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Personality traits and combat exposure as predictors of psychopathology over time

Published online by Cambridge University Press:  08 September 2015

E. Koffel ,
M. D. Kramer ,
P. A. Arbisi ,
C. R. Erbes ,
M. Kaler  and
M. A. Polusny
E. Koffel
Affiliation:
Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA Minneapolis VA Healthcare System, Minneapolis, MN, USA Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
M. D. Kramer
Affiliation:
Minneapolis VA Healthcare System, Minneapolis, MN, USA Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
P. A. Arbisi
Affiliation:
Minneapolis VA Healthcare System, Minneapolis, MN, USA Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA Department of Psychology, University of Minnesota, Minneapolis, MN, USA
C. R. Erbes
Affiliation:
Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA Minneapolis VA Healthcare System, Minneapolis, MN, USA Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
M. Kaler
Affiliation:
Minneapolis VA Healthcare System, Minneapolis, MN, USA
M. A. Polusny*
Affiliation:
Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA Minneapolis VA Healthcare System, Minneapolis, MN, USA Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
*
* Address for correspondence: Dr M. A. Polusny, Minneapolis Veterans Affairs Medical Center, (B68-2), Minneapolis, MN 55417, USA. (Email: [email protected])
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Abstract

Background.

Research suggests that personality traits have both direct and indirect effects on the development of psychological symptoms, with indirect effects mediated by stressful or traumatic events. This study models the direct influence of personality traits on residualized changes in internalizing and externalizing symptoms following a stressful and potentially traumatic deployment, as well as the indirect influence of personality on symptom levels mediated by combat exposure.

Method.

We utilized structural equation modeling with a longitudinal prospective study of 522 US National Guard soldiers deployed to Iraq. Analyses were based on self-report measures of personality, combat exposure, and internalizing and externalizing symptoms.

Results.

Both pre-deployment Disconstraint and externalizing symptoms predicted combat exposure, which in turn predicted internalizing and externalizing symptoms. There was a significant indirect effect for pre-deployment externalizing symptoms on post-deployment externalizing via combat exposure (p < 0.01). Negative Emotionality and pre-deployment internalizing symptoms directly predicted post-deployment internalizing symptoms, but both were unrelated to combat exposure. No direct effects of personality on residualized changes in externalizing symptoms were found.

Conclusions.

Baseline symptom dimensions had significant direct and indirect effects on post-deployment symptoms. Controlling for both pre-exposure personality and symptoms, combat experiences remained positively related to both internalizing and externalizing symptoms. Implications for diagnostic classification are discussed.

Keywords

Externalizing disordersinternalizing disorderspersonalitypersonality traits and combat exposure as predictors of psychopathology over timetrauma
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 1 , January 2016 , pp. 209 - 220
Copyright
Copyright © Cambridge University Press 2015 

