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. 2017 Jul;5(4):650-663.
doi: 10.1177/2167702617703436. Epub 2017 May 24.

Predictors of Postdeployment Functioning in Combat-Exposed U.S. Military Veterans

Seth G Disner  1 , Mark D Kramer  1 , Nathaniel W Nelson  2 , Alexandra J Lipinski  1   3 , Julia M Christensen  1 , Melissa A Polusny  1   4 , Scott R Sponheim  1   4
Affiliations

Predictors of Postdeployment Functioning in Combat-Exposed U.S. Military Veterans

Seth G Disner et al. Clin Psychol Sci. 2017 Jul.

Abstract

Posttraumatic stress disorder (PTSD) and sequelae of mild traumatic brain injury (mTBI) are presumed to contribute to reintegration difficulties in combat-exposed veterans. Yet their relative impacts on postdeployment functioning are not well understood. The current study used structural equation modeling (SEM) to clarify the extent to which symptoms of internalizing disorders (e.g., depression, anxiety), mTBI symptoms, and cognitive performance are associated with functional impairment in 295 combat-exposed veterans. SEM results showed that internalizing symptoms most significantly predicted functional impairment (r = 0.72). Blast mTBI and cognitive performance were associated with internalizing (r = 0.24 and -0.25, respectively), but functional impairment was only modestly related to cognition (r = -0.17) and unrelated to mTBI. These results indicate that internalizing symptoms are the strongest predictor of functioning in trauma-exposed veterans, exceeding the effects of mTBI and cognitive performance. This evidence supports prioritizing interventions that target internalizing psychopathology to improve functioning in cases of co-occurring PTSD and mTBI.

Keywords: neuropsychology; posttraumatic stress disorder; trauma; war.

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Conflict of interest statement

The authors declared that they had no conflicts of interest with respect to their authorship or the publication of this article.

Figures

Fig. 1.
Fig. 1.
Measurement model parameter estimates. Shown are the latent structures for the selected clinical and cognitive variables (CFA-4 and CFA-8, respectively). (a) The latent structure of both the internalizing and functional impairment structures indicates strong loading of the observed clinical variables on the internalizing factor and SAS-SR variables on the functional impairment factor (N = 295). (b) The best fitting hierarchical (bifactor) model of cognitive functioning shows that each indicator is saturated by an overarching general cognitive factor, and two residual cognitive factors (RCF1 and RCF2) vary independently from the general factor and from one another (N = 246). COWAT = Controlled Oral Word Association Test; CVLT = California Verbal Learning Test; MPQ = Multidimensional Personality Questionnaire; NEM = Negative Emotional Temperament; PTSD = Posttraumatic Stress Disorder; ROCF = Rey-Osterrieth Complex Figure; SAS-SR = Social Adjustment Scale–Self-Report; TMT-A = Trail Making Test Part A; TMT-B = Trail Making Test Part B; WAIS = Wechsler Adult Intelligence Scale; WB = Well-Being.
Fig. 2.
Fig. 2.
SEM depicting relationships between internalizing and functional impairment factors with mTBI symptoms and cognitive factors regressed upon them (N = 225). Note all paths in italics are significant at p < .05, and paths in bold are significant at p < .001. Shown is the series of relationships between all latent factors along with the two observed mTBI symptom severity scores. Paths between mTBI factors and cognitive measures were nonsignificant and therefore were excluded to enhance model fit. MPQ = Multidimensional Personality Questionnaire; NEM = Negative Emotional Temperament; PTSD = Posttraumatic Stress Disorder; RCF = Residual Cognitive Factor; WB = Well-Being.
See this image and copyright information in PMC

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