Although numerous longitudinal studies have examined heterogeneity in posttraumatic stress disorder (PTSD) symptom course, the long-term course of the disorder remains poorly understood. This study sought to understand and predict long-term PTSD symptom course among a nationwide sample of Operations Enduring Freedom and Iraqi Freedom veterans enrolled in Veterans Health Administration services. We assessed PTSD symptoms at 4 time points over approximately 4.5 years (M = 55.11 months, SD = 6.89). Participants (N = 1,353) with and without probable PTSD were sampled at a 3:1 ratio, and male and female veterans were sampled at a 1:1 ratio to fully explore the heterogeneity of PTSD symptom course and the effect of sex on symptom course. By coding time as years since index trauma, we estimated the course of PTSD symptoms over 20 years. Results indicate symptom course is most appropriately characterized by substantial heterogeneity. On average, veterans experienced initial PTSD symptom severity above the diagnostic threshold following trauma exposure, which was initially stable over time and later began to gradually improve. Although results indicate symptoms eventually began to decline, this effect was gradual; most participants continued to meet or exceed the PTSD provisional diagnostic threshold long after trauma exposure. We identified several predictors and correlates of symptom course, including Hispanic ethnicity, postdeployment social support, and co-occurring psychopathology. Results highlight the heterogeneous nature of PTSD symptom course following trauma exposure and the urgency of the need to ensure access to evidence-based care and to improve available treatments. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

中文翻译：

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退伍军人创伤后应激障碍症状的 20 年病程。

尽管许多纵向研究已经检验了创伤后应激障碍 (PTSD) 症状病程的异质性，但对该病的长期病程仍知之甚少。本研究旨在了解和预测在全国范围内参加退伍军人健康管理服务的持久自由行动和伊拉克自由退伍军人样本中的长期 PTSD 症状过程。我们在大约 4.5 年（M = 55.11 个月，SD = 6.89）的 4 个时间点评估了 PTSD 症状。有和没有可能 PTSD 的参与者 (N = 1,353) 以 3:1 的比例抽样，男性和女性退伍军人以 1:1 的比例抽样，以充分探索 PTSD 症状过程的异质性和性别对症状过程的影响. 通过将时间编码为指数创伤后的年数，我们估计了 20 年以上 PTSD 症状的过程。结果表明，症状过程的最恰当特征是显着的异质性。平均而言，退伍军人在创伤暴露后经历的初始 PTSD 症状严重程度高于诊断阈值，随着时间的推移最初稳定，后来开始逐渐改善。尽管结果表明症状最终开始下降，但这种影响是渐进的；大多数参与者在创伤暴露后很长时间内继续达到或超过 PTSD 临时诊断阈值。我们确定了症状过程的几个预测因素和相关因素，包括西班牙裔种族、部署后社会支持和共同发生的精神病理学。结果强调了创伤暴露后 PTSD 症状过程的异质性，以及确保获得循证护理和改进可用治疗的紧迫性。