Trajectories of trauma symptoms and resilience in deployed US military service members: prospective cohort study
Trajectories of trauma symptoms and resilience in deployed US military service members: prospective cohort study
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DOI：
10.1192/bjp.bp.111.096552
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发表时间：
2012-04-01
影响因子：
10.5
通讯作者：
Smith, Tyler C.
中科院分区：
文献类型：
--
作者：
Bonanno, George A.;Mancini, Anthony D.;Smith, Tyler C.
背景 之前大多数确定军事部署心理成本的尝试都受到依赖于方便样本、缺乏部署前数据或机密性和横截面设计的限制。目的本研究使用基于人口的前瞻性队列来支持伊拉克和阿富汗行动的美国军事人员来解决这些局限性。方法样本由曾部署过一次（n=3393）或多次（n=4394）的美国各军种军人组成，包括现役、预备役和国民警卫队。在部署之前和相隔 3 年的两次随访中获得了自我报告的创伤后应激症状。使用潜在生长混合模型检查数据的纵向轨迹。结果每次分析都揭示了随时间变化的创伤后应激轨迹非常相似。最常见的模式是低稳定的创伤后压力或复原力（83.1% 单一部署者，84.9% 多重部署者）、中等改善（8.0%、8.5%）、然后恶化的慢性创伤后压力（6.7%、4.5%）、高稳定（仅 2.2% 单一部署者）和高改善（仅 2.2% 多重部署者）。确定了与每个轨迹相关的协变量。结论最终的模型对于单个和多个部署者表现出相似类型的轨迹；最值得注意的是，部署前和部署后的低创伤后压力或复原力的稳定轨迹异常高。确定了预测轨迹的几个因素，我们希望这些因素将有助于未来的研究，旨在降低部署人员患创伤后应激障碍的风险。
BackgroundMost previous attempts to determine the psychological cost of military deployment have been limited by reliance on convenience samples, lack of pre-deployment data or confidentiality and cross-sectional designs.AimsThis study addressed these limitations using a population-based, prospective cohort of US military personnel deployed in support of the operations in Iraq and Afghanistan. Method The sample consisted of US 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.ResultsEach 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.ConclusionsThe final models exhibited similar types of trajectories for single and multiple deployers; most notably, the stable trajectory of low post-traumatic stress pre- to 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.