PTSD: Catastrophizing in Combat as Risk and Protection

Abstract

We used the Army Person-Event Data Environment to explore risk and protective factors for diagnosed posttraumatic stress disorder (PTSD). We examined the entire eligible cohort of 79,438 active duty soldiers who deployed to Iraq or Afghanistan between 2009 and 2013, an unusually large and complete cohort. Soldiers highest on catastrophic thinking were 29% more likely to develop PTSD than soldiers with average catastrophic thinking, whereas soldiers lowest on catastrophic thinking were 25% less likely to develop PTSD, adjusting for demographic characteristics; psychological (including baseline depression), behavioral, and physical health; and military characteristics. Soldiers who faced four or more combat stressors were 120% more likely to develop PTSD than soldiers who experienced two combat stressors. Additionally, soldiers higher in catastrophic thinking and experiencing higher combat intensity were 274% more likely to develop PTSD than those low on both. The Army might consider interventions to reduce catastrophic thinking prior to combat to lower PTSD casualties.