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FIGURE 2 Mixed-effects longitudinal model examining PTSD TABLE 3 A Mixed-Effects Longitudinal Model Predicting
symptoms in matched samples of SOF and CF by TBI severity. Posttraumatic Stress Disorder Symptoms
df df
Predictor numerator denominator F value P value
SOF/CF 1 194 0.285 .594
Time 3 499 14.285 <.001
TBI severity 2 194 25.552 <.001
Mental health 1 499 22.793 <.001
treatment, past year
Problematic
substance use, 1 499 0.289 .591
past year
Interaction between 3 499 0.462 .709
SOF/CF and time
Interaction between
SOF/CF and TBI 2 194 0.490 .613
severity
Interaction between
time and TBI severity 6 499 1.899 .079
Three-way
interaction 6 499 1.267 .271
CF = Conventional Forces; SOF = Special Operations Forces; TBI =
TABLE 2 Mixed-Effects Longitudinal Model of PTSD Symptoms by traumatic brain injury.
TBI Severity and SOF Status
Model-based 95% CI 95% CI
TBI Years since PCL-C lower upper have no negative career consequences, and 70% believed that
34
severity Group index TBI estimate bound bound treatment would be kept confidential. Clearly, there are
Mild CF 0 43 39 47 cultural variations between SOF components that influence
SOF 0 47 42 53 beliefs about treatment. More empirical data are needed to
CF 1 44 41 47 understand which barriers and facilitators of screening and
accessing PTSD treatment SOF experience.
SOF 1 46 42 50
CF 2 45 42 48 When SOF SM/Vs screen positive for PTSD, further assess-
SOF 2 45 41 48 ment and possible treatment are warranted. Importantly, a
CF 5 47 44 50 shorter interval between onset of mental health symptoms
SOF 5 43 40 47 and beginning treatment is associated with reduced attrition
CF 10 48 45 52 from the military. Evidence-based psychotherapies for PTSD
8
SOF 10 45 40 50 are the first-line recommendations for full and subthreshold
35
Moderate CF 0 32 25 40 PTSD. SM/Vs who have sustained a TBI of any severity can
SOF 0 36 28 43 benefit from these treatments. 36,37 Evidence-based psychother-
CF 1 34 27 41 apies for PTSD can be delivered in timeframes as short as 2
weeks, which may be ideal for SOF who are concerned about
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SOF 1 35 29 40 maintaining their ability to rapidly deploy. Ensuring treatment
CF 2 37 29 46 for PTSD is immediately available to SOF could assist in main-
SOF 2 35 29 41 taining military readiness and reducing attrition from the mili-
CF 5 49 37 61 tary. Finally, PTSD treatment will need to be accessible to SOF
SOF 5 41 35 48 with a history of TBI who have delayed seeking care, as mean
CF 10 35 9 60 symptom levels remained stable or increased with time.
SOF 10 44 35 54
Severe CF 0 28 23 32 Limitations of the study should be noted. The study exam-
SOF 0 31 26 35 ined mean levels of PTSD symptoms after TBI at a group level
CF 1 31 28 35 rather than an individual level. Thus, the results speak to the
stability of PTSD symptoms in the community and not neces-
SOF 1 32 28 35 sarily for an individual SM/V. The original PCL-C was used
CF 2 34 30 38 rather than the updated PCL-5, as the VA TBIMS study has
SOF 2 33 29 37 used the PCL-C since the inception of the study. The PCL-C
CF 5 35 31 40 also cannot confirm PTSD diagnoses; thus, the current analy-
SOF 5 38 33 43 ses only refer to PCL-C scores rather than diagnoses of PTSD.
CF 10 34 28 40 The database did not allow us to distinguish which roles each
SOF 10 40 33 47 participant held on the Tier 1 or Tier 2 units, nor did it allow
CF = Conventional Forces; SOF = Special Operations Forces; TBI = us to examine the type or quantity of mental health treatment
traumatic brain injury. received. Finally, we created matched samples of SOF and CF
to compare those who were similar in terms of baseline and
TBI characteristics. This method choice could have excluded
variation in unknown, important variables.

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