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Long-term trajectories of posttraumatic stress disorder in veterans: the role of social resources.
J Clin Psychiatry. 2013 Dec; 74(12):e1163-8.JC

Abstract

OBJECTIVE

To (1) identify long-term trajectories of combat-induced posttraumatic stress disorder (PTSD) symptoms over a 20-year period from 1983 to 2002 in veterans with and without combat stress reaction (CSR) and (2) identify social predictors of these trajectories.

METHOD

A latent growth mixture modeling analysis on PTSD symptoms was conducted to identify PTSD trajectories and predictors. PTSD was defined according to DSM-III and assessed through the PTSD Inventory. Israeli male veterans with (n = 369) and without (n = 306) CSR were queried at 1, 2, and 20 years after war about combat exposure, military unit support, family environment, and social reintegration.

RESULTS

For both study groups, we identified 4 distinct trajectories with varying prevalence across groups: resilience (CSR = 34.4%, non-CSR = 76.5%), recovery (CSR = 36.3%, non-CSR = 10.5%), delayed onset (CSR = 8.4%, non-CSR = 6.9%), and chronicity (CSR = 20.9%, non-CSR = 6.2%). Predictors of trajectories in both groups included perception of war threat (ORs = 1.59-2.47, P values ≤ .30), and negative social reintegration (ORs = 0.24-0.51, P values ≤ .047). Social support was associated with symptomatology only in the CSR group (ORs = 0.40-0.61, P values ≤ .045), while family coherence was predictive of symptomatology in the non-CSR group (OR = 0.76, P = .015) but not in the CSR group.

CONCLUSIONS

Findings confirmed heterogeneity of long-term sequelae of combat, revealing 4 trajectories of resilience, recovery, delay, and chronicity in veterans with and without CSR. Symptomatic trajectories were more prevalent for the CSR group, suggesting that acute functional impairment predicts pathological outcomes. Predictors of symptomatic trajectories included perceived threat and social resources at the family, network, and societal levels.

Authors+Show Affiliations

The National Centre for Psychotraumatology, University of Southern Denmark, Campusvej 55, Odense, Funen, Denmark kikarstoft@health.sdu.dk.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24434104

Citation

Karstoft, Karen-Inge, et al. "Long-term Trajectories of Posttraumatic Stress Disorder in Veterans: the Role of Social Resources." The Journal of Clinical Psychiatry, vol. 74, no. 12, 2013, pp. e1163-8.
Karstoft KI, Armour C, Elklit A, et al. Long-term trajectories of posttraumatic stress disorder in veterans: the role of social resources. J Clin Psychiatry. 2013;74(12):e1163-8.
Karstoft, K. I., Armour, C., Elklit, A., & Solomon, Z. (2013). Long-term trajectories of posttraumatic stress disorder in veterans: the role of social resources. The Journal of Clinical Psychiatry, 74(12), e1163-8. https://doi.org/10.4088/JCP.13m08428
Karstoft KI, et al. Long-term Trajectories of Posttraumatic Stress Disorder in Veterans: the Role of Social Resources. J Clin Psychiatry. 2013;74(12):e1163-8. PubMed PMID: 24434104.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term trajectories of posttraumatic stress disorder in veterans: the role of social resources. AU - Karstoft,Karen-Inge, AU - Armour,Cherie, AU - Elklit,Ask, AU - Solomon,Zahava, PY - 2013/03/20/received PY - 2013/08/06/accepted PY - 2014/1/18/entrez PY - 2014/1/18/pubmed PY - 2014/4/9/medline SP - e1163 EP - 8 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 74 IS - 12 N2 - OBJECTIVE: To (1) identify long-term trajectories of combat-induced posttraumatic stress disorder (PTSD) symptoms over a 20-year period from 1983 to 2002 in veterans with and without combat stress reaction (CSR) and (2) identify social predictors of these trajectories. METHOD: A latent growth mixture modeling analysis on PTSD symptoms was conducted to identify PTSD trajectories and predictors. PTSD was defined according to DSM-III and assessed through the PTSD Inventory. Israeli male veterans with (n = 369) and without (n = 306) CSR were queried at 1, 2, and 20 years after war about combat exposure, military unit support, family environment, and social reintegration. RESULTS: For both study groups, we identified 4 distinct trajectories with varying prevalence across groups: resilience (CSR = 34.4%, non-CSR = 76.5%), recovery (CSR = 36.3%, non-CSR = 10.5%), delayed onset (CSR = 8.4%, non-CSR = 6.9%), and chronicity (CSR = 20.9%, non-CSR = 6.2%). Predictors of trajectories in both groups included perception of war threat (ORs = 1.59-2.47, P values ≤ .30), and negative social reintegration (ORs = 0.24-0.51, P values ≤ .047). Social support was associated with symptomatology only in the CSR group (ORs = 0.40-0.61, P values ≤ .045), while family coherence was predictive of symptomatology in the non-CSR group (OR = 0.76, P = .015) but not in the CSR group. CONCLUSIONS: Findings confirmed heterogeneity of long-term sequelae of combat, revealing 4 trajectories of resilience, recovery, delay, and chronicity in veterans with and without CSR. Symptomatic trajectories were more prevalent for the CSR group, suggesting that acute functional impairment predicts pathological outcomes. Predictors of symptomatic trajectories included perceived threat and social resources at the family, network, and societal levels. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/24434104/Long_term_trajectories_of_posttraumatic_stress_disorder_in_veterans:_the_role_of_social_resources_ L2 - http://www.psychiatrist.com/jcp/article/pages/2013/v74n12/v74n1205.aspx DB - PRIME DP - Unbound Medicine ER -