title: Trajectories of trauma symptoms and resilience in deployed U.S. military service members: prospective cohort study.
abstract: BACKGROUND
  Most previous attempts to determine the psychological cost of military deployment have been limited by reliance on convenience samples, lack of pre-deployment data or confidentiality and cross-sectional designs.
  
  
  OBJECTIVE
  This study addressed these limitations using a population-based, prospective cohort of U.S. military personnel deployed in support of the operations in Iraq and Afghanistan.
  
  
  METHODS
  The sample consisted of U.S. military service members in all branches including active duty, reserve and national guard who deployed once (n = 3393) or multiple times (n = 4394). Self-reported symptoms of post-traumatic stress were obtained prior to deployment and at two follow-ups spaced 3 years apart. Data were examined for longitudinal trajectories using latent growth mixture modelling.
  
  
  RESULTS
  Each analysis revealed remarkably similar post-traumatic stress trajectories across time. The most common pattern was low-stable post-traumatic stress or resilience (83.1% single deployers, 84.9% multiple deployers), moderate-improving (8.0%, 8.5%), then worsening-chronic post-traumatic stress (6.7%, 4.5%), high-stable (2.2% single deployers only) and high-improving (2.2% multiple deployers only). Covariates associated with each trajectory were identified.
  
  
  CONCLUSIONS
  The final models exhibited similar types of trajectories for single and multiple deployers; most notably, the stable trajectory of low post-traumatic stress preto post-deployment, or resilience, was exceptionally high. Several factors predicting trajectories were identified, which we hope will assist in future research aimed at decreasing the risk of post-traumatic stress disorder among deployers.
authors.affiliation: Department of Counseling and Clinical Psychology Teachers College, Columbia University, 525 West 120th Street, Box 218, New York, NY 10027, USA. gab38@columbia.edu
authors.forename: George A
authors.initials: GA
authors.lastname: Bonanno
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Mancini
authors.forename: Jaime L
authors.initials: JL
authors.lastname: Horton
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Powell
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Leardmann
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Wells
authors.forename: Tomoko I
authors.initials: TI
authors.lastname: Hooper
authors.forename: Gary D
authors.initials: GD
authors.lastname: Gackstetter
authors.forename: Tyler C
authors.initials: TC
authors.lastname: Smith
mesh_terms: D000346:Afghanistan; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014857:Warfare