Abstract: Multivariate Latent Difference Score Models to Test Dynamic Associations between PTSD Symptoms, Physical Pain, and Pain-Related Fear Among U.S. Veterans (Society for Social Work and Research 27th Annual Conference - Social Work Science and Complex Problems: Battling Inequities + Building Solutions)
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Multivariate Latent Difference Score Models to Test Dynamic Associations between PTSD Symptoms, Physical Pain, and Pain-Related Fear Among U.S. Veterans

Schedule:
Friday, January 13, 2023
Valley of the Sun A, 2nd Level (Sheraton Phoenix Downtown)
* noted as presenting author
Shaddy Saba, PhD student, University of Southern California, CA
Jordan Davis, PhD, Assistant Professor, University of Southern California, Los Angeles, CA
John Prindle, PhD, Research Faculty, University of Southern California, Los Angeles, CA
Daniel A. Hackman, PhD, Assistant Professor, University of Southern California, Los Angeles, CA
Carl Castro, PhD, Professor, University of Southern California, Los Angeles, CA
Eric Pedersen, PhD, Associate Professor, University of Southern California, CA
Background and purpose: Physical pain and posttraumatic stress disorder (PTSD) are highly prevalent and co-occurring among post-9/11 American veterans, likely driven by both physical (i.e., injury) and psychological factors. The mutual maintenance model posits a bidirectional, dynamic association between pain and PTSD and fear-avoidance models suggest pain-related fear may play a mechanistic role in these associations. Prior tests of these theoretical models are marred by methodological issues, and improved statistical modeling techniques could enhance knowledge of dynamic symptom associations.

Methods: We used multivariate latent difference score (LDS) models to test among a sample of post-9/11 veterans (N=1230) whether prior changes in PTSD symptoms are associated with subsequent changes in physical pain and vice versa, and to explore whether pain-related fear is involved these associations. To explore whether dynamic symptom associations differed between veterans physically injured and not injured in combat, we again employed LDS models with our sample first limited to veterans who endorsed injury and next limited to those who did not endorse injury.

Results: Results revealed a positive association between prior changes in physical pain and subsequent changes in PTSD symptoms among veterans not injured in combat. There was also a positive association between prior changes in pain and subsequent changes in pain-related fear, and a negative association between prior changes in pain-related fear and subsequent change in PTSD symptoms among non-combat-injured veterans. Among the full sample, there was a positive association between one’s prior level of PTSD symptoms and subsequent changes in pain-related fear.

Conclusions and implications: Dynamic associations between symptoms were primarily seem among veterans not injured in combat. It may be particularly important to monitor for clinically significant changes in pain among non-combat-injured veterans with co-occurring PTSD. Research elucidating the role of additional clinical and military-specific factors is needed.

Back to: Understand veteran trauma: Protectors and consequences associated with mental and physical health outcomes
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