Publication year
2016
Citation Title
Post-traumatic stress symptoms 5 years after military deployment to Afghanistan: An observational cohort study
Journal Name
The Lancet Psychiatry
Journal Volume
3
Issue Number
1
Page Numbers
58-64
DOI
10.1016/s2215-0366(15)00368-5
Summary
Service members who are deployed are at risk for developing posttraumatic stress disorder (PTSD) symptoms. This study uses longitudinal data to model trajectories for how symptoms may present over time: low level and stable (resilient), moderate but increasing (delayed onset), and increasing symptoms in the first year but decreasing (recovering). Findings indicate that Soldiers who experience heavy combat and younger Soldiers may more likely display a delayed onset of symptoms.
Key Findings
Average level of PTSD symptoms increased in the first six months after deployment when compared with pre-deployment; however, 12 months after deployment levels returned to pre-deployment then levels increased in the later follow ups at 2 years and 5 years, illustrating a delayed onset trajectory.
Participants who were deployed in 2007 or 2008 scored higher on the survey, suggesting a relationship between combat exposure and increased PTSD symptoms as Dutch Soldiers faced heavier combat.
Younger Soldiers reported higher survey scores and were more likely to experience delayed onset symptoms for PTSD.
Implications for Program Leaders
Establish a mentoring system for younger Service members to pair up with older Service members or Veterans
Provide ongoing education regarding stress management for Service members and their families
Collaborate with community providers and professionals to develop a toolkit or awareness resources for Service members and families to recognize PTSD-related symptoms
Implications for Policy Makers
Encourage help-seeking behaviors as a healthy way to promote Service member and family readiness
Propose ongoing and longer-term follow-ups for Service members who may present PTSD symptoms
Recommend monitoring of younger Service members as they may be at an increased risk of developing PTSD symptoms
Methods
A self-report questionnaire was used to assess participants for symptoms of PTSD.
Participants were assessed at 1 month prior to deployment and follow-up assessments were conducted at 1 month, 6 months, 12 months, 2 years, and 5 years after deployment.
Scores from the survey were analyzed at the different time points and models were designed to illustrate symptomatic trajectories: resilient, delayed onset, or recovery.
Participants
Participants consisted of 1,007 Dutch military personnel who were deployed to Afghanistan anytime between March 2005 and September 2008.
Of the 960 participants who had a high survey score at one or more time points, 91% were male and 86% were 21 years old or older; no race/ethnicity was reported.
Rank of participants included: 40% Private, 21% Corporal, 26% Non-commissioned Officer, and 14% Staff Officer.
Most (76%) were deployed in either 2007 or 2008 while 24% were deployed in either 2005 or 2006 and 69% had no redeployments, 20% had one and 11% had multiple deployments.
Limitations
Female Soldiers were underrepresented in this study, leading to an incomplete understanding of how all Soldiers are affected by trauma.
No information was collected regarding any treatment or help-seeking behaviors and no information was collected regarding possible comorbidity of other conditions over time.
There were no efforts to collect any clinical or objective measures of PTSD from participants.
Avenues for Future Research
Include more female participants to gain a better understanding of how PTSD symptoms present over time with female as well as male Service members
Incorporate question items that address any help-seeking behaviors or whether the participant may have any other psychiatric conditions emerging during the follow up portions of the study
Explore a more detailed way to measure combat stress rather than use years of deployment to represent combat intensity and stress
Focus
International Military
Target Population
Population Focus
Abstract
Background: Deployment can put soldiers at risk of developing post-traumatic stress symptoms. Despite several longitudinal studies, little is known about the timing of an increase in post-traumatic stress symptoms relative to predeployment. Longitudinal studies starting pre-deployment, in which participants are repeatedly measured over time, are warranted to assess the timing of an increase in symptoms to ultimately assess the timing of an increase in treatment demand after deployment. Methods: In this large observational cohort study, Dutch military personnel who were deployed to Afghanistan as part of the International Security Assistance Forces between March, 2005, and September, 2008, were assessed for posttraumatic stress symptoms with the Self-Rating Inventory for Post-traumatic Stress Disorder (SRIP) questionnaire. Participants were assessed 1 month before deployment and followed up at 1 month, 6 months, 12 months, 2 years, and 5 years after deployment, with changes in SRIP scores compared with pre-deployment using a mixed model analysis. The primary outcome was the total score of post-traumatic stress symptoms measured with SRIP at predeployment and the five follow-up assessments, with a score of 38 used as the cutoff to indicate substantial posttraumatic stress symptoms. Findings: Between March, 2005, and September, 2008, 1007 participants were recruited to this study. The results show two important effects of deployment on post-traumatic stress symptoms. A short-term symptom increase within the first 6 months after deployment (symptom increase coefficient for SRIP score vs pre-deployment [?] 0.99, 95% CI 0.50_1.48); and a long-term symptom increase at 5 years after deployment (? 1.67, 1.14_2.20). Interpretation: This study underlines the importance of long-term monitoring of the psychological health of soldiers after deployment because early detection of symptoms is essential to early treatment, which is related to improved psychological health.
Abstract Document
PRTW Document
Attach