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References

APA (2000). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.Google Scholar
Beck, AT, Steer, RA, Brown, GK (1996). Beck Depression Inventory Manual. Psychological Corporation: San Antonio, TX.Google Scholar
Blanchard, EB, Jones-Alexander, J, Buckley, TC, Forneris, CA (1996). Psychometric properties of the PTSD Checklist (PCL). Behavior Research and Therapy 34, 669–673.Google Scholar
Breslau, N, Davis, GC, Andreski, P (1995). Risk factors for PTSD-related traumatic events: a prospective analysis. American Journal of Psychiatry 152, 529–535.Google Scholar
Breslau, N, Davis, GC, Andreski, P, Peterson, E (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry 48, 216–222.Google Scholar
Butcher, JN, Graham, JR, Ben-Porath, YS, Tellegen, A, Dahlstrom, WG, Kaemmer, B (2001). MMPI-2: Manual for Administration, Scoring and Interpretation. University of Minnesota Press: Minneapolis.Google Scholar
Campbell, SB, Renshaw, KD, Righter, JB (2015). The role of personality traits and profiles in post-trauma comorbidity. Journal of Trauma & Dissociation 16, 197–210.Google Scholar
Dedert, EA, Green, KT, Calhoun, PS, Yoash-Gantz, R, Taber, KH, Mumford, MM, Tupler, LA, Morey, RA, Marx, CE, Weiner, RD, Beckham, JC (2009). Association of trauma exposure with psychiatric morbidity in military veterans who have served since September 11, 2001. Journal of Psychiatric Research 43, 830–836.Google Scholar
Erbes, CR, Arbisi, PA, Kehle, SM, Ferrier-Auerbach, AG, Barry, RA, Polusny, MA (2011). The distinctiveness of hardiness, positive emotionality, and negative emotionality in National Guard soldiers. Journal of Research in Personality 45, 508–512.Google Scholar
Erbes, CR, Polusny, MA, Arbisi, PA, Koffel, E (2012). PTSD symptoms in a cohort of National Guard soldiers deployed to Iraq: evidence for nonspecific and specific components. Journal of Affective Disorders 142, 269–274.Google Scholar
Fergusson, DM, Horwood, LJ (1987). Vulnerability to life events exposure. Psychological Medicine 17, 739–749.Google Scholar
Finch, JF, West, SG (1997). The investigation of personality structure: statistical models. Journal of Research in Personality 31, 439–485.Google Scholar
Foley, DL, Neale, MC, Kendler, KS (1996). A longitudinal study of stressful life events assessed at interview with an epidemiological sample of adult twins: the basis of individual variation in event exposure. Psychological Medicine 26, 1239–1252.Google Scholar
Forbes, D, Elhai, JD, Miller, MW, Creamer, M (2010). Internalizing and externalizing classes in posttraumatic stress disorder: a latent class analysis. Journal of Traumatic Stress 23, 340–349.Google Scholar
Harkness, AR, Finn, JA, McNulty, JL, Shields, SM (2012). The Personality Psychopathology-Five (PSY-5): recent constructive replication and assessment literature review. Psychological Assessment 24, 432–443.Google Scholar
Harkness, AR, McNulty, JL, Ben-Porath, YS (1995). The personality psychopathology five (PSY-5): constructs and MMPI-2 scales. Psychological Assessment 7, 104–114.Google Scholar
Headey, B, Wearing, A (1989). Personality, life events, and subjective well-being: toward a dynamic equilibrium model. Journal of Personality and Social Psychology 57, 731–739.Google Scholar
Helzer, JE, Robins, LN, Wish, E, Hesselbrock, M (1979). Depression in Viet Nam veterans and civilian controls. American Journal of Psychiatry 136, 526–529.CrossRefGoogle ScholarPubMed
Horwood, LJ, Fergusson, DM (1986). Neuroticism, depression and life events: a structural equation model. Social Psychiatry and Psychiatric Epidemiology 21, 63–71.Google Scholar
Hu, L, Bentler, PM (1998). Fit indices in covariance structure modeling: sensitivity to underparameterized model misspecification. Psychological Methods 3, 424–453.Google Scholar
Hu, L, Bentler, PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling 6, 1–55.Google Scholar
