A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans

PLoS One. 2015 Mar 20;10(3):e0120270. doi: 10.1371/journal.pone.0120270. eCollection 2015.

Abstract

Post-traumatic stress disorder (PTSD), a complex and chronic disorder caused by exposure to a traumatic event, is a common psychological result of current military operations. It causes substantial distress and interferes with personal and social functioning. Consequently, identifying the risk factors that make military personnel and veterans more likely to experience PTSD is of academic, clinical, and social importance. Four electronic databases (PubMed, Embase, Web of Science, and PsycINFO) were used to search for observational studies (cross-sectional, retrospective, and cohort studies) about PTSD after deployment to combat areas. The literature search, study selection, and data extraction were conducted by two of the authors independently. Thirty-two articles were included in this study. Summary estimates were obtained using random-effects models. Subgroup analyses, sensitivity analyses, and publication bias tests were performed. The prevalence of combat-related PTSD ranged from 1.09% to 34.84%. A total of 18 significant predictors of PTSD among military personnel and veterans were found. Risk factors stemming from before the trauma include female gender, ethnic minority status, low education, non-officer ranks, army service, combat specialization, high numbers of deployments, longer cumulative length of deployments, more adverse life events, prior trauma exposure, and prior psychological problems. Various aspects of the trauma period also constituted risk factors. These include increased combat exposure, discharging a weapon, witnessing someone being wounded or killed, severe trauma, and deployment-related stressors. Lastly, lack of post-deployment support during the post-trauma period also increased the risk of PTSD. The current analysis provides evidence of risk factors for combat-related PTSD in military personnel and veterans. More research is needed to determine how these variables interact and how to best protect against susceptibility to PTSD.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Female
  • Humans
  • Male
  • Military Personnel*
  • Odds Ratio
  • Prevalence
  • Risk Factors
  • Stress Disorders, Post-Traumatic / epidemiology*
  • Stress Disorders, Post-Traumatic / etiology*
  • Veterans*
  • War Exposure / adverse effects*

Grant support

Work on this manuscript was supported by the National Natural Science Foundation of China (LZ, grant number 91224005, and YL, grant number 71103194); the Major Project of the "12th Five-Year Plan" of People's Liberation Army (LZ, grant number AWS12J002); and Key Joint project of "Major diseases" of Shanghai health system (LZ, grant number 2013ZYJB0006). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.