Post-traumatic Stress Disorder in Older U.S. Military Veterans: Prevalence,Characteristics, and Psychiatric and Functional Burden |
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| Institution: | 1. VA New England Geriatric Research Education and Clinical Center (GRECC) (JM), Boston, MA;2. VA Boston Healthcare System (JM, APK), Boston, MA;3. Department of Psychiatry, Harvard Medical School (JM), Boston, MA;4. National Center for PTSD (APK), Boston MA;5. Boston University School of Medicine (APK), Boston, MA;6. U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System (JC, RHP), West Haven, CT;7. Department of Psychiatry, Yale School of Medicine (JC, RHP), New Haven, CT;8. Department of Social and Behavioral Sciences, Yale School of Public Health (RHP), New Haven, CT;1. Clinical and Research Memory Center of Lyon (CMRR Lyon- Centre Mémoire Ressource et Recherche de Lyon) (VD, AGC, CM, PKS), Institute For Elderly (Institut du vieillissement I-Vie), University hospital of Lyon (HCL-Hospices Civils de Lyon), Lyon, France;2. Clinical Research Centre CRC - VCF (CRC VCF - Centre de recherche clinique Vieillissement - Cerveau - Fragilité), Hospital of Charpennes (VD, CM, PKS), University Hospital of Lyon (HCL-Hospices Civils de Lyon), Lyon, France;3. Neuroscience Research Centre of Lyon (CRNL- Centre de recherche en neurosciences de Lyon) (PKS), Lyon, France;1. McLean Hospital, Belmont, MA; Harvard Medical School, Boston, MA;2. Massachusetts Alzheimer''s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA;3. Harvard Catalyst Biostatistical Consulting, Harvard Catalyst/CTSA; Harvard Medical School, Boston, MA;4. Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA;1. Department of Public Health Sciences (SC, DY, HTG), University of Rochester School of Medicine and Dentistry, Rochester, NY;2. Department of Public Health Sciences, Biological Sciences Division (SW), University of Chicago, Chicago, IL;3. Department of Psychiatry (YC), University of Rochester School of Medicine and Dentistry, Rochester, NY;1. Department of Medical Genetics, University of Calgary (CAB), Calgary, AB, Canada;2. Department of Psychiatry, University of Calgary (CAB), Calgary, AB, Canada;3. Department of Physiology & Pharmacology, University of Calgary (CAB), Calgary, AB, Canada;4. Alberta Children''s Hospital Research Institute, University of Calgary (CAB, AO), Calgary, AB, Canada;5. Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary (CAB, CDJ), Calgary, AB, Canada;6. Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (RRT), Cleveland, OH;7. Department of Psychiatry, Yale School of Medicine (RRT), New Haven, CT;8. Division of Geriatric Psychiatry, McLean Hospital (BPF), Belmont, MA;9. Harvard Medical School (BPF), Boston, MA;10. Neuroscience-inspired Policy Initiative, Organisation for Economic Co-Operation and Development (OECD) and PRODEO Institute (HAE), Paris, France;11. Institute for Mental Health and Physical Health and Clinical Translation (IMPACT), Deakin University (HAE), Geelong, Victoria, Australia;12. Global Brain Health Institute, University of California, San Francisco and Trinity College Dublin (HAE), Dublin, Ireland;13. Department of Psychiatry, Baylor College of Medicine (HAE), Houston, TX;14. Department of Psychiatry, Semel Institute for Neuroscience, University of California Los Angeles (HL), Los Angeles, CA;15. Department of Psychiatry, University of Toronto (DJM), Toronto, Ontario, Canada;16. Centre for Addiction and Mental Health, University of Toronto (DJM), Toronto, Ontario, Canada |
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| Abstract: | ObjectiveTo characterize the prevalence, characteristics, and comorbidities of subthreshold and full post-traumatic stress disorder (PTSD) in older U.S. military veterans.Design and SettingA 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.ParticipantsU.S. veterans aged 60 and older (n = 3,001; mean age = 73.2, SD: 7.9, range: 60–99).MeasurementsPTSD 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.ResultsThe 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.ConclusionSubthreshold 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. |
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