title: Clarifying Heterogeneity of Daytime and Nighttime Symptoms of Post-traumatic Stress in Combat Veterans with Insomnia.
abstract: Daytime and nighttime symptoms of posttraumatic stress disorder (PTSD) are common among combat veterans and military service members. However, there is a great deal of heterogeneity in how symptoms are expressed. Clarifying the heterogeneity of daytime and nighttime PTSD symptoms through exploratory clustering may generate hypotheses regarding ways to optimally match evidence-based treatments to PTSD symptom profiles. We used mixture modeling to reveal clusters based on six daytime and nighttime symptoms of 154 combat veterans with insomnia and varying levels of PTSD symptoms. Three clusters with increasing symptom severity were identified (N1=50, N2=70, N3=34). These results suggest that, among veterans with insomnia, PTSD symptoms tend to exist on a continuum of severity, rather than as a categorical PTSD diagnosis. Hypotheses regarding possible targeted treatment strategies for veterans within each identified cluster, as well as ways to generalize these methods to other groups within the military, are discussed.
authors.affiliation: University of Pittsburgh Department of Psychiatry, Pittsburgh, PA ; University of Pittsburgh Department of Statistics, Pittsburgh, PA.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Wallace
authors.affiliation: University of Pittsburgh Department of Psychiatry, Pittsburgh, PA ; University of Pittsburgh Department of Statistics, Pittsburgh, PA.
authors.forename: Satish
authors.initials: S
authors.lastname: Iyengar
authors.affiliation: VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Bramoweth
authors.affiliation: University of Pittsburgh Department of Psychiatry, Pittsburgh, PA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.affiliation: University of Pittsburgh Department of Psychiatry, Pittsburgh, PA.
authors.forename: Anne
authors.initials: A
authors.lastname: Germain
keywords: PTSD; Veterans; chronic insomnia; clustering; personalized medicine; sleep