Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug;53(11):5322-5331.
doi: 10.1017/S0033291722002410. Epub 2022 Aug 22.

Post-traumatic growth amongst UK armed forces personnel who were deployed to Afghanistan and the role of combat injury, mental health and pain: the ADVANCE cohort study

Daniel Dyball  1   2 , Alexander N Bennett  3   4 , Susie Schofield  4 , Paul Cullinan  4 , Christopher J Boos  5 , Anthony M J Bull  6 , Sharon A M Stevelink  1   2 , Nicola T Fear  1   2   7 ; ADVANCE Study
Affiliations

Post-traumatic growth amongst UK armed forces personnel who were deployed to Afghanistan and the role of combat injury, mental health and pain: the ADVANCE cohort study

Daniel Dyball et al. Psychol Med. 2023 Aug.

Abstract

Background: Post-traumatic growth (PTG) is a positive psychological consequence of trauma. The aims of this study were to investigate whether combat injury was associated with deployment-related PTG in a cohort of UK military personnel who were deployed to Afghanistan, and whether post-traumatic stress disorder (PTSD), depression and pain mediate this relationship.

Methods: 521 physically injured (n = 138 amputation; n = 383 non-amputation injury) and 514 frequency-matched uninjured personnel completed questionnaires including the deployment-related Post-Traumatic Growth Inventory (DPTGI). DPTGI scores were categorised into tertiles of: no/low (score 0-20), moderate (score 21-34) or a large (35-63) degree of deployment-related PTG. Analysis was completed using generalised structural equation modelling.

Results: A large degree of PTG was reported by 28.0% (n = 140) of the uninjured group, 36.9% (n = 196) of the overall injured group, 45.4% (n = 62) of amputee and 34.1% (n = 134) of the non-amputee injured subgroups. Combat injury had a direct effect on reporting a large degree of PTG [Relative risk ratio (RRR) 1.59 (95% confidence interval (CI) 1.17-2.17)] compared to sustaining no injury. Amputation injuries also had a significant direct effect [RRR 2.18 (95% CI 1.24-3.75)], but non-amputation injuries did not [RRR 1.35 (95% CI 0.92-1.93)]. PTSD, depression and pain partially mediate this relationship, though mediation differed depending on the injury subtype. PTSD had a curvilinear relationship with PTG, whilst depression had a negative association and pain had a positive association.

Conclusions: Combat injury, in particular injury resulting in traumatic amputation, is associated with reporting a large degree of PTG.

Keywords: Afghanistan; military personnel; post-traumatic growth; wound and injuries.

PubMed Disclaimer

Conflict of interest statement

S. Stevelink is part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, and the NIHR (ref: NIHR300592). N Fear is part funded by a grant from the UK Ministry of Defence (MoD) and a trustee of a charity supporting the wellbeing of service personnel, veterans and their families. A Bennett is a serving member of the Royal Air Force. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, MoD or the Department of Health and Social Care.

Figures

Fig. 1.
Fig. 1.
Generalised Structural Equation Model investigating the effect of PTSD, depression and pain on a moderate/large degree of PTG in the whole cohort. Model adjusted for age at ADVANCE assessment, rank at sampling and time since sampled deployment/injury to completing the DPTGI. Standardised coefficients and 95% confidence intervals shown. Confidence intervals that suggest non-significant associations are denoted as dotted lines.
Fig. 2.
Fig. 2.
Generalised Structural Equation Model assessing the relationship between combat injured group (v. uninjured group) and reporting a large degree of PTG, mediated by PTSD symptoms, PTSD symptoms2, depression and pain. Model adjusted for age at ADVANCE assessment, rank at sampling and time since sampled deployment/injury to completing the DPTGI. Standardised coefficients and 95% confidence intervals shown. Confidence intervals that suggest non-significant associations are denoted as dotted lines.
Fig. 3.
Fig. 3.
Generalised Structural Equation Model assessing the relationship between amputation injured subgroup (v. uninjured group) and reporting a large degree of PTG, mediated by PTSD symptoms, PTSD symptoms2, depression and pain. Model adjusted for age at ADVANCE assessment, rank at sampling and time since sampled deployment/injury to completing the DPTGI. Standardised coefficients and 95% confidence intervals shown. Confidence intervals that suggest non-significant associations are denoted as dotted lines.
Fig. 4.
Fig. 4.
Generalised Structural Equation Model assessing the relationship between non-amputation injured subgroup (v. uninjured group) and reporting a large degree of PTG, mediated by PTSD symptoms, PTSD symptoms2, depression and pain. Model adjusted for age at ADVANCE assessment, rank at sampling and time since sampled deployment/injury to completing the DPTGI. Standardised coefficients and 95% confidence intervals shown. Confidence intervals that suggest non-significant associations are denoted as dotted lines.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Barskova, T., & Oesterreich, R. (2009). Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: A systematic review. Disability and Rehabilitation, 31(21), 1709–1733. - PubMed
    1. Benetato, B. B. (2011). Posttraumatic growth among operation enduring freedom and operation Iraqi freedom amputees. Journal of Nursing Scholarship, 43(4), 412–420. - PubMed
    1. Bennett, A. N., Dyball, D. M., Boos, C. J., Fear, N. T., Schofield, S., Bull, A. M., & Cullinan, P. (2020). Study protocol for a prospective, longitudinal cohort study investigating the medical and psychosocial outcomes of UK combat casualties from the Afghanistan war: The ADVANCE Study. BMJ Open, 10(10), e037850. - PMC - PubMed
    1. Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34(8), 669–673. - PubMed
    1. Bondesson, E., Larrosa Pardo, F., Stigmar, K., Ringqvist, Å, Petersson, I., Jöud, A., & Schelin, M. (2018). Comorbidity between pain and mental illness–evidence of a bidirectional relationship. European Journal of Pain, 22(7), 1304–1311. - PubMed

Publication types