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Mediation and Moderation of the Relationship Between Combat Experiences and Post-Traumatic Stress Symptoms in Active Duty Military Personnel.
Mil Med. 2017 05; 182(5):e1632-e1639.MM

Abstract

BACKGROUND

Post-traumatic stress disorder (PTSD) is a major health concern among the U.S. military population, affecting up to 12% to 24% of veterans returning from Iraq and Afghanistan. Sleep disturbances, neuroticism, and childhood trauma have all been associated with the development of PTSD in military populations, especially in relation to combat experiences. The effects of disrupted sleep and post-traumatic stress can affect the physical well-being of soldier and sailors in the field and impact them for years after deployment. This study aimed to evaluate the relationship between self-reported measures of combat experiences, PTSD symptoms, sleep, neuroticism, and childhood adversity in an active duty military population.

METHODS

972 U.S. Navy Sailors serving in Afghanistan were given anonymous surveys that assess scales of combat stressors, PTSD symptoms, sleep problems, neuroticism, adverse child experiences (ACEs), and other covariates. Sleep disturbances were hypothesized as moderators, having an indirect effect on the relationship between combat experiences and PTSD symptoms. Neuroticism scores and ACEs were proposed as moderators of the combat-PTSD symptom relationship. Mediation and moderation models were developed and tested using logistic regressions.

FINDINGS

Increased number of combat experiences was found to be a significant predictor of PTSD, even when adjusting for all covariates (p < 0.05). Consistent with partial mediation, nightmares had an indirect effect on the relationship between combat experiences and PTSD symptoms in the final model (path coefficient = 0.233, 95% confidence interval = 0.036, 0.483). Neuroticism was an independent predictor of PTSD symptoms (p < 0.001), but the interaction of combat and neuroticism did not predict symptoms of PTSD. ACEs did not have a significant impact in the model as either an independent predictor or a moderating factor.

DISCUSSION

These results indicate that the presence of nightmares may partially explain how traumatic combat experiences lead to the development of PTSD. The study also reaffirms neuroticism as risk factor for developing PTSD symptoms. These findings highlight the importance of sleep hygiene and operational stress models in combat situations and may help stress control professionals address risk factors associated with PTSD symptoms.

Authors+Show Affiliations

Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Sterling Plaza, Room 240, Pittsburgh, PA 15213.Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Sterling Plaza, Room 240, Pittsburgh, PA 15213.SPAWAR Systems Center Pacific, 53560 Hull Street, San Diego, CA 92152.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29087905

Citation

Steele, Marshall, et al. "Mediation and Moderation of the Relationship Between Combat Experiences and Post-Traumatic Stress Symptoms in Active Duty Military Personnel." Military Medicine, vol. 182, no. 5, 2017, pp. e1632-e1639.
Steele M, Germain A, Campbell JS. Mediation and Moderation of the Relationship Between Combat Experiences and Post-Traumatic Stress Symptoms in Active Duty Military Personnel. Mil Med. 2017;182(5):e1632-e1639.
Steele, M., Germain, A., & Campbell, J. S. (2017). Mediation and Moderation of the Relationship Between Combat Experiences and Post-Traumatic Stress Symptoms in Active Duty Military Personnel. Military Medicine, 182(5), e1632-e1639. https://doi.org/10.7205/MILMED-D-16-00169
Steele M, Germain A, Campbell JS. Mediation and Moderation of the Relationship Between Combat Experiences and Post-Traumatic Stress Symptoms in Active Duty Military Personnel. Mil Med. 2017;182(5):e1632-e1639. PubMed PMID: 29087905.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mediation and Moderation of the Relationship Between Combat Experiences and Post-Traumatic Stress Symptoms in Active Duty Military Personnel. AU - Steele,Marshall, AU - Germain,Anne, AU - Campbell,Justin S, PY - 2017/11/1/entrez PY - 2017/11/1/pubmed PY - 2018/7/11/medline SP - e1632 EP - e1639 JF - Military medicine JO - Mil Med VL - 182 IS - 5 N2 - BACKGROUND: Post-traumatic stress disorder (PTSD) is a major health concern among the U.S. military population, affecting up to 12% to 24% of veterans returning from Iraq and Afghanistan. Sleep disturbances, neuroticism, and childhood trauma have all been associated with the development of PTSD in military populations, especially in relation to combat experiences. The effects of disrupted sleep and post-traumatic stress can affect the physical well-being of soldier and sailors in the field and impact them for years after deployment. This study aimed to evaluate the relationship between self-reported measures of combat experiences, PTSD symptoms, sleep, neuroticism, and childhood adversity in an active duty military population. METHODS: 972 U.S. Navy Sailors serving in Afghanistan were given anonymous surveys that assess scales of combat stressors, PTSD symptoms, sleep problems, neuroticism, adverse child experiences (ACEs), and other covariates. Sleep disturbances were hypothesized as moderators, having an indirect effect on the relationship between combat experiences and PTSD symptoms. Neuroticism scores and ACEs were proposed as moderators of the combat-PTSD symptom relationship. Mediation and moderation models were developed and tested using logistic regressions. FINDINGS: Increased number of combat experiences was found to be a significant predictor of PTSD, even when adjusting for all covariates (p < 0.05). Consistent with partial mediation, nightmares had an indirect effect on the relationship between combat experiences and PTSD symptoms in the final model (path coefficient = 0.233, 95% confidence interval = 0.036, 0.483). Neuroticism was an independent predictor of PTSD symptoms (p < 0.001), but the interaction of combat and neuroticism did not predict symptoms of PTSD. ACEs did not have a significant impact in the model as either an independent predictor or a moderating factor. DISCUSSION: These results indicate that the presence of nightmares may partially explain how traumatic combat experiences lead to the development of PTSD. The study also reaffirms neuroticism as risk factor for developing PTSD symptoms. These findings highlight the importance of sleep hygiene and operational stress models in combat situations and may help stress control professionals address risk factors associated with PTSD symptoms. SN - 1930-613X UR - https://www.unboundmedicine.com/medline/citation/29087905/Mediation_and_Moderation_of_the_Relationship_Between_Combat_Experiences_and_Post_Traumatic_Stress_Symptoms_in_Active_Duty_Military_Personnel_ L2 - https://academic.oup.com/milmed/article-lookup/doi/10.7205/MILMED-D-16-00169 DB - PRIME DP - Unbound Medicine ER -