PTSD, depression, and treatment outcomes: A latent profile analysis among active duty personnel in a residential PTSD program.

Depression frequently co-occurs with posttraumatic stress disorder (PTSD), including among active duty service members. However, symptom heterogeneity of this comorbidity is complex and its association with treatment outcomes is poorly understood, particularly among active duty service members in residential treatment. This study used latent profile analysis (LPA) to identify symptom-based subgroups of PTSD and depression among 282 male service members in a 10-week, residential PTSD treatment program with evidence-based PTSD psychotherapies and adjunctive interventions. The PTSD Checklist-Military Version and Patient Health Questionnaire-8 were completed by service members at pre- and posttreatment and weekly during treatment. Multilevel models compared subgroups on PTSD and depression symptom change across treatment. LPA indicated four subgroups provided optimal fit: Depressive (high depression severity, low PTSD avoidance; n = 33, 11.7%), Avoidant (high PTSD avoidance, moderate depression severity; n = 89, 31.6%), Moderate (moderate PTSD and depression severity; n = 27, 9.6%), and Distressed (high PTSD and depression severity; n = 133, 47.2%). Treatment response differed across classes for both PTSD and depression outcomes (time × LPA class interaction ps < 0.001). In PTSD models, post-hoc comparisons indicated the Moderate class was associated with less PTSD symptom improvement relative to the other classes (ps < 0.006). In depression models, symptom reduction was greatest for the Distressed and Depressive subgroups relative to the other two classes (ps < 0.009). Study results provide an initial model for two prevalent, impairing disorders among service members and show how these symptom-based subgroups may differentially respond to residential PTSD treatment.

Residual posttraumatic stress disorder and depression symptoms following a residential posttraumatic stress disorder treatment program for U.S. active duty service members.

OBJECTIVE: Even after the most effective posttraumatic stress disorder (PTSD) treatments, symptoms often persist. Understanding residual symptoms is particularly relevant in military populations, who may be less responsive to PTSD interventions. METHOD: The sample consisted of 282 male service members who engaged in a residential PTSD treatment program at a military treatment facility that provided evidence-based PTSD psychotherapies and adjunctive interventions. PTSD and depression symptoms were assessed before and after treatment and weekly during treatment via the PTSD Checklist-Military Version and Patient Health Questionnaire-8. Logistic regression with Hochberg's step-up procedure compared the likelihood of individual residual symptoms between service members who did (n = 92, 32.6%) and did not (n = 190, 67.4%) experience clinically significant PTSD change (≥ 10-point PTSD Checklist-Military Version reduction). RESULTS: Not achieving clinically significant PTSD change was associated with greater odds of nearly all residual symptoms (OR = 2.03-6.18), excluding two Patient Health Questionnaire-8 items (appetite and psychomotor changes). Among service members experiencing clinically significant PTSD change, concentration difficulties (73.3%), physical reactions to reminders (71.1%), and intrusions (70.8%) were PTSD symptoms most likely to persist. Poor sleep (56.2%), low energy (50.0%), and concentration difficulties (48.3%) were the most common for depression. CONCLUSIONS: To our knowledge, this study is the first to examine residual PTSD and depression symptoms following residential PTSD treatment for active duty service members. Given the low rates of clinically significant PTSD change and the high frequency of residual symptoms, strategies may be needed to improve residential PTSD treatment outcomes in the military. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychological comorbidity: Predictors of residential treatment response among U.S. service members with posttraumatic stress disorder.

Residential posttraumatic stress disorder (PTSD) research in military samples generally shows that in aggregate, PTSD symptoms significantly improve over the course of treatment but can remain at elevated levels following treatment. Identifying individuals who respond to residential treatment versus those who do not, including those who worsen, is critical given the extensive resources required for such programs. This study examined predictors of treatment response among 282 male service members who received treatment in a U.S. Department of Defense residential PTSD program. Using established criteria, service members were classified as improved, indeterminate (referent), or worsened in terms of self-reported PTSD symptoms. Multinomial logistic regression results showed that for PTSD symptoms, higher levels of pretreatment PTSD symptom severity were associated with significantly lower odds of being in the improved group, adjusted odds ratio (aOR) = 0.955, p = .018. In addition, service members who completed treatment were significantly more likely to be in the improved group, aOR = 2.488, p = .048. Longer average pretreatment nightly sleep duration, aOR = 1.157, p = .035, and more severe pretreatment depressive symptoms, aOR = 1.109, p = .014, were associated with significantly higher odds of being in the improved group. These findings reveal clinical characteristics better suited for residential PTSD treatment and highlight implications for comorbid conditions.

