Associations Among PTSD, Cognitive Functioning, and Health-Promoting Behavior in Post-9/11 Veterans

Karen A Lawrence; Natasha E Garcia-Willingham; Emily Slade; Bryann B DeBeer; Eric C Meyer; Sandra B Morissette

doi:10.1093/milmed/usad035

Associations Among PTSD, Cognitive Functioning, and Health-Promoting Behavior in Post-9/11 Veterans

Mil Med. 2023 Feb 24;188(7-8):e2284-e2291. doi: 10.1093/milmed/usad035. Online ahead of print.

Authors

Karen A Lawrence¹, Natasha E Garcia-Willingham², Emily Slade³, Bryann B DeBeer^{4

5}, Eric C Meyer⁶, Sandra B Morissette⁷

Affiliations

¹ College of Social Work, University of Kentucky, Lexington, KY 40506, USA.
² Department of Psychology, College of Arts & Sciences, University of Kentucky, Lexington, KY 40506, USA.
³ Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY 40506, USA.
⁴ Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO 80045, USA.
⁵ Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA.
⁶ Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
⁷ Department of Psychology, The University of Texas at San Antonio, San Antonio, TX 78249, USA.

Abstract

Introduction: PTSD is associated with negative health behaviors that increase chronic disease risk, yet health behaviors and their determinants are not well investigated in this context. One understudied mechanism of health behaviors is cognitive functioning. Deficits in cognitive functioning may undermine engagement in health-promoting behavior, thereby increasing the negative impact of PTSD. We tested three hypotheses: (1) Greater PTSD symptom severity is associated with less health-promoting behavior; (2) greater PTSD symptom severity is associated with poorer cognitive functioning across verbal memory, processing speed, attention, and executive functioning domains; and (3) verbal memory and executive functioning exhibit indirect effects on the relationship between PTSD and health-promoting behavior.

Materials and methods: We examined associations between PTSD symptom severity (Clinician-Administered PTSD Scale for DSM-IV), cognitive functioning, and health-promoting behavior (Health-Promoting Lifestyle Profile II) in 124 post-9/11 veterans (average age = 37.82; 85.5% male; 63.7% White; 18.5% Black; 26.6% Hispanic). Cognitive domains examined included verbal memory (California Verbal Learning Test), processing speed (Digit Symbol Coding), attention and working memory (Digit Span), and executive functions (Trail Making Test and Stroop Interference).

Results: Regression analyses indicated that greater PTSD symptom severity was associated with less health-promoting behavior (B = -.0101, SE = 0.0016, P < .0001; R2 = 0.3052). Path analyses revealed that verbal learning and memory partially accounted for this relationship (R2 = 0.037- 0.043; P < .05).

Conclusions: Therapeutic targeting of these relationships may have implications for the prevention of long-term disease impact in veterans; longitudinal research is needed to elucidate the potential impact on chronic disease.

Abstract

Grants and funding