Probable Posttraumatic Stress Disorder in the US Veteran Population According to DSM-5: Results From the National Health and Resilience in Veterans Study.

With the publication of DSM-5, important changes were made to the diagnostic criteria for posttraumatic stress disorder (PTSD), including the addition of 3 new symptoms. Some have argued that these changes will further increase the already high rates of comorbidity between PTSD and other psychiatric disorders. This study examined the prevalence of DSM-5 PTSD, conditional probability of PTSD given certain trauma exposures, endorsement of specific PTSD symptoms, and psychiatric comorbidities in the US veteran population. Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a Web-based survey of a cross-sectional, nationally representative, population-based sample of 1,484 US veterans, which was fielded from September through October 2013. Probable PTSD was assessed using the PTSD Checklist-5. The weighted lifetime and past-month prevalence of probable DSM-5 PTSD was 8.1% (SE = 0.7%) and 4.7% (SE = 0.6%), respectively. Conditional probability of lifetime probable PTSD ranged from 10.1% (sudden death of close family member or friend) to 28.0% (childhood sexual abuse). The DSM-5 PTSD symptoms with the lowest prevalence among veterans with probable PTSD were trauma-related amnesia and reckless and self-destructive behavior. Probable PTSD was associated with increased odds of mood and anxiety disorders (OR = 7.6-62.8, P < .001), substance use disorders (OR = 3.9-4.5, P < .001), and suicidal behaviors (OR = 6.7-15.1, P < .001). In US veterans, the prevalence of DSM-5 probable PTSD, conditional probability of probable PTSD, and odds of psychiatric comorbidity were similar to prior findings with DSM-IV-based measures; we found no evidence that changes in DSM-5 increase psychiatric comorbidity. Results underscore the high rates of exposure to both military and nonmilitary trauma and the high public health burden of DSM-5 PTSD and comorbid conditions in veterans.

Wisco BE ，Marx BP ，Miller MW ，Wolf EJ ，Mota NP ，Krystal JH ，Southwick SM ，Pietrzak RH ... -  《-》

Posttraumatic stress disorder in the US veteran population: results from the National Health and Resilience in Veterans Study.

To describe the prevalence of posttraumatic stress disorder (PTSD) and comorbid psychiatric disorders and identify correlates of PTSD in a contemporary, nationally representative sample of US veterans. Data were analyzed from Wave 1 of the National Health and Resilience in Veterans Study, a cross-sectional, retrospective, web-based survey of a population-based sample of 3,157 US veterans conducted between October and December 2011. The main outcome measure was probable lifetime PTSD, which was assessed by using a DSM-IV version of the PTSD Checklist (PCL), the PCL-Specific Stressor version. The weighted lifetime and current prevalence of probable PTSD was 8.0% (standard error [SE] = 0.48) and 4.8% (SE = 0.40), respectively. 87.0% of veterans reported exposure to at least 1 potentially traumatic event (PTE); veterans reported a mean of 3.4 (SD = 2.8) different PTE types in their lifetime. Sudden death of a loved one was the most frequently endorsed PTE (61.3%), and sexual abuse in adulthood had the highest conditional probability of PTSD (37.3%). PTSD was associated with increased odds of mood, anxiety, and substance use disorders (odds ratios [ORs] = 2.2-19.1, P values < .001); suicidal ideation (OR = 9.7, P < .001); and suicide attempts (OR = 11.8, P < .001). Psychosocial factors, including resilience, community integration, and secure attachment, were associated with decreased odds of PTSD (ORs = 0.5-0.7, P values < .05). In a nationally representative sample of US veterans, the prevalence of lifetime and current PTSD was 8.0% and 4.8%, respectively, and PTSD was associated with elevated risk for several psychiatric conditions and suicidality. Veterans reported exposure to many PTE types in addition to combat, and conditional risk for PTSD was high for noncombat-related trauma. Prevention and treatment efforts designed to bolster protective psychosocial factors may help mitigate PTSD risk in this population.

Wisco BE ，Marx BP ，Wolf EJ ，Miller MW ，Southwick SM ，Pietrzak RH ... -  《-》

Course of Posttraumatic Stress Disorder 40 Years After the Vietnam War: Findings From the National Vietnam Veterans Longitudinal Study.

Marmar CR ，Schlenger W ，Henn-Haase C ，Qian M ，Purchia E ，Li M ，Corry N ，Williams CS ，Ho CL ，Horesh D ，Karstoft KI ，Shalev A ，Kulka RA ... -  《-》

Examining the association between psychiatric illness and suicidal ideation in a sample of treatment-seeking Canadian peacekeeping and combat veterans with posttraumatic stress disorder PTSD.

Richardson JD ，St Cyr KC ，McIntyre-Smith AM ，Haslam D ，Elhai JD ，Sareen J ... -  《CANADIAN JOURNAL OF PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE》

Examining the relation between combat-related concussion, a novel 5-factor model of posttraumatic stress symptoms, and health-related quality of life in Iraq and Afghanistan veterans.

This study examined demographic, military, and clinical characteristics associated with combat-related concussion and persistent postconcussive symptoms; and how combat-related concussion and persistent postconcussive symptoms and a novel 5-factor model of posttraumatic stress disorder (PTSD) symptoms are related to physical and mental health-related quality of life in veterans who served in Iraq and Afghanistan. 233 veterans recruited from the Veterans Affairs Hawaii Program Registry who served in Iraq and Afghanistan completed a survey in 2010 that assessed combat-related concussion and persistent postconcussive symptoms, PTSD (DSM-IV criteria), alcohol use problems, and physical and mental health-related quality of life. The primary measure was physical and mental health-related quality of life as assessed by the 12-item Short-Form Health Survey, version 2. Veterans who screened positive for combat-related concussion and persistent postconcussive symptoms were more likely than those who did not to report direct combat exposure (χ2 = 15.46, P < .001), living in a rural area (χ2 = 6.86, P < .01), and screening positive for PTSD (χ2 = 37.67, P < .001) and alcohol use problems (χ2 = 11.62, P < .01); 57.3% of veterans who screened positive for combat-related concussion and persistent postconcussive symptoms screened positive for PTSD. In bivariate analyses, combat-related concussion and persistent postconcussive symptoms were associated with lower scores on measures of physical and mental health-related quality of life (r = -0.27 to -0.45, P < .001). In multivariate analyses, combat-related concussion and persistent postconcussive symptoms were no longer related to these outcomes, with PTSD-related dysphoric arousal symptoms as the strongest predictor of physical health-related quality of life (β = -0.55, P < .001) and PTSD-related emotional numbing symptoms (β = -0.56, P < .001) as the strongest predictor of mental health-related quality of life. Results of this study suggest that a 5-factor model of PTSD symptoms may provide greater specificity in understanding the relation between combat-related concussion and persistent postconcussive symptoms, PTSD symptoms, and health-related physical and mental quality of life in Iraq/Afghanistan veterans. Psychiatric clinicians should consider this heterogeneity of PTSD symptoms when assessing and treating symptomatic veterans.

Tsai J ，Whealin JM ，Scott JC ，Harpaz-Rotem I ，Pietrzak RH ... -  《-》