Overcoming Adversity and Stress Injury Support (OASIS): Evaluation of Residential Treatment Outcomes for U.S. Service Members with Posttraumatic Stress Disorder.

Research on residential posttraumatic stress disorder (PTSD) treatment has predominantly focused on the U.S. veteran population, whereas limited research exists regarding active duty service members. The present study evaluated outcomes among service members who received treatment in the Department of Defense's only residential PTSD program, Overcoming Adversity and Stress Injury Support (OASIS). Over a 5-year period, 289 male service members with combat-related PTSD received treatment in the program. Service members completed an initial assessment and weekly PTSD and depression self-report measures during the 10-week program. Multilevel modeling results demonstrated statistically significant reductions in PTSD. On average, participants reported a 0.76-point reduction on the PTSD Checklist, B = -0.76, p < .001, for each additional week of treatment. Pretreatment symptom scores and fitness-for-duty status predicted PTSD symptoms across time. Weekly changes in depression symptoms were not statistically significant; however, a significant Time × Pretreatment Depression Severity interaction emerged. Service members with higher baseline levels of depression severity showed larger reductions in depression symptom severity than those with lower levels, B = -0.02, p = .020, although a sizeable minority continued to retain symptoms at diagnostic levels. Depression symptom change was not related to any other treatment- or service-related variables. Differing trajectories were found between service members whose symptoms improved over the course of residential treatment and those who did not. The results indicate that there were larger improvements in PTSD than depression symptoms and highlight the need to optimize care provision for service members with severe PTSD or comorbid symptoms.

Mediation and Moderation of the Relationship Between Combat Experiences and Post-Traumatic Stress Symptoms in Active Duty Military Personnel.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a major health concern among the U.S. military population, affecting up to 12% to 24% of veterans returning from Iraq and Afghanistan. Sleep disturbances, neuroticism, and childhood trauma have all been associated with the development of PTSD in military populations, especially in relation to combat experiences. The effects of disrupted sleep and post-traumatic stress can affect the physical well-being of soldier and sailors in the field and impact them for years after deployment. This study aimed to evaluate the relationship between self-reported measures of combat experiences, PTSD symptoms, sleep, neuroticism, and childhood adversity in an active duty military population. METHODS: 972 U.S. Navy Sailors serving in Afghanistan were given anonymous surveys that assess scales of combat stressors, PTSD symptoms, sleep problems, neuroticism, adverse child experiences (ACEs), and other covariates. Sleep disturbances were hypothesized as moderators, having an indirect effect on the relationship between combat experiences and PTSD symptoms. Neuroticism scores and ACEs were proposed as moderators of the combat-PTSD symptom relationship. Mediation and moderation models were developed and tested using logistic regressions. FINDINGS: Increased number of combat experiences was found to be a significant predictor of PTSD, even when adjusting for all covariates (p < 0.05). Consistent with partial mediation, nightmares had an indirect effect on the relationship between combat experiences and PTSD symptoms in the final model (path coefficient = 0.233, 95% confidence interval = 0.036, 0.483). Neuroticism was an independent predictor of PTSD symptoms (p < 0.001), but the interaction of combat and neuroticism did not predict symptoms of PTSD. ACEs did not have a significant impact in the model as either an independent predictor or a moderating factor. DISCUSSION: These results indicate that the presence of nightmares may partially explain how traumatic combat experiences lead to the development of PTSD. The study also reaffirms neuroticism as risk factor for developing PTSD symptoms. These findings highlight the importance of sleep hygiene and operational stress models in combat situations and may help stress control professionals address risk factors associated with PTSD symptoms.

Meta-analysis of average symptom change in inpatient treatment for posttraumatic stress disorder in veteran and active duty U.S. military samples.

