Combat-related posttraumatic stress disorder among Croatian veterans: The causal models of symptom clusters

Objective: This study investigated the etiological roles of premilitary risk factors, military entry conditions, war zone experiences, dissociative reactions, and homecoming reception in the development of chronic posttraumatic stress disorder symptom clusters among Croatian veterans. Methods: 150 Croatian war veterans with the diagnosis of chronic combat-related PTSD, who sought treatment at the Department of Psychiatry Osijek, Croatia, and who provided complete data, were selected as the sample for this study from the treatment-seeking group of the ex-soldier populations (N = 192). Structural equation modeling was used to develop an etiological model of relationships of premilitary risk factors, military entry conditions, war zone experiences, dissociative reactions, and homecoming reception with current PTSD symptom clusters. Results: The causal models with satisfactory fit and parsimony were developed. The result analysis suggests that there is a different etiological effect of studied variables on PTSD symptom clusters in all three studied models. War zone experiences, peritraumatic dissociation and homecoming reception have a higher and primary etiological effect in relation to a lower and secondary etiological effect of premilitary risk factors and military entry conditions in all three studied models. The exception is sometimes a higher etiological effect of premilitary risk factors in the causal model for the avoidance symptom cluster and military entry conditions in the causal model for the arousal cluster. Conclusions: The results may Support Study hypothesis that all PTSD symptoms do not have the same etiology and that a different hierarchy of etiological influence exists among studied variables in all three contructed models of PTSD symptom clusters.