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Post-traumatic Stress Disorder in Older U.S. Military Veterans: Prevalence, Characteristics, and Psychiatric and Functional Burden

  • Jennifer Moye
    Correspondence
    Send correspondence and reprint requests to Jennifer Moye, VA Boston Healthcare System, 150 South Huntington Avenue, Jamaica Plain, MA 02130
    Affiliations
    VA New England Geriatric Research Education and Clinical Center (GRECC) (JM), Boston, MA

    VA Boston Healthcare System (JM, APK), Boston, MA

    Department of Psychiatry, Harvard Medical School (JM), Boston, MA
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  • Anica Pless Kaiser
    Affiliations
    VA Boston Healthcare System (JM, APK), Boston, MA

    National Center for PTSD (APK), Boston MA

    Boston University School of Medicine (APK), Boston, MA
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  • Joan Cook
    Affiliations
    U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System (JC, RHP), West Haven, CT

    Department of Psychiatry, Yale School of Medicine (JC, RHP), New Haven, CT
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  • Robert H. Pietrzak
    Affiliations
    U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System (JC, RHP), West Haven, CT

    Department of Psychiatry, Yale School of Medicine (JC, RHP), New Haven, CT

    Department of Social and Behavioral Sciences, Yale School of Public Health (RHP), New Haven, CT
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Published:October 29, 2021DOI:https://doi.org/10.1016/j.jagp.2021.10.011

      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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