Kehle, SM, Ferrier-Auerbach, AG, Meis, LA, Arbisi, PA, Erbes, CR, Polusny, MA (2011 a). Predictors of postdeployment alcohol use disorders in National Guard soldiers deployed to Operation Iraqi Freedom. Psychology of Addictive Behaviors 26, 42–50.Google Scholar
Kehle, SM, Reddy, MK, Ferrier-Auerbach, AG, Erbes, CR, Arbisi, PA, Polusny, MA (2011 b). Psychiatric diagnoses, comorbidity, and functioning in National Guard troops deployed to Iraq. Journal of Psychiatric Research 45, 126–132.Google Scholar
Kendler, KS, Gardner, CO, Prescott, CA (2003 a). Personality and the experience of environmental adversity. Psychological Medicine 33, 1193–1202.CrossRefGoogle ScholarPubMed
Kendler, KS, Prescott, CA, Myers, J, Neale, MC (2003 b). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry 60, 929–937.Google Scholar
King, DW, King, LA, Foy, DW, Gudanowski, DM (1996). Prewar factors in combat-related posttraumatic stress disorder: structural equation modeling with a national sample of female and male Vietnam veterans. Journal of Consulting and Clinical Psychology 64, 520–531.Google Scholar
King, DW, King, LA, Vogt, DS (2003). Manual for the Deployment Risk and Resilience Inventory (DRRI): A Collection of Measures for Studying Deployment-Related Experiences of Military Veterans. National Center for PTSD: Boston, MA.Google Scholar
Koffel, E, Polusny, MA, Arbisi, PA, Erbes, CR (2012). A preliminary investigation of the new and revised symptoms of posttraumatic stress disorder in DSM-5. Depression and Anxiety 29, 731–738.Google Scholar
Krueger, RF (1999). The structure of common mental disorders. Archives of General Psychiatry 56, 921–926.Google Scholar
Krueger, RF, Caspi, A, Moffitt, TE, Silva, PA, McGee, R (1996). Personality traits are differentially linked to mental disorders: a multitrait-multidiagnosis study of an adolescent birth cohort. Journal of Abnormal Psychology 105, 299–312.Google Scholar
Krueger, RF, Hicks, BM, Patrick, CJ, Carlson, SR, Iacono, WG, McGue, M (2002). Etiologic connections among substance dependence, antisocial behavior and personality: modeling the externalizing spectrum. Journal of Abnormal Psychology 111, 411–424.Google Scholar
Krueger, RF, Markon, KE, Patrick, CJ, Benning, SD, Kramer, MD (2007). Linking antisocial behavior, substance use, and personality: an integrative quantitative model of the adult externalizing spectrum. Journal of Abnormal Psychology 116, 645–666.Google Scholar
Krueger, RF, McGue, M, Iacono, WG (2001). The higher-order structure of common DSM mental disorders: internalization, externalization, and their connections to personality. Personality & Individual Differences 30, 1245–1259.Google Scholar
Lahey, BB (2009). Public health significance of neuroticism. American Psychologist 64, 241–256.CrossRefGoogle ScholarPubMed
Lockenhoff, CE, Terracciano, A, Patriciu, NS, Eaton, WW, Costa, PT Jr. (2009). Self-reported extremely adverse life events and longitudinal changes in five-factor model personality traits in an urban sample. Journal of Traumatic Stress 22, 53–59.Google Scholar
Magnus, K, Diener, E, Fujita, F, Pavot, W (1993). Extraversion and neuroticism as predictors of objective life events: a longitudinal analysis. Journal of Personality and Social Psychology 65, 1046–1053.Google Scholar
Markon, KE (2010). Modeling psychopathology structure: a symptom-level analysis of Axis I and II disorders. Psychological Medicine 40, 273–288.Google Scholar
Markon, KE, Chmielewski, M, Miller, CJ (2011). The reliability and validity of discrete and continuous measures of psychopathology: a quantitative review. Psychological Bulletin 137, 856–879.Google Scholar
Markon, KE, Krueger, RF, Watson, D (2005). Delineating the structure of normal and abnormal personality: an integrative hierarchical approach. Journal of Personality and Social Psychology 88, 139–157.Google Scholar
