Associations Among Increases in Posttraumatic Stress Symptoms, Neurocognitive Performance, and Long‐Term Functional Outcomes in U.S. Iraq War Veterans

Abstract Cross‐sectional research suggests that posttraumatic stress symptoms (PTSS) among war zone veterans are associated with functional impairment and poor quality of life. Less is known about the long‐term functional repercussions of PTSS. This study of Iraq War veterans examined the associations between increases in PTSS and long‐term functional outcomes, including the potential contributions of neurocognitive decrements. Service members and veterans ( N = 594) completed self‐report measures of functioning and PTSS severity before Iraq War deployment and again after their return ( M = 9.3 years postdeployment). Some participants ( n = 278) also completed neurocognitive testing at both times. Multiple regression analyses with the full sample—adjusted for TBI, demographic characteristics, military variables, and predeployment PTSS and functioning—revealed that increased PTSS severity over time was significantly associated with unemployment, a OR = 1.04, 95% CI [1.03, 1.06]; poorer work performance; and poorer physical, emotional, and cognitive health–related functioning at long‐term follow‐up, f 2 s = 0.37–1.79. Among participants who completed neurocognitive testing, a decline in select neurocognitive measures was associated with poorer functioning; however, neurocognitive decrements did not account for associations between increased PTSS and unemployment, a OR = 1.04, 95% CI [1.02, 1.07], with the size and direction upheld after adding neurocognitive variables, or poorer functional outcomes, with small increases after adding neurocognitive measures to the models, f 2 s = 0.03–0.10. War zone veterans experiencing long‐term increased PTSS and/or neurocognitive decrements may be at elevated risk for higher‐level functional impairment over time, suggesting that early PTSS management may enhance long‐term functioning.