The evolution of PTSD symptoms in serving and ex-serving personnel of the UK armed forces from 2004 to 16: A longitudinal examination.

Whilst most military personnel do not develop Post-Traumatic Stress Disorder (PTSD), ex-serving personnel exhibit higher levels compared to those in service. The heterogeneity of symptom development for serving and ex-serving personnel has not yet been examined in the UK Armed Forces (UK AF). Latent class growth modelling was employed to estimate the trajectories of PTSD symptoms from three waves of data from the PTSD Checklist (PCL-C) from a UK AF sample (N = 7357). Regression mixture models were conducted to investigate covariates of class membership. Five trajectory classes were identified. Most of the sample reported no-low symptoms (71.3%). Of those reporting probable PTSD during the 12 year-period, 4.6% showed improvements, 4.9% worsened, and 1.8% displayed chronic symptoms. A class with subthreshold elevated symptoms (18.2%) was also identified. Trajectories of serving and ex-serving personnel did not differ, but more ex-serving personnel were symptomatic and those with chronic symptoms worsened over time. Chronic disorder was associated with lower rank, experiencing violent combat, and proximity to wounding/death on deployment. Worsening symptoms were associated with childhood stress/violence, lower rank, not being in a relationship, inconsistent post-deployment social support, proximity to wounding/death, and voluntary, or medical discharge. The present study found most UKAF personnel did not report PTSD symptoms between 2004 and 16 but, among those experiencing probable PTSD, more participants reported deteriorating/persistent symptoms than who improved. PTSD-onset was related to adversities across childhood and deployment, and lack of social support. Findings underscore the importance of addressing the through-life contributors of PTSD in order to prevent ingrained disorder.

[1]  D. Leightley,et al.  Associations between Post-Traumatic Stress Disorder, Quality of Life and Alcohol Misuse among UK Veterans , 2022, Military Behavioral Health.

[2]  R. Bryant,et al.  Mental health across the early years in the military , 2022, Psychological Medicine.

[3]  O. Mors,et al.  Time course of symptoms in posttraumatic stress disorder with delayed expression: A systematic review , 2021, Acta psychiatrica Scandinavica.

[4]  Z. Solomon,et al.  Prior trauma, PTSD long-term trajectories, and risk for PTSD during the COVID-19 pandemic: A 29-year longitudinal study , 2021, Journal of Psychiatric Research.

[5]  C. Armour,et al.  Disentangling the Symptom-Level Nuances in Comorbid Posttraumatic Stress Disorder and Problematic Alcohol Use in Northern Irish Military Veterans: A Network Analysis. , 2021, Journal of traumatic stress.

[6]  S. Southwick,et al.  Subthreshold post-traumatic stress disorder as a risk factor for post-traumatic stress disorder: results from a sample of USA veterans , 2021, The British Journal of Psychiatry.

[7]  J. Bisson,et al.  Psychometric properties of the PTSD Checklist for DSM-5 in a sample of trauma exposed mental health service users , 2021, European journal of psychotraumatology.

[8]  Alyson K. Zalta,et al.  Self-reported PTSD symptoms and social support in U.S. military service members and veterans: a meta-analysis , 2021, European journal of psychotraumatology.

[9]  H. Krumholz,et al.  Using Latent Class Analysis to Identify Hidden Clinical Phenotypes. , 2020, JAMA.

[10]  Francis J. Doyle,et al.  Pre-deployment risk factors for PTSD in active-duty personnel deployed to Afghanistan: a machine-learning approach for analyzing multivariate predictors , 2020, Molecular Psychiatry.

[11]  S. Norman,et al.  Bidirectional relationship of posttraumatic stress disorder (PTSD) symptom severity and alcohol use over the course of integrated treatment. , 2020, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[12]  D. Hasin,et al.  Psychiatric comorbidities in alcohol use disorder. , 2019, The lancet. Psychiatry.

[13]  Alyson K. Zalta,et al.  Examining military population and trauma type as moderators of treatment outcome for first-line psychotherapies for PTSD: A meta-analysis. , 2019, Journal of anxiety disorders.

[14]  R. Pietrzak,et al.  Heterogeneity of posttraumatic stress symptomatology and social connectedness in treatment-seeking military veterans: a longitudinal examination , 2019, European journal of psychotraumatology.

[15]  N. Youssef,et al.  Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review , 2019, Front. Psychiatry.

[16]  D. Murphy,et al.  Exploring patterns of alcohol misuse in treatment-seeking UK veterans: A cross-sectional study. , 2019, Addictive behaviors.

[17]  Megumi M Iyar,et al.  Social causation or social erosion? Evaluating the association between social support and PTSD among Veterans in a transition program , 2019, Journal of Military, Veteran and Family Health.

[18]  E. Geuze,et al.  Cohort profile: the Prospective Research In Stress-Related Military Operations (PRISMO) study in the Dutch Armed Forces , 2019, BMJ Open.

[19]  S. Wessely,et al.  Fourteen-year trajectories of posttraumatic stress disorder (PTSD) symptoms in UK military personnel, and associated risk factors. , 2019, Journal of psychiatric research.

[20]  L. Goodwin,et al.  Do serving and ex-serving personnel of the UK armed forces seek help for perceived stress, emotional or mental health problems? , 2019, European journal of psychotraumatology.

