Abstract
Although research has shown that exposure to potentially traumatic and morally injurious events is associated with psychological symptoms among veterans, knowledge regarding functioning impacts remains limited. A population-based sample of post-9/11 veterans completed measures of intimate relationship, health, and work functioning at approximately 9, 15, 21, and 27 months after leaving service. Moral injury, posttraumatic stress, and depression were assessed at ~9 months post-separation. We used Latent Growth Mixture Models to identify discrete classes characterized by unique trajectories of change in functioning over time and to examine predictors of class membership. Veterans were assigned to one of four functioning trajectories: high and stable, high and decreasing, moderate and increasing, and moderate and stable. Whereas posttraumatic stress, depression, and moral injury associated with perpetration and betrayal predicted worse outcomes at baseline across multiple functioning domains, moral injury associated with perpetration and depression most reliably predicted assignment to trajectories characterized by relatively poor or declining functioning. Moral injury contributes to functional problems beyond what is explained by posttraumatic stress and depression, and moral injury due to perpetration and depression most reliably predicted assignment to trajectories characterized by functional impairment over time.
Highlights
In recent years, there has been a shift from focusing on psychological symptoms, disease, and disability to considering the full continua of physical, mental, and social well-being (Cooke, Melchert, & Connor, 2016)
Inspection of the plotted estimated mean values of intimate relationship functioning across time revealed that the four-class solution contained trajectories that were different in form from trajectories revealed by models with fewer classes, while the five-class solution split one of the primary trajectories observed in the four-class solution into two separate classes with minor differences
Some studies have found that posttraumatic stress disorder (PTSD) and depression impact functioning, PTSD impacts functioning more than depression, or depression impacts functioning more than PTSD
Summary
There has been a shift from focusing on psychological symptoms, disease, and disability to considering the full continua of physical, mental, and social well-being (Cooke, Melchert, & Connor, 2016). Symptoms are important and can serve as indicators of well-being, functioning contributes to well-being and is essential to assess in its own right, especially in the course of recovery from psychological trauma. To this end, studies that examine trajectories of posttraumatic stress (e.g. Galatzer-Levy, Huang,& Bonanno, 2018) or depression Moral injury contributes to functional problems beyond what is explained by posttraumatic stress and depression, and moral injury due to perpetration and depression most reliably predicted assignment to trajectories characterized by functional impairment over time
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