The role of trauma, social support, and demography on veteran resilience

Figures & data

Table 1. Race codes for analyses.

0	Caucasian
1	Black or African American
2	American Indian or Alaska Native
3	Asian
4	Native Hawaiian or other Pacific Islander
5	Other

Table 2. Military rank codes for analyses.

0	E-1
1	E-2
2	E-3
3	E-4
4	E-5
5	E-6
6	E-7
7	E-8
8	E-9
9	W-1
10	W-2
11	W-3
12	W-4
13	W-5
14	O-1
15	O-2
16	O-3
17	O-4
18	O-5
19	O-6
20	O-7
21	O-8
22	O-9

Table 3. Correlation matrix – MIRECC Post Deployment Mental Health (PDMH) dataset (n = 3849).

	Age	Gender	Race	CD-RISC	DTS	MOSSS	CES	EDU	EMP	IP	OP	CritAPre	CritADur	CritAPost	Rank
Age	1
Gender	−0.1	1
Race	−6*	115.6*	1
CD-RISC	0.1*	0.5	0.3	1
DTS	−0.1*	0.4	2*	−0.6*	1
MOSSS	0.1*	1.9*	4.3*	0.5*	−0.35*	1
CES	−0.2*	16.6*	12.7*	−0.2*	0.5*	−0.1*	1
EDU	0.2*	−4.6*	3*	0.1*	−0.1*	0.1*	−0.1	1
EMP	0.4*	2.2*	−3.6*	0.01	−0.02	0.04	−0.0004	0.1*	1
IP	−0.1*	0.5	−0.7	−0.3*	0.3*	−0.2*	0.2*	−0.1*	−0.04	1
OP	−0.03*	1.2	−1.3	−0.3*	0.4*	−0.2*	0.5*	0.02*	0.002	0.4*	1
CritAPre	0.02	−14*	−5.8*	−0.2*	0.2*	−0.13*	0.002	0.03*	−0.005	0.07*	0.1*	1
CritADur	0.06*	−6.8*	−6*	−0.2*	0.5*	−0.2*	0.3*	0.01	0.05*	0.1*	0.2*	0.5*	1
CritAPost	0.02	−7.3*	−5.8*	−0.3*	0.3*	−0.07*	0.03*	0.03	−0.03	0.08*	0.1*	0.4*	0.4*	1
Rank	0.5*	1.6	6.6*	0.15*	−0.1*	0.08*	−0.05*	0.3*	0.2*	−0.04*	−0.04*	−0.08	−0.02	−0.08*	1

Abbreviations: EDU: Years of education; EMP: Number of months of most recent employment; IP: number of inpatient hospitalizations; OP: number of outpatient visits; CD-RISC: Connor Davidson Resilience Rating Scale; MOSSS: Medical Outcomes Study (MOS) Social Support Survey; CES: Combat Exposure Scale; DTS: Davidson Trauma Scale; TLEQ: Trauma Life Events Questionnaire; CritAPre: Number of criterion-A events on TLEQ items prior to military service; CritADur: Number of criterion-A events on TLEQ items during military service; CritAPost: Number of criterion-A events on TLEQ items after military service.

Numbers in red are correlation coefficients, those in blue are t-test statistic values and those in green are χ² statistic values. Significant statistic values (p ≤ .05) are indicated by asterisk (*).

Table 4. Demographic and clinical characteristics (n = 3849).

