Highlights
- •What is the primary question addressed by this study? This study provides estimates of PTSD and associated comorbidities in a nationally representative sample of older U.S. military veterans.
- •What is the main finding of this study? Overall, 9.6% of veterans had subthreshold PTSD and 1.9% full PTSD; but was higher in women and those who use VA as their main source healthcare. Veterans with subthreshold PTSD were equally as likely as those with full PTSD to have psychiatric, mental, cognitive, and functional comorbidities, including a history of suicide attempts and current suicidal ideation.
- •What is the meaning of the finding? Clinicians should attend to subthreshold and full PTSD in older adults.
ABSTRACT
Objective
To characterize the prevalence, characteristics, and comorbidities of subthreshold
and full post-traumatic stress disorder (PTSD) in older U.S. military veterans.
Design and Setting
A nationally representative web-based survey of older U.S. military veterans who participated
in the National Health and Resilience in Veterans Study (NHRVS) between November 18,
2019 and March 8, 2020.
Participants
U.S. veterans aged 60 and older (n = 3,001; mean age = 73.2, SD: 7.9, range: 60–99).
Measurements
PTSD was assessed using the PTSD Checklist for DSM-5. Self-report measures assessed
sociodemographic characteristics, trauma exposures, suicidal behaviors, psychiatric
and substance use disorders, as well as mental, cognitive, and physical functioning.
Multivariable analyses examined correlates of subthreshold and full PTSD.
Results
The vast majority of the sample (n = 2,821; 92.7%) reported exposure to one or more
potentially traumatic events. Of those exposed to such events, 262 (9.6%, 95% confidence
interval [CI]: 8.4%–10.9%) and 68 (1.9%, 95% CI: 1.3%–2.6%) screened positive for
subthreshold and full PTSD, respectively. The prevalence of subthreshold and full
PTSD was significantly higher in female veterans and veterans who use VA as their
primary healthcare. Subthreshold and full PTSD groups endorsed more adverse childhood
experiences and total traumas than the no/minimal PTSD symptom group, the most common
traumatic experiences endorsed were combat exposure, physical or sexual assault, and
life-threatening illness or injury. Veterans with subthreshold and full PTSD were
also more likely to screen positive for depression, substance use disorders, suicide
attempts, nonsuicidal self-injury, and suicidal ideation, and reported lower mental,
cognitive, and physical functioning.
Conclusion
Subthreshold PTSD and full PTSD are prevalent and associated with substantial clinical
burden in older U.S. veterans. Results underscore the importance of assessing both
subthreshold and full PTSD in this population.
Key Words
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Article info
Publication history
Published online: October 29, 2021
Accepted:
October 22,
2021
Received in revised form:
October 21,
2021
Received:
September 27,
2021
Identification
Copyright
Published by Elsevier Inc. on behalf of American Association for Geriatric Psychiatry.
