Effect of Multimorbidity and Psychosocial Factors on Posttraumatic Stress Symptoms Among Post-9/11 Veterans

Anthony J. Longoria, Avery Horton, Alicia A. Swan, Andrea Kalvesmaki, Mary Jo Pugh

Research output: Contribution to journalArticlepeer-review


Objectives: Examine the association of multimorbidity and psychosocial functioning with posttraumatic stressdisorder (PTSD) symptom severity reported among post-9/11 veterans. Method: This was a secondary analysisof survey data collected from a national sample of post-9/11 veterans with at least 3 years of Department ofVeterans Affairs care, stratified by comorbidity trajectory and sex (N = 1,989). Comorbidity trajectories werederived by latent class analysis to develop probabilistic combinations of physical and mental health conditions ina previous effort (Pugh et al., 2016). In this study, linear models analyzed symptom severity reported on thePTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition by psychosocialfactors (i.e., resilience, self-efficacy, and postdeployment social support) while controlling for sociodemographiccharacteristics and deployment experiences. Results: Veterans in the mental health, pain, and polytrauma clinical triad comorbidity trajectories reported more severe PTSD symptoms than the healthy comorbidity trajectory(p,.01). All psychosocial factors were significantly associated with PTSD symptom severity, accounting fornearly 43% of variability in follow-up analyses. Confidence in self-efficacy demonstrated the strongest association among them (p,.01). Conclusion: Veterans experiencing multimorbidity, particularly mental health distress, reported greater PTSD symptom severity after controlling for psychosocial factors, sociodemographics,and deployment experiences. The salience of psychosocial factors in reported PTSD symptom severity underscores resilience, self-efficacy and social support as potential facilitators of functional reintegration followingmilitary service. Our analyses underscore the need to address the systemic barriers in health care access anddelivery for minority patient populations in future investigations.

Original languageEnglish (US)
Pages (from-to)69-78
Number of pages10
JournalRehabilitation Psychology
Issue number1
StatePublished - 2022
Externally publishedYes


  • Multimorbidity
  • Ptsd
  • Reintegration
  • Resilience
  • Self-efficacy

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation
  • Clinical Psychology
  • Psychiatry and Mental health


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