Effects of Psychiatric Symptom and Cognitive Functioning Changes on Functional Disability Trajectories in Post-9/11 Veterans

John P.K. Bernstein, Ph.D.

VA Boston Healthcare System
Effects of Psychiatric Symptom and Cognitive Functioning Changes on Functional Disability Trajectories in Post-9/11 Veterans

Scientific Abstract


Background: Post-9/11 Veterans report difficulties with reintegration and daily functioning following military service. While prior work has tied these difficulties to psychiatric diagnoses and cognitive dysfunction, the cross-sectional nature of many of these studies has limited the potential for causal inferences. The current study examined these relationships using a longitudinal approach and continuous measurement of cognitive and psychiatric functioning.

Methods: A total of 237 post-9/11 Veterans (90% male, 77% Caucasian, 33 (SD=9) years of age, 14 (SD=2) years of education) enrolled in the TRACTS longitudinal cohort study at VA Boston Healthcare System completed an assessment battery at baseline and ~2-year follow-up. The battery included self-reported functional disability (WHO Disability Assessment Schedule total and subscales), PTSD symptoms (Clinician-Administered PTSD Scale), depression and anxiety (Depression Anxiety Stress Scales subscales), sleep quality (Pittsburgh Sleep Quality Index total), pain (McGill Pain Questionnaire average pain) and alcohol use (Lifetime

Drinking History lifetime quantity total). Cognitive tests tapped attention (TOVA/digit span/Trails A), verbal memory (CVLT-II) and executive function (Trails B/category fluency/Stroop). Linear regressions examined whether changes in psychiatric and cognitive variables independently predicted reliable change indices in functional disability.

Results: Increased PTSD, depression, anxiety and pain were independently associated with increases in overall functional disability (adjusted R-square=.47, p<.05). Increases in PTSD and depression were most frequently tied to increases in specific facets of disability (e.g., work/school performance, relationships) (adjusted R-square range = .19 to .38, p<.05). Changes in cognitive performance were not linked to changes in disability (p>.05).

Conclusions: Changes in psychiatric symptoms, but not cognitive functioning, frequently accompany changes in post-9/11 Veterans’ functional disability. PTSD and depression may be particularly important targets of clinical interventions aimed at supporting these individuals’ everyday functioning.

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research Areas


John P.K. Bernstein, Ph.D., Anna Stumps, B.A., Francesca Fortenbaugh, Ph.D., Jennifer Fonda, Ph.D., Regina McGlinchey, Ph.D., William Milberg, Ph.D., Catherine Fortier, Ph.D., Mike Esterman, Ph.D., Melissa Amick, Ph.D., & Joe DeGutis, Ph.D.

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