, in particular insomnia, nightmares, anxiety, intrusive recollections, guilt feelings and tiredness.