Preinjury psychiatric status, injury severity, and postdeployment posttraumatic stress disorder

Donald A Sandweiss, Donald J Slymen, Cynthia A Leardmann, Besa Smith, Martin R White, Edward J Boyko, Tomoko I Hooper, Gary D Gackstetter, Paul J Amoroso, Tyler C Smith
Archives of General Psychiatry 2011, 68 (5): 496-504

CONTEXT: Physical injury has been associated with the development of posttraumatic stress disorder (PTSD). Previous studies have retrospectively examined the relationship of preinjury psychiatric status and postinjury PTSD with conflicting results, but no prospective studies regarding this subject have been conducted, to our knowledge.

OBJECTIVE: To prospectively assess the relationship of predeployment psychiatric status and injury severity with postdeployment PTSD.

DESIGN: Prospective, longitudinal study.

SETTING: United States military personnel deployed in support of the conflicts in Iraq and Afghanistan.

PARTICIPANTS: United States service member participants in the Millennium Cohort Study who completed a baseline questionnaire (from July 1, 2001, through June 30, 2003) and at least 1 follow-up questionnaire (from June 1, 2004, through February 14, 2006, and from May 15, 2007, through December 31, 2008) and who were deployed in the intervening period. Self-reported health information was used to prospectively examine the relationship between baseline psychiatric status and follow-up PTSD in injured and uninjured deployed individuals.

MAIN OUTCOME MEASURES: A positive screening result using the PTSD Checklist-Civilian Version.

RESULTS: Of 22 630 eligible participants, 1840 (8.1%) screened positive for PTSD at follow-up, and 183 (0.8%) sustained a deployment-related physical injury that was documented in the Joint Theater Trauma Registry or the Navy-Marine Corps Combat Trauma Registry Expeditionary Medical Encounter Database. The odds of screening positive for PTSD symptoms were 2.52 (95% confidence interval, 2.01-3.16) times greater in those with 1 or more defined baseline mental health disorder and 16.1% (odds ratio, 1.16; 95% confidence interval, 1.01-1.34) greater for every 3-unit increase in the Injury Severity Score. Irrespective of injury severity, self-reported preinjury psychiatric status was significantly associated with PTSD at follow-up.

CONCLUSIONS: Baseline psychiatric status and deployment-related physical injuries were associated with screening positive for postdeployment PTSD. More vulnerable members of the deployed population might be identified and benefit from interventions targeted to prevent or to ensure early identification and treatment of postdeployment PTSD.

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