title: Posttraumatic stress in deployed Marines: prospective trajectories of early adaptation.
abstract: We examined the course of PTSD symptoms in a cohort of U.S. Marines (N = 867) recruited for the Marine Resiliency Study (MRS) from a single infantry battalion that deployed as a unit for 7 months to Afghanistan during the peak of conflict there. Data were collected via structured interviews and self-report questionnaires 1 month prior to deployment and again at 1, 5, and 8 months postdeployment. Second-order growth mixture modeling was used to disaggregate symptom trajectories; multinomial logistic regression and relative weights analysis were used to assess the role of combat exposure, prior life span trauma, social support, peritraumatic dissociation, and avoidant coping as predictors of trajectory membership. Three trajectories best fit the data: a low-stable symptom course (79%), a new-onset PTSD symptoms course (13%), and a preexisting PTSD symptoms course (8%). Comparison in a separate MRS cohort with lower levels of combat exposure yielded similar results, except for the absence of a new-onset trajectory. In the main cohort, the modal trajectory was a low-stable symptoms course that included a small but clinically meaningful increase in symptoms from predeployment to 1 month postdeployment. We found no trajectory of recovery from more severe symptoms in either cohort, suggesting that the relative change in symptoms from predeployment to 1 month postdeployment might provide the best indicator of first-year course. The best predictors of trajectory membership were peritraumatic dissociation and avoidant coping, suggesting that changes in cognition, perception, and behavior following trauma might be particularly useful indicators of first-year outcomes.
authors.affiliation: Boston VA Research Institute.
authors.forename: William P
authors.initials: WP
authors.lastname: Nash
authors.affiliation: VA Boston Healthcare System.
authors.forename: Alyssa M
authors.initials: AM
authors.lastname: Boasso
authors.affiliation: VA Boston Healthcare System.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Steenkamp
authors.affiliation: VA Boston Healthcare System.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Larson
authors.affiliation: VA Boston Healthcare System.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Lubin
authors.affiliation: VA Boston Healthcare System.
authors.forename: Brett T
authors.initials: BT
authors.lastname: Litz
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D006801:Humans; D016015:Logistic Models; D008297:Male; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D055500:Resilience, Psychological; D012307:Risk Factors; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult