The differences between war- and civilian-related traumatic events and the presentation of posttraumatic stress disorder and suicidal ideation in a sample of National Guard soldiers

Although posttraumatic stress disorder (PTSD) is considered a single condition, the heterogeneity of PTSD symptoms may impact PTSD diagnosis and the subsequent report of suicidal ideation. Given the differences between war- and civilian-related traumatic events, we first determined the presence of PTSD symptom heterogeneity between soldiers who experienced war- vs. civilian-related events. Second, we determined the utility of criterion A2 (fear, helplessness, and/or horror) for the diagnosis of PTSD after war- and civilian-related events. Third, we determined the role of traumatic event experiences in the report of suicidal ideation. We utilized a cross-sectional sample of 898 guard soldiers and assessed the participants' history of potentially traumatic events, the presence of PTSD symptoms and diagnosis, and the presence of suicidal ideation. Potentially traumatic events were classified as war- (assaultive, shocking, or the sudden unexpected death of someone close during the most recent deployment to a combat zone) or civilian-related (similar events in civilian life). We used the PTSD Checklist-17 to assess PTSD and the Patient Health Questionnaire-9 to assess suicidal ideation. For the first objective, we used logistic regression to estimate the association between event type (war vs. civilian) and each PTSD symptom for all participants (etiologic heterogeneity) and those with psychopathology after the event (clinical heterogeneity). For the second objective, we used logistic regression to examine the association between criterion A2 and PTSD symptom criteria B-F by event type. For the third objective, we ran separate logistic regressions to examine the association of any event (any vs. non), as well as the event type (war vs. civilian), with suicidal ideation. We found that soldiers with war-related events were less likely to report re-experiencing symptoms as well as report criterion A2 than were those with civilian events. Few individuals who did not report criterion A2 developed the remaining PTSD symptom criteria. Additionally, we found that soldiers with war-related events were less likely to report suicidal ideation than were those with civilian events. We suggest that war-related events as compared to similar civilian events occur in contexts that may buffer some of the consequences of trauma.