title: The role of stress sensitization in progression of posttraumatic distress following deployment.
abstract: OBJECTIVE
  Military personnel exposed to combat are at risk for experiencing post-traumatic distress that can progress over time following deployment. We hypothesized that progression of post-traumatic distress may be related to enhanced susceptibility to post-deployment stressors. This study aimed at examining the concept of stress sensitization prospectively in a sample of Dutch military personnel deployed in support of the conflicts in Afghanistan.
  
  
  METHODS
  In a cohort of soldiers (N = 814), symptoms of post-traumatic stress disorder (PTSD) were assessed before deployment as well as 2, 7, 14, and 26 months (N = 433; 53 %) after their return. Data were analyzed using latent growth modeling. Using multiple group analysis, we examined whether high combat stress exposure during deployment moderated the relation between post-deployment stressors and linear change in post-traumatic distress after deployment.
  
  
  RESULTS
  A higher baseline level of post-traumatic distress was associated with more early life stressors (standardized regression coefficient = 0.30, p < 0.001). In addition, a stronger increase in posttraumatic distress during deployment was associated with more deployment stressors (standardized coefficient = 0.21, p < 0.001). A steeper linear increase in posttraumatic distress post-deployment (from 2 to 26 months) was predicted by more post-deployment stressors (standardized coefficient = 0.29, p < 0.001) in high combat stress exposed soldiers, but not in a less combat stress exposed group. The group difference in the predictive effect of post-deployment stressors on progression of post-traumatic distress was significant (χ²(1) = 7.85, p = 0.005).
  
  
  CONCLUSIONS
  Progression of post-traumatic distress following combat exposure may be related to sensitization to the effects of post-deployment stressors during the first year following return from deployment.
authors.affiliation: Foundation Centrum'45/Arq, Nienoord 5, 1112 XE, Diemen, The Netherlands, g.smid@centrum45.nl.
authors.forename: Geert E
authors.initials: GE
authors.lastname: Smid
authors.forename: Rolf J
authors.initials: RJ
authors.lastname: Kleber
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Rademaker
authors.forename: Mirjam
authors.initials: M
authors.lastname: van Zuiden
authors.forename: Eric
authors.initials: E
authors.lastname: Vermetten
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology*; D009426:Netherlands; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology*