Combat Exposure Scale Research Articles

An empirical study of the post-experiential growth of military personnel – combatants

The need to find innovative technologies for psychological recovery and rehabilitation of servicemen – combatants, taking into account the positive personal changes that can develop as a result of their experience of traumatic and non-traumatic (negative stressful) events in a combat situation, led to the choice of the research topic. The purpose of the study is to examine the relationship between the post-experiential growth of servicemen and women combatants and their life and combat experience. The study was conducted in the period from January 2023 to January 2024 among 375 servicemen and servicewomen of the Armed Forces of Ukraine. The study used theoretical (analysis, synthesis, systematisation, generalisation of information) and diagnostic (S. Blight and K. Norris Post-Experiential Growth Questionnaire; Combat Exposure Scale; author's questionnaire consisting of 5 questions to determine the presence of traumatic events in life and in the workplace). The empirical study has established that: 1) moderate signs of positive psychological changes were found in groups of military personnel both with and without traumatic experience; 2) no statistically significant differences were found between the level of manifestation of signs of post-experiential growth in groups of military personnel with and without traumatic experience, while the size of the standardised effect was insignificant; 3) signs of post-experiential growth in servicemen and women who participated in combat operations have positive correlations with the rates of injury and the presence of a serious event in their life and combat experience. The results of the study give grounds to identify and build on positive psychological changes in a wider range of servicemen and women and veterans as a personal resource in the course of their psychological recovery and psychological rehabilitation. Positive psychological changes are moderately manifested in groups of military personnel – combatants with different life and combat experience. At the same time, there were no statistically significant differences between the manifestation of post-experiential growth in servicemen and women combatants of these groups. This confirms the idea that post-experiential growth of servicemen and women combatants can occur, unlike post-traumatic growth, as a result of experiencing not only traumatic but also non-traumatic (negative stressful) events.

Gender Disparities in Neurobehavioral Symptoms and the Role of Post-Traumatic Symptoms in US Service Members Following Mild Traumatic Brain Injury.

Women are more directly involved in combat operations today than ever before, currently making up 18.6% of officers and 16.8% of enlisted personnel in the United States military. However, women continue to be under-represented in military research. Studies that do consider gender differences in traumatic brain injury (TBI) outcomes have shown that women report significantly more post-concussive symptoms than men. Conclusions for true gender differences related to TBI are hard to make without controlling for non-TBI factors. The effects previously identified in the literature may be an artifact of how men and women differ in their response to injury, unrelated to the neurological recovery process associated with TBI. The objective of this study was to examine the effects of gender specifics on mild TBI (mTBI) sequelae on injured and uninjured control groups, and to investigate the role of post-traumatic stress disorder (PTSD) on symptom reporting. It should be noted that the terms "gender" and "men/women" are used in this article in place of "sex" or "males/females" given that we are not discussing biological attributes. A total of 966 United States military service members and veterans were included in the study. Of the total sample, 455 men and 46 women were in the mTBI group, 285 men and 31 women were in the injured controls group (IC), and 111 men and 38 women in the non-injured controls group (NIC). Post-concussive and quality of life symptoms were compared for men and women while controlling for combat exposure. MTBI and IC groups were also stratified by PTSD presentation. Measures used included the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist (PCL-C), Traumatic Brain Injury Quality of Life (TBI-QOL), and Combat Exposure Scale. In the mTBI group, women had worse scores on NSI total, NSI Somatosensory and Affective clusters, and the TBI-QOL Anxiety, Fatigue, and Headache scales (n2 = 0.018-0.032, small to small-medium effect sizes). When PTSD was present, women had worse scores on the NSI Somatosensory cluster only (n2 = 0.029, small-medium effect size). In contrast, when PTSD was absent, women had worse scores than men on the NSI Somatosensory and Affective clusters, and the TBI-QOL Anxiety and Headache scales (n2 = 0.032-0.063, small to medium effect sizes). In the IC group, women had worse scores on the NSI Cognitive cluster and the TBI-QOL Fatigue and Pain Interference scales (n2 = 0.024-0.042, small to small-medium effect sizes). However, group differences were no longer found when stratified by PTSD sub-groups. In the NIC group, there were no significant group differences for any analyses. We were able to identify symptoms unique to women recovering from mTBI that were not present following other forms of physical injury or in healthy controls. However, the impact of PTSD exacerbates the symptom profile and its comorbidity with mTBI equates to most of the noted gender differences.

