Beyond Combat Exposure: Non-Traumatic Deployment Stressors and Anger As Risk Factors for Developing Posttraumatic Stress Symptoms

Background/Purpose: While combat exposure is a well-established predictor of military posttraumatic stress symptoms (PTSS), other risk factors may also contribute to the development of PTSS.  The present study examines two potential risk factors typically neglected in studies of PTSS in soldiers returning from combat:  non-traumatic deployment stressors and anger.  In terms of non-traumatic deployment stressors, previous research suggests that these stressors should be included in models of deployment-related PTSS.  Several studies have also found that anger/aggression increases following deployment.  Anger/aggression has also been associated with subsequent risk-taking and health-related behaviors post deployment, as well as ethical decision making during combat deployments.  The present study examines the degree to which potentially traumatic combat experiences, non-traumatic deployment stressors, and anger are associated with PTSS in soldiers returning from a combat deployment. Expanding the known risk factors associated with PTSS can facilitate the early identification of PTSS in a high-risk occupational context like the military. 

Methods:  This study is an analysis of cross-sectional survey data originally collected as part of a larger longitudinal study conducted by the Walter Reed Army Institute of Research (WRAIR).  The survey was administered to U.S. soldiers from a Brigade Combat Team within a week following their return home after a 12-month deployment to Iraq in 2005.  In all, 2,297 consented to participate (76%).  PTSS was assessed using the PTSD Checklist.  Non-traumatic deployment stressors were assessed using a WRAIR measure of 11 deployment stressors (e.g., family separation, sleep deprivation, long deployment length).  Anger was measured using a 4-item measure of anger and aggressive behaviors.  Data were analyzed using multiple regression analysis; PTSS was regressed on combat exposure, non-traumatic deployment stressors, and anger. 

Results:  The step-wise regression model was statistically significant (F_(3,2171)=412.68, p<.001), adjusted R²=.36.  Combat exposure, non-traumatic deployment stressors, and anger were all significantly associated with PTSS (β=.17, p<.001; β=.35, p<.001, and β=.30, p<.001, respectively).

Conclusions & Implications:  While cross-sectional data precluded identifying predictors of PTSS over time, the findings identify the importance of considering non-traumatic deployment stressors and anger in understanding military members and veterans reporting PTSS.  Although non-traumatic deployment stressors are not typically the focus of clinical attention, the findings suggest that social workers and other clinicians may want to address these experiences in working with at-risk military members and veterans.  This suggestion is particularly salient in light of the focus on traumatic events in the evidence-based treatments for PTSS.  It may be that expanding the focus to include non-traumatic stressors may address underlying dimensions of PTSS.  Furthermore, clinicians may also want to identify and intervene early with soldiers displaying anger, given that anger is a risk factor for PTSS.  These findings also suggest that deployed social workers should encourage leaders to minimize non-traumatic deployment stressors where feasible.  Non-traumatic deployment stressors may drain an individual’s resilience resources, and these resources may be better allocated to managing the stress of traditional combat-related events.