Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans.
Department of Psychology, University of Minnesota.
Psychol Trauma. 2019 Nov;11(8):861-868. doi: 10.1037/tra0000462. Epub 2019 Apr 18.
Some veterans may benefit from psychosocial interventions to facilitate reintegration and prevent chronic impairments following discharge from the service. In a randomized controlled trial, an online expressive writing intervention for Iraq and Afghanistan War veterans with reintegration difficulties reduced distress relative to control conditions, albeit with small between-group effect sizes (Sayer, Noorbaloochi et al., 2015). The aims of this study were to further explore changes in distress severity in the parent study's experimental group by identifying subgroups with similar trajectories and examining predictors of those trajectories.
We used latent class growth modeling to identify trajectories of change in distress among veterans randomized into expressive writing (N = 508). We also tested six predictors of trajectory membership: baseline probable PTSD, social support, combat exposure, sex, VA user status, and active-duty versus National Guard/Reserve status. The sample was mostly White, middle-aged, Army veterans deployed from active duty, all of whom reported reintegration difficulties.
A four-class model, with the following classes, best fit the data: Low Baseline Distress-Moderate Decrease (60%; Cohen's d = -0.69), Moderate Baseline Distress-No Change (25%; Cohen's d = -0.16), Severe Baseline Distress-Small Increase (10%; Cohen's d = 0.23), and Severe Baseline Distress-Very Large Decrease (5%; Cohen's d = -4.80). Veterans without probable PTSD, with less combat exposure, and with higher social support were more likely to be in classes with decreasing distress.
Analyses revealed several subgroups with unique patterns of change. Non-therapist-assisted expressive writing may be most suitable for veterans with less complex psychosocial problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
对于从军队中退役的人员，一些退伍军人可能会从社会心理干预中受益，这有助于他们重新融入社会，防止在服役后出现慢性损伤。在一项随机对照试验中，针对在重新融入社会过程中遇到困难的伊拉克和阿富汗战争退伍军人，一种在线表达性写作干预措施降低了他们的痛苦，与对照组相比，这一效果虽小，但具有统计学意义（Sayer、Noorbaloochi 等人，2015 年）。本研究的目的是通过确定具有相似轨迹的亚组，并检验这些轨迹的预测指标，进一步探讨实验组中退伍军人的痛苦严重程度变化。
我们使用潜在类别增长建模来识别接受表达性写作随机分组的退伍军人的痛苦变化轨迹（n=508）。我们还测试了轨迹成员的六个预测指标：基线可能的 PTSD、社会支持、战斗暴露、性别、VA 用户状态以及现役军人与国民警卫队/预备役状态。该样本主要是白人，年龄在中年，是从现役部队中部署的陆军退伍军人，所有人都报告说在重新融入社会的过程中遇到了困难。
一个具有以下类别的四分类模型最适合数据：低基线痛苦-适度下降（60%；Cohen's d=-0.69）、中等基线痛苦-无变化（25%；Cohen's d=-0.16）、严重基线痛苦-略有增加（10%；Cohen's d=0.23）和严重基线痛苦-大幅下降（5%；Cohen's d=-4.80）。没有 PTSD 的退伍军人、战斗暴露程度较低且社会支持度较高的退伍军人，更有可能处于痛苦下降的类别中。
分析显示，有几个亚组具有独特的变化模式。非治疗师辅助的表达性写作可能最适合社会心理问题不太复杂的退伍军人。