Variables	DTS scores > 32 Mean (SD) n = 1838	DTS scores ≤ 32 Mean (SD) n = 2011	T test or χ^2 (Test statistic) with degrees of freedom	p
Mean age in years (SD)	37 (10.1)	39 (10.8)	t (3847) = 6.7	p < .0001
Number of males, n (%), number of females, n (%)	1440 (78.3%), 398 (21.6 %)	1547 (77%), 464 (23%)	χ^2 (3) = 1.1	p = .8
Race (Caucasian:African American)	844:871	994:928	χ^2 (3) = 2.3	p = .5
Mean years of education (SD)	13.3 (3.6)	13.9 (3.8)	t (3815) = 4.6	P < .0001
Mean months of current employment (SD)	67.8 (90)	71 (89)	t (3703) = 1	p = .3
CD-RISC score, mean (SD)	62.7 (16.3)	81.2 (13.5)	t (3847) = 36.2	p < .0001
CES Score, mean (SD)	15.7 (10.3)	7.2 (8.6)	t (3839) = −27.7	p < .0001
MOSSS Score, mean (SD)	64.6 (26)	80.8 (23)	t (3077) = 18.3	p < .0001
Mean number of inpatient hospitalizations (SD)	0.5 (0.8)	0.1 (0.5)	t (3843) = −15.4	p < .0001
Mean number of outpatient visits (SD)	1.2 (1)	0.5 (0.9)	t (3768) = −24.6	p < .0001
Mean number of TLEQ Criterion-A events (SD) prior to military service	2.2 (2.4)	1.3 (1.7)	t (3847) =  −15.5	p < .0001
Mean number of TLEQ Criterion-A events (SD) during military service	2.8 (2.2)	1.2 (1.6)	t (3847) = −31.5	p < .0001
Mean number of TLEQ Criterion-A events (SD) after military service	1 (1.5)	0.5 (1)	t (3847) = −15.8	p < .0001
Highest rank while in military	5	5.4	t (3829) = 2.86	p = .0042

Abbreviations: CD-RISC: Connor Davidson Resilience Rating Scale; MOSSS: MOS Social Support Survey; CES: Combat Exposure Scale; DTS: Davidson Trauma Scale; TLEQ: Trauma Life Events Questionnaire; SD: Standard deviation.

Table 5. CD-RISC associations with variables including PTSD severity.

Predictor variables Model R^2 (2849) = 0.44	Beta	SE	T	p	Cohen’s d	Effect size	Confidence intervals
Age	0.07	0.03	2.21	.03	0.08	Small	0.01	0.16
Gender	0.18	0.66	0.28	.78	0.01	Small	−0.06	0.08
Race	0.90	0.29	3.10	.002	0.12	Small	0.04	0.19
MOSSS	0.23	0.01	22.25	<.0001	0.83	Large	0.76	0.90
Combat Exposure Scale	0.12	0.03	3.90	.0001	0.15	Small	0.07	0.22
Years of education	0.02	0.07	0.29	.77	0.01	Small	−0.06	0.08
Employment	−0.005	0.003	−1.44	.15	0.05	Small	−0.13	0.02
DTS	−0.23	0.009	−25.27	<.0001	0.94	Large	−1.02	−0.87
Number of inpatient hospitalizations	−0.80	0.41	−1.98	.05	0.07	Small	−0.15	0.00
Number of outpatient visits	0.25	0.29	0.87	.39	0.03	Small	−0.04	0.11
TLEQ Criterion-A events prior to deployment	0.09	0.14	0.62	.53	0.02	Small	−0.05	0.10
TLEQ Criterion-A events during deployment	−0.15	0.15	−0.99	.32	0.04	Small	−0.11	0.04
Criterion-A after deployment	0.15	0.20	0.75	.45	0.03	Small	−0.05	0.10
Rank	−0.08	0.07	−1.07	.28	0.04	Small	−0.11	0.03

Notes: Dependent variable is CD-RISC. Independent variables are age, gender, race, MOSSS, combat exposure, years of education, months of employment at last job, DTS, number of inpatient hospitalizations, number of outpatient visits, Number of TLEQ criterion A events prior to deployment, during deployment, and after deployment, and military rank before discharge. Effect size ≤ 0.2 was classified as small, effect size ≥ 0.5 was classified as medium and ≥0.8 was classified as large.

Abbreviations: CD-RISC: Connor Davidson Resilience Rating Scale; CES: Combat Exposure Scale; DTS: Davidson Trauma Scale; MOSSS: Medical Outcome Social Support Survey; TLEQ: Traumatic Life Events Questionnaire.

Figure 1. Interaction between combat exposure (CES) and resilience (CD-RISC).

Table 6. DTS associations with variables including CD-RISC.

