Examining the dimensionality of combat-related posttraumatic stress and depressive symptoms in treatment-seeking OEF/OIF/OND veterans

Abstract

This study examined the factor structure of two of the most commonly used screening measures of posttraumatic stress disorder and depression in 164 treatment-seeking veterans who served in Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND). Exploratory factor analysis was used to assess the dimensionality of items from the Posttraumatic Stress Disorder Checklist-Military Version (PCL-M) and the Patient Health Questionnaire-9 (PHQ-9). Regression analyses were then conducted to examine associations between factor scores of the resulting factor solution and measures of alcohol use, cognitive coping, psychological resilience, social support, and healthcare utilization. A four-factor solution was found that consisted of clusters of symptoms reflecting reexperiencing/avoidance, detachment/numbing, hopelessness/depression, and bodily disturbance. Scores on the detachment/numbing factor were uniquely related to alcohol use, whereas scores on the hopelessness/depression factor was uniquely associated with emergency room visits. Compared to conventional PCL-M and PHQ-9 total scores, the four-factor solution explained 2 to 10% more variance in scores on measures of alcohol use, cognitive coping, psychological resilience, social support, and healthcare utilization. This study was limited by a small sample size and cross-sectional design. Combat-related posttraumatic stress disorder and depressive symptoms in treatment-seeking OEF/OIF/OND veterans may be better conceptualized by four dimensions of reexperiencing/avoidance, detachment/numbing, hopelessness/depression, and bodily disturbance symptoms. This symptom structure may provide greater utility when examining other outcomes of interest in this population.