This study tested the hypothesis that inpatient/residential treatment for PTSD associated with military duty should result in significantly lower PTSD symptoms at patient discharge compared to patient intake. Meta-analysis of effects comparing intake and discharge PTSD symptoms from 26 samples, reported in 16 studies, supported this hypothesis (d = -.73; p < .00001). Moderator analysis indicated between-study variation in PTSD symptom changes was predominantly due to the type of measure used, with the Clinician Administered PTSD Scale producing the largest effect (d = -1.60). Larger effects were also observed for more recently published studies and studies with larger percentages of females. These findings support the efficacy of inpatient treatment for military PTSD, although a causal factor for effectiveness could not be identified. Further, the results indicate between-program comparisons of symptom reduction require the same measure of PTSD. (PsycINFO Database Record

Reliable Change Estimates for Assessing Recovery From Concussion Using the ANAM4 TBI-MIL.

OBJECTIVE: To establish the reliable change parameters for the Automated Neuropsychological Assessment Metrics (ANAM) using a healthy normative sample of active duty service members (SMs) and apply the parameters to sample of recently deployed SMs. METHODS: Postdeployment neurocognitive performance was compared in 1893 US Marines with high rates of combat exposure during deployment. Of the sample, 289 SMs had data for 2 predeployment assessments and were used as a normative subsample and 502 SMs had data for predeployment and postdeployment assessments and were used as a deployed subsample. On the basis of self-report, the deployed subsample were further classified as concussed (n = 238) or as nonconcussed controls (n = 264). Reliable change parameters were estimated from the normative sample and applied data for both deployed groups. Postdeployment performance was quantified using a general linear model (2 group × 2 time) multivariate analysis of variance with repeated measures. RESULTS: Both deployed groups demonstrated a pattern of meaningful decreases in performance over time. CONCLUSIONS: Information from this effort, specifically the reliable change parameters and the base rates of reliable decline, can be used to assist with the identification of postdeployment cognitive issues.

Psychometric investigation of the abbreviated concussion symptom inventory in a sample of U.S. Marines returning from combat.

This study describes the psychometric investigation of an 11-item symptom checklist, the Abbreviated Concussion Symptom Inventory (ACSI). The ACSI is a dichotomously scored list of postconcussive symptoms associated with mild traumatic brain injury. The ACSI was administered to Marines (N = 1,435) within the 1st month of their return from combat deployments to Afghanistan. Psychometric analyses based upon nonparametric item response theory supported scoring the ACSI via simple summation of symptom endorsements; doing so produced a total score with good reliability (α = .802). Total scores were also found to significantly differentiate between different levels of head injury complexity during deployment, F(3, 1,431) = 100.75, p < .001. The findings support the use of the ASCI in research settings requiring a psychometrically reliable measure of postconcussion symptoms.

Prevalence and mental health correlates of sleep disruption among military members serving in a combat zone.

Sleep disruption is an emergent military health issue, but remarkably little is known of its prevalence or comorbidities in the combat zone. This study was designed to quantify the prevalence and mental health correlates of sleep disruption among military personnel serving within a ground combat zone during Operation Enduring Freedom. This was a large, cross-sectional survey of active duty and reserve U.S. Navy personnel (N = 3,175). Self-reported sleep measures included total hours of sleep per day, total hours of sleep required to feel well-rested, difficulty falling asleep, and difficulty staying asleep. The survey also measured mental health symptoms, including post-traumatic stress symptoms, anxiety, and depression. Participants reported an average of 5.9 hours of sleep per day despite requiring on average 6.8 hours to feel well rested. More than half (56%) were classified as sleep deficient, and 67% reported 6 or fewer hours of sleep per day. Adjusted for covariates, individuals endorsing sleep disruption were at substantially elevated risk of meeting criteria for post-traumatic stress disorder, generalized anxiety disorder, and major depressive disorder. This study documents the prevalence of sleep disruption in a very large and difficult-to-access sample of military members serving in a combat zone, and details robust associations with mental health.

Analysis of post-deployment cognitive performance and symptom recovery in U.S. Marines.

