Abstract
Methods: We assessed PTSD (PCL N=50), combat intensity (34 summed, weighted items in tertiles), depression (PHQ), and alcohol misuse (TICS) in a sample of 2422 Soldiers. Family history of depression and alcohol misuse were assessed using 2 items from the Adverse Childhood Experiences Study. Results: In logistic regression models, combat intensity increases risk for PTSD (for intermediate intensity, odds ratio [OR]=2.5, 95% confidence interval [CI]=1.8–3.5; for high intensity, OR=5.2, CI=3.8,7.2; prNχ for trend=0.000). Family history of depression (OR=1.4, CI=1.0–2.0), and alcohol misuse (OR=1.4, CI=1.1–1.9), and subject depression (OR=20.6, CI=15.0–28.4) and alcohol misuse (OR=1.5, CI=1.1–2.0), all increase risk for PTSD but do not confound the association of combat experiences and PTSD. No effect modification was detected. Conclusion: Family histories of depression and alcohol misuse modestly predict PTSD, but neither confound nor modify the effect of subjects' combat experience, depression, and alcohol misuse on PTSD. Intensity of exposure to warfare itself principally drives PTSD symptomatology and concomitant depression and alcohol misuse.
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