A Network Analysis of Post-traumatic Stress and Neuropsychological Functioning among United States Military Personnel
The primary aim of this dissertation was to explore pre-deployment and post-deployment factors that precipitate post-traumatic stress reactions, neuropsychological functioning, and health-related quality of life (HRQoL) among deployed personnel. A secondary aim was to compare deployed and non-deployed military personnel. This dissertation employed Bayesian structure learning with Markov chain Monte Carlo [MCMC] search and score, which estimates an optimal causal network with every variable simultaneously assessed for complex relations. Models included a primary longitudinal network for deployed personnel (n = 819, I = 27), a post-deployment model of these same personnel (n = 819, I = 32), and undirected networks for all personnel in the study (including item-level networks for post-traumatic stress items before and after deployment; N = 1,142, I = 34). This dissertation hypothesized that a complex model would emerge in which neuropsychological, psychological, and deployment experience variables would have direct effects on post-traumatic stress reactions, with a central role for attention and executive functioning. In undirected networks, post-traumatic stress scores and several measures of attention and executive functioning showed relatively higher importance for the network of deployed personnel at post-deployment when compared to the network of non-deployed personnel. Directed longitudinal models suggested mixed evidence that neuropsychological measures had an independent / exogenous effect on post-traumatic stress at pre-deployment with a chain involving decisional sustained attention (i.e., reaction time under conditions of conflict monitoring; BIC = -1.29, w = 0.10, PPStr = 96.9%, PPDir = 26.7%). Post-traumatic stress scores had an effect on decisional sustained attention after deployment (BIC = -16.6, w = 0.18, PPStr = 100.0%, PPDir = 99.97%), with numerous neuropsychological measures as ancestors / descendants of this path, as well as cognitive complaints and HRQoL. The supplemental directed model suggested that wartime exposures were linked to post-traumatic stress with descendant effects on depression, cognitive complaints, and HRQoL. These findings support several theoretical factors in the etiopathology of PTSD such as current models of memory disturbance and attentional bias. Overall, this dissertation strengthens the evidence in favor of pre and post-deployment screening with psychological and neuropsychological measures, and early intervention in military personnel with post-traumatic stress.
Frank, Brandon, "A Network Analysis of Post-traumatic Stress and Neuropsychological Functioning among United States Military Personnel" (2020). ETD Collection for Fordham University. AAI27669878.