A prediction model for differential resilience to the effects of combat-related stressors in US army soldiers.

Abstract

To develop a composite score for differential resilience to effects of combat-related stressors (CRS) on persistent DSM-IV post-traumatic stress disorder (PTSD) among US Army combat arms soldiers using survey data collected before deployment. A sample of n=2542 US Army combat arms soldiers completed a survey shortly before deployment to Afghanistan and then again two to three and 8-9months after redeployment. Retrospective self-reports were obtained about CRS. Precision treatment methods were used to determine whether differential resilience to persistent PTSD in the follow-up surveys could be developed from pre-deployment survey data in a 60% training sample and validated in a 40% test sample. 40.8% of respondents experienced high CRS and 5.4% developed persistent PTSD. Significant test sample heterogeneity was found in resilience (t=2.1, p=0.032), with average treatment effect (ATE) of high CRS in the 20% least resilient soldiers of 17.1% (SE=5.5%) compared to ATE=3.8% (SE=1.2%) in the remaining 80%. The most important predictors involved recent and lifetime pre-deployment distress disorders. A reliable pre-deployment resilience score can be constructed to predict variation in the effects of high CRS on persistent PTSD among combat arms soldiers. Such a score could be used to target preventive interventions to reduce PTSD or other resilience-related outcomes.