Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Community integration after deployment to Afghanistan: a longitudinal investigation of Danish soldiers



In the years following military deployment, soldiers may experience problems integrating into the community. However, little is known about the nature and prevalence of these problems and if they relate to posttraumatic symptomatology.


In a prospective, longitudinal study of Danish soldiers deployed to Afghanistan in 2009 (N = 743), we assessed community reintegration difficulties 2.5 years after home coming (study sample: N = 454). Furthermore, symptoms of posttraumatic stress disorder (PTSD) were assessed before, during, and after deployment. Trajectories of PTSD symptoms from a previously published latent growth mixture modeling analysis were used to address whether community reintegration difficulties differ as a result of course and level of PTSD symptoms.


Between 3.6 and 18.0 % reported to have some, a lot, or extreme difficulties in reintegration domains such as interpersonal functioning, productivity, community involvement, and self-care. Mean level of reintegration difficulties differed significantly across six PTSD symptom trajectories (range 6.35–36.00); with more symptomatic trajectories experiencing greater community reintegration difficulties.


Reintegration difficulties after deployment are present in less than 20 % of Danish soldiers who return from Afghanistan. Difficulties are greater in individuals who follow symptomatic PTSD trajectories in the first years following deployment than in those who follow a low-stable trajectory with no or few symptoms.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    Gates MA, Holowka DW, Vasterling JJ, Keane TM, Marx BP et al (2012) Posttraumatic stress disorder in veterans and military personnel: epidemiology, screening, and case recognition. Psychol Serv 9:361–382

  2. 2.

    Sayer NA, Carlson KF, Frazier PA (2014) Reintegration challenges in U.S. service members and veterans following combat deployment. Soc Issues Policy Rev 8:33–73

  3. 3.

    Smith MW, Schnurr PP, Rosenheck RA (2005) Employment outcomes and PTSD symptom severity. Mental Health Services Res 7:89–101

  4. 4.

    Zatzick DF, Marmar CR, Weiss DS, Browner WS, Metzler TJ et al (1997) Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. Am J Psychiatry 154:1690–1695

  5. 5.

    Savoca E, Rosenheck R (2000) The civilian labor market experiences of Vietnam-era veterans: the influence of psychiatric disorders. J Mental Health Policy Econ 3:199–207

  6. 6.

    Iversen A, Nikolaou V, Greenberg N, Unwin C, Hull L et al (2005) What happens to British veterans when they leave the armed forces? Eur J Public Health 15:175–184

  7. 7.

    Horton JL, Jacobson IG, Wong CA, Wells TS, Boyko EJ et al (2013) The impact of prior deployment experience on civilian employment after military service. Occup Environ Med 70:408–417

  8. 8.

    Schnurr PP, Lunney CA, Bovin MJ, Marx BP (2009) Posttraumatic stress disorder and quality of life: extension of findings to veterans of the wars in Iraq and Afghanistan. Clin Psychol Rev 29:727–735

  9. 9.

    Shea MT, Vujanovic AA, Mansfield AK, Sevin E, Liu FJ (2010) Posttraumatic stress disorder symptoms and functional impairment among OEF and OIF national guard and reserve veterans. J Trauma Stress 23:100–107

  10. 10.

    Elbogen EB, Johnson SC, Wagner HR, Newton VM, Beckham JC (2012) Financial well-being and postdeployment adjustment among Iraq and Afghanistan war veterans. Mil Med 177:669–675

  11. 11.

    Riggs DS, Byrne CA, Weathers FW, Litz BT (1998) The quality of the intimate relationships of male Vietnam veterans: problems associated with posttraumatic stress disorder. J Trauma Stress 11:87–101

  12. 12.

    Allen ES, Rhoades GK, Stanley SM, Markman HJ (2010) Hitting home: relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for army couples. J Fam Psychol 24:280–288

  13. 13.

    Sayer NA, Frazier P, Orazem RJ, Murdoch M, Gravely A et al (2011) Military to civilian questionnaire: a measure of postdeployment community reintegration difficulty among veterans using Department of Veterans Affairs medical care. J Trauma Stress 24:660–670

  14. 14.

    Sayer NA, Noorbaloochi S, Frazier P, Carlson K, Gravely A et al (2010) Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care. Psychiatr Services 61:589–597

  15. 15.

    Beder J, Coe R, Sommer D (2011) Women and men who have served in Afghanistan/Iraq: coming home. Soc Work Health Care 50:515–526

  16. 16.

    Dickstein BD, Suvak M, Litz BT, Adler AB (2010) Heterogeneity in the course of posttraumatic stress disorder: trajectories of symptomatology. J Trauma Stress 23:331–339

  17. 17.

    Berntsen D, Johannessen KB, Thomsen YD, Bertelsen M, Hoyle RH et al (2012) Peace and war: trajectories of posttraumatic stress disorder symptoms before, during, and after military deployment in Afghanistan. Psychol Sci 23:1557–1565

  18. 18.

    Bonanno GA, Mancini AD, Horton JL, Powell TM, LeardMann CA et al (2012) Trajectories of trauma symptoms and resilience in deployed US military service members: prospective cohort study. Br J Psychiatry 200:317–323

  19. 19.

    Orcutt HK, Erickson DJ, Wolfe J (2004) The course of PTSD symptoms among Gulf War Veterans: a growth mixture modeling approach. J Trauma Stress 17:195–202

  20. 20.

    Weathers FW, Litz BT, Herman D, Huska J, Keane TM (1993) The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. The annual convention of the International Society for Traumatic Stress Studies, San Antonio

  21. 21.

    Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA (1996) Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 34:669–673

  22. 22.

    Muthen LK, Muthen BO (1998–2012) Mplus User’s Guide, Los Angeles

  23. 23.

    Andersen SB, Karstoft KI, Bertelsen MB, Madsen T (2014) Latent trajectories of trauma symptoms and resilience: the 3-year longitudinal prospective USPER study of Danish veterans deployed in Afghanistan. J Clin Psychiatry 75(9):1001–1008

  24. 24.

    Asparouhov T (2007) Wald test of mean equality for potential latent class predictors in mixture modeling. Technical Appendix

  25. 25.

    Clark SL, Muthen BO (2009) Relating latent class analysis results to variables not included in the analysis

  26. 26.

    Karstoft KI, Andersen SB, Bertelsen M, Madsen T (2013) Diagnostic accuracy of the posttraumatic stress disorder checklist—civilian version in a representative military sample. Psychol Assess 26:321–325

Download references

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Correspondence to Karen-Inge Karstoft.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 128 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Karstoft, K., Armour, C., Andersen, S.B. et al. Community integration after deployment to Afghanistan: a longitudinal investigation of Danish soldiers. Soc Psychiatry Psychiatr Epidemiol 50, 653–660 (2015).

Download citation


  • Community reintegration
  • PTSD
  • Military
  • Operation enduring freedom
  • Longitudinal analysis
  • Mixture modeling