A Meta-Analysis of Risk Factors for Combat-Related PTSD among Military Personnel and Veterans

Abstract

Post-traumatic stress disorder (PTSD), a complex and chronic disorder caused by exposure to a traumatic event, is a common psychological result of current military operations. It causes substantial distress and interferes with personal and social functioning. Consequently, identifying the risk factors that make military personnel and veterans more likely to experience PTSD is of academic, clinical, and social importance. Four electronic databases (PubMed, Embase, Web of Science, and PsycINFO) were used to search for observational studies (cross-sectional, retrospective, and cohort studies) about PTSD after deployment to combat areas. The literature search, study selection, and data extraction were conducted by two of the authors independently. Thirty-two articles were included in this study. Summary estimates were obtained using random-effects models. Subgroup analyses, sensitivity analyses, and publication bias tests were performed. The prevalence of combat-related PTSD ranged from 1.09% to 34.84%. A total of 18 significant predictors of PTSD among military personnel and veterans were found. Risk factors stemming from before the trauma include female gender, ethnic minority status, low education, non-officer ranks, army service, combat specialization, high numbers of deployments, longer cumulative length of deployments, more adverse life events, prior trauma exposure, and prior psychological problems. Various aspects of the trauma period also constituted risk factors. These include increased combat exposure, discharging a weapon, witnessing someone being wounded or killed, severe trauma, and deployment-related stressors. Lastly, lack of post-deployment support during the post-trauma period also increased the risk of PTSD. The current analysis provides evidence of risk factors for combat-related PTSD in military personnel and veterans. More research is needed to determine how these variables interact and how to best protect against susceptibility to PTSD.

Deployment-related trauma and post-traumatic stress disorder: does gender matter?

“…However, the results suggest that women have an overall increased risk of PTSD. In line with some past research, when the model did not include non-deployment-related trauma, there was a significant effect of gender, where women were more likely to report PTSD (Luxton et al, 2010; Mustillo & Kysar-Moon, 2016; Xue et al, 2015). However, after controlling for non-deployment-related trauma, the gender differences decreased considerably, indicating that non-deployment trauma exposure substantially contributes to gender differences in PTSD.…”

“…Jacobson, Donoho, Crum-Cianflone, & Maguen, 2015; Maguen, Luxton, Skopp, & Madden, 2012), others report an increased risk of PTSD among women (e.g. LeardMann, Smith, Smith, Wells, & Ryan, 2009; Luxton, Skopp, & Maguen, 2010; Mustillo & Kysar-Moon, 2016; Xue et al, 2015), and one study reported an increased risk of PTSD among men (i.e. Hourani, Willians, Bray, Wilk, & Hoge, 2016).…”

“…physical abuse) as a determinant of mental health among military personnel (Cabrera, Hoge, Bliese, Castro, & Messer, 2007; Lee, Phinney, Watkins, & Zamorski, 2016; Seifert, Polusny, & Murdoch, 2011), but they have largely ignored the potential effects of other lifetime traumatic events. This is problematic, as prior trauma exposure is a significant predictor of PTSD among military personnel (Xue et al, 2015), and women may be particularly vulnerable to specific types of trauma.…”

Perceived danger during deployment: a Rasch validation of an instrument assessing perceived combat exposure and the witnessing of combat consequences in a war zone

“…Studies hitherto have found a relatively consistent positive association between previous deployments and depression, as well as PTSD (Kline et al, 2010; Reger, Gahm, Swanson, & Duma, 2009; Xue et al, 2015). An association between lower rank and higher risk of post-deployment PTSD has also been found (Iversen et al, 2008; Xue et al, 2015). The same is true for female gender, which has consistently been found to be associated with higher risk of post-deployment PTSD (Xue et al, 2015).…”

“…Studies have shown that the intensity and frequency of combat exposure are often proportional to post-deployment severity of posttraumatic stress disorder (PTSD) (Fear et al, 2010; Xue et al, 2015). However, life in a war zone often includes stressful experiences not related directly to combat and not posing a direct threat, e.g.…”