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Trajectories of Self-Rated Health Among Veterans: A Latent Growth Curve Analysis of the Impact of Posttraumatic Symptoms

From the Bob Shapell School of Social Work (Y.B., K.G., Z.S.), Tel Aviv University, Tel Aviv, Israel, and New School of Psychology (T.E.-D.), Interdisciplinary Center (IDC), Herzliya, Israel.

Address correspondence and reprint requests to Yael Benyamini, Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv 69978, Israel. E-mail: benyael{at}post.tau.ac.il

Objectives: To examine the effects of combat stress reaction (CSR) and posttraumatic stress symptoms (PTS) on the level and trajectories of self-rated health (SRH) over 20 years after war exposure.

Methods: A total of 675 veterans comprising two groups, a CSR group (n = 369) and a matched control group without CSR (n = 306), were assessed in a prospective longitudinal design, 1, 2, 3, and 20 years after their participation in the 1982 Lebanon War. SRH and PTS were assessed repeatedly, at each point of measurement.

Results: The CSR participants showed more impaired initial SRH than the controls. Although the CSR group showed an improvement in SRH over time, its SRH level remained lower than that of the control group in all 4 points in time. Initial levels of PTS were associated with more impaired SRH and lower improvement over time. In addition, increased levels of PTS in the first follow-up period were related to poorer SRH, in comparison to the predicted trajectory on the basis of CSR and initial PTS.

Conclusions: Stress reaction to war trauma affected the trajectory of SRH over a 20-year period. Although the differences between veterans who had shown acute stress reaction and those who had not persisted over the entire period, there was slow improvement in SRH over time among the more impaired CSR group. PTS in the first years after the war slowed this improvement and thus played a key role in the relationship between war trauma and physical health.

Key Words: combat stress reaction • posttraumatic stress symptoms • posttraumatic stress disorder • self-rated health • war veterans

Abbreviations: CSR = combat stress reaction; LGM = latent growth models; PTS = posttraumatic stress symptoms; PTSD = posttraumatic stress disorder; SRH = self-rated health.