Posttraumatic stress symptoms across the deployment cycle: A latent transition analysis

doi:10.1016/j.jpsychires.2016.08.002

Journal of Psychiatric Research

Volume 83, December 2016, Pages 54-60

https://doi.org/10.1016/j.jpsychires.2016.08.002 Get rights and content

Abstract

Our objective was to examine symptom-level changes in the course in posttraumatic stress disorder (PTSD) across the deployment cycle among combat-exposed Marines, and to determine the degree to which combat exposure and post-deployment stressor exposure predicted PTSD symptom profile transitions. We examined PTSD symptoms in a cohort of U.S. Marines (N = 892) recruited for the Marine Resiliency Study (MRS). Marines deployed as one battalion infantry unit to Afghanistan in 2010 and were assessed pre-deployment and one, five, and eight months post-deployment. We employed latent transition analysis (LTA) to examine Marines' movement across PTSD symptom profiles, determined by latent class analysis (LCA). LCAs revealed a 3-class solution one month pre-deployment, a 4-class solution at five months post-deployment, and a 3-class solution at eight months post-deployment. LTA revealed notable movement between classes over time, which depended chiefly on pre-deployment symptom presentation. Marines who reported few pre-deployment symptoms either maintained these low levels or returned to low levels by eight months. Marines who reported a moderate number of symptoms at pre-deployment had variable outcomes; 50% had reductions by eight months, and those who reported numbing symptoms at five months post-deployment tended to report more symptoms at eight months. Marines who reported more PTSD symptoms prior to deployment retained more symptoms eight months post-deployment. Combat exposure and post-deployment stressor exposure predicted profile transitions. Examining transitions between latent class membership over time revealed prognostic information about Marines' eight-month PTSD outcomes. The extent of pre-deployment PTSD symptoms was particularly informative of likely PTSD outcomes.

Section snippets

Design and participants

The data source for this study was the Marine Resiliency Study (MRS), a longitudinal study of four battalion cohorts of active-duty male Marines deployed to Iraq and Afghanistan between 2008 and 2012 (Baker et al., 2012). For the current report we analyzed Marines who deployed with the fourth battalion (Cohort 4). Cohort 4 was the largest cohort (N = 892), had more evenly spaced modal assessment periods across the deployment cycle, and reported the greatest combat experiences of any MRS cohort,

Results

Table 1 shows the model fit statistics for each cross-section. At T0, the Consistent Akaike's Information Criteria (CAIC) and the Bayesian Information Criterion (BIC) favored a 3-class solution, whereas the Sample Size Adjusted BIC (SSA-BIC) indicated that a 5-class solution was a comparatively better fit to the data; consequently we selected the 3-class solution. At T2, the 3-class solution had the lowest CAIC and BIC (which given the sample size, would have a 92% likelihood of

Discussion

We used LTA to examine changes in clinically significant PTSD symptoms at three time points across the deployment cycle. Three PTSD symptom classes were evident at one month pre-deployment, four at five months post-deployment, and three at eight months post-deployment. This heterogeneity in symptom presentation across assessment points may reflect the varied stressors and emotional demands associated with different phases of the deployment cycle, for example, the demands of preparing to deploy

Contributions

Alyssa Boasso: Manuscript writing and Statistics.

Maria M. Steenkamp: Manuscript Writing.

Jonathan L. Larson: Statistics and Manuscript Writing.

Brett T. Litz: Manuscript Writing.

Acknowledgements

The authors acknowledge the Marine Resiliency Study (MRS) team who made this work possible. This study was funded by VA Health Service Research and Development (SDR 09-0128) and by the U.S. Marine Corps and Navy Bureau of Medicine and Surgery.

