1. I. Introduction
•Pain affects about 50% of OIF/OEF military personnel.
•Several studies have reported a relationship between
PTSD and pain in military samples.
•Other evidence suggests a relationship between PTSD
and depression.
•PTSD and depression can exacerbate pain complaints.
•Pain and PTSD can intensify by increasing depression,
which reduces pain tolerance and increases somatic
pain complaints.
•Many injuries limit the functional abilities of military
personnel, making it difficult to carry out daily tasks.
•Pain is indirectly associated with physical role
limitation.
•Treatment becomes challenging when PTSD exhibits
itself through depression and physical role limitation
Primary Aim: The purpose of this study is to
understand the complex relationships among PTSD,
depression, pain, and physical role limitation in
military personnel.
•Hypothesis: (1) The relation of somatic symptoms
with physical role limitations will be moderated by
depression and PTSD severity; (2) Bodily pain will
mediate the relationship between physical role
limitations and the somatic-by-depression interaction
and the somatic-by-PTSD interaction.
Depression as a Moderator of Somatic Complaints and
Functional Impairment in Military Personnel
Amanda B. Snyder
University of Utah
Dr. Craig Bryan
National Center For Veteran Studies
University of Utah
II. Methods
Participants:
•207 male Air Force rescue personnel
•78.7% Caucasian
•Ages 23 to 50 (M=32.05; SD=5.86)
Procedures:
Volunteer participants were invited to fill out the survey with
absence of unit leadership to minimize coercion.
Measures:
Depression: Patient Health Questionnaire-9 (PHQ-9)
Somatic Symptoms: Patient Health Questionnaire-15 (PHQ-15)
Physical Role Limitation: Short Form 26 Survey (SF-36)
Bodily Pain: Short Form 36 Survey (SF-36)
PTSD: PTSD Checklist (PCL)
III. Results
•Participants reported these domains of health as less
problematic than normative samples.
•Depression, posttraumatic stress, and somatic
symptom levels were also well below clinical levels.
•Physical role limitation and bodily pain scores were
positively correlated with each other (r=.54, p<.001)
but none of the symptom scales.
•Symptom scale scores were positively intercorrelated
(r’s>.46, p’s<.001).
Due to the insufficient fit of the fully saturated
theoretical model:
•Nonsignificant direct paths from depression and PTSD
symptoms to physical role limitation were removed
•Indirect path of somatic symptoms to bodily pain
through PTSD symptoms was removed
IV. Conclusions
•Depression and PTSD were associated with more
somatic symptoms.
•Bodily pain mediated the relationships of depression
and PTSD with physical role limitation.
•There was a significant somatic symptom by
depression interaction.
•Participants reporting higher depression reported
similar levels of bodily pain regardless of the number
of somatic symptoms experienced.
•Participants with lower depression scores reported
different levels of pain depending on how many
somatic symptoms they reported.
Limitations:
•Self-report methods
•Very homogeneous sample
•Additional research needed to differentiate
psychosomatic and physical pain
Study conducted with funding from the Department of the Air Force (#FA8650-
12-2-6277) and lab assistance from the National Center for Veterans Studies.
Figure 1
Final model predicting
physical role limitations
among 208 U.S. Air Force
rescue personnel, with
standardized regression
coefficients (*p<.05,
**p<.01, ***p<.001)
Figure 2 – Simple slopes showing a
somatic symptomXdepression interaction
Table 1- Means, standard deviations, and intercorrelations of all variables
Note: Values in bold are statistically significant at p<.001
Amanda B. Snyder
University of Utah
National Center For Veteran Studies
Amanda.Snyder@hsc.utah.edu
Please leave this space blank.
1. 2. 3. 4. 5.
1. Bodily pain 1.00
2. Phys. role limitation 0.54 1.00
3. Depression 0.04 0.02 1.00
4. PTSD 0.10 0.07 0.75 1.00
5. Somatic -0.07 -0.02 0.52 0.46 1.00
Mean 77.66 87.92 2.33 21.43 2.57
SD 19.64 27.19 3.15 7.73 2.17
The reduced model
showed excellent fit to
the data and accounted
for 29.5% of the variance
in physical role
limitations: χ2(4)=.75,
p=.946; RMSEA=.00 (90%
CI: .00, .02); CFI=1.00;
SRMR=.01.