Does the course of posttraumatic stress disorder (PTSD) differ depending on whether the person is in the military or has left? Researchers from Naval Health Research Center and the VA wondered whether separation from the military could create a “significant disruption of routine, order, and structure,” which might exacerbate PTSD symptoms, and would the symptoms subside as the veteran adjusted to civilian life?
Using data from the Millennium Cohort Study, researchers examined trajectories of PTSD among 22,080 military personnel across 4 time points, about 3 years apart, from 2001 to 2013. They compared trajectories between people who separated before the second time point or remained in the military across the entire study period. The researchers assessed PTSD screening and symptoms using the PTSD Checklist-Civilian, for which higher scores represent more severe symptoms.
The researchers say 4 distinct classes described symptom trajectories: resilient, delayed onset, improving, and elevated-recovering. Overall, the trajectories were similar for veterans and active-duty personnel. Veterans had a higher likelihood of screening positive for PTSD at baseline before separation and were more likely to newly screen positive for PTSD at waves 2, 3, and 4. Of participants who screened positive for PTSD, veterans had more severe symptoms compared with active-duty personnel at baseline but not at any subsequent assessments.
However, differences between the “elevated-recovering” classes grew over time, showing that veterans did not recover as soon or as “dramatically,” the researchers say. This might be due to symptoms being exacerbated by the change in routine.
The good news is that most veterans and active-duty personnel fell into the resilient class (82% and 87%, respectively). The researchers cite other studies that have found resilience is the most common response to PTSD.
The researchers noted several risk factors for slower recovery, such as lower physical well-being and a history of multiple life stressors. The “delayed onset” group may be a good target for interventions, they suggest. This group reported high use of VA care, but still 26% reported no VA care, indicating that they could benefit from continued efforts to identify and treat them.