[21]  L. Goodwin,et al.  Mental health outcomes at the end of the British involvement in the Iraq and Afghanistan conflicts: a cohort study , 2018, The British journal of psychiatry : the journal of mental science.

[22]  S. Galea,et al.  Association of suicidal ideation with trajectories of deployment-related PTSD symptoms , 2018, Psychiatry Research.

[23]  C. Castro,et al.  PTSD in U.S. Veterans: The Role of Social Connectedness, Combat Experience and Discharge , 2018, Healthcare.

[24]  D. Murphy,et al.  Understanding the Needs of Veterans with PTSD , 2018, Healthcare.

[25]  I. Buchan,et al.  Framework to construct and interpret latent class trajectory modelling , 2018, BMJ Open.

[26]  S. Wessely,et al.  Combat Experiences and their Relationship to Post-Traumatic Stress Disorder Symptom Clusters in UK Military Personnel Deployed to Afghanistan , 2018, Behavioral medicine.

[27]  Hollie Melton,et al.  The provision of services in the UK for UK armed forces veterans with PTSD: a rapid evidence synthesis , 2018 .

[28]  C. LeardMann,et al.  Factors associated with persistent posttraumatic stress disorder among U.S. military service members and veterans , 2018, BMC Psychiatry.

[29]  G. Bonanno,et al.  A Decade of War: Prospective Trajectories of Posttraumatic Stress Disorder Symptoms Among Deployed US Military Personnel and the Influence of Combat Exposure , 2017, American journal of epidemiology.

[30]  P. Thuras,et al.  Resilience and Posttraumatic Stress Disorder Symptoms in National Guard Soldiers Deployed to Iraq: A Prospective Study of Latent Class Trajectories and Their Predictors. , 2017, Journal of traumatic stress.

[31]  S. Wessely,et al.  Post-deployment screening for mental disorders and tailored advice about help-seeking in the UK military: a cluster randomised controlled trial , 2017, The Lancet.

[32]  Dan J Stein,et al.  Posttraumatic stress disorder in the World Mental Health Surveys , 2017, Psychological Medicine.

[33]  S. Galea,et al.  Trajectories of Posttraumatic Stress Symptoms After Civilian or Deployment Traumatic Event Experiences , 2017, Psychological trauma : theory, research, practice and policy.

[34]  G. Bonanno,et al.  Prospective post-traumatic stress disorder symptom trajectories in active duty and separated military personnel. , 2017, Journal of psychiatric research.

[35]  N. Crum‐Cianflone,et al.  Mental Health and Comorbidities in U.S. Military Members. , 2016, Military medicine.

[36]  J. Calabrese,et al.  Mental Health Over Time in a Military Sample: The Impact of Alcohol Use Disorder on Trajectories of Psychopathology After Deployment. , 2015, Journal of traumatic stress.

[37]  Eric Elbogen,et al.  The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans: a meta-analysis. , 2015, Journal of anxiety disorders.

[38]  Meng Wang,et al.  A Meta-Analysis of Risk Factors for Combat-Related PTSD among Military Personnel and Veterans , 2015, PloS one.

[39]  A. Høgh,et al.  Posttraumatic Stress Disorder among Danish Soldiers 2.5 Years after Military Deployment in Afghanistan: The Role of Personality Traits as Predisposing Risk Factors , 2015 .

[40]  B. Litz,et al.  The relationship between course of PTSD symptoms in deployed U.S. Marines and degree of combat exposure. , 2015, Journal of traumatic stress.

[41]  Alyssa M. Boasso,et al.  Posttraumatic stress in deployed Marines: prospective trajectories of early adaptation. , 2015, Journal of abnormal psychology.

[42]  N. Greenberg,et al.  Service Life and Beyond – Institution or Culture? , 2014 .

[43]  Karen-Inge Karstoft,et al.  Latent trajectories of trauma symptoms and resilience: the 3-year longitudinal prospective USPER study of Danish veterans deployed in Afghanistan. , 2014, The Journal of clinical psychiatry.

[44]  G. Bonanno,et al.  Prospective trajectories of posttraumatic stress in college women following a campus mass shooting. , 2014, Journal of traumatic stress.

[45]  L. Goodwin,et al.  A systematic review of the comorbidity between PTSD and alcohol misuse , 2014, Social Psychiatry and Psychiatric Epidemiology.

[46]  Z. Solomon,et al.  Long-term trajectories of posttraumatic stress disorder in veterans: the role of social resources. , 2013, The Journal of clinical psychiatry.

[47]  S. Wessely,et al.  Life in and after the Armed Forces: social networks and mental health in the UK military. , 2013, Sociology of health & illness.

[48]  L. Goodwin,et al.  What explains post-traumatic stress disorder (PTSD) in UK service personnel: deployment or something else? , 2012, Psychological Medicine.

[49]  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.

[50]  S. Wessely,et al.  Leadership, Cohesion, Morale, and the Mental Health of UK Armed Forces in Afghanistan , 2012, Psychiatry.

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

[52]  Christopher Dandeker,et al.  What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study , 2010, The Lancet.

[53]  Arnoud Arntz,et al.  Deployment-related stress and trauma in Dutch soldiers returning from Iraq. Prospective study. , 2007, The British journal of psychiatry : the journal of mental science.

[54]  Christopher Dandeker,et al.  The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study , 2006, The Lancet.