Wounded Warriors: Post-Traumatic Stress Disorder, Pain, and Religious Involvement in Veterans and Active Duty Military
Chris Lea, Theology, Medicine and Culture Fellow, Duke Divinity School
Up to 80% of US military veterans with post-traumatic stress disorder (PTSD) report experiencing chronic pain (Liedl & Knaevelsrud, 2008), and the co-occurrence between PTSD and pain results in an increased risk of negative mental health outcomes (Elbogen et al., 2018; Alschuler & Otis, 2012; Morasco et al., 2013). Interestingly, interventions shown to be effective in treating PTSD may also reduce pain (Bremner et al., 2017).
Few studies have examined social factors that might buffer the relationship between PTSD and pain. Recently published in the journal Military Behavioral Health, we present a multi-site, cross-sectional study that was conducted involving 585 Veterans and Active Duty Military (V/ADM) from across the United States, which is, to our knowledge, the first study to examine the moderating effect of religiosity on the relationship between PTSD and physical pain in V/ADM with PTSD symptoms. Multi-dimensional measures of religiosity (BIAC), PTSD symptoms (PCL-5), depression (HADS-D) and anxiety (HADS-A) were administered, along with physical pain on a 0 to 10 visual analogue scale (Koenig et al., 2015a,b; Blevins et al., 2015; Zigmond & Snaith, 1983). The 10 items on the religiosity scale seek to determine the extent to which a person devotes precious resources (time and money) to private and communal religious activities. Bivariate and multivariate relationships were examined, along with the moderating effects of religiosity.
Because religious beliefs and behaviors have been shown to alleviate symptoms of both PTSD and pain, we hypothesized that religiosity would buffer the positive correlation between PTSD and pain (Hasanović & Pajević, 2010; Wachholtz and Pargament, 2005). We also hypothesized that religiosity would still moderate this relationship irrespective of whether PTSD or pain was taken as the independent variable and, also, after controlling for demographics (i.e. age, gender, race), military, social, and psychological characteristics.
Our data demonstrated that PTSD symptoms were significantly related to pain level. This positive relationship between PTSD and pain was only slightly weaker in the group of highly religious veterans in comparison to the strength of the relationship in the non-highly religious group. In multivariate analyses, the interaction terms between 1) religiosity and PTSD severity and 2) religiosity and pain were not significant, although stratified analyses indicated a somewhat weaker relationship between PTSD severity and pain in the highly religious compared to those who were not. This study provides only minimal evidence that high religious involvement buffers the effects of PTSD symptoms on pain and vice-versa.
Given the prevalence of religious beliefs/activities among veterans and active duty military, which may be used to cope with severe pain and PTSD symptoms, future studies should further explore these relationships. Future studies should utilize tailored measures of religiosity that assess the kinds of religious/spiritual activities in which military personnel with pain and PTSD symptoms regularly engage. As an aspect of culturally competent care, including a spiritual component to interventions for chronic pain among military personnel with PTSD may be beneficial. Of note, researchers are already exploring the benefits of spiritual engagement among veterans in palliative care (Boucher et al., 2018).
Few studies have examined social factors that might buffer the relationship between PTSD and pain. Recently published in the journal Military Behavioral Health, we present a multi-site, cross-sectional study that was conducted involving 585 Veterans and Active Duty Military (V/ADM) from across the United States, which is, to our knowledge, the first study to examine the moderating effect of religiosity on the relationship between PTSD and physical pain in V/ADM with PTSD symptoms. Multi-dimensional measures of religiosity (BIAC), PTSD symptoms (PCL-5), depression (HADS-D) and anxiety (HADS-A) were administered, along with physical pain on a 0 to 10 visual analogue scale (Koenig et al., 2015a,b; Blevins et al., 2015; Zigmond & Snaith, 1983). The 10 items on the religiosity scale seek to determine the extent to which a person devotes precious resources (time and money) to private and communal religious activities. Bivariate and multivariate relationships were examined, along with the moderating effects of religiosity.
Because religious beliefs and behaviors have been shown to alleviate symptoms of both PTSD and pain, we hypothesized that religiosity would buffer the positive correlation between PTSD and pain (Hasanović & Pajević, 2010; Wachholtz and Pargament, 2005). We also hypothesized that religiosity would still moderate this relationship irrespective of whether PTSD or pain was taken as the independent variable and, also, after controlling for demographics (i.e. age, gender, race), military, social, and psychological characteristics.
Our data demonstrated that PTSD symptoms were significantly related to pain level. This positive relationship between PTSD and pain was only slightly weaker in the group of highly religious veterans in comparison to the strength of the relationship in the non-highly religious group. In multivariate analyses, the interaction terms between 1) religiosity and PTSD severity and 2) religiosity and pain were not significant, although stratified analyses indicated a somewhat weaker relationship between PTSD severity and pain in the highly religious compared to those who were not. This study provides only minimal evidence that high religious involvement buffers the effects of PTSD symptoms on pain and vice-versa.
Given the prevalence of religious beliefs/activities among veterans and active duty military, which may be used to cope with severe pain and PTSD symptoms, future studies should further explore these relationships. Future studies should utilize tailored measures of religiosity that assess the kinds of religious/spiritual activities in which military personnel with pain and PTSD symptoms regularly engage. As an aspect of culturally competent care, including a spiritual component to interventions for chronic pain among military personnel with PTSD may be beneficial. Of note, researchers are already exploring the benefits of spiritual engagement among veterans in palliative care (Boucher et al., 2018).