Does Prior Civilian Trauma Moderate the Relationship Between Combat Trauma and Post-deployment Mental Health Symptoms?

Brianna A George, Kaitlin E Bountress, Ruth C Brown, Sage E Hawn, Emily A Brown Weida, Scott D McDonald, Treven Pickett, Carla Kmett Danielson, Christina M Sheerin, Ananda B Amstadter
Author Information
  1. Brianna A George: Virginia Commonwealth University, Richmond, VA, United States. ORCID
  2. Kaitlin E Bountress: Virginia Commonwealth University, Richmond, VA, United States. ORCID
  3. Ruth C Brown: Virginia Commonwealth University, Richmond, VA, United States.
  4. Sage E Hawn: Virginia Commonwealth University, Richmond, VA, United States.
  5. Emily A Brown Weida: Drexel University, Philadelphia, PA, United States.
  6. Scott D McDonald: Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States.
  7. Treven Pickett: National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, MD, United States.
  8. Carla Kmett Danielson: Medical University of South Carolina, Charleston, SC, United States.
  9. Christina M Sheerin: Virginia Commonwealth University, Richmond, VA, United States.
  10. Ananda B Amstadter: Virginia Commonwealth University, Richmond, VA, United States.

Abstract

In addition to combat trauma, childhood and adult non-military, interpersonal trauma exposures have been linked to a range of psychiatric symptoms (e.g., alcohol use problems, posttraumatic stress disorder [PTSD], depression symptoms) in veterans. However, few studies simultaneously explore the associations between these civilian and combat trauma types and mental health outcomes. Using a sample of combat-exposed veterans who were previously deployed to Iraq and Afghanistan ( = 302), this study sought to (a) understand the independent associations of civilian interpersonal trauma (i.e., childhood trauma and non-military adult trauma) and combat-related trauma with post-deployment alcohol use, PTSD symptoms, and depressive symptoms, respectively and (b) to examine the interactive effects of trauma type to test whether childhood and non-military adult trauma moderate the association of combat trauma with these outcomes. A path analytic framework was used to allow for the simultaneous prediction of these associations. In the final model non-military adult trauma and combat trauma were found to be significantly associated with PTSD symptoms and depression symptoms, but not average amount of drinks consumed per drinking day. Childhood trauma was not associated with any outcomes (i.e., PTSD symptoms, depression symptoms, average amount of drinks consumed per day). Only combat trauma was significantly associated with average amount of drinks consumed per day. Results underscore the importance of assessing multiple trauma types and considering trauma as a non-specific risk factor, as different trauma types may differentially predict various mental health outcomes other than PTSD. Further, results highlight the noteworthiness of considering co-occurring outcomes within the veteran community. Limitations, future directions, and implications of diversity are discussed.

