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

Abstract

In the study reported here, we examined posttraumatic stress disorder (PTSD) symptoms in 746 Danish soldiers measured on five occasions before, during, and after deployment to Afghanistan. Using latent class growth analysis, we identified six trajectories of change in PTSD symptoms. Two resilient trajectories had low levels across all five times, and a new-onset trajectory started low and showed a marked increase of PTSD symptoms. Three temporary-benefit trajectories, not previously described in the literature, showed decreases in PTSD symptoms during (or immediately after) deployment, followed by increases after return from deployment. Predeployment emotional problems and predeployment traumas, especially childhood adversities, were predictors for inclusion in the nonresilient trajectories, whereas deployment-related stress was not. These findings challenge standard views of PTSD in two ways. First, they show that factors other than immediately preceding stressors are critical for PTSD development, with childhood adversities being central. Second, they demonstrate that the development of PTSD symptoms shows heterogeneity, which indicates the need for multiple measurements to understand PTSD and identify people in need of treatment.

Fig. 1

Flowchart showing attrition of the total sample through the five measurement occasions. PCL = Posttraumatic Stress Disorder Checklist (Blanchard, Jones-Alezander, Buckley, & Forneris, 1996).

Fig. 2

Scores on the Posttraumatic Stress Disorder Checklist (PCL; Blanchard, Jones-Alezander, Buckley, & Forneris, 1996) as a function of measurement occasion and group. The upper panel shows results for the extremely resilient group (n = 255, or 70% of the sample), the resilient group (n = 51, 14%), and the new-onset group (n = 14, 4%), and the lower panel shows results for the three benefit groups (i.e., those whose symptoms decreased at one or more measurement occasions during and following deployment): the strong-benefit group (n = 8, 2%), the mild-benefit group (n = 24, 7%), and the late-benefit group (n = 14, 4%). Error bars indicate standard errors.