A systematic review of posttraumatic stress and resilience trajectories: Identifying predictors for future treatment of veterans and service members.

Abstract

Posttraumatic stress disorder (PTSD) often presents with comorbidities and can result in functional impairment. Veterans and service members report PTSD at higher rates than civilians, which represents a public health concern among those who have served or are serving in the military. Prior reviews of evidence-based treatments for PTSD demonstrate smaller effect sizes for veterans and service members than for civilians. One line of investigation that may contribute to our understanding in this area is developmental trajectory research. Understanding predictors of different symptomatic trajectories compared to resilient trajectories and vice versa may help clinicians better tailor evidence-based conceptualizations, treatments, and change agents to the individual, facilitate prevention efforts, and embark on a process-based, flexible, cognitive-behavioral approach that is patient-centered. The current systematic review examined predictors of both resilient (i.e., compared to heterogeneous symptomatic trajectories) and variable symptomatic trajectories (i.e., compared to resilient and/ or other symptomatic trajectories) in veterans and service members. Twenty-seven studies met inclusion criteria. Across all included studies reporting percentages of resilience trajectories (i.e., including some studies that used the same data sets and/or samples), 73.4% reported a resilience trajectory, while the remaining 26.6% encompassed heterogeneous symptomatic trajectories on average. Predictors are presented and discussed, in

A dynamic, multilevel approach to conceptualising and designing resilience research in the context of military stress

“…Integrating person‐centred and variable‐centred approaches, these procedures have allowed researchers to identify latent classes (groupings) of individuals with similar trajectories of adaptation over time (Cosco et al., 2019). Compelling evidence shows a resilience trajectory characterised by stable, healthy functioning is the most common outcome following exposure to military stressors (Pavlacic et al., 2022). However, most studies have examined a limited number of outcome parameters in isolation (e.g., PTSD, depression, alcohol use) with few including positive indicators of adaptive responding.…”

“…A recent systematic review of longitudinal studies using military/veteran populations revealed a dearth of studies that examined predictors of resilience trajectories (Pavlacic et al., 2022). Results identified the following predictors of resilience compared to symptomatic trajectories: preparedness, limited combat experiences, lower levels of depression, increased social support, fewer post‐deployment stressors, and demographic factors (e.g., being older, male, White, more highly educated, and having higher income).…”

Inhibitory control and alcohol use history predict changes in posttraumatic stress disorder symptoms.

“…Preexisting and posttrauma vulnerabilities related to PTSD symptom development have been relatively well studied (e.g., Elwood et al, 2009; Marx et al, 2009; Samuelson et al, 2020; Schultebraucks et al, 2022; see Pavlacic et al, 2022, for a recent review). For example, Galatzer-Levy et al (2017) found that, in trauma-exposed adults, the presence of childhood trauma was related to the development of PTSD 5 months later.…”

Inhibitory Control and Alcohol Use History Predict Changes in Post-traumatic Stress Disorder Symptoms

“…Pre-existing and post-trauma vulnerabilities related to PTSD symptom development have been relatively well studied (e.g., Elwood et al 2008;Marx et al, 2009;Samuelson et al, 2020;Schultebraucks et al, 2022; for a recent review see Pavlacic et al, 2022). For example, Galatzer- Levy et al (2017) found that, in trauma-exposed adults, the presence of childhood trauma was related to the development of PTSD five months later.…”