Longitudinal Associations of PTSD and Social Support by Support Functions among Returning Veterans

Objective: Research has shown a consistent, negative correlation between social support and PTSD severity among a variety of populations, including military servicemembers and veterans. However, longitudinal data has been mixed on the direction of this effect. One possible explanation for these contradictory findings is that the direction of the effect varies depending on the function of social support. The current study examined naturalistic longitudinal associations between functions of social support and PTSD symptoms among returning veterans. Method: 238 military veterans who had deployed to Afghanistan or Iraq were recruited. Veterans were assessed at baseline, 6, 12, and 24-months postdeployment. Assessments included a self-report measure of perceived social support by support function and the Clinician Administered PTSD Scale to measure PTSD symptoms. Multilevel modeling was used to test longitudinal associations between PTSD symptoms and social support. Secondary analyses tested associations by PTSD symptom cluster. Results: Between-person PTSD symptom severity was associated with lower average social support of all functions of support and predicted decreases in tangible support over time. Between-person belonging support predicted decreases in PTSD symptom severity over time. No within-person effects were significant. Supplemental analyses suggested the DSM-IV-TR avoidance/numbing cluster of PTSD was most consistently associated with lower social support. Conclusions: The direction of associations between PTSD symptoms and support varied by function of support, suggesting nuanced associations between PTSD and perceived social support. Clinicians should assess and target social functioning during PTSD treatment. Further research is needed to replicate findings in other populations and for other trauma types. Clinical Impact Statement Social support and PTSD symptoms are known to be associated, but research is mixed about whether PTSD symptoms decrease social support over time or if support buffers against PTSD. How PTSD and social support relate over time might depend on the specific function of social support. We assessed returning veterans repeatedly after deployment to assess social support functions and PTSD symptoms. PTSD symptoms predicted a decline in tangible aid, while feeling connected to others predicted a decline in PTSD symptoms. These types of support are important to address in treatment to prevent the harmful effects of PTSD symptoms on a patient's social relationships.