Predicting multi-modal symptom trajectories across 7 years in veterans with chronic posttraumatic stress

BackgroundVeterans are disproportionately affected by symptoms of post-traumatic stress (PTS) and associated poor health and psychosocial functioning. While most improve over time, others experience severe and persistent concerns. The ability to predict this latter group is critical for early intervention. Characterizing this subgroup has proven difficult, with most studies focusing on PTS and neglect a wider assessment of veterans wellbeing. Consequently, little is known about veterans who experience chronic symptoms and far-reaching impairment. MethodThe present study uses dimension reduction, growth mixture modeling, and clustering methods to identify veterans with the worst-faring trajectories of psychiatric symptoms, health, and psychosocial functioning, using data from the seven-year Mind Your Heart study (MYH) of people receiving Veterans Affairs services (n = 747). Random forest classification and feature selection were then used to examine predictors that distinguish the worst-fairing veteran group from others in the cohort. ResultsThe combined analyses revealed a subgroup of veterans with severe and diverse symptoms across psychiatric domains, impairment in multiple facets of living, and poor health with deterioration over seven years. This subgroup was distinguished by transdiagnostic symptom severity and greater social isolation, avoidance, anhedonia, cynicism, anger/hostility, and immune response and inflammation. ConclusionsVeterans whose distress spans multiple domains appear to be more broadly impaired, socially isolated, cynical or angry/hostile to others, and show elevated immunoreactivity and inflammation. Care for this population should be informed by a multidisciplinary approach that is conscious of veterans mental and physical health, and interpersonal needs.