Heterogeneity of posttraumatic stress symptomatology and social connectedness in treatment-seeking military veterans: a longitudinal examination

Abstract

Elucidating whether PTSD symptoms predict poorer social connectedness over time (i.e. social erosion) and/or that poor social connectedness contributes to maintenance of PTSD (i.e. social causation) has implications for PTSD treatment and relapse prevention. Most extant research has been cross-sectional and examined overall PTSD symptoms. Evidence of longitudinal associations among heterogeneous PTSD symptom clusters and social connectedness could provide insight into more nuanced targets for intervention. Using data from 1,491 U.S. military veterans in residential treatment for PTSD at 35 Department of Veterans Affairs facilities, we evaluated a two-wave cross-lagged panel model including a five-factor model of PTSD and two aspects of social connectedness. PTSD, quality of connectedness (i.e. degree of distress related to interpersonal conflict), and structural social support (i.e. number of days of contact with supportive loved ones) in the past 30 days were assessed at baseline and 4 months after discharge. The largest effect was greater severity of PTSD dysphoric arousal symptoms (i.e. irritability/anger, poor concentration, and sleep problems) at baseline predicting more conflict-related distress at follow-up (β = 0.43). Post-hoc symptom-level analyses indicated that irritability/anger drove this association. In addition, conflict-related distress predicted greater PTSD symptom severity across all five clusters (β’s = 0.10 to 0.14, p ’s < 0.01). More days of contact predicted lower severity of avoidance and numbing symptoms (β’s = −.05 and −.07, p ’s < 0.01), along with individual symptoms within these clusters, plus flashbacks. Results support both social erosion and social causation models. Engaging loved ones in veterans’ treatment and targeting dysphoric arousal symptoms, particularly anger and irritability, may improve long-term PTSD and relationship outcomes, respectively.

Longitudinal survey of UK veterans with pre-existing mental health difficulties: mental health during the COVID-19 pandemic

“… 12 Importantly, individuals experiencing severe psychological ill-health may be more susceptible to difficulties with social isolation and loneliness during the pandemic, 13 and poor social connection can work to maintain PTSD difficulties. 14 Such findings suggest that COVID-19 mitigation measures such as self-isolation may exacerbate veteran difficulties, for example, by presenting practical obstacles for veterans to engage with appropriate social (and, potentially, health) support.…”

“…Another study among Israeli veterans revealed that those with previous combat or captivity trauma were highly vulnerable to mental health deterioration during the COVID-19 pandemic, showing higher rates and greater severity of PTSD 12. Importantly, individuals experiencing severe psychological ill-health may be more susceptible to difficulties with social isolation and loneliness during the pandemic,13 and poor social connection can work to maintain PTSD difficulties 14. Such findings suggest that COVID-19 mitigation measures such as self-isolation may exacerbate veteran difficulties, for example, by presenting practical obstacles for veterans to engage with appropriate social (and, potentially, health) support.…”

Mental health treatment utilization and relationship functioning among male and female OEF/OIF veterans.

“…PTSD is consistently associated with relationship difficulties. Longitudinal studies suggest that PTSD symptoms are associated with lower social support (Shallcross et al, 2016) and poorer social connectedness quality (Sippel et al, 2019). Additionally, studies show that individuals diagnosed with PTSD, compared with those without the disorder (even if trauma-exposed) experience more relationship problems and poorer social adjustment (for reviews see Galovski & Lyons, 2004; Monson et al, 2009).…”

Cortisol awakening response over the course of humanitarian aid deployment: a prospective cohort study

“…Similarly, concurrent perceived social support may also moderate this course as it has been frequently recognized as a key protective factor against the adverse impact of trauma exposure on mental health (Sippel, Pietrzak, Charney, Mayes, & Southwick, 2015;Sippel, Watkins, Pietrzak, Hoff, & Harpaz-Rotem, 2019). In the cohort investigated in the current study, it was previously observed that higher perceived social support was associated with lower depressive and PTSD symptoms prior to deployment (Eriksson et al, 2013) and lower depressive symptoms and psychological distress over the course of the deployment until at least six months after return (Lopes Cardozo et al, 2012).…”