Potentially Modifiable Pre-, Peri-, and Postdeployment Characteristics Associated With Deployment-Related Posttraumatic Stress Disorder Among Ohio Army National Guard Soldiers

Purpose

To evaluate potentially modifiable deployment characteristics—predeployment preparedness, unit support during deployment, and postdeployment support—that may be associated with deployment-related posttraumatic stress disorder (PTSD).

Methods

We recruited a sample of 2616 Ohio Army National Guard (OHARNG) soldiers and conducted structured interviews to assess traumatic event exposure and PTSD related to the soldiers’ most recent deployment, consistent with DSM-IV criteria. We assessed preparedness, unit support, and postdeployment support by using multimeasure scales adapted from the Deployment Risk and Resilience Survey.

Results

The prevalence of deployment-related PTSD was 9.6%. In adjusted logistic models, high levels of all three deployment characteristics (compared with low) were independently associated with lower odds of PTSD. When we evaluated the influence of combinations of deployment characteristics on the development of PTSD, we found that postdeployment support was an essential factor in the prevention of PTSD.

Conclusions

Results show that factors throughout the life course of deployment—in particular, postdeployment support—may influence the development of PTSD. These results suggest that the development of suitable postdeployment support opportunities may be centrally important in mitigating the psychological consequences of war.

Introduction

The authors of several studies have documented the prevalence of psychopathology after combat. In a study of veterans from the first Gulf War (1990−1991), Kang et al. (1) reported that the prevalence of posttraumatic stress disorder (PTSD) was 10.1% approximately 10 years after the war. Hoge et al. (2) examined soldiers upon returning from deployment and found prevalence estimates of 12.9% and 6.2% among U.S. Army soldiers in Iraq (Operation Iraqi Freedom, [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]), respectively, and 12.2% among Marine Corps soldiers who served in OIF. The Millennium Cohort Study, a prospective study that assesses mental health in current and former members of the U.S. military, reported at baseline that 2.4% of respondents had the symptoms of PTSD in the past month (3).

Although there are fewer such studies, some investigators have also estimated the burden of PTSD among National Guard and Reserve soldiers, ranging from 2.0% in Gulf War veterans 4, 5 to 12.7% in OIF veterans (6). These soldiers have historically contributed only part-time to the military and have principally participated in mostly domestic incidents. However, more recently they have increasingly been deployed to war zones oversees. As of 2008, Guard and Reserve forces constituted approximately 11% of current combat forces in OIF and 21% in OEF (7). Understanding what factors influence PTSD development among Guard and Reserve forces may shed light on post-deployment psychopathology in this population.

Risk factors for PTSD can be divided into three groups on the basis of their temporal relationship with the traumatic event (i.e., characteristics from before, during, and after the event) (8). In studies that use data from various military populations, e.g., veterans of the Vietnam War (9), the first Gulf War (10), OIF and OEF 11, 12, as well as soldiers and peacekeepers in other combat locations (13), authors have examined the relationship between these types of variables and PTSD after deployment. They have found associations between PTSD and predeployment risk factors, such as socioeconomic status, history of early trauma, antisocial behavior during childhood, friendships and family environment in childhood, age at entry to Vietnam, and exposure to predeployment stressors 10, 14, 15, 16. Other studies report relations between PTSD and factors during deployment, such as traditional combat experience, difficult living/working environment, concerns about family at home, unit support, experience with atrocities or abusive violence, and perceived life threat 10, 13, 16, 17, 18. Postdeployment factors such as additional stressful life events, hardiness, and social support also are influential in the development of PTSD, with perceived functional social support acting as a particularly strong predictor of the disorder 13, 15, 16, 19, 20, 21.

Although some of the risk factors identified in these studies are inextricable from the experience of war, other factors may well be modifiable and can therefore point to potential interventions that may mitigate the psychological consequences of war. In this study we consider modifiable factors pre-, peri-, and post-deployment that may influence the risk of PTSD by using baseline data from a 10-year prospective study of a current Army National Guard population. We approach the study from a life-course perspective, considering both the independent and the interactive contribution of these factors (22). Although we evaluate the independent relations between each deployment factor and deployment-related PTSD, we are particularly interested in how these factors together influence risk of PTSD. We hope that through this approach we might (i) identify potential areas of intervention that can be modified throughout the course of deployment to mitigate the consequences of deployment experience or (ii) identify one modifiable deployment characteristic whose improvement may have the greatest benefit to soldiers’ postdeployment psychological well-being.