Functional Impairment as a Variable in Adjustment Post-Combat

This study examined how functional impairment relates to postcombat adjustment over time, controlling for the influence of combat exposure. Analyses used sequential random coefficient models to examine 2 hypotheses: a) combat exposure and functional impairment predict the change in posttraumatic stress, depression, and anger/aggression symptoms during the first year postcombat; and b) combat exposure and functional impairment at reintegration predict symptom scores at 1 year postdeployment. A Brigade Combat Team completed surveys at reintegration, 4 months, and 12 months after a 1-year deployment to Iraq. Soldiers reporting high functional impairment at reintegration had higher symptoms at both follow-up periods, and functional impairment was a significant predictor of symptoms at the last time point, even after accounting for the influence of combat exposure. There was also an interaction effect, such that functional impairment exacerbated the impact of combat exposure on posttraumatic stress and anger/aggression symptoms at 12 months postdeployment.

[1]  D. Kaloupek,et al.  Consistency of Retrospective Reporting About Exposure to Traumatic Events , 2003, Journal of traumatic stress.

[2]  K. Wright,et al.  The impact of predeployment functional impairment on mental health after combat. , 2012 .

[3]  D. Wingard,et al.  PTSD Prevalence, Associated Exposures, and Functional Health Outcomes in a Large, Population-Based Military Cohort , 2009, Public health reports.

[4]  Timothy J. Robinson,et al.  Multilevel Analysis: Techniques and Applications , 2002 .

[5]  J. Talbott,et al.  Trajectories of trauma symptoms and resilience in deployed US military service members: prospective cohort study , 2013 .

[6]  Paul D Bliese,et al.  Battlemind debriefing and battlemind training as early interventions with soldiers returning from iraq: Randomization by platoon. , 2009, Journal of consulting and clinical psychology.

[7]  Judith D. Singer,et al.  Using SAS PROC MIXED to Fit Multilevel Models, Hierarchical Models, and Individual Growth Models , 1998 .

[8]  B. Dohrenwend,et al.  The Psychological Risks of Vietnam for U.S. Veterans: A Revisit with New Data and Methods , 2006, Science.

[9]  Stef van Buuren,et al.  MICE: Multivariate Imputation by Chained Equations in R , 2011 .

[10]  Charles W Hoge,et al.  Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq. , 2010, Archives of general psychiatry.

[11]  G. A. Marcoulides.  Multilevel Analysis Techniques and Applications , 2002 .

[12]  S. van Buuren.  Multiple imputation of discrete and continuous data by fully conditional specification , 2007, Statistical methods in medical research.

[13]  T. M. Davis,et al.  Posttraumatic stress disorder in female veterans: association with self-reported health problems and functional impairment. , 2004, Archives of internal medicine.

[14]  C. Hoge,et al.  Combat duty in Iraq and Afghanistan, mental health problems and barriers to care. , 2004, U.S. Army Medical Department journal.

[15]  Charles W Hoge,et al.  Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. , 2007, JAMA.

[16]  A. Adler,et al.  Reconceptualizing combat-related posttraumatic stress disorder as an occupational hazard. , 2011 .

[17]  Kathleen M. Wright,et al.  Timing of postcombat mental health assessments. , 2007 .

[18]  R. Spitzer,et al.  Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. , 1999, JAMA.

[19]  S. Raudenbush,et al.  Application of Hierarchical Linear Models to Assessing Change , 1987 .

[20]  Paul D Bliese,et al.  Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. , 2008, Journal of consulting and clinical psychology.

[21]  A. Adler,et al.  Heterogeneity in the course of posttraumatic stress disorder: trajectories of symptomatology. , 2010, Journal of traumatic stress.

[22]  Robert E. Ployhart,et al.  Growth Modeling Using Random Coefficient Models: Model Building, Testing, and Illustrations , 2002 .

[23]  G. Bonanno,et al.  Trajectories of trauma symptoms and resilience in deployed U.S. military service members: prospective cohort study. , 2012, The British journal of psychiatry : the journal of mental science.

[24]  D. Kaloupek,et al.  Structural equation modeling of associations among combat exposure, PTSD symptom factors, and Global Assessment of Functioning. , 2008, Journal of rehabilitation research and development.

[25]  Paul D. Bliese,et al.  Being Both Too Liberal and Too Conservative: The Perils of Treating Grouped Data as though They Were Independent , 2004 .

[26]  Rachel D. Eckford,et al.  Contrasting approaches to psychological screening with U.S. combat soldiers. , 2007, Journal of traumatic stress.

[27]  Kenneth A Bollen,et al.  The role of coding time in estimating and interpreting growth curve models. , 2004, Psychological methods.

[28]  C. Judd,et al.  Statistical difficulties of detecting interactions and moderator effects. , 1993, Psychological bulletin.

[29]  J. Schafer,et al.  Missing data: our view of the state of the art. , 2002, Psychological methods.

[30]  M. Hotopf,et al.  The impact of posttraumatic stress disorder on impairment in the UK military at the time of the Iraq war. , 2009, Journal of psychiatric research.