1044 — Predictors of Change in Overall Mental Health and PTSD Symptom Severity in OEF/OIF Veterans following Return from Deployment
Schultz MR, and Glickman ME, Center for Health Quality, Outcomes & Economic Research (CHQOER), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Vogt D, Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System; Elwy AR, Drainoni ML, and Osei-Bonsu PE, CHQOER, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Martin J, Mawr College; Eisen SV, CHQOER, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA;
Study objectives were to: 1) examine change in mental health and post traumatic stress disorder (PTSD) symptom severity over a 6-9 month period in a national sample of 512 OEF/OIF Veterans, and 2) identify demographic and deployment predictors of symptom improvement or worsening.
We assessed Veterans within one year of return from deployment (T1) and again 6-9 months later (T2) using validated measures of risk and resilience, mental health (BASIS24), and PTSD (PCL) obtained through a mailed survey. Using an effect size of .5, suggested in the literature as a criterion for clinically meaningful change, we classified participants into 3 groups: improved, same, and worse. We then conducted two sets of logistic regressions. Predictors of improvement were identified by comparing those who improved with those who stayed the same or got worse. Predictors of decline were identified by comparing those who got worse with those who improved or stayed the same.
Based on mean scores, there was no statistically significant change from Time 1 to Time 2. However, on both measures there was positive or negative clinically meaningful change for some Veterans. For PTSD 23.4% improved, 58.3% were unchanged, and 18.3% declined; for mental health 21.5% improved, 62.1% were unchanged, and 16.4% declined. Predictors of PTSD worsening included greater concern over physical or co-morbid mental health problems, greater deployment concerns, and a lower level of education. Predictors of mental health worsening included a lower education and higher levels of pre-deployment stressful events. A predictor of PTSD improvement was the lack of other co-morbid mental health conditions.
Examination of mean scores masks the fact that mental health status and PTSD symptom severity show clinically meaningful change in some Veterans. Negative change seems to be related to factors that can be modified by appropriate and timely interventions.
Better understanding of predictors of change in mental health status will help inform better prevention and intervention services for Veterans in VHA. Decline is of particular interest because it has implications for future service use and cost, as well as potential to prevent decline via education and/or other interventions.