Applying and Extending the Conservation of Resources (COR) Model to Trauma in U.S. Veterans

This was a novel pilot study about the relationship between PTSD severity and resource gain and loss using the conservation of resources (COR) model with U.S. Veterans. Higher PTSD severity was predicted to be associated with greater resource loss scores, and lower PTSD scores were predicted to be associated with greater resource gain scores. The sample size was limited (N = 19) due to the COVID-19 outbreak. Veterans completed a demographic questionnaire, the Montreal Cognitive Assessment (MoCA), the Combat Exposure Scale (CES), the PTSD Symptom Scale–Interview (PSS-I), the Conservation of Resources–Evaluation (COR-E), and two additional open-ended questions. A statistically significant negative medium effect size was found between PTSD diagnosis and resource gain (r(17) = −0.42, p = 0.039, one-tailed). A large effect size in resource gain scores between PTSD and non-PTSD groups was also found (t(17) = 1.880, p = 0.077, d = 0.87), with the non-PTSD group reporting more gain of resources than the PTSD group. Post hoc tests revealed that the resource gain score of the mild PTSD group was significantly higher than that of the severe + very severe PTSD group (p = 0.034). Results suggest that resource gain, when compared to resource loss, was the strongest predictor for a non-PTSD diagnosis.

Convergent and Discriminant Validity of the Blast Exposure Threshold Survey in United States Military Service Members and Veterans.

The Blast Exposure Threshold Survey (BETS) is a recently developed and promising new self-report measure of lifetime blast exposure (LBE). However, there are no studies that have examined the psychometric properties of the BETS, which currently limits its clinical utility. The purpose of this study was to examine the convergent and discriminant validity of the BETS by comparing the BETS Generalized Blast Exposure Value (GBEV) to six variables hypothesized to be associated with LBE (i.e., single-item LBE, combat exposure, years in the military, number of combat deployments, and military occupation specialty [MOS]) and three variables hypothesized not to be associated with LBE (i.e., age at the time of injury, estimated pre-morbid Full-Scale Intelligence Quotient [FSIQ], and resilience). Participants were 202 United States service members and veterans prospectively enrolled from three military medical treatment facilities (68.7%) and via community recruitment initiatives (31.3%). Participants completed the BETS, Combat Exposure Scale (CES), Deployment Risk and Resiliency Inventory-2 Combat Experiences (DRRI-2 CE), Traumatic Brain Injury-Quality of Life Resilience scale, and a brief structured interview. For some analyses, participants were classified into two blast risk MOS groups: high (n = 89) and low (n = 94). The BETS GBEV was not significantly correlated with all three non-blast related variables (rs = 0.01 to rs = -0.12). In contrast, GBEV was significantly (p < 0.001) associated with all blast-related variables; single-item LBE (rs = 0.76), CES (rs = 0.58), number of combat deployments (rs = 0.53), DRRI-2 CE (rs = 0.48), and high blast risk MOS (r = 0.36, medium effect size). However, a stronger relationship was found between the blast-related variables and three modified GBEV scores when excluding some small weapons categories; single-item LBE (rs = 0.80-0.82), CES (rs = 0.64-0.67), number of combat deployments (rs = 0.56), DRRI-2 CE (rs = 0.51-0.53), and high blast risk MOS (r = 0.42-0.49, medium-large effect size). This is the first study to examine the psychometric properties of the BETS. Overall, these results offer support for the convergent and discriminant validity of the BETS. In order to ensure that the BETS can be confidently used as a valid and reliable measure of LBE, more research is needed to further examine the psychometric properties of the test, particularly with regard to the establishment of test-retest reliability.

22 Cognitive and Psychological Profiles of a Specialized Military Force

Objective:The Explosive Ordinance Disposal (EOD) community within the US Military is a specialized force in charge of the most fundamental aspects of the military operations in combat which include disarming and safely disposing explosive threats. EOD technicians have provided critical protection for our military and civilians exposed to improvised explosive devices (IEDs), which became the signature threat of both Afghan and Iraq wars. The nature of the job puts EOD technicians at high risk for blast exposures (from training and combat) resulting in traumatic brain injury (TBI) and sub-concussive head impact. Further, this population is exposed to high levels of combat with psychologically traumatic events. Given the groups neurological and psychological risk factors as well as their critical role in combat, we hypothesized that EOD technicians will present with increased psychological and neurobehavioral symptoms as well decreased cognitive functioning compared to other military personnel.Participants and Methods:Participants were recruited from a military hospital with at least one diagnosed mild traumatic brain injury (MTBI). Exclusion criteria included TBI greater then mild severity and invalid performance on the Rey-15. Final sample included 10 EOD and 90 other military.CognCognitive measures included Hopkins Verbal Learning Test-Reviseitive measures included Hopkins Verbal Learning Test-Revised (HVLT-R); DKEFS Color Word Condition 4 Switching (CW4), Trail Making Condition 3 Letter Sequencing (TM3) and Condition 4 Switching (TM4), and Paced Auditory Serial Addition Test (PASAT). Self-report measures included the Neurobehavioral Symptom Inventory (NSI), Key Behaviors Change Inventory (KBCI), Post-Traumatic Stress Disorder Checklist (PCL-M), Patient Health Questionnaire (PHQ), Combat Exposure Scale (CES) and Blast Exposure Threshold Survey (BETS). The Ohio State University Traumatic Brain Injury Identification Method (OSU) assessed TBI history.Results:EOD were older (EOD M=38.4, SD=4.06; Others M=33.32, SD=8.08; p=0.05), had a higher pre-morbid IQ (EOD M=110.90, SD=7.64; Other M=101.59, SD=10.55; p=0.008), more combat deployments (EOD M=5.5, SD=2.37; Others M=3.55, SD=2.98; p=0.049) and exposure to wartime atrocities (CES, p=0.003). They had greater number of MTBI (OSU EOD M=6.67, SD=3.33; Other M=3.67, SD=2.34; p=0.007), blast related MTBI (OSU-TBI EOD M=2.33, SD=1.63; Other M=0.67, SD=0.91; p&lt;0.001), and exposure to large explosives (BETS p&lt;0.0001). EOD reported better attention skills (KBCI Inattention, p=0.016, d=0.82; Impulsivity p=0.047, d=0.67). There was a trend for EOD to have lower neurobehavioral symptoms (NSI Total, d=0.32), post-traumatic stress (PCL d=0.39), and depression (PHQ d=0.50); however, despite the moderate effect sizes (p’s &gt;0.05). EOD presented with significantly better scores on DKEFS TMT3 (p=0.037, d=0.70), HVLT-R-Total (p=0.001, d=1.10), HVLT-R-Delayed (p=0.03, d=0.74), and attention/executive functioning skills (PASAT p=0.001, d=1.12). DKEFTS CW4 Switching (d=0.51) and TMT4 Switching were approaching significance (d=0.61) with EOD performing better.Conclusions:As expected, the EOD sample in this study had higher number of combat deployments, greater exposure to combat atrocities (e.g., death), higher levels of exposure to large explosives, as well as a higher number of MTBI. Inconsistent with our hypotheses, despite these psychological and neurological risk factors, EOD performed better on cognitive measures of memory, attention and executive functioning. They also reported less problems with inattention and impulsivity. Results may reflect the impact of psychological and cognitive resiliency.

The generation that lived during/participated in the war and the generation that inherited it: association between veterans PTSD and adult offspring’s emotional regulation strategies and alexithymia levels

BackgroundThe long-term repercussions that war can have on both war generations and post-war generations lack in the literature. It is imperative to understand the psychological consequences of the Lebanese Civil War that took place from 1975 to 1990, on the offspring of those who took part in it. Accordingly, the objective of this study was to assess the association between paternal/veterans PTSD and adult offspring’s emotional regulation strategies and alexithymia levels, 30 years after the end of war.MethodA cross-sectional study was carried out between September 2020 and September 2021 on a sample of 75 fathers of Lebanese former veterans and paramilitary veterans and their adult offspring. For the veterans and paramilitary veterans’ population, the PTSD Checklist was used to assess post-traumatic stress disorder, and the Combat Exposure Scale (CES) was used to measure the level of combat exposure. For the offspring population, the Emotional Regulation Questionnaire (ERQ) was used to assess emotional regulation strategies and the Toronto Alexithymia Scale (TAS) was used to measure the levels of alexithymia.ResultsPaternal PTSD (Beta = 10.19) was associated with higher levels of alexithymia in the offspring population. Regarding emotional regulation strategies, results showed that paternal PTSD (Beta = -3.24) was significantly associated with a decrease in the cognitive reappraisal score in the offspring. Also, paternal PTSD (Beta = 4.57) was significantly associated with an increase in expressive suppression score. Additionally, an older father’s age (Beta = 1.11) was significantly associated with an increased alexithymia score in the offspring. Moreover, results showed that paternal combat injuries (Beta = -4.24) were significantly associated with a decrease in the alexithymia score in the offspring population and an increase in the expressive suppression score (Beta = 3.28).ConclusionThis study shows that fathers’ traumatic experience of war influences emotion regulation and alexithymia levels in their offspring. Longitudinal studies taking into account the age of the offspring at the time of onset of fathers’ symptoms may provide us with additional information to understand the influence of paternal PTSD on the emotional functioning of offspring during different phases of emotional development.

Association between catastrophizing, postoperative pain, and injury severity in soldiers injured during the first year of the war in Ukraine

Aims: The aim of this study was to investigate the associ-ation between catastrophizing, postoperative pain, and in-jury severity following war-related injuries among soldiers injured during the first year of the war in Ukraine.Methods: This cross-sectional study included 135 patients with war-related injuries treated at the Center of Thermal Trauma and Reconstructive Surgery of the Vinnytsia re-gional University hospital in Ukraine between August 2022 and November 2022. Following surgical treatment, patients’ catastrophizing was assessed using the Ukrainian version of the Pain Catastrophizing Scale (UA-PCS) and correlated with the pain levels assessed with the numerical rating scale (NRS), and the scores obtained with Injury Severity Score (ISS) and the Combat Exposure Scale (CES). The poten-tial pre-existing traumatic events in a participant’s lifetime were assessed with The Life Events Checklist for DSM-5 (LEC-5).Results: Multiple regression analyses showed no significant association between the PCS total score and demographic variables of age, gender, marital status, education, duration of military service, or time from injury. Only 3.6% of the variance in the catastrophizing scores was accountable for the contribution of independent demographic variables. We found a moderate positive correlation between catastroph-izing scores (including all the subscales) with pain NRS, ISS, and CES scores. The pain NRS, ISS, and CES scores account for 43.4% of the variability of PCS scores. Previous traumat-ic events did not contribute to the catastrophizing scores.Conclusion: Our study describes a positive association be-tween catastrophizing, sustained injuries, combat expo-sure, and postoperative pain. Since our sample consists of injured soldiers that were young and healthy before suffering major war-related polytrauma, our study offers a unique perspective, different from all other previous studies in which catastrophizing was investigated in a ci-vilian population.

Emotion regulation and combat severity differentiates PTSD diagnostic status among veterans.

This study examined whether posttraumatic stress disorder (PTSD) diagnostic groups in veterans were differentiated by combat severity and specific avoidance and approach-related emotion regulation (ER) strategies. In a cohort study, 725 participants (Mage = 58.39, SD = 11.27, 94.5% male, 58.2% White) recruited from VHA facilities completed the Clinician Administered PTSD Scale (CAPS), Combat Exposure Scale (CES), and Emotion Regulation Questionnaire (ERQ). Participants were categorized into three PTSD groups: Current, Remitted, and Never. Multinomial logistic regressions adjusting for age, sex, and race, showed combat severity significantly differentiated all groups from each other (ps < .001). Specifically, combat severity was significantly associated with increased odds of Current PTSD versus Remitted (OR: 1.02, 95% CI [1.01, 1.05]) and Never PTSD (OR: 1.14, [1.12, 1.17]) and odds of Remitted compared with Never PTSD (OR: 1.11, [1.09, 1.14]). Suppression, but not reappraisal, was significantly associated with increased odds of Current PTSD compared with Remitted (OR: 1.15, [1.06, 1.24]) and Never PTSD (OR: 1.14, [1.06, 1.22]; ps < .001). Lower reappraisal was only significantly associated with the likelihood of Remitted PTSD compared with Never PTSD (OR: 0.93, [0.88, 0.99], p = .03). Increasing levels of combat severity differentiated veterans with current, remitted, and no history of PTSD, suggesting screening for severity of combat may be helpful. Greater habitual suppression distinguished current versus non-current PTSD status, whereas only less reappraisal distinguished non-current groups from each other. Lower suppression may be an important treatment target for veterans with moderate and high combat severity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Military personnel’s stress reactivity during pre-deployment in a war zone

ABSTRACT Many studies have been conducted on the numerous negative post-deployment outcomes for military personnel. However, data on service members’ pre-deployment stress reactivity are absent. This is a serious gap in existing research, as stress has an important regulatory role. This study aimed to determine possible manifestations of military personnel’s stress reactivity during pre-deployment in a war zone in eastern Ukraine. The study involved 270 Ukrainian service members (all male, aged 18 to 58 years). Sample 1 (n = 108) were preparing to be deployed for the first time, sample 2 (n = 84) were preparing to be deployed and had previous experience of deployment, and sample 3 (n = 108) were not preparing to deploy and had no previous deployment experience. We used the Ukrainian adaptation of the Giessen Subjective Complaints List (GBB-24), the Symptom Checklist-90-Revised (SCL-90-R), the Short Screening Scale for DSM–IV posttraumatic stress disorder and the Combat Exposure Scale (CES). We found that indicators for physical complaints, psychological problems and psychopathological and posttraumatic symptoms among service members from samples 1 and 2 were significantly higher than those of sample 3 in 15 of 18 cases (p < 0.001–0.05). The indicators obtained for sample 2 were higher than those of sample 1 in six of nine cases (p < 0.001–0.05). Both our study hypotheses were confirmed. The present findings can be used to develop efficient psychological interventions for military personnel during pre-deployment in a war zone.

The role of trauma, social support, and demography on veteran resilience

ABSTRACT Background Historically, resilience has often been conceptualized as the sustained lack of symptoms following trauma exposure. In line with a novel conceptualization of resilience as being dynamic over lifespan, determined by interacting biological and environmental factors, we examined the VA Mid-Atlantic Post Deployment Mental Health Repository (PDMH) comprised of 3876 US Military Veterans with and without PTSD diagnoses. Methods We performed regression modelling to study the relationship between resilience (measured with Connor Davidson Resilience Scale; CD-RISC), posttraumatic stress disorder (PTSD) severity (Davidson Trauma Scale; DTS), social support (Medical Outcome Study Social Support Survey; MOSSS), combat exposure (Combat Exposure Scale; CES), childhood trauma (Trauma Life Events Questionnaire; TLEQ), and demographic factors. CD-RISC was positively correlated with years of education and negatively correlated with DTS, CES and TLEQ scores. Results We found an interaction between CD-RISC and CES in predicting PTSD severity (Davidson Trauma Scale). Specifically, high resilience predicted lower PTSD symptom severity than low resilience, this relationship was amplified with increasing levels of combat exposure. Structural equation modelling (SEM) identified an optimal latent variable that represents resilience and relationships between latent variables for resilience, trauma, and illness. We derived a resilience latent variable composed of age, education level, MOSSS and race. Conclusions Our results support a conceptualization of resilience as a multifactorial determinant that coexists with PTSD, a state rather than trait variable, and can be quantified by biological and behavioural metrics. HIGHLIGHTS • Historically, resilience has often been conceptualized as the sustained lack of symptoms following trauma exposure. • We examined the VA Mid-Atlantic Post Deployment Mental Health Repository (PDMH) comprised of 3876 US Military Veterans. • We found an interaction effect between CD-RISC and CES in predicting PTSD severity (Davidson Trauma Scale)

Translation, cultural adaptation, and psychometric properties of the Spanish version of the Combat Exposure Scale (CES-S) with U.S. military Spanish speaking Latino veterans living in the Caribbean: A cross-sectional preliminary data study.

The Combat Exposure Scale (CES) is one of the most used self-report instruments to assess various combat situations experienced by military personnel. This article presents a comprehensive translation and cultural adaptation of the CES to Spanish and its psychometric properties. Fifty-five (n = 55) U.S. military Spanish-speaking Latino veterans diagnosed with combat-related PTSD were recruited from 2018 to 2020 to participate in this cross-sectional preliminary data study at the VA Caribbean Health Care System. The translation and cultural adaptation followed the recommendations by Chavez & Canino (2005). Statistical analysis included principal component factor analysis, internal consistency analysis, and content validity analysis. It included two different expert bilingual committees composed of veterans with combat experience and university professors at a doctoral level. The CES-S consists of seven items. The principal component factor analysis resulted in one factor and the content validity of =1. CES-S has an internal consistency of α=.84. The CES-S is suitable for its use with Spanish-speaking Latino veteran samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Prevalence of Post-Traumatic Stress Disorder and its Associated Factors among Nepali Army Service Members and Veterans: 15 Years Post Insurgency

Globally, mental health problems constitute a serious public health problem, contributing 14 % to the global burden of disease. The aim of this epidemiological study was to identify prevalence rates of post-traumatic stress disorder (PTSD), factors associated and its relationship with combat exposure in a post-insurgency period in Nepali army personnel and Veterans. This cross-sectional study was conducted among 300 adults in 2021. In the study both quantitative and qualitative mixed approach with descriptive design was followed. The outcome measures used in the study were locally validated with PCL-M and combat exposure scale. Of the sample, 9 % met threshold for PTSD. The association of variable in reference to age, rank, education and service years with PTSD showed that Age group and Education in current study did not show significant association. However, PTSD with years of service and rank showed significant association. The study also showed a significant relationship between combat exposure and PTSD. There is a significant association between different level of education and combat exposure as well. Overall, the prevalence rates of PTSD in the sample are comparable to other studies conducted with populations affected by conflict and with refugees. However, the findings underscore the need to address the current mental health care awareness and resources in combatants who were exposed to traumatic events during combat in insurgency period. Traumatic exposure predicted increase in PTSD.

