Confounding by Symptomatic Mefloquine Exposure in Military Studies of Post-Traumatic Stress Disorder

摘要

Dear Editor,I read with interest the recent article by Osorio and colleagues,1 which employs principal components analysis to examine associations between combat experiences and reported clusters of post-traumatic stress disorder (PTSD) symptoms among UK military personnel deployed to Afghanistan. I am concerned the authors’ model may be invalid due to a failure to control for an important confounder. Symptomatic prophylactic exposure to the antimalarial drug mefloquine among military personnel may be correlated with combat experience, and creates a separate causal pathway, which could predict the PTSD symptom clusters that are the subject of this analysis.