Pre-deployment prediction of partial and full PTSD in a French military cohort

Abstract

Background

Post-traumatic stress disorder (PTSD), in its partial or full forms, is frequently observed in military populations. It is therefore important to predict the risk of PTSD prior to deployment. Objective. Since elevated allostatic load markers have been described in PTSD, we investigated whether these alterations pre-exist before PTSD onset. Our objective was to explore the ability of four allostatic load markers (urinary and blood cortisol, BDNF and 8-iso-PGF2α) to predict partial/full PTSD onset after a 6-month deployment. Methods. We conducted a prospective study in a French military cohort deployed to Afghanistan. PTSD was assessed before (M₀) and after (M₆) deployment using PTSD Checklist Scale (PCLS). At M₀, only subjects who were medically fit and who scored healthy at PCLS were considered. We evaluated whether biological markers of allostatic load at M₀ would predict partial/full PTSD at M₆. Psychological correlates were assessed, including anxious-depressive symptoms (HAD; Hospital Anxiety and Depression), burnout (BMS; Burnout Measure-Short version), anxiety (STAI; Spielberger State-Trait Anxiety Inventory), general mood (POMS; Profile of Mood State), perceived stress (PSS; Perceived Stress Scale), alexithymia (TAS; Toronto Alexithymia scale) and mental health–related scores (GHQ-28; General Health Questionnaire-28 items). Results. After controlling for age, pre-deployment PCLS scores, and the number of missions, we found that elevated M₀ nocturnal urinary cortisol excretion predicted M₆ partial/full PTSD. Conclusions. Asymptomatic subjects at risk of partial/full PTSD exhibit a common pattern of hypothalamic-pituitary axis dysregulation, similar to that observed in established PTSD.