Warzone experiences and subsequent clinician suicide risk assessment in veterans

AbstractObjectiveTo determine in veterans whether severity of combat exposure was predictive of subsequently receiving a suicide risk assessment (SRA), and whether this relationship was meditated by depression symptomatology.MethodWe conducted an electronic medical records review for SRA ratings of 486 veterans who had completed Combat Exposure Scale (CES) and Beck Depression Inventory‐II (BDI‐II) assessments in a study of Post‐Deployment Mental Health (PDMH).ResultsHigher total scores on the CES and BDI‐II were characteristic of PDMH participants who subsequently (mean 29.2 months later) received an SRA from a Veterans Health Administration provider. Among participants with an SRA, those scoring at high risk had significantly greater CES and BDI‐II scores than those rated at low risk. Participants rated at low risk tended to have CES and BDI‐II scores higher than those of participants for whom no SRA was found. Relationships between combat exposures and both performance of an SRA and the SRA risk level were mediated by BDI‐II scores.ConclusionThese data extend previous findings of depression‐mediated linkages between warzone experiences and subsequent self‐reported suicide risk among veterans, by indicating chronicity of combat trauma‐related suicide risk and demonstrating a concordance between self‐reported and clinician‐reported suicidality as it relates to experiential and psychiatric factors.

A-124 Acute Predictors of Chronic PTSD Symptoms Following TBI in U.S. Military Service Members

Abstract Objective Post-Traumatic Stress Disorder (PTSD) has been shown to be a major contributor to poor outcome after Traumatic Brain Injury (TBI). Understanding the factors that contribute to PTSD symptoms may lead to improved clinical management of PTSD and TBI. This study examines acute predictors of self-reported PTSD symptoms after TBI in military service members. Method Participants included 210 U.S. military service members (Age: M = 33.9 years, SD = 10.2) without injury (n = 86), or with history of uncomplicated mild TBI (n = 56), complicated mild, moderate, or severe TBI (n = 43), or bodily injury (n = 25) assessed at 0–8 months and ≥ 2 years post-injury. At both assessments, participants completed the PTSD Checklist (PCL-C), Neurobehavioral Symptom Inventory, Alcohol Use Disorder Checklist, Combat Exposure Scale, and TBI Quality of Life and passed symptom validity tests. Stepwise linear regression included 26 potential predictors (demographics, injury characteristics, military characteristics, and self-report measures at baseline) of PCL-C Total at follow-up. Results In this model, (F(4,188) = 68.0; p &amp;lt; .001; R2 = .591), baseline PCL-C (R2Δ = .52) was the main predictor of follow-up PCL-C Total, followed by Cognitive Concerns (R2Δ = .04), number of deployments (R2Δ = .01), and injury severity (R2Δ = .02). When baseline PCL-C was excluded as a predictor, somatosensory symptoms (R2Δ = .361), Emotional/Behavioral Dyscontrol (R2Δ = .067), Sleep (R2Δ = .033), Combat Exposure (R2Δ = .024), and Cognitive Concerns (R2Δ = .017) predicted follow-up PCL-C (F(5,187) = 37.7; p &amp;lt; .001; R2 = .502). Semipartial correlations revealed that most of the explained variance was shared among self-report predictors. Conclusion Findings suggest acute psychological distress impacts future PTSD symptomatology, whereas TBI characteristics, such as TBI severity and number of TBIs, have minimal influence.

A-116 Predicting Chronic Neurobehavioral Symptoms based on Acute Injury Characteristics and Symptoms in U.S. Military Service Members with and without history of TBI

Abstract Objective Recovery following traumatic brain injury (TBI) is complex. Often following mild TBI, recovery occurs within days or weeks, though this is not always the case. Following more severe TBI, some recover quickly, while many never fully recover. This study examines acute predictors of chronic neurobehavioral symptoms in U.S. military service members (Age: M = 33.9 years, SD = 10.2) without injury (n = 86), or with history of uncomplicated mild traumatic brain injury (TBI; n = 56), complicated mild, moderate, or severe TBI (mod-sev TBI; n = 43), or bodily injury (n = 25). Method Participants completed the Neurobehavioral Symptom Inventory (NSI), Posttraumatic Stress Disorder Checklist, Alcohol Use Disorder Checklist, Combat Exposure Scale, and TBI Quality of Life and passed symptom validity tests at 0–8 months and ≥ 2 years post-injury. Forward stepwise logistic regression included 26 potential predictors (demographics, injury characteristics, military characteristics, and self-report measures at baseline) of International Statistical Classification of Diseases and Related Health Problems-10 Postconcussional Syndrome (PCSy) at follow-up. Results Cognitive Concerns (Exp(B) = .896, p = .001), Sleep (Exp(B) = 1.874, p &amp;lt; .001), Somatosensory Symptoms (Exp(B) = 1.194, p = .012), and mod-sev TBI (Exp(B) = 2.959, p = .045) significantly predicted follow-up PCSy. When baseline NSI symptoms were removed from the model, Cognitive Concerns (Exp(B) = .902, p &amp;lt; .001), Post-traumatic stress (Exp(B) = 1.173, p = .001), and Resilience (Exp(B) = .950, p &amp;lt; .031) significantly predicted PCSy. For all included measures in both models, higher symptoms at baseline predicted increased likelihood of follow-up PCSy. Both models correctly classified 81.3% of participants. Conclusion Findings suggest patients reporting psychological distress and cognitive concerns acutely should be targeted for treatment to mitigate prolonged neurobehavioral symptoms.

