Trajectories of functioning in a population-based sample of veterans: contributions of moral injury, PTSD, and depression.
Trajectories of functioning in a population-based sample of veterans: contributions of moral injury, PTSD, and depression.
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DOI：
10.1017/s0033291720004249
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发表时间：
2022-09
影响因子：
6.9
通讯作者：
Vogt, Dawne
中科院分区：
文献类型：
--
作者：
Maguen, Shira;Griffin, Brandon J.;Copeland, Laurel A.;Perkins, Daniel F.;Richardson, Cameron B.;Finley, Erin P.;Vogt, Dawne
尽管研究表明，暴露在潜在的创伤和道德伤害事件中与退伍军人的心理症状有关，但对功能影响的了解仍然有限。911事件后退伍军人的人口样本在退役后大约9个月、15个月、21个月和27个月完成了亲密关系、健康和工作功能的测量。在分离后约9个月评估精神伤害、创伤后应激和抑郁。我们使用潜在生长混合模型来识别离散的类别，其特征是随着时间的推移功能变化的独特轨迹，并检查类别成员的预测因素。退伍军人被分配到四个功能轨迹之一：高和稳定，高和下降，中等和增加，和中等和稳定。创伤后应激、抑郁和与实施和背叛相关的精神伤害预测了多个功能领域基线上更糟糕的结果，而与实施和抑郁相关的精神伤害最可靠地预测了分配到以相对较差或功能下降为特征的轨迹。精神损伤导致的功能问题超出了创伤后应激和抑郁的解释，而由实施和抑郁引起的精神损伤最可靠地预测了随着时间的推移分配到以功能障碍为特征的轨迹。
Although research has shown that exposure to potentially traumatic and morally injurious events is associated with psychological symptoms among veterans, knowledge regarding functioning impacts remains limited. A population-based sample of post-9/11 veterans completed measures of intimate relationship, health, and work functioning at approximately 9, 15, 21, and 27 months after leaving service. Moral injury, posttraumatic stress, and depression were assessed at ~9 months post-separation. We used Latent Growth Mixture Models to identify discrete classes characterized by unique trajectories of change in functioning over time and to examine predictors of class membership. Veterans were assigned to one of four functioning trajectories: high and stable, high and decreasing, moderate and increasing, and moderate and stable. Whereas posttraumatic stress, depression, and moral injury associated with perpetration and betrayal predicted worse outcomes at baseline across multiple functioning domains, moral injury associated with perpetration and depression most reliably predicted assignment to trajectories characterized by relatively poor or declining functioning. Moral injury contributes to functional problems beyond what is explained by posttraumatic stress and depression, and moral injury due to perpetration and depression most reliably predicted assignment to trajectories characterized by functional impairment over time.