Publication year
2012
Citation Title
Trajectories of trauma symptoms and resilience in deployed US miliary service members: Prospective cohort study.
Journal Name
British Journal of Psychiatry
Journal Volume
200
Issue Number
4
Page Numbers
317-323
DOI
10.1192/bjp.bp.111.096552
Summary
Within the larger Millennium Cohort Study (MCS), this longitudinal study sampled nearly 8,000 deployed Service members from all branches of the military. Researchers investigated trajectories of posttraumatic stress disorder (PTSD) symptoms among Service members prior to and after deployment to Iraq and Afghanistan. Results suggest that the trajectories of PTSD symptoms were very similar for Service members with one or multiple deployments, and that the most common category by far was the stable “low symptoms of PTSD over time.”
Key Findings
The two cohorts (one deployment vs. multiple deployments) were remarkably similar in most trajectories of PTSD symptoms: low symptoms over time (83% vs. 85%), moderate symptoms decreasing over time (8% vs. 9%), and high symptoms over time (2% for both cohorts, but symptoms actually improved for the multiple deployers).
Service members with one deployment (7%) were more likely than those with multiple deployments (5%) to have PTSD symptoms that were initially low but increased over time.
For the single deployers, those in the stable low PTSD symptom group had better initial physical health, less combat experience (except for moderate-improving group) or were more likely to be heavy drinkers (except for the chronic worsening group) compared to those in the other patterns of symptom groups.
For the multiple deployers, those in the stable low PTSD group had less combat experience and were less likely to be smokers (except for the chronic worsening group) compared to the other patterns of symptom groups.
Implications for Program Leaders
Use curricula based on psychological resiliency, such as battlemind training, to help support Service members and improve their well-being and resilience
Employ evidence-based classes and workshops to help prevent or improve PTSD symptoms among Service members experiencing deployment and those already experiencing some PTSD symptoms at pre-deployment
Offer workshops during reintegration to help families and Service members adjust to the Service member’s return, especially when the deployment has included combat exposure
Implications for Policy Makers
Continue to support screening for PTSD and other mental health concerns among Service members
Recommend integrating mental health education into existing service delivery systems for military families
Recommend education of professionals (e.g. child caregivers, mental health, and education professionals) on the possible effects of parents’ emotion regulation and parenting during deployment and post-deployment
Methods
Previously deployed Service members who completed all three questionnaires of the Millennium Cohort Study were examined as two separate subpopulations based on single deployment versus multiple deployment in support of operations in Iraq and Afghanistan between 2001 and 2008.
Self-reported symptoms of PTSD were obtained prior to deployment and at two follow-ups (three years apart).
Data were examined for longitudinal trajectories using statistical analyses.
Participants
The study sample included 7,787 U.S. Military Service members who were mostly male (80%). The two subpopulations included Service members who deployed once (n= 3,393) or multiple times (n= 4,394).
Average age of the participants was 35 years (SD = 8.5 years); the sample consisted of 74% enlisted personnel and 26% officers.
All service branches were represented in sample: 46% Army, 35% Air Force, 15% Navy/Coast Guard, and 5% Marines Corps.
The following was the racial/ethnic composition of the sample: 73% White, 10% Black, and 17% other.
Limitations
This article only examined one aspect of mental/behavioral health (PTSD symptoms) and uses only one measure of this outcome; other findings may be evident if additional behavioral health outcomes were included.
PTSD symptoms were measured using self-report; participants may be reporting in ways that are socially desirable, and this data may be less precise than had standardized assessments been used.
Other variables beside deployment history likely contribute to the trajectory of PTSD symptoms (e.g., family support, use of programs, use of mental health services), and these variables were not included in the models.
Avenues for Future Research
Examine which factors can shape the trajectories of PTSD symptoms experienced by Service members or how to increase psychological resiliency
Investigate which sources of psychosocial support and services available to military personnel may buffer the onset and effects of PTSD symptoms
Consider the role culture and gender have in the findings and subsequent interventions based on these findings
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
This study addressed these limitations using a population-based, prospective cohort of U.S. military personnel deployed in support of the operations in Iraq and Afghanistan. Method: The sample consisted of U.S. military service members in all branches including active duty, reserve and national guard who deployed once (n = 3393) or multiple times (n = 4394). Self-reported symptoms of post-traumatic stress were obtained prior to deployment and at two follow-ups spaced 3 years apart. Data were examined for longitudinal trajectories using latent growth mixture modelling. Results: Each analysis revealed remarkably similar post-traumatic stress trajectories across time. The most common pattern was low-stable post-traumatic stress or resilience (83.1% single deployers, 84.9% multiple deployers), moderate-improving (8.0%, 8.5%), then worsening-chronic post-traumatic stress (6.7%, 4.5%), high-stable (2.2% single deployers only) and high-improving (2.2% multiple deployers only). Covariates associated with each trajectory were identified. Conclusions: The final models exhibited similar types of trajectories for single and multiple deployers; most notably, the stable trajectory of low post-traumatic stress preto post-deployment, or resilience, was exceptionally high. Several factors predicting trajectories were identified, which we hope will assist in future research aimed at decreasing the risk of post-traumatic stress disorder among deployers.
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