BACKGROUND: Computerized neurocognitive testing (NCAT) has been proposed to be useful as a screening tool for post-deployment cognitive deficits in the setting of mild traumatic brain injury (mTBI). We assessed the clinical utility of post-injury/post-deployment Automated Neurocognitive Assessment Metric (ANAM) testing, using a longitudinal design to compare baseline ANAM tests with two post-deployment ANAM tests in a group of Marines who experienced combat during deployment. METHODS AND FINDINGS: Post-deployment cognitive performance and symptom recovery were compared in a subsample of 1324 U.S. Marines with high rates of combat exposure during deployment. Of the sample, 169 Marines had available baseline and twice repeated post-deployment ANAM results. A retrospective analysis of the ANAM data, which consisted of a self-report questionnaire about deployment-related blast exposure, recent history of mTBI, current clinical symptoms, and cognitive performance. Self-reported concussion sustained anytime during deployment was associated with a decrease in cognitive performance measured between 2-8 weeks post-deployment. At the second post-deployment test conducted on average eight months later, performance on the second simple reaction time test, in particular, remained impaired and was the most consistent and sensitive indicator of the cognitive decrements. Additionally, post-concussive symptoms were shown to persist in injured Marines with a self-reported history of concussion for an additional five months after most cognitive deficits resolved. Results of this study showed a measurable deployment effect on cognitive performance, although this effect appears to resolve without lasting clinical sequelae in those without history of deployment-related concussion. CONCLUSIONS: These results highlight the need for a detailed clinical examination for service members with history of concussion and persistent clinical symptoms. Reliance solely upon computerized neurocognitive testing as a method for identifying service members requiring clinical follow-up post-concussion is not recommended, as cognitive functioning only slowly returned to baseline levels in the setting of persistent clinical symptoms.

Five-factor model facet characteristics of non-aeronautically adaptable military aviators.

BACKGROUND: The present study revisited a large sample of clinically referred military aviators, previously evaluated across factors of the Five Factor Model of personality (FFM), to determine whether identified facet differences were consistent with U.S. Navy guidelines for evaluating aeronautical adaptability. METHODS: Clinically evaluated U.S. Naval aviators and flight officers (N = 954) disposed as either aeronautically adaptable (AA) or not aeronautically adaptable (NAA) were compared with respect to their facet level scores on the NEO Personality Inventory (NEO PI-R). Additional analyses were conducted to control for NAA status attributable to physical as opposed to psychological standards and for student versus designated aviator/flight officer experience levels. RESULTS: NAA aviators and flight officers, when compared to their AA counterparts, evidenced significant and substantive effect size differences on facets measuring negative emotionality, interpersonal effectiveness, and goal-orientation. CONCLUSION: FFM facet differences between AA and NAA officers were only partially consistent with U.S. Navy guidelines; expected facet differences related to compliance, deliberation, actions, and excitement-seeking/impulsivity were not observed.

Epilepsy, sleep disturbances, and psychiatric consequences.

Neurologic impairment after TBI causes serious morbidity for patients and their families. Prior articles have discussed headache and memory impairment. In this article, epilepsy, sleep disturbances, and psychiatric consequences will be covered. People who have suffered traumatic brain injury are at risk for any of these disturbances, and each person will have a constellation of neurologic symptoms spanning the spectrum from no difficulty in any area to symptoms in each of these areas.

Personality traits in clinically referred aviators: two clusters related to occupational suitability.

BACKGROUND: The Five Factor Model (FFM) of normal personality provides a compelling framework for investigating personality subtypes in large military populations. The FFM was used to determine whether a sample of clinically referred military aviators exhibited commonly occurring personality clusters. METHODS: The Revised NEO Personality Inventory (NEO-PI-R) was used to evaluate 956 clinically referred U.S. Naval aviators and flight officers on the domains of neuroticism (N), extroversion (E), openness (O), agreeableness (A), and conscientiousness (C). The scores were subjected to model-based cluster analysis and emergent clusters were compared with respect to their scores and clinical outcomes. RESULTS: A two-cluster model provided the best fit to the data. MANOVA indicated significant differences between the two cluster groups with respect to four of the five factors (N, E, A, and C). The greatest differences were for N and E, with the smaller group (Group 1, N = 291) being significantly more neurotic and less extroverted than Group 2 (N = 665). Cluster membership had more specificity (0.74) than sensitivity (0.59) for predicting adverse clinical outcome, with the probability of an adverse clinical outcome increasing from 0.14 to 0.28 for those in the neurotic and introverted Group 1. CONCLUSIONS: Elevated neuroticism and depressed extraversion were the defining traits of the personality cluster less suited for aviation duty (Group 1). Results support assessment of neuroticism and extroversion during clinical mental health evaluations related to military aviation duty.

