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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1063 — The Influence of PTSD Symptom Clusters, TBI, Chronic Pain, and Alcohol Abuse on Multiple Domains of Functioning in Trauma-Exposed OEF/OIF Veterans

Meyer ECMorissette SBKimbrel NAKruse MI, and Gulliver SB, VISN 17 COE for Research on Returning War Veterans; Marx BP, National Center for Posttraumatic Stress Disorder; Schumm JA, Cincinnati VA Medical Center; Penk WE, Texas A&M Health Science Center;

PTSD is associated with impaired functioning among OEF/OIF Veterans. Research suggests that the avoidance/emotional numbing symptom cluster may have the strongest relationship with functional impairment. Few studies have examined the influence of PTSD on functioning in comparison to other injuries and conditions common to OEF/OIF Veterans.

Potential predictors of functioning were assessed via self-report and interview during an in-person assessment of 114 trauma-exposed OEF/OIF Veterans. Predictors included demographic variables, combat exposure, TBI exposure, post-concussive symptoms, chronic pain, and symptoms of alcohol abuse and PTSD. Seven domains of current functioning were assessed using the World Health Organization Disability Assessment Schedule.

Using hierarchical regression, demographic characteristics did not account for a significant proportion of variance in global functional impairment. Next, combat exposure, positive TBI screen, post-concussive symptoms, and chronic pain accounted for 26.8% of additional variance in global impairment (p <.001). Chronic pain and post-concussive symptoms were significant individual predictors, whereas combat exposure and TBI were not. Next, alcohol abuse symptoms did not predict global impairment (2.3%; p = .09). Finally, PTSD symptoms accounted for 29.9% of unique variance in global impairment over and above all other predictors (p <.001; large effect). The avoidance/numbing symptom cluster was the strongest predictor of global impairment. Avoidance/numbing was the only cluster that predicted social impairment (understanding and communicating with others, getting along with people, participation in society). Hyperarousal was the only cluster that predicted work/school impairment. Re-experiencing was the only cluster that predicted impairment with household activities and getting around.

PTSD symptoms predicted functional impairment after controlling for demographics, combat exposure, TBI, post-concussive symptoms, chronic pain, and alcohol abuse. Different PTSD symptom clusters had differential effects on domains of functioning.

Several of the most common injuries and conditions among OEF/OIF Veterans were associated with worse functioning. Among these, PTSD appears to have the strongest relationship with functioning. Comprehensive rehabilitation efforts should address PTSD. Interventions that target different symptoms (e.g., avoidance, sleep problems, nightmares) may have differential effects on individual domains of functioning. Longitudinal research, including research following Veterans receiving treatment, is warranted to examine the effects of changes in symptoms on functioning.

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