1068 Using Sleep to Avoid Inpatient PTSD Treatment

Abstract Introduction During inpatient psychiatric treatment, mattress actigraphy can be used to track nightly sleep in a zero-burden fashion to examine its relationships with other markers of treatment progress. We report here on associations between actigraphic sleep parameters and treatment markers in combat veteran engaged in inpatient treatment for posttraumatic stress disorder. We focus first on sleep scheduling, the best-validated outcome available from actigraphic data. Methods 140 combat veteran inpatients provided between 5 and 164 nights of mattress actigraphy over the course of their inpatient psychiatric hospitalizations. The sample was characterized by multiple traumas and a high prevalence of comorbid mood and substance use disorders. Approximately one-half of the sample had undergone objective screening for OSA and for this subsample AHI &amp;lt; 20 was used as an inclusion criterion. Unscreened participants were required to have a BMI &amp;lt; 35. Inclusion also required mean actigraphic SE &amp;gt; 60%. The PTSD Checklist and Combat Exposure Scale were obtained at admission, from which a trauma load index was created by adding z-scores obtained from standardizing these scales. Results In a multiple regression analysis, after accounting for secular change in LOS, higher trauma loads (p &amp;lt; 0.001) and earlier bed times (p = 0.001) were both significantly associated with shorter lengths of stay (LOS; F(3,137) = 10.4, p &amp;lt; 0.001; adj. R-squared = 0.17). Trauma load and bed time did not interact (p = 0.7). Conclusion Avoidance is a criterial symptom of PTSD. Early bed times and early exits from treatment may both reflect the impact of syndromal avoidance on treatment, limiting its dosage and benefit. If so, prescribing later bed times may have utility in inpatient treatment programming. Support Award W81XWH-15-2-0005 from the Department of Defense, Military Operational Medicine Research Program and the Department of Veterans Affairs. This material is the result of work supported with resources and the use of facilities at the Palo Alto VA Medical Center.

Validation of a brief measure of combat exposure among Canadian Armed Forces personnel.

Exposure to military combat is associated with mental health problems, including posttraumatic stress disorder (PTSD) and depression. To understand the effects of combat on adverse health outcomes, the sound measurement of combat experiences is required; however, many scales used in past research are lengthy. A brief measure of combat exposure benefits militaries by reducing the burden on respondents as well as administration time in post-deployment settings and large population-based health surveys. The current study sought to describe the psychometric properties of a brief measure of combat exposure among Canadian Armed Forces (CAF) personnel. Data from post-deployment screening were used to compare the psychometric properties of an 8-item scale with the full scale that it was derived from. The 8-item measure did not fit a one-factor solution well and did not offer a statistically significant improvement in model fit over the full 30-item measure. However, its association with increased odds of a number of health outcomes indicates that it could be useful as a brief measure of combat exposure in settings where using the full scale is not feasible. Brief measures of combat exposure are valuable for assessing events experienced during deployment among military personnel. Although the 8-item Combat Exposure Scale assessed in the current study represents a potentially useful measure for CAF personnel, further research is necessary to improve its fit.

Depression and Disability Among Combat Veterans’ Transition to an Historically Black University

ABSTRACT Forty-five veterans were recruited from an historically Black university (HBCU) using purposive, non-probability sampling to study their transition to college. Schlossberg’s 4Ss transition model evaluated their Situation (operationalized as combat exposure, dangerous duty), Self (current depressive symptoms), Supports/Deficits (marital status/disability), and Strategies for coping (insurance, income). Bivariate analyses and multivariate regression evaluated the relationship of the independent variable (score on the Combat Exposure Scale) and dependent variable (Center of Epidemiologic Studies Depression score), controlling for socio-demographics factors, support, and strategies for coping. The interaction effect of combat exposure or dangerous duty (henceforth referred to as “combat exposure”) and having a disability were assessed to investigate whether change occurred in response to the exposure of combat on disability status. Thirty-three percent of the sample reported a military-related disability, 53% used military insurance, more than half the sample’s income source was military compensation, and more than half used the GI Bill. Severity of combat exposure predicted higher depression score (p < 0.01) but the relationship was greater among disabled students (p = 0.015) and less among married students (p = 0.033). Schlossberg’s 4S theory was partially supported. Neither strategies for coping predicted fewer depressive symptoms in this sample.