Miller, MW (2003). Personality and the etiology and expression of PTSD: a three-factor model perspective. Clinical Psychology: Science and Practice 10, 373–393.Google Scholar
Miller, MW, Fogler, JM, Wolf, EJ, Kaloupek, DG, Keane, TM (2008). The internalizing and externalizing structure of psychiatric comorbidity in combat veterans. Journal of Traumatic Stress 21, 58–65.CrossRefGoogle ScholarPubMed
Miller, MW, Greif, JL, Smith, AA (2003). Multidimensional Personality Questionnaire profiles of veterans with traumatic combat exposure: externalizing and internalizing subtypes. Psychological Assessment 15, 205–215.CrossRefGoogle ScholarPubMed
Miller, MW, Vogt, DS, Mozley, SL, Kaloupek, DG, Keane, TM (2006). PTSD and substance-related problems: the mediating roles of disconstraint and negative emotionality. Journal of Abnormal Psychology 115, 369–379.Google Scholar
Miller, MW, Wolf, EJ, Reardon, A, Greene, A, Ofrat, S, McInerney, S (2012). Personality and the latent structure of PTSD comorbidity. Journal of Anxiety Disorders 26, 599–607.CrossRefGoogle ScholarPubMed
Muthen, LK, Muthen, BO (2012). Mplus User's Guide. Muthen & Muthen: Los Angeles, CA.Google Scholar
Naragon-Gainey, K, Watson, D, Markon, KE (2009). Differential relations of depression and social anxiety symptoms to the facets of extraversion/positive emotionality. Journal of Abnormal Psychology 118, 299–310.CrossRefGoogle Scholar
Nock, MK, Stein, MB, Heeringa, SG, Ursano, RJ, Colpe, LJ, Fullerton, CS, Hwang, I, Naifeh, JA, Sampson, NA, Schoenbaum, M, Zaslavsky, AM, Kessler, RC (2014). Prevalence and correlates of suicidal behavior among soldiers: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA Psychiatry 71, 514–522.Google Scholar
Park, CL, Frazier, P, Tennen, H, Mills, MA, Tomich, P (2013). Prospective risk factors for subsequent exposure to potentially traumatic events. Anxiety Stress Coping 26, 254–269.Google Scholar
Patrick, CJ, Kramer, MD, Krueger, RF, Markon, KE (2013). Optimizing efficiency of psychopathology assessment through quantitative modeling: development of a brief form of the Externalizing Spectrum Inventory. Psychological Assessment 25, 1332–1348.CrossRefGoogle ScholarPubMed
Plomin, R, DeFries, JC, Loehlin, JC (1977). Genotype-environment interaction and correlation in the analysis of human behavior. Psychological Bulletin 84, 309–322.Google Scholar
Polusny, MA, Erbes, CR, Murdoch, M, Arbisi, PA, Thuras, P, Rath, MB (2011). Prospective risk factors for new-onset post-traumatic stress disorder in National Guard soldiers deployed to Iraq. Psychological Medicine 41, 687–698.Google Scholar
Poulton, RG, Andrews, G (1992). Personality as a cause of adverse life events. Acta Psychiatrica Scandinavica 85, 35–38.CrossRefGoogle ScholarPubMed
Prigerson, HG, Maciejewski, PK, Rosenheck, RA (2002). Population attributable fractions of psychiatric disorders and behavioral outcomes associated with combat exposure among US men. American Journal of Public Health 92, 59–63.Google Scholar
Quilty, LC, Zhang, KA, Bagby, RM (2010). The latent symptom structure of the Beck Depression Inventory-II in outpatients with major depression. Psychological Assessment 22, 603–608.CrossRefGoogle ScholarPubMed
Rubin, DC, Berntsen, D, Bohni, MK (2008). A memory-based model of posttraumatic stress disorder: evaluating basic assumptions underlying the PTSD diagnosis. Psychological Review 115, 985–1011.Google Scholar
Sadeh, N, Miller, MW, Wolf, EJ, Harkness, KL (2015). Negative emotionality and disconstraint influence PTSD symptom course via exposure to new major adverse life events. Journal of Anxiety Disorders 31, 20–27.Google Scholar
Saudino, KJ, Pedersen, NL, Lichtenstein, P, McClearn, GE, Plomin, R (1997). Can personality explain genetic influences on life events? Journal of Personality and Social Psychology 72, 196–206.Google Scholar
Saunders, JB, Aasland, OG, Babor, TF, De la Fuente, JR, Grant, M (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction 88, 791–804.CrossRefGoogle ScholarPubMed