References (36)

L. Ayer et al.
Latent classes of adolescent posttraumatic stress disorder predict functioning and disorder after 1 year
J. Am. Acad. Child Adolesc. Psychiatr.
(2011)
O.A. Cabrera et al.
Childhood adversity and combat as predictors of depression and post-traumatic stress in deployed troops
Am. J. Prev. Med.
(2007)
C. Hebenstreit et al.
Latent classes of PTSD symptoms in Iraq and Afghanistan female veterans
J. Affect. Disord.
(2014)
K.M. Magruder et al.
Prevalence of posttraumatic stress disorder in Veterans Affairs primary care clinics
General Hosp. psychiatr.
(2005)
S. Maguen et al.
Killing and latent classes of PTSD symptoms in Iraq and Afghanistan veterans
J. Affect. Disord.
(2013)
L.S. Malta et al.
Numbing symptoms as predictors of unremitting posttraumatic stress disorder
J. Anxiety Disord.
(2009)
R.H. Pietrzak et al.
Support for a novel five-factor model of posttraumatic stress symptoms in three independent samples of Iraq/Afghanistan veterans: a confirmatory factor analytic study
J. Psychiatr. Res.
(2012)
M.M. Steenkamp et al.
Post-traumatic stress disorder: review of the comprehensive soldier fitness program
Am. J. Prev. Med.
(2013)
M.M. Steenkamp et al.
PTSD symptom presentation across the deployment cycle
J. Affect. Disord.
(2015)
D.G. Baker et al.
Predictors of risk and resilience for posttraumatic stress disorder among ground combat Marines: methods of the Marine Resiliency Study
Prev. chronic Dis.
(2012)

D. Berntsen et al.

Peace and war trajectories of posttraumatic stress disorder symptoms before, during, and after military deployment in Afghanistan

Psychol. Sci.

(2012)

D.D. Blake et al.

The development of a clinician-administered PTSD scale

J. Trauma. stress

(1995)

A.M. Boasso et al.

The structure of PTSD in active-duty marines across the deployment cycle

Psychol. Trauma Theory, Res. Pract. Policy

(2016)

G.A. Bonanno et al.

Trajectories of resilience, depression, and anxiety following spinal cord injury

Rehabil. Psychol.

(2012)

G.A. Bonanno et al.

Trajectories of trauma symptoms and resilience in deployed US military service members: prospective cohort study

Br. J. Psychiatr.

(2012)

N. Breslau et al.

The structure of posstraumatic stress disorder: latent class analysis in 2 community samples

Arch. General Psychiatr.

(2005)

L.M. Collins et al.

Latent transition analysis and how it can address prevention research questions

NIDA Res. Monogr.

(1994)

N.C. Feeny et al.

Exploring the roles of emotional numbing, depression, and dissociation in PTSD

J. Trauma. Stress

(2000)

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View full text

Posttraumatic stress symptoms across the deployment cycle: A latent transition analysis

Abstract

Section snippets

Design and participants

Results

Discussion

Contributions

Acknowledgements

J. Am. Acad. Child Adolesc. Psychiatr.

Am. J. Prev. Med.

J. Affect. Disord.

General Hosp. psychiatr.

J. Affect. Disord.

J. Anxiety Disord.

J. Psychiatr. Res.

Am. J. Prev. Med.

J. Affect. Disord.

Predictors of risk and resilience for posttraumatic stress disorder among ground combat Marines: methods of the Marine Resiliency Study

Prev. chronic Dis.

Peace and war trajectories of posttraumatic stress disorder symptoms before, during, and after military deployment in Afghanistan

Psychol. Sci.

The development of a clinician-administered PTSD scale

J. Trauma. stress

The structure of PTSD in active-duty marines across the deployment cycle

Psychol. Trauma Theory, Res. Pract. Policy

Trajectories of resilience, depression, and anxiety following spinal cord injury

Rehabil. Psychol.

Trajectories of trauma symptoms and resilience in deployed US military service members: prospective cohort study

Br. J. Psychiatr.

The structure of posstraumatic stress disorder: latent class analysis in 2 community samples

Arch. General Psychiatr.

Latent transition analysis and how it can address prevention research questions

NIDA Res. Monogr.

Exploring the roles of emotional numbing, depression, and dissociation in PTSD

J. Trauma. Stress