Treatment Responsivity in Service Members With PTSD and a History of Childhood Trauma and Combat

Adverse childhood experiences (ACEs) and combat exposure are risk factors for developing posttraumatic stress disorder (PTSD) in adulthood. Higher proportions of military service members (SMs) self-report ACEs than do civilians. Combat exposure subsequent to ACEs has been found to predict PTSD severity beyond the expected effect of combat exposure alone. Adverse childhood experiences appear to impede responsivity to treatment of mood disorders; less is known about their impact on responsivity to treatment of PTSD, including following combat exposure. The current study examined whether SMs receiving treatment for self-reported PTSD differed in symptom severity trajectories based on their childhood sexual and/or physical abuse and combat exposure histories.

We conducted a secondary analysis of data from a randomized clinical trial (RCT) that evaluated the effectiveness of collaborative primary care programs for treating SMs with self-reported PTSD (N = 561). Patients completed PTSD, depression, and somatic symptom assessments over 12 months. We used latent growth-curve models to measure symptom trajectories based on childhood sexual and/or physical abuse (ACE status) and combat exposure status. The original RCT was approved by multiple institutional research review boards.

Of 561 patients who screened positive for probable PTSD, 47.2% reported exposure to ACEs and 69.0% to combat; 30.7% of patients reported exposure to both. On average, participants had reductions in PTSD, depression, and somatic symptoms by 12 months (d = -0.59, -0.66, and -0.34, respectively). We did not find evidence for effect measure modification between ACE and combat exposure for any of the 3 outcome models. The decreases in PTSD and depression did not appreciably differ as a function of ACE or combat exposure. There was weak evidence that combat-exposed individuals had a smaller decrease in depression symptoms and ACE-exposed individuals had a larger decrease in somatic symptoms by 12 months compared to their nonexposed counterparts.

There was only weak evidence of an association between ACEs or combat exposure, alone or in combination, on the symptom improvement shown by SMs with self-reported PTSD. This suggests that SMs with ACEs can benefit from PTSD treatment managed through collaborative primary care to a similar extent as SMs without ACEs. Further research is needed to determine which characteristics of the childhood trauma, adult trauma, patient population, and trauma-focused therapy interact to best predict responsivity to treatment in SMs with PTSD.