Longitudinal Analysis of the Relationship Between Symptoms and Quality of Life in Veterans Treated for Posttraumatic Stress Disorder Paula P. Schnurr National Center for Post-Traumatic Stress Disorder, U.S. Department of Veterans Affairs, and Dartmouth Medical School Andrew F. Hayes The Ohio State University Carole A. Lunney National Center for Post-Traumatic Stress Disorder, U.S. Department of Veterans Affairs Miles McFall Veterans Affairs Puget Sound Healthcare System and University of Washington School of Medicine Madeline Uddo New Orleans Veterans Affairs Medical Center This study examined how change in posttraumatic stress disorder (PTSD) symptoms relates to change in quality of life. The sample consisted of 325 male Vietnam veterans with chronic PTSD who participated in a randomized trial of group psychotherapy. Latent growth modeling was used to test for synchronous effects of PTSD symptom change on psychosocial and physical health-related quality of life within the same time period and lagged effects of initial PTSD symptom change on later change in quality of life. PTSD symptoms were associated with reduced quality of life before treatment. There were synchronous effects of symptom change on change in quality of life but no significant lagged effects. Results indicate the importance of measuring quality of life in future investigations of PTSD treatment. Keywords: posttraumatic stress disorder, quality of life, military veterans, group psychotherapy Individuals with posttraumatic stress disorder (PTSD) experi- ence reduced quality of life (e.g., Magruder et al., 2004; Schonfeld et al., 1997; Stein, Walker, Hazen, & Forde, 1997). For example, a recent study found that 59% of PTSD patients had severe quality of life impairment, which was comparable to 63% of patients with major depression (Rapaport, Clary, Fayyad, & Endicott, 2005). Furthermore, prospective cohort studies have found that initial PTSD predicts poor life quality at subsequent follow-up intervals (Holbrook, Hoyt, Stein, & Sieber, 2001; Michaels et al., 1999; Zatzick, Jurkovich, Gentilello, Wisner, & Rivara, 2002). There also is growing evidence that quality of life improves following treatment for PTSD (e.g., Foa et al., 1999; Rapaport, Endicott, & Clary, 2002; Tucker et al., 2001). Including quality of life as an outcome in studies of PTSD symptom-focused treatment reflects the assumption that reduced quality of life is secondary to symptoms. However, the observation of improvements in both symptoms and quality of life is only an indirect reflection of the relationship between these domains. Fur- thermore, such studies fail to capture lagged relationships. Time may be needed in order for immediate improvement in symptoms to affect quality of life. For example, a person whose avoidance and irritability decrease following treatment may not show im- provements in social functioning for months afterward because of the time it takes to make and rebuild friendships. The effects of PTSD symptom improvement on physical health might be delayed given the complexity of factors hypothesized to underlie the rela- tionship between PTSD and poor physical health (Schnurr & Green, 2004). We used latent growth modeling to fit a longitudinal model to examine how change in PTSD symptoms relates to change in quality of life. Data came from veterans with chronic PTSD who took part in a randomized clinical trial of group psychotherapy that compared trauma-focused and present-centered approaches (Schnurr, Friedman, Lavori, & Hsieh, 2001). The year-long treat- ment consisted of 30 weekly sessions to help patients reduce symptoms, followed by 5 monthly sessions to help patients main- tain their gains. Both conditions showed significant and compara- Paula P. Schnurr, National Center for Post-Traumatic Stress Disorder, U.S. Department of Veterans Affairs, and Department of Psychiatry, Dart- mouth Medical School; Andrew F. Hayes, School of Communication, The Ohio State University; Carole A. Lunney, National Center for Post- Traumatic Stress Disorder, Department of Veterans Affairs; Miles McFall, VA Puget Sound Healthcare System and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine; and Madeline Uddo, New Orleans VA Medical Center. This research was supported by a grant to Paula P. Schnurr from the U.S. Veterans Affairs Cooperative Studies Program. A version of the paper was presented in November 2005 as a poster at the annual meeting of the International Society for Traumatic Stress Studies, Toronto, Canada. The views expressed in this article are those of the authors and do not neces- sarily represent the views of the National Center for Post-Traumatic Stress Disorder or the U.S. Department of Veterans Affairs. Correspondence concerning this article should be addressed to Paula P. Schnurr, National Center for Post-Traumatic Stress Disorder (116D), U.S. Veterans Affairs Medical Center, White River Junction, VT 05009. E-mail: paula.schnurr@dartmouth.edu Journal of Consulting and Clinical Psychology In the public domain 2006, Vol. 74, No. 4, 707–713 DOI: 10.1037/0022-006X.74.4.707 707