Steele Marshall, Germain Anne, Campbell Justin S
Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Sterling Plaza, Room 240, Pittsburgh, PA 15213.
SPAWAR Systems Center Pacific, 53560 Hull Street, San Diego, CA 92152.
Mil Med. 2017 May;182(5):e1632-e1639. doi: 10.7205/MILMED-D-16-00169.
Post-traumatic stress disorder (PTSD) is a major health concern among the U.S. military population, affecting up to 12% to 24% of veterans returning from Iraq and Afghanistan. Sleep disturbances, neuroticism, and childhood trauma have all been associated with the development of PTSD in military populations, especially in relation to combat experiences. The effects of disrupted sleep and post-traumatic stress can affect the physical well-being of soldier and sailors in the field and impact them for years after deployment. This study aimed to evaluate the relationship between self-reported measures of combat experiences, PTSD symptoms, sleep, neuroticism, and childhood adversity in an active duty military population.
972 U.S. Navy Sailors serving in Afghanistan were given anonymous surveys that assess scales of combat stressors, PTSD symptoms, sleep problems, neuroticism, adverse child experiences (ACEs), and other covariates. Sleep disturbances were hypothesized as moderators, having an indirect effect on the relationship between combat experiences and PTSD symptoms. Neuroticism scores and ACEs were proposed as moderators of the combat-PTSD symptom relationship. Mediation and moderation models were developed and tested using logistic regressions.
Increased number of combat experiences was found to be a significant predictor of PTSD, even when adjusting for all covariates (p < 0.05). Consistent with partial mediation, nightmares had an indirect effect on the relationship between combat experiences and PTSD symptoms in the final model (path coefficient = 0.233, 95% confidence interval = 0.036, 0.483). Neuroticism was an independent predictor of PTSD symptoms (p < 0.001), but the interaction of combat and neuroticism did not predict symptoms of PTSD. ACEs did not have a significant impact in the model as either an independent predictor or a moderating factor.
These results indicate that the presence of nightmares may partially explain how traumatic combat experiences lead to the development of PTSD. The study also reaffirms neuroticism as risk factor for developing PTSD symptoms. These findings highlight the importance of sleep hygiene and operational stress models in combat situations and may help stress control professionals address risk factors associated with PTSD symptoms.
创伤后应激障碍（PTSD）是美国军人中的一个主要健康问题，影响着高达12%至24%从伊拉克和阿富汗归来的退伍军人。睡眠障碍、神经质和童年创伤都与军人中PTSD的发生有关，特别是与战斗经历相关。睡眠中断和创伤后应激的影响会影响战场上士兵和水手的身体健康，并在部署多年后对他们产生影响。本研究旨在评估现役军人中自我报告的战斗经历、PTSD症状、睡眠、神经质和童年逆境之间的关系。
对972名在阿富汗服役的美国海军水手进行匿名调查，评估战斗应激源、PTSD症状、睡眠问题、神经质、儿童不良经历（ACEs）和其他协变量的量表。睡眠障碍被假设为调节因素，对战斗经历与PTSD症状之间的关系有间接影响。神经质得分和ACEs被提议作为战斗与PTSD症状关系的调节因素。使用逻辑回归开发并测试中介和调节模型。
即使在调整所有协变量后，战斗经历数量的增加仍是PTSD的显著预测因素（p < 0.05）。与部分中介一致，在最终模型中，噩梦对战斗经历与PTSD症状之间的关系有间接影响（路径系数 = 0.233，95%置信区间 = 0.036，0.483）。神经质是PTSD症状的独立预测因素（p < 0.001），但战斗与神经质的交互作用并未预测PTSD症状。ACEs作为独立预测因素或调节因素在模型中均无显著影响。
这些结果表明，噩梦的存在可能部分解释了创伤性战斗经历如何导致PTSD的发生。该研究还重申神经质是发生PTSD症状的风险因素。这些发现凸显了战斗情况下睡眠卫生和作战应激模型的重要性，并可能有助于应激控制专业人员解决与PTSD症状相关的风险因素。