Schafer, JL, Graham, JW (2002). Missing data: our view of the state of the art. Psychological Methods 7, 147–177.Google Scholar
Sellbom, M, Ben-Porath, YS, Patrick, CJ, Wygant, DB, Gartland, DM, Stafford, KP (2012). Development and construct validation of MMPI-2-RF indices of global psychopathy, fearless-dominance, and impulsive-antisociality. Personality Disorder 3, 17–38.Google Scholar
Sellbom, M, Drislane, LE, Johnson, AK, Goodwin, BE, Phillips, TR, Patrick, CJ (in press). Development and validation of MMPI-2-RF Scales for indexing triarchic psychopathy constructs. Assessment.Google Scholar
Singh, AL, Waldman, ID (2010). The etiology of associations between negative emotionality and childhood externalizing disorders. Journal of Abnormal Psychology 119, 376–388.Google Scholar
Slade, T, Watson, D (2006). The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population. Psychological Medicine 36, 1593–1600.Google Scholar
Tellegen, A, Ben-Porath, YS (2008). MMPI-2-RF: Technical Manual. University of Minnesota Press: Minneapolis, MN.Google Scholar
Tellegen, A, Ben-Porath, YS, McNulty, JL, Arbisi, PA, Graham, JR, Kaemmer, B (2003). MMPI-2 Restructured Clinical (RC) Scales: Development, Validation, and Interpretation. University of Minnesota Press: Minneapolis, MN.Google Scholar
Thomas, KM, Hopwood, CJ, Donnellan, MB, Wright, AG, Sanislow, CA, McDevitt-Murphy, ME, Ansell, EB, Grilo, CM, McGlashan, TH, Shea, MT, Markowitz, JC, Skodol, AE, Zanarini, MC, Morey, LC (2014). Personality heterogeneity in PTSD: distinct temperament and interpersonal typologies. Psychological Assessment 26, 23–34.Google Scholar
Vogt, DS, Proctor, SP, King, DW, King, LA, Vasterling, JJ (2008). Validation of scales from the Deployment Risk and Resilience Inventory in a sample of Operation Iraqi Freedom veterans. Assessment 15, 391–403.Google Scholar
Vollebergh, WA, Iedema, J, Bijl, RV, de Graaf, R, Smit, F, Ormel, J (2001). The structure and stability of common mental disorders: The NEMESIS study. Archives of General Psychiatry 58, 597–603.Google Scholar
Ward, LC (2006). Comparison of factor structure models for the Beck Depression Inventory-II. Psychological Assessment 18, 81–88.Google Scholar
Watson, D (2005). Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology 114, 522–536.Google Scholar
Watson, D (2009). Differentiating the mood and anxiety disorders: a quadripartite model. Annual Review of Clinical Psychology 5, 221–247.CrossRefGoogle ScholarPubMed
Watson, D, Clark, LA, Chmielewski, M (2008). Structures of personality and their relevance to psychopathology: II. Further articulation of a comprehensive unified trait structure. Journal of Personality 76, 1545–1586.CrossRefGoogle ScholarPubMed
Watson, D, Clark, LA, Harkness, AR (1994). Structures of personality and their relevance to psychopathology. Journal of Abnormal Psychology 103, 18–31.Google Scholar
Watson, D, Gamez, W, Simms, LJ (2005). Basic dimensions of temperament and their relation to anxiety and depression: a symptom-based perspective. Journal of Research in Personality 39, 46–66.Google Scholar
Watson, D, Naragon-Gainey, K (2010). On the specificity of positive emotional dysfunction in psychopathology: evidence from the mood and anxiety disorders and schizophrenia/schizotypy. Clinical Psychology Review 30, 839–848.Google Scholar
Weathers, FW, Litz, BT, Herman, DS, Huska, JA, Keane, TM (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. In 1993 annual meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.Google Scholar
Whisman, MA, Perez, JE, Ramel, W (2000). Factor structure of the Beck Depression Inventory-Second Edition (BDI-II) in a student sample. Journal of Clinical Psychology 56, 545–551.Google Scholar
Widiger, TA, Samuel, DB (2005). Diagnostic categories or dimensions? A question for the diagnostic and statistical manual of mental disorders–Fifth Edition. Journal of Abnormal Psychology 114, 494–504.Google Scholar