LeardMann et al. BMC Public Health 2010, 10:437 http://www.biomedcentral.com/1471-2458/10/437 R E S E A R C H A R T I C L E Open Access Do adverse childhood experiences increase the risk of postdeployment posttraumatic stress disorder in US Marines? Cynthia A LeardMann*, Besa Smith, Margaret AK Ryan Abstract Background: Posttraumatic stress disorder (PTSD) has been associated with combat intensity, lack of social support, and adverse childhood factors among military personnel in previous studies. It has not been well established if adverse childhood experiences reported predeployment are independently associated with postdeployment PTSD. Methods: Data were evaluated from 8,391 male responders of the Recruit Assessment Program survey at Marine Corps Recruit Depot in San Diego who were deployed in support of military conflicts between September 2001 and June 2004. Using patient medical records to determine PTSD diagnoses, Cox proportional hazard modeling was performed to examine if adverse childhood experiences were independently associated with postdeployment PTSD. Results: After adjustment, those who reported adverse childhood experiences in more than one category were significantly more likely to be diagnosed with postdeployment PTSD. Specifically, childhood physical neglect was mostly strongly associated with postdeployment PTSD. Conclusions: Findings suggest that Marines who experience multiple types of adverse childhood experiences may be at increased risk for postdeployment PTSD. It is possible, however, that these results indicate that men willing to report childhood adverse experiences are also more willing to seek care for PTSD. Background Posttraumatic stress disorder (PTSD) can occur after a traumatic event, such as combat exposure, serious acci- dent, and violent personal assault. However, not all indivi- duals who survive a severely traumatic event develop PTSD. Certain factors may cause some people to be more vulnerable to developing PTSD than others [1]. It has been suggested that the psychological process that occurs during and immediately following a traumatic event affects an individual’s post-event mental health status [2]. Specifi- cally, those who respond to a traumatic event with inten- sely negative emotions, have dissociative experiences, and lack coping skills are at increased risk for PTSD. Factors, such as family history of mental illness and prior traumatic events, may lead to psychological difficulties, emotional * Correspondence: cynthia.leardmann@med.navy.mil Department of Defense Center for Deployment Health Research, Naval Health Research Center, San Diego, CA, USA dysregulation, and self-destructive behaviors [2,3]. In addi- tion, individuals who have been maltreated as children are less likely to have well formed social networks for support [4]. Therefore individuals who have experienced childhood trauma may be more vulnerable to develop PTSD, as they have less ability to positively respond and cope with new traumatic events. Among military members, intensity of combat expo- sure has consistently been demonstrated as one of the strongest predictors of subsequent combat-related PTSD [5-10], while many pretrauma and posttrauma factors have shown less-consistent associations with PTSD [7,8,11,12]. Adverse childhood experiences (ACE), including sexual, physical, emotional abuse; physical and emotional neglect; and family dysfunction, have also been well documented as risk factors for PTSD among military service members. In a meta-analysis of risk fac- tors for PTSD, trauma severity, lack of social support, and adverse childhood factors (excluding abuse) were © 2010 LeardMann et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.