Social Psychiatry and Psychiatric Epidemiology

, Volume 48, Issue 11, pp 1743–1754 | Cite as

The role of stress sensitization in progression of posttraumatic distress following deployment

  • Geert E. Smid
  • Rolf J. Kleber
  • Arthur R. Rademaker
  • Mirjam van Zuiden
  • Eric Vermetten
Original Paper



Military personnel exposed to combat are at risk for experiencing post-traumatic distress that can progress over time following deployment. We hypothesized that progression of post-traumatic distress may be related to enhanced susceptibility to post-deployment stressors. This study aimed at examining the concept of stress sensitization prospectively in a sample of Dutch military personnel deployed in support of the conflicts in Afghanistan.


In a cohort of soldiers (N = 814), symptoms of post-traumatic stress disorder (PTSD) were assessed before deployment as well as 2, 7, 14, and 26 months (N = 433; 53 %) after their return. Data were analyzed using latent growth modeling. Using multiple group analysis, we examined whether high combat stress exposure during deployment moderated the relation between post-deployment stressors and linear change in post-traumatic distress after deployment.


A higher baseline level of post-traumatic distress was associated with more early life stressors (standardized regression coefficient = 0.30, p < 0.001). In addition, a stronger increase in posttraumatic distress during deployment was associated with more deployment stressors (standardized coefficient = 0.21, p < 0.001). A steeper linear increase in posttraumatic distress post-deployment (from 2 to 26 months) was predicted by more post-deployment stressors (standardized coefficient = 0.29, p < 0.001) in high combat stress exposed soldiers, but not in a less combat stress exposed group. The group difference in the predictive effect of post-deployment stressors on progression of post-traumatic distress was significant (χ²(1) = 7.85, p = 0.005).


Progression of post-traumatic distress following combat exposure may be related to sensitization to the effects of post-deployment stressors during the first year following return from deployment.


Post-traumatic stress disorder Delayed onset Stress sensitization Military deployment 



Funded by a grant from the Dutch Ministry of Defense. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Geert E. Smid, MD, PhD had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors thank Col. Kees IJzerman, MD, MPH for his valuable comments and the commanders and troops for their time and effort. The authors also thank Kim Kroezen, Anne Muilwijk, Capt. Maurits Baatenburg de Jong, Capt. Jessie Smulders, Lt. Martijn Derks, and Sgt. Loes van den Boomen for organizing the data acquisition.

Conflict of interest


Supplementary material

127_2013_709_MOESM1_ESM.doc (135 kb)
Supplementary material 1 (DOC 136 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Geert E. Smid
    • 1
  • Rolf J. Kleber
    • 1
    • 2
  • Arthur R. Rademaker
    • 3
  • Mirjam van Zuiden
    • 3
    • 4
    • 5
  • Eric Vermetten
    • 3
    • 6
  1. 1.Foundation Centrum’45/ArqDiemenThe Netherlands
  2. 2.Department of Clinical and Health PsychologyUtrecht UniversityUtrechtThe Netherlands
  3. 3.Research Centre-Military Mental Health, Ministry of DefenseUtrechtThe Netherlands
  4. 4.Department of Psychiatry, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  5. 5.Laboratory of Neuroimmunology and Developmental Origins of DiseaseUniversity Medical Center UtrechtUtrechtThe Netherlands
  6. 6.Rudolf Magnus Institute of NeurosciencesUniversity Medical Center UtrechtUtrechtThe Netherlands

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