Reciprocal associations between PTSD symptoms and functioning over time among veteran men and women

Psychological distress and functional impairment are key diagnostic criteria for posttraumatic stress disorder (PTSD). However, most studies focus on PTSD symptom distress with minimal attention on functioning. The aim of this study was to investigate the temporal dynamics of PTSD symptom severity and global functional impairment, as well as specific areas of functioning (e.g., family, work, parenting, self-care). A gender-balanced sample of 1,461 returning veteran men and women completed measures of PTSD symptom severity and functional impairment at five timepoints between 2010 and 2019. Latent growth curve modeling revealed that during the 18-year period following return from deployment, PTSD symptoms and global functioning showed statistically significant improvement among both men and women, although women experienced more modest improvements in both constructs. There was significant heterogeneity in initial level and rate of change among both men and women, but on average the changes were modest in terms of their clinical meaningfulness. Among subdomains of functioning, women and men exhibited different patterns of change, with only women experiencing improvements in some areas (family, parenting), only men experiencing improvements in some areas (work, romantic relationships), and both experiencing improvements in friendship. Women experienced modest worsening in self-care functioning over time. Parallel process growth modeling indicated that over time, and across virtually all domains of functioning, worse initial symptom severity was associated with greater functioning improvement, and vice versa. Results suggest that interventions directly targeting functioning could be as effective as targeting PTSD symptoms in improving veterans' psychosocial outcomes and enhancing adaptive recovery processes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).