Latent Trajectories of Trauma Symptoms and Resilience: The 3-Year Longitudinal Prospective USPER Study of Danish Veterans Deployed in Afghanistan
Latent Trajectories of Trauma Symptoms and Resilience: The 3-Year Longitudinal Prospective USPER Study of Danish Veterans Deployed in Afghanistan
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DOI：
10.4088/jcp.13m08914
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发表时间：
2014-09-01
影响因子：
5.3
通讯作者：
Madsen, Trine
中科院分区：
文献类型：
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作者：
Andersen, Soren Bo;Karstoft, Karen-Inge;Madsen, Trine
目的：确定创伤后应激障碍(PTSD)症状从部署前到部署后2.5年的轨迹，并评估症状波动和迟发性PTSD的危险因素。方法：使用创伤后应激障碍检查表(PCL)对2009年派往阿富汗的743名士兵从部署前到部署后2.5年的6次PTSD症状进行评估(研究样本=561)。还评估了部署前的脆弱性以及部署和部署后的压力源。结果：确定了6条轨迹：在所有评估中具有较低症状级别的弹性轨迹(78.1%)和5条表现出症状波动的轨迹。这些因素包括发病晚(5.7%)，由早期情绪问题(OR=5.59；95%CI，1.57-19.89)和部署前和部署后创伤(OR=1.10；95%CI，1.04-1.17和OR=1.13；95%CI，1.00-1.26)独立预测。还发现了两条症状波动在低到中等范围内的轨迹(7.5%和4.1%)；在部署期间症状缓解的轨迹，但在最后评估时急剧增加(2.0%)；以及在部署期间症状轻微增加，然后在返回时缓解(2.7%)。症状波动由部署前危险因素(抑郁[OR=1.27；95%CI，1.16-1.39]、神经质[OR=1.10；95%CI，1.00-1.21]和早期创伤[OR=1.09；95%CI，1.03-1.16])和部署相关应激源(危险/伤害暴露[OR=1.20；95%CI，1.04-1.40]，但不受部署后应激的影响。讨论：该结果证实了军事部署后应激反应异质性的早期发现，并强调部署前、部署周围和部署后危险因素在预测PTSD症状和迟发性PTSD症状方面的影响。
Objective: To identify trajectories of posttraumatic stress disorder (PTSD) symptoms from before to 2.5 years after deployment and to assess risk factors for symptom fluctuations and late-onset PTSD.Method: 743 soldiers deployed to Afghanistan in 2009 were assessed for PTSD symptoms using the PTSD Checklist (PCL) at 6 occasions from predeployment to 2.5 years postdeployment (study sample = 561). Predeployment vulnerabilities and deployment and postdeployment stressors were also assessed.Results: Six trajectories were identified: a resilient trajectory with low symptom levels across all assessments (78.1%) and 5 trajectories showing symptom fluctuations. These included a trajectory of late onset (5.7%), independently predicted by earlier emotional problems (OR = 5.59; 95% CI, 1.57-19.89) and predeployment and postdeployment traumas (OR = 1.10; 95% CI, 1.04-1.17 and OR = 1.13; 95% CI, 1.00-1.26). Two trajectories of symptom fluctuations in the low-to-moderate range (7.5% and 4.1%); a trajectory of symptom relief during deployment, but with a drastic increase at the final assessments (2.0%); and a trajectory with mild symptom increase during deployment followed by relief at return (2.7%) were also found. Symptom fluctuation was predicted independently by predeployment risk factors (depression [OR = 1.27; 95% CI, 1.16-1.39], neuroticism [OR = 1.10; 95% CI, 1.00-1.21], and earlier traumas [OR = 1.09; 95% CI, 1.03-1.16]) and deployment-related stressors (danger/injury exposure [OR = 1.20; 95% CI, 1.04-1.40]), but not by postdeployment stressors.Discussion: The results confirm earlier findings of stress response heterogeneity following military deployment and highlight the impact of predeployment, perideployment, and postdeployment risk factors in predicting PTSD symptomatology and late-onset PTSD symptoms.