Background: Posttraumatic stress disorder (PTSD) is a poorly understood event-driven anxiety disorder. The social and economic impact of this disease is severe, particularly in relation to military conflicts. People diagnosed with PTSD have poor functional/occupational outcomes. Past research has implicated PTSD criteria C symptoms as the best predictor of functional impairment. There is disagreement about the predictive nature of PTSD symptom categories and contradictory evidence has been reported supporting criteria D symptoms as the best indicator for poor functional/occupational outcomes.
Objective: The objective is to determine the PTSD predictors of occupational impairment by exploring the relationship between PTSD symptoms and occupational outcome among mental health care-seeking U.S. Army active duty soldiers who endorse PTSD symptoms.
Method: A 1-year prospective observational study was conducted in which data on PTSD symptoms were collected using the patient checklist (PCLm). Primary outcome was occupational status assessed at 1 year. Multivariate logistic regression was used to generate predictive models of occupational status.
Results: The study enrolled 570 soldiers; 55 were lost to follow up. Forty-seven percent of the cohort had severe PTSD, measured by a PCLm score greater than 50. The remaining 54% were identified as having moderate PTSD. Multivariate logistic modeling of PTSD symptoms to occupational impairment indicated that criteria B (OR 1.93, p=0.0061) and criteria C (OR 1.72, p=0.0229) symptoms were associated with occupational impairment. Adjustment for potential confounding variables did not result in any qualitative change and estimates for criteria B (OR 2.01, p=0.0267) and criteria C (OR 3.17, p=0.0155) were adjusted upward.
Conclusion: PTSD symptom criteria B and C can prospectively predict occupational impairment and, by proxy, PTSD criteria E. This association remains significant after adjustments for symptom correlation and other confounding factors. The association of symptom criteria B with increased odds of occupational impairment is a novel finding and has reasonable theoretical basis. Criteria C symptoms association with increased odds of occupational impairment is a confirmatory finding and agrees with prior studies. The ability to detect this association is influenced by the categorization techniques applied to the symptom data, and may help explain contradictory results found in the relevant literature.
|Advisor:||Ginzburg, Harold M., Robinson, James E.|
|Commitee:||Constans, Joseph I., Figley, Charles R., Rice, Janet C.|
|School Location:||United States -- Louisiana|
|Source:||DAI-B 74/06(E), Dissertation Abstracts International|
|Subjects:||Clinical psychology, Military studies, Epidemiology|
|Keywords:||Criteria b, Criteria e, Discharge, Military, Occupation, Ptsd|
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