An integrated model of risk and protective factors for post-deployment PTSD symptoms in OEF/OIF era combat veterans

Background: Few attempts have been made to integrate the known risk factors for combat-related posttraumatic stress disorder (PTSD) into a comprehensive model. This study investigated relative contributions of combat experiences, post-battle experiences, and perceptions of threat to post-deployment PTSD symptoms, and also examined whether pre-deployment preparedness moderated associations among these variables. Methods: Two hundred seven troops deployed to the Middle East between 2001 and 2008 completed self-report measures. Data were analyzed using path analysis and regressions. A comprehensive model including additive effects, mediation, and moderation was examined. Results: Perceptions of threat mediated the association of combat experiences with PTSD, but not that of post-battle experiences with PTSD. Sense of preparedness for deployment moderated the association of combat experiences with perceived threat, such that troops with low preparedness perceived high levels of threat regardless of combat exposure, whereas troops with high preparedness perceived levels of threat that were correlated with levels of combat. Limitations: Data were cross-sectional, all assessment was retrospective self-report, and the sample was primarily White, male, and married. Conclusions: Combat and post-battle experiences appear linked to PTSD via separate pathways. Thus, PTSD prevention efforts may need to vary based on types of events experienced. Pre-deployment preparation mitigated perceived threat in the context of low combat exposure, but it did not moderate direct associations of risk factors with PTSD symptoms. Thus, pre-deployment training and preparation do not appear sufficient to protect against PTSD. (C) 2010 Elsevier B.V. All rights reserved.