Youth psychopathy and criminal recidivism: a meta-analysis of the psychopathy checklist measures.

Although narrative reviews have suggested that "youth psychopathy" is a strong predictor of future crime and violence, to date no quantitative summaries of this literature have been conducted. We meta-analyzed recidivism data for the Psychopathy Checklist measures across 21 non-overlapping samples of male and female juvenile offenders. After removing outliers, psychopathy was significantly associated with general and violent recidivism (r (w)'s of .24 and .25, respectively), but negligibly related to sexual recidivism in the few studies examining this low base rate outcome. Even after eliminating outliers, however, considerable heterogeneity was noted among the effects, with some of this variability being explained by the gender and ethnic composition of the samples. Effect sizes for the small number of female samples available for analysis were mostly small and nonsignificant, and psychopathy was a weaker predictor of violent recidivism among more ethnically heterogeneous samples. In relation to predicting both general and violent recidivism, psychopathy performed comparably to an instrument designed specifically to assess risk, the Youth Level of Service/Case Management Inventory (Hoge & Andrews, 2002).

Shame coping styles and psychopathic personality traits.

The convergent validity of the primary and secondary psychopathy scales of the Levenson, Kiehl, and Fitzpatrick (1995) Self-Report Psychopathy Scale (SRPS) were investigated by contrasting correlations between the two SRPS scales and self-report adaptive and maladaptive shame coping scales. The results, from a sample of 305 undergraduates, supported the convergent validity of the SRPS primary (selfish, uncaring, manipulative interpersonal style) and secondary (impulsivity and self-defeating behavior) scales; both possessed small but significant negative relationships with adaptive shame coping and small but significant positive relationships with externalizing shame coping. An opposing pattern of convergent validity was evidenced by partial correlations (controlling for SPRS scale covariance) that indicated the SRPS primary scale had a negative relationship and the secondary scale had a positive relationship to internalizing shame coping.

Atividade física e níveis de fadiga em pacientes portadores de câncer / Physical activity and levels of fatigue in cancer patients

OBJETIVO: O presente estudo teve como objetivo relacionar as adaptações fisiológicas proporcionadas pela atividade física e os níveis de fadiga em pacientes portadores de câncer. MATERIAL E MÉTODOS: Vinte e sete pacientes (56,7 ± 14,8 anos) diagnosticados com câncer e que participavam de tratamento de quimioterapia, de radiação ou de uma combinação desses dois tipos de tratamentos foram os voluntários neste projeto. Todos os pacientes participaram de duas avaliações físicas: uma antes do início do programa de exercícios físicos e outra seis meses após. Nos dias das avaliações físicas, os pacientes responderam ao questionário de escala de fadiga de Piper et al. (1989). Todas as variáveis independentes (adaptações fisiológicas) foram padronizadas (escores Z). De acordo com o modelo de regressão linear múltipla, todas as variáveis independentes foram inseridas no modelo simultaneamente. RESULTADOS: Os resultados não demonstraram relação significativa (p < 0,01) na variação da redução de fadiga (r² = 0,102). Após o resultado não significativo da análise de regressão linear múltipla, os resultados das correlações simples também não demonstraram resultados significativos. CONCLUSAO: Apesar de a melhora na aptidão física dos pacientes com câncer não ter apresentado correlação significativa com a redução da fadiga, a relação entre a melhora do condicionamento físico geral em pacientes com câncer mostrou um padrão positivo e linear.

Juvenile sex offenders in diversion.

This study was designed to address the treatment of juvenile sex offenders within diversion programs. Using data from 32 diversion programs in Colorado during the 1998-1999 fiscal year, the study observed the demographic and legal characteristics of 112 juvenile (Mean age = 14.64) sex offenders referred to diversion programs for seven types of sex assault, incest, and indecent exposure charges. Descriptions of services offered to juveniles and their in-program outcome were also observed. Data support previous contentions in the literature that diversion is an option for adjudicated juvenile sex offenders as well as diversion's traditional nonadjudicated population. However, the assumption that only nonserious juvenile sex offenders are referred to diversion was challenged by the data observed in this study.