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Unformatted text preview: ORIGINAL ARTICLE Association of Time Since Deployment, Combat Intensity, and Posttraumatic Stress Symptoms With Neuropsychological Outcomes Following Iraq War Deployment Brian P. Marx, PhD; Kevin Brailey, PhD; Susan P. Proctor, DSc; Helen Z. MacDonald, PhD; Anna C. Graefe, BA; Paul Amoroso, MD, MPH; Timothy Heeren, PhD; Jennifer J. Vasterling, PhD Context : Previous research has demonstrated neuropsy- chological changes following Iraq deployment. It is un- known whether these changes endure without subse- quent war-zone exposure or chronic stress symptoms. Objective : To determine the associations of time since deployment,combatintensity,andposttraumaticstressdis- order (PTSD) and depression symptoms with longer-term neuropsychological outcomes in war-deployed soldiers. Design : Prospective cohort study involving (1) soldiers assessed at baseline (median, 42 days prior to deploy- ment) and following return from Iraq (median, 404 days after return and 885 days since baseline), and (2) soldiers more recently returned from deployment assessed at base- line (median, 378 days prior to deployment) and follow- ing return from Iraq (median, 122 days after return and 854 days since baseline assessment). Setting : Active-duty military installations. Participants : Two hundred sixty-eight male and female regularactive-dutysoldiers(164with1-yearfollow-up;104 recently returned). Main Outcome Measures : Neuropsychological per- formances (verbal learning, visual memory, attention, and reaction time). Results : There was a significant interaction between time and PTSD symptom severity (B=-0.01 [unstan- dardized], P =.04). Greater PTSD symptoms were asso- ciated with poorer attention in soldiers tested at 1-year follow-up (B=0.01, P =.03) but not in recently returned soldiers. At 1-year follow-up, mean adjusted attention error scores increased by 0.10 points for every 10 points on the PTSD scale. Greater combat intensity was asso- ciated with more efficient postdeployment reaction- time performances, regardless of time since deployment (B=0.48, P =.004), with mean adjusted reaction effi- ciency scores increasing by 4.8 points for every 10 points on the combat experiences scale. Neither depres- sion nor contextual variables (alcohol use and deploy- ment head injury) were significantly related to neuro- psychological outcomes. Conclusions : In this study of army soldiers deployed to the Iraq war, only PTSD symptoms (among soldiers back from deployment for 1 year) were associated with a neu- ropsychological deficit (reduced attention). Greater com- bat intensity was associated with enhanced reaction time, irrespective of time since return. Arch Gen Psychiatry. 2009;66(9):996-1004 I N RESPONSE TO COGNITIVE PROB- lems reported by veterans follow- ing previous wars, 1-4 the Neuro- cognition Deployment Health Study 5,6 was initiated to examine theneuropsychologicaloutcomesofIraqwar deployment. Results of earlier assessment waves (predeployment/immediate postde- ployment) suggested that deployment led...
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