Jacoby Vanessa M, Straud Casey L, Tyler Hannah, Dondanville Katherine A, Yarvis Jeffrey S, Mintz Jim, Young-McCaughan Stacey, Peterson Alan L, Wachen Jennifer Schuster, Resick Patricia A
Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA.
J Trauma Stress. 2024 Dec;37(6):984-997. doi: 10.1002/jts.23080. Epub 2024 Aug 1.
Between 44% and 87% of active duty service members and veterans who deployed following the September 11, 2001, terrorist attacks know someone who was killed or seriously injured in combat. Considering the high frequency and known impact of traumatic loss, it is important to understand if and how traumatic loss may impede posttraumatic stress disorder (PTSD) treatment progress in military personnel. Additionally, experiencing a traumatic loss elevates the risk of developing prolonged grief disorder (PGD), which is associated with higher levels of PTSD symptoms, more functional impairment, and more lifetime suicide attempts among military personnel. Given what is known about the association between PGD and PTSD in treatment-seeking service members and veterans, it is also important to understand whether grief-related symptom severity negatively impacts PTSD treatment response. The current study examined associations among traumatic loss, complicated grief, depressive symptoms, and PTSD treatment response among military personnel (N = 127) who participated in variable-length cognitive processing therapy (CPT). There was no direct, F(2, 125) = 0.77, p = .465, or indirect, β = .02, p = .677, association between a traumatic loss index event and PTSD treatment response compared with other trauma types. Prior assessments of depressive symptom severity were directly related to PTSD at later assessments across two models, ps < .001-p = .021 Participants with a traumatic loss index trauma demonstrated significant reductions in complicated grief, depressive symptoms, and PTSD following CPT, ps < .001, ds = -0.61--0.83. Implications, study limitations, and suggestions for future research are presented.
在2001年9月11日恐怖袭击后被部署的现役军人和退伍军人中，44%至87%的人认识在战斗中丧生或受重伤的人。考虑到创伤性损失的高频率和已知影响，了解创伤性损失是否以及如何阻碍军事人员创伤后应激障碍（PTSD）的治疗进展非常重要。此外，经历创伤性损失会增加患持续性悲伤障碍（PGD）的风险，这与军事人员中更高水平的PTSD症状、更多的功能损害以及更多的终身自杀未遂有关。鉴于已知寻求治疗的军人和退伍军人中PGD与PTSD之间的关联，了解与悲伤相关的症状严重程度是否会对PTSD治疗反应产生负面影响也很重要。本研究调查了参与不同时长认知加工疗法（CPT）的军事人员（N = 127）中创伤性损失、复杂悲伤、抑郁症状与PTSD治疗反应之间的关联。与其他创伤类型相比，创伤性损失指数事件与PTSD治疗反应之间不存在直接关联，F(2, 125) = 0.77，p = 0.465，也不存在间接关联，β = 0.02，p = 0.677。在两个模型中，先前对抑郁症状严重程度的评估与后期评估中的PTSD直接相关，p值小于0.001至p = 0.021。经历创伤性损失指数创伤的参与者在接受CPT后，复杂悲伤、抑郁症状和PTSD均有显著减轻，p值小于0.001，效应量ds = -0.61至-0.83。本文还阐述了研究的意义、局限性以及对未来研究的建议。
