Longitudinal Relationship Between Posttraumatic Stress Symptoms and Physical Symptoms in Military Veterans

Abstract

ObjectiveThis study aimed to assess the temporal relationship of posttraumatic stress disorder (PTSD) symptoms and physical symptoms in a non–treatment-seeking deployed military sample.MethodsData were from a longitudinal study of Australian Defence Force personnel deployed to the Middle East Area of Operations between 2010 and 2012 (n = 1871). Predeployment assessment was conducted 4 months before deployment (T1). Of these, 1324 (70.8% retention rate) participated in assessment within 4 months after deployment (T2), and 1122 (60.0%) completed the third time point at 4 years after deployment (T3). PTSD symptoms were assessed with the posttraumatic stress checklist and physical symptoms with a 67-item self-report Health Symptom Checklist. To explore directional influences between symptoms over time, longitudinal cross-lagged association between the modeled latent factors for PTSD symptoms and physical symptoms was estimated using structural equation modeling.ResultsFrom T1 to T2, there was a significant bidirectional effect with higher physical symptom count at T1 predicting higher PTSD symptom severity at T2 (β = 0.17, p < .001) and higher PTSD symptom severity at T1 predicting higher physical symptom count at T2 (β = 0.13, p < .001). The effect of T2 on T3 was unidirectional. PTSD symptom severity at T2 had no effect on physical symptom count at T3, but physical symptom count at T2 predicted an increase in PTSD symptom severity at T3 (β = 0.11, p = .013).ConclusionsConsidering early physical symptoms and their physiological underpinnings after traumatic exposures could help identify those at risk of later PTSD.

Somatic symptoms and insomnia among bereaved parents and siblings eight years after the Utøya terror attack

“…Recent studies have suggested that somatic symptoms predict PTSS after a traumatic event (McAndrew et al, 2019 ; Stensland et al, 2020 ). This may be due to the amount of hyperarousal and somatic symptoms experienced from exposure to trauma, leading to a higher allostatic load and bodily dysregulation, which can develop before the onset of PTSS and therefore predict its occurrence later (Graham et al, 2022 ; Stensland et al, 2020 ). Conversely, PTSS could increase the risk of somatic symptoms because of several complex processes, such as the alterations of the hypothalamic–pituitary–adrenal axis and the sympathoadrenal medullary axis, which affect the neuroendocrine and immune functions, which again affect the central nervous system, sleep-wake regulation, and the autonomic nervous system (Gupta, 2013 ).…”

“…Previous studies have established the relationship between psychological trauma and somatic symptoms (Gupta, 2013 ; McEwen, 1998 ). Individuals with PTSS often exhibit somatic symptoms such as heightened activation of the autonomic nervous system, hyperarousal, pain, fatigue, and gastrointestinal issues (Graham et al, 2022 ; Gupta, 2013 ; Lewis et al, 2020 ; Osório et al, 2012 ; Sugiyama et al, 2020 ). In general, the number of somatic symptoms has shown to be related to the diagnoses of mental health problems (Kapfhammer, 2006 ).…”

Yoga resilience training to prevent the development of posttraumatic stress disorder in active-duty first responders: A cluster randomized controlled trial.

“…These modifiable risk factors include both adaptive and maladaptive strategies such as perceived resilience, suppression, avoidance coping styles, and social support. There is also increasing evidence showing that physical (pain and somatic) symptoms following trauma exposure precede and may even predict later PTSD psychopathology (Graham et al, 2022; McFarlane, 2010; Stensland et al, 2020). Yet the underlying physiological and biological mechanisms associated with trauma exposure and PTSD are rarely targeted by existing treatment and prevention efforts, and somatic experiences of individuals remain largely neglected (Daskalakis et al, 2016; Graham et al, 2022).…”

“…There is also increasing evidence showing that physical (pain and somatic) symptoms following trauma exposure precede and may even predict later PTSD psychopathology (Graham et al, 2022; McFarlane, 2010; Stensland et al, 2020). Yet the underlying physiological and biological mechanisms associated with trauma exposure and PTSD are rarely targeted by existing treatment and prevention efforts, and somatic experiences of individuals remain largely neglected (Daskalakis et al, 2016; Graham et al, 2022). While research on the precise pathways and mechanisms linking trauma exposure, physical symptoms, as well as PTSD is ongoing, there are increasing calls for better integration of psychological and physical health strategies in prevention and early intervention efforts (McFarlane, 2017; Milligan-Saville et al, 2017).…”