ICD-11 complex post-traumatic stress disorder and psychiatric comorbidity among UK Armed Forces veterans in Northern Ireland: a latent class analysis

ABSTRACT

Background: There is evidence to suggest that the experience of complex post-traumatic stress disorder (C-PTSD) may be commonly associated with elevated risk for several mental ill-health comorbidities.

Objective: The current study seeks to contribute to the growing literature on C-PTSD comorbidity by examining the relationship between C-PTSD and other mental health disorders in a UK Armed Forces veteran sample.

Method: This study used data from the Northern Ireland Veterans’ Health and Wellbeing Study (NIVHWS). The effective sample consisted of 638 veterans (90.0% male). Tetrachoric correlations examined the relationship between C-PTSD caseness and other mental health outcomes. Latent class analysis was then conducted, determining the optimal number and nature of classes in the sample in relation to C-PTSD, depression, anxiety, and suicidality.

Results: C-PTSD caseness (i.e. probable diagnosis) was found to be significantly associated with positive caseness of depression, anxiety, and suicidality. Overall, four latent classes emerged, with each of these classes characterized by varying degrees of comorbidity: a ‘Resilient/Low Comorbidity’ class, a ‘Lifetime Suicidal’ class, a ‘PTSD Polymorbid’ class, and a ‘C-PTSD Polymorbid’ class.

Conclusions These findings support and extend previous results indicating the highly comorbid nature of C-PTSD. C-PTSD may be considered a highly polymorbid condition, increasing the risk for multiple mental health pathologies concurrently.

HIGHLIGHTS

• The results showed that probable complex PTSD was associated with depression, anxiety, and suicidality in this military veteran sample.

• Latent class analysis revealed that probable complex PTSD was associated with multiple conditions concurrently, suggesting that complex PTSD is not only highly comorbid but polymorbid.

• The findings highlight the importance of screening for multiple pathologies, particularly in cases of probable complex PTSD.

Antecedentes: Existen evidencias que sugieren que la experiencia del TEPT Complejo (TEPT-C) puede estar comúnmente asociada con un riesgo elevado de varias comorbilidades de salud mental.

Objetivo: El presente estudio pretende contribuir a la creciente literatura sobre la comorbilidad del TEPT-C examinando la relación entre el TEPT-C y otros trastornos de salud mental en una muestra de veteranos de las Fuerzas Armadas del Reino Unido.

Método: Este estudio utilizó datos del Estudio de Salud y Bienestarde los Veteranos de NI (NIVHWS por sus siglas en ingles). La muestra efectiva consistió en 638 veteranos (90,0% hombres). Las correlaciones tetracóricas examinaron la relación entre la casuística del TEPT-C y otros resultados de salud mental. A continuación, se realizó un análisis de clases latentes para determinar el número y la naturaleza óptimos de las clases dentro de la muestra en relación con TEPT-C, depresión, ansiedad y suicidalidad.

Resultados: La casuística del TEPT-C (es decir, el diagnóstico probable) se asoció significativamente con la casuística positiva de depresión, ansiedad y suicidalidad. En general, surgieron cuatro clases latentes, cada una de las cuales se caracterizaba por diversos grados de comorbilidad: una clase "Resiliente/Baja comorbilidad", una clase "Suicida de por vida", una clase "Polimorbilidad de TEPT" y una clase "Polimorbilidad de TEPT-C".

Conclusiones: Estos hallazgos apoyan y amplían los anteriores que indican la naturaleza altamente comórbida del TEPT-C. El TEPT-C puede considerarse una condición con alta polimorbilidad, que aumenta el riesgo de múltiples patologías de salud mental concurrentemente.

目的：有证据表明，复杂性 PTSD (C-PTSD) 的经历可能通常与一些精神疾病共病风险增加有关。本研究旨在通过考查英国武装部队退伍军人样本中 C-PTSD 与其他心理健康障碍之间的关系，为不断积累的 C-PTSD 共病文献做出贡献。

方法：本研究利用了来自 NI 退伍军人健康与福祉研究 (NIVHWS) 的数据。 有效样本包括 638 名退伍军人（90.0% 为男性）。四分相关性考查了 C-PTSD 案例与其他心理健康结果之间的关系。然后进行潜在类别分析，确定样本中与 C-PTSD、抑郁、焦虑和自杀相关的最佳类别数量和性质。

结果：发现 C-PTSD 个体（即可能的诊断）与抑郁、焦虑和自杀的阳性个体显著相关。总体而言，出现了四个潜在类别，每个类别都以不同程度的共病为特征：“韧性/低共病”类别、“终身自杀”类别、“PTSD 多病”类别和“C-PTSD 多病”类别。

结论：这些发现支持并扩展了前人那些表明 C-PTSD 高度共病性质的发现。 C-PTSD 可能被认为是一种同时增加了多种心理健康疾病风险的高度多病态疾病。

KEYWORDS:

• ICD-11
• complex PTSD
• military veterans
• comorbidity
• depression
• anxiety
• suicide

PALABRAS CLAVE:

• CIE-11
• TEPT complejo
• veteranos militares
• comorbilidad
• depresión
• ansiedad
• suicidio

关键词:

• ICD-11
• 复杂性PTSD
• 退伍军人
• 共病
• 抑郁
• 焦虑
• 自杀

Acknowledgements

The authors acknowledge the support of the members of the NIVHWS team, which supported recruitment and administration throughout the timeline of the project, and would like to thank the Forces in Mind Trust for providing funding.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics approval and consent to participate

Ethical approval for this study was provided by the Ulster University Research Ethics Committee [REC/17/0031] and ratified by the Queen’s University Belfast Faculty of Engineering and Physical Sciences ethical committee [EPS19_156]. All participants provided written consent for participation in the study. Consent for publication was not required.

Data availability statement

The data sets generated and/or analysed during the current study are not publicly available as consent was not sought to share this information during original data collection, but are available from the corresponding author upon reasonable request.

Authors’ contributions

MR was responsible for the study design, data analysis, and manuscript writing. EMcG was responsible for the literature review, data analysis, and manuscript writing. CA was responsible for manuscript writing and review.

Additional information

Funding

This research was supported by the Forces in Mind Trust funding the Northern Ireland Veterans' Health and Well-being Study. The funders had no role in the study design or publication of the results.