Elevated perceived threat is associated with reduced hippocampal volume in combat veterans

Reduced hippocampal volume is frequently observed in posttraumatic stress disorder (PTSD), but the psychological processes associated with these alterations remain unclear. Given hippocampal involvement in memory and contextual representations of threat, we investigated relationships between retrospectively reported combat exposure, perceived threat, and hippocampal volume in trauma-exposed veterans. T1-weighted anatomical MRI scans were obtained from 56 veterans (4 women, 52 men; 39 with elevated PTSD symptoms, “PTSS” group) and hippocampal volume was estimated using automatic segmentation tools in FreeSurfer. Hippocampal volume was regressed on self-reported perceived threat from the Deployment Risk and Resilience Inventory, and combat exposure from the Combat Exposure Scale. As a secondary analysis, hippocampal volume was regressed on Clinician-Administered PTSD Scale (CAPS) symptoms. In veterans with elevated PTSD symptoms, hippocampal volume was inversely related to perceived threat while deployed while controlling for self-reported combat exposure. Hippocampal volume was also inversely correlated with avoidance/numbing CAPS symptoms. Future research should clarify the temporal milieu of these effects and investigate whether individual differences in hippocampal structure and function contribute to heightened threat appraisal at the time of trauma vs. subsequently elevated appraisals of traumatic events.

SA57 - GENETIC AND EPIGENETIC INVOLVEMENT OF THE FKPB5 GENE IN POSTTRAUMATIC STRESS DISORDER AFTER COMBAT TRAUMA

Background FK506 binding protein 5 (FKBP5) is a major regulatory protein of the HPA axis, which binds to the glucocorticoid receptors and modulate glucocorticoid sensitivity. The FKBP5 genes have been implicated in dysregulation of human stress responses, contributing to vulnerable phenotypes such as depression and anxiety. The present study aimed to investigate whether genetic and epigenetic factors of the FKBP5 are a predictive biomarker of Posttraumatic Stress Disorder (PTSD) among veterans exposed to combat. In addition, the influence of potentially associated factors, including combat exposure levels and alcohol problem, was examined in the pathophysiology of PTSD. Methods All subjects were Korean male veterans who served on active duty during the Vietnam War and the Combat Exposure Scale (CES) was used for assessing the level of wartime stressors experienced by combatants. Using the Clinician-Administered PTSD Scale (CAPS), combat veterans were grouped into those with (n=124) and without (n=120) PTSD. Three SNPs of the FKBP5 locus (rs9296158, rs1360780, and rs9470080) were genotyped with single base primer extension assay using the ABI PRISM SNaPShot Multiplex kit. DNA methylation levels at two CpG sites in the FKBP5 intron 7 region were quantified in the peripheral blood using the bisulfite pyrosequencing method. The effects of FKBP5 variants, the DNA methylation levels and clinical factors on the diagnosis of PTSD were tested using binary logistic regression analysis. Results Since a significant interaction effect between alcohol problem and FKBP5 variants was found for PTSD symptom, logistic regression analyses stratified by presence of alcohol problem were performed. Among combat-exposed individuals without alcohol problem, the risk allele of FKBP5 rs1360780, higher methylation levels at the FKBP5 CpG1 site, high combat exposure significantly predicted PTSD diagnosis in combat-exposed individuals (Model Summary: -2 Log likelihood=144.07, Nagelkerke R2=0.279; Overall percentage of correct classification resulting from the model=72.9%). In the logistic model among subjects with alcohol problem, the combat exposure level was an only significant predictor of PTSD status. Discussion The present study demonstrated the involvement of FKBP5 genetic variants and higher DNA methylation of the FKBP5 in PTSD status without alcohol problem. The present findings suggest that the external traumatic events may influence PTSD pathophysiology via genetic and epigenetic modulation of the FKBP5 and alcohol problem may be a moderating factor of PTSD. Further prospective research examining genetic variants and epigenetic changes of FKBP5 locus in people exposed to trauma might shed light on the role and the biological basis of FKBP5 in susceptibility to PTSD.