Keywords

References

  1. Psychosom Med. 2007 Apr;69(3):242-8 [PMID: 17401056]
  2. Ann N Y Acad Sci. 2008 Oct;1141:105-30 [PMID: 18991954]
  3. Drug Alcohol Depend. 1996 Sep;42(1):49-54 [PMID: 8889403]
  4. Soc Sci Med. 1988;26(3):319-25 [PMID: 3347854]
  5. Psychiatr Serv. 2017 Jan 1;68(1):48-55 [PMID: 27476804]
  6. J Head Trauma Rehabil. 2017 May/Jun;32(3):E65-E74 [PMID: 27455436]
  7. Subst Abus. 2018;39(4):452-460 [PMID: 29485365]
  8. JAMA. 2008 Aug 13;300(6):720-1 [PMID: 18698070]
  9. J Trauma Stress. 2010 Apr;23(2):248-54 [PMID: 20419733]
  10. Alcohol Clin Exp Res. 2014 Jul;38(7):2048-55 [PMID: 24961735]
  11. JAMA Psychiatry. 2017 Mar 1;74(3):270-281 [PMID: 28055082]
  12. Assessment. 2008 Dec;15(4):391-403 [PMID: 18436857]
  13. Addict Behav. 2014 Feb;39(2):414-9 [PMID: 23768787]
  14. J Clin Psychiatry. 2014 Feb;75(2):147-53 [PMID: 24345958]
  15. J Psychiatr Res. 2009 Jun;43(9):830-6 [PMID: 19232639]
  16. Drug Alcohol Depend. 2013 Dec 1;133(2):615-24 [PMID: 24054989]
  17. Drug Alcohol Depend. 2011 Jul 1;116(1-3):93-101 [PMID: 21277712]
  18. J Clin Psychiatry. 2006 Sep;67(9):1346-53 [PMID: 17017820]
  19. Addict Behav. 2017 Jul;70:54-60 [PMID: 28214434]
  20. Psychol Med. 2016 Jan;46(2):327-43 [PMID: 26511595]
  21. Child Abuse Negl. 2012 May;36(5):423-32 [PMID: 22633055]
  22. Arch Gen Psychiatry. 2003 Oct;60(10):993-1000 [PMID: 14557144]
  23. Compr Psychiatry. 1998 Jul-Aug;39(4):176-84 [PMID: 9675501]
  24. PLoS One. 2015 Mar 20;10(3):e0120270 [PMID: 25793582]
  25. Psychiatry Res. 2013 Mar 30;206(1):33-6 [PMID: 23068077]
  26. J Psychiatr Res. 2017 Jan;84:119-127 [PMID: 27728852]
  27. Drug Alcohol Depend. 2010 Apr 1;108(1-2):115-21 [PMID: 20060237]
  28. Arch Gen Psychiatry. 2003 Mar;60(3):289-94 [PMID: 12622662]
  29. J Clin Psychiatry. 2008 Nov;69(11):1686-93 [PMID: 19012816]
  30. J Clin Psychiatry. 2000;61 Suppl 5:4-12; discussion 13-4 [PMID: 10761674]
  31. Rand Health Q. 2018 Oct 11;8(2):5 [PMID: 30323988]
  32. JAMA. 2008 Aug 13;300(6):663-75 [PMID: 18698065]
  33. J Trauma Stress. 2012 Apr;25(2):216-9 [PMID: 22522738]
  34. Int J Soc Psychiatry. 1981 Autumn;27(3):204-12 [PMID: 7327868]
  35. J Trauma Stress. 1995 Jan;8(1):75-90 [PMID: 7712061]
  36. Psychol Bull. 2003 Jan;129(1):52-73 [PMID: 12555794]
  37. J Anxiety Disord. 2015 Apr;31:98-107 [PMID: 25768399]
  38. J Psychosom Res. 1981;25(4):309-20 [PMID: 7288683]
  39. J Anxiety Disord. 2005;19(8):861-76 [PMID: 16243635]
  40. Am J Public Health. 2009 Sep;99(9):1651-8 [PMID: 19608954]
  41. Am J Prev Med. 2007 Aug;33(2):77-82 [PMID: 17673093]

Grants

  1. K01 AA028058/NIAAA NIH HHS
  2. R01 AA020179/NIAAA NIH HHS
  3. K02 AA023239/NIAAA NIH HHS
  4. K01 AA025692/NIAAA NIH HHS
  5. F31 AA025820/NIAAA NIH HHS

MeSH Term

Adult
Afghan Campaign 2001-
Combat Disorders
Humans
Iraq War, 2003-2011
Mental Health
Military Personnel
Stress Disorders, Post-Traumatic
Veterans

Word Cloud

Created with Highcharts 10.0.0traumasymptomsPTSDcombatoutcomesadultnon-militarychildhoodealcoholdepressionassociationstypesassociatedaverageamountdrinksconsumedperdayinterpersonaluseveteranscivilianmentalhealthisignificantlyconsideringTraumaadditionexposureslinkedrangepsychiatricgproblemsposttraumaticstressdisorder[PTSD]HoweverstudiessimultaneouslyexploreUsingsamplecombat-exposedpreviouslydeployedIraqAfghanistan=302studysoughtunderstandindependentcombat-relatedpost-deploymentdepressiverespectivelybexamineinteractiveeffectstypetestwhethermoderateassociationpathanalyticframeworkusedallowsimultaneouspredictionfinalmodelfounddrinkingChildhoodResultsunderscoreimportanceassessingmultiplenon-specificriskfactordifferentmaydifferentiallypredictvariousresultshighlightnoteworthinessco-occurringwithinveterancommunityLimitationsfuturedirectionsimplicationsdiversitydiscussedPriorCivilianModerateRelationshipCombatPost-deploymentMentalHealthSymptoms?Hxchildabuse<drugsviolenceexposurewar

Similar Articles

Cited By (3)