Depression Suppresses Treatment Response for Traumatic Loss–Related Posttraumatic Stress Disorder in Active Duty Military Personnel

Jacoby, Vanessa M.; Hale, Willie J.; Dillon, Kirsten H.; Dondanville, Katherine A.; Wachen, Jennifer Schuster; Yarvis, Jeffrey S.; Litz, Brett T.; Mintz, Jim; Young‐McCaughan, Stacey; Peterson, Alan L.; Resick, Patricia A.

doi:10.1002/jts.22441

Cited by 6 publications

(2 citation statements)

References 42 publications

(68 reference statements)

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“…A final point to discuss is the fact that PTSD in humans is considered as a failure to follow the normative trajectory of recovery (e.g., in terms of physiological, cognitive, or behavioral symptoms) after exposure to a traumatic event [148]. Recent evidence indicates that some individuals may take long periods of time to recover from PTSD [149] and, therefore, animal studies may need to define the range of testing that would allow characterizing deficiencies in remote symptoms, e.g., [150].…”

Section: Recoverymentioning

confidence: 99%

Title: “Labels Matter: Is it stress or is it Trauma?”

Richter‐Levin

Sandi

2021

Transl Psychiatry

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In neuroscience, the term ‘Stress’ has a negative connotation because of its potential to trigger or exacerbate psychopathologies. Yet in the face of exposure to stress, the more common reaction to stress is resilience, indicating that resilience is the rule and stress-related pathology the exception. This is critical because neural mechanisms associated with stress-related psychopathology are expected to differ significantly from those associated with resilience.Research labels and terminology affect research directions, conclusions drawn from the results, and the way we think about a topic, while choice of labels is often influenced by biases and hidden assumptions. It is therefore important to adopt a terminology that differentiates between stress conditions, leading to different outcomes.Here, we propose to conceptually associate the term ‘stress’/‘stressful experience’ with ‘stress resilience’, while restricting the use of the term ‘trauma’ only in reference to exposures that lead to pathology. We acknowledge that there are as yet no ideal ways for addressing the murkiness of the border between stressful and traumatic experiences. Yet ignoring these differences hampers our ability to elucidate the mechanisms of trauma-related pathologies on the one hand, and of stress resilience on the other. Accordingly, we discuss how to translate such conceptual terminology into research practice.

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Section: Recoverymentioning

confidence: 99%

Title: “Labels Matter: Is it stress or is it Trauma?”

Richter‐Levin

Sandi

2021

Transl Psychiatry

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“…Many PTSD treatment studies also measure depression symptoms, which tend to show moderate to large reductions that are maintained for longer periods posttreatment (Resick et al, 2015; Zoellner et al, 2019). For example, Jacoby et al (2019) showed that patients who “recovered less from depression recovered less from PTSD” (p. 780) in a military sample. Interestingly, depression level may interact with response to PTSD treatment (Kline et al, 2018), and PTSD and depression may show different long-term recovery trajectories in response to disorder-specific therapy treatments (Karyotaki et al, 2016; Kline et al, 2021).…”

Section: Purpose Of the Studymentioning

confidence: 99%

Factor structure and psychometric performance of the PCL-5 in a clinical sample of veterans seeking treatment in a VA PTSD outpatient clinic.

Jenkins‐Guarnieri¹,

McEuin²,

Smolenski³

et al. 2023

Psychological Assessment

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There is a clear need to improve the measurement of posttraumatic symptoms in veterans seeking trauma-focused treatment. We evaluated the structure and psychometric performance of the Posttraumatic Stress Disorder (PTSD) Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) in a naturalistic sample of veterans engaging in evidence-based therapy in a Veterans Affairs (VA) PTSD outpatient clinic. We collected data from 500 sequential patients at the beginning and end of treatment, evaluating the PCL-5 factor structure followed by psychometric analyses. Results align with recent research following rigorous methods and advanced statistical techniques in suggesting a unidimensional factor structure for the PCL-5, with indications for its items representing a general factor with no clear support for multiple factors or subscales aligned with specific symptom clusters. In addition, psychometric analyses suggest a wider range of potential cutoff scores predicting PTSD diagnosis that may be specific to this population or setting. Given the remaining research questions surrounding the PCL-5 and its structure and functioning specifically, as well as the evolving conceptualizations of PTSD as a psychological disorder, further research is needed to guide clinical practice and future research.

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An evaluation of the associations among posttraumatic stress disorder, depression, and complicated grief in active duty military personnel with traumatic loss

Jacoby,

Straud,

Tyler

et al. 2024

Journal of Traumatic Stress

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Between 44% and 87% of active duty service members and veterans who deployed following the September 11, 2001, terrorist attacks know someone who was killed or seriously injured in combat. Considering the high frequency and known impact of traumatic loss, it is important to understand if and how traumatic loss may impede posttraumatic stress disorder (PTSD) treatment progress in military personnel. Additionally, experiencing a traumatic loss elevates the risk of developing prolonged grief disorder (PGD), which is associated with higher levels of PTSD symptoms, more functional impairment, and more lifetime suicide attempts among military personnel. Given what is known about the association between PGD and PTSD in treatment‐seeking service members and veterans, it is also important to understand whether grief‐related symptom severity negatively impacts PTSD treatment response. The current study examined associations among traumatic loss, complicated grief, depressive symptoms, and PTSD treatment response among military personnel (N = 127) who participated in variable‐length cognitive processing therapy (CPT). There was no direct, F(2, 125) = 0.77, p = .465, or indirect, β = .02, p = .677, association between a traumatic loss index event and PTSD treatment response compared with other trauma types. Prior assessments of depressive symptom severity were directly related to PTSD at later assessments across two models, ps < .001–p = .021 Participants with a traumatic loss index trauma demonstrated significant reductions in complicated grief, depressive symptoms, and PTSD following CPT, ps < .001, ds = −0.61–−0.83. Implications, study limitations, and suggestions for future research are presented.

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Depression Suppresses Treatment Response for Traumatic Loss–Related Posttraumatic Stress Disorder in Active Duty Military Personnel

Cited by 6 publications

References 42 publications

Title: “Labels Matter: Is it stress or is it Trauma?”

Title: “Labels Matter: Is it stress or is it Trauma?”

Factor structure and psychometric performance of the PCL-5 in a clinical sample of veterans seeking treatment in a VA PTSD outpatient clinic.

An evaluation of the associations among posttraumatic stress disorder, depression, and complicated grief in active duty military personnel with traumatic loss

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