Predictor variables Model R^2 (2845) = 0.58	Beta	SE	T	P	Cohen’s d	Effect size	Confidence intervals
Age	−0.16	0.05	−2.87	.004	0.11	Small	−0.18	−0.03
Gender	1.41	1.21	1.17	.24	0.04	Small	−0.03	0.12
Race	2.15	0.53	4.07	<.0001	0.15	Small	0.08	0.23
MOSSS	−0.03	0.02	−1.49	.14	0.06	Small	−0.13	0.02
CD-RISC	−0.73	0.05	−15.44	<.0001	0.58	Medium	−0.65	−0.50
CES	1.55	0.19	8.34	<.0001	0.31	Small	0.24	0.38
Years of education	−0.24	0.13	−1.90	.06	0.07	Small	−0.14	0.00
Employment	0.0006	0.006	0.11	.91	0.004	Small	−0.07	0.08
Number of inpatient hospitalizations	3.29	0.74	4.45	<.0001	0.17	Small	0.09	0.24
Number of outpatient visits	6.19	0.51	12.14	<.0001	0.45	Small	0.38	0.53
Criterion-A prior to deployment	−0.4	0.96	−0.41	.68	0.02	Small	−0.09	0.06
Criterion-A during deployment	3.32	0.98	3.39	.0007	0.13	Small	0.05	0.20
Criterion-A after deployment	1.73	1.26	1.37	.17	0.05	Small	−0.02	0.12
Rank	−0.0002	0.13	−0.002	.99	0.0001	Small	−0.07	0.07
CD-RISC*CES	−0.009	0.003	−3.42	.0006	0.13	Small	−0.20	−0.05
CD-RISC*Criterion A prior to deployment	0.02	0.014	1.27	.20	0.05	Small	−0.03	0.12
CD-RISC*Criterion A during deployment	0.01	0.014	0.71	.48	0.03	Small	−0.05	0.10
CD-RISC* Criterion A after deployment	0.003	0.019	0.18	.86	0.01	Small	−0.07	0.08

Notes: Dependent variable is DTS. Independent variables are age, gender, race, MOSSS, combat exposure, years of education, months of employment at last job, CD-RISC, number of inpatient hospitalizations, number of outpatient visits, Number of TLEQ criterion A events prior to deployment, during deployment and after deployment, and military rank before discharge. Effect size ≤ 0.2 was classified as small, effect size ≥ 0.5 was classified as medium and ≥0.8 was classified as large.

Abbreviations: CD-RISC: Connor Davidson Resilience Rating Scale; CES: Combat Exposure Scale; DTS: Davidson Trauma Scale; MOSSS: Medical Outcome Social Support Survey; TLEQ: Traumatic Life Events Questionnaire.

Table 7. Structural equation modelling (SEM) latent variables.

Latent variable confirmatory factor analysis
Manifest variables	Beta (estimate)	SE	Z	P value
Trauma latent variable
CES score	1.00
TLEQ Criterion A events before deployment	1.6	0.1	12.8	<.0001
TLEQ Criterion A events during deployment	3.2	0.2	19.4	<.0001
TLEQ Criterion A events after deployment	1.1	0.1	11.6	<.0001
Resilience latent variable
Age	1.00
Race	−0.7	0.2	−4.1	<.0001
MOSSS	10.6	1.9	5.5	<.0001
Years of education	0.4	0.1	5.3	<.0001
Illness latent variable
DTS	1.00
Number of inpatient admissions	0.6	0.04	14.2	<.0001
Number of outpatient visits	1.1	0.06	20	<.0001

Abbreviations: CD-RISC: Connor Davidson Resilience Rating Scale; DTS: Davidson Trauma Scale; TLEQ: Trauma Life Events Questionnaire; CES: Combat Exposure Scale; SE: Standard Error; MOSSS: Medical Outcome Social Support Survey.

Figure 2. SE Model 1 – Illness latent variable as outcome.

Figure 3. SE Model 2 – Trauma latent variable as outcome.

Figure 4. SE Model 3 – Resilience latent variable as outcome.

Figure 5. SE Model 4 – Resilience manifest variable (CD-RISC) as outcome.

Data availability statement

The data that support the findings of this study may be available on request from the corresponding author. Additional approvals may be required. The data are not publicly available due to privacy or ethical restrictions.