StrongVeterans.com BlogPTSD in US Veterans

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that can develop after a traumatic or extremely stressful event, such as military combat, a physical or sexual assault, or a serious accident. PTSD symptoms include problems such as re-experiencing the trauma in the form of intrusive memories or nightmares, not wanting to think or talk about what happened, having persistent negative thoughts and feelings, and feeling “on guard” or vigilant for threat.

The history of the PTSD diagnosis in the United States is intertwined with US military history; in fact, PTSD was added to the Diagnostic and Statistical Manual of Mental Disorders in 1980 largely due to research on psychological problems facing Vietnam veterans. Although much research has been conducted on PTSD among convenience samples of active duty members and veterans, few contemporary studies have examined the prevalence and correlates of PTSD in nationally representative samples of US veterans, which is necessary to draw conclusions about the entire population of veterans in our country. Consequently, surprisingly little is known about how prevalent PTSD is in the current population of US veterans, how often US veterans are exposed to different types of traumas, how frequently other types of psychiatric disorders co-occur with PTSD, and what types of sociodemographic, military, and psychosocial factors are associated with PTSD in this population.

In the National Health and Resilience in Veterans Study, we examined the prevalence of trauma exposure, PTSD, and other psychiatric problems in a contemporary, nationally representative sample of 3,157 US veterans. We found that 8.0% of veterans screened positive for PTSD in their lifetimes, a rate slightly higher than those observed in the general US adult population by Pietrzak et al and Kessler et al (6.4% to 6.8%). Lifetime probable PTSD rates were higher among female veterans (19.4 % vs. 6.8% in men) and among younger veterans (23.8% in those aged 21–29 years versus 3.5% in those aged 60 years or older).

Although clinicians working with veterans often assume that veterans’ PTSD symptoms result from military combat, the veterans in our study frequently reported that their PTSD symptoms resulted from other types of trauma, such as physical or sexual assault during childhood. In fact, the trauma type that veterans most frequently endorsed as their “worst” traumatic experience was the sudden death of a loved one (27.5%), a finding consistent with other research in the general US population. Relative to veterans without PTSD, veterans with PTSD were 2.3 to 19.1 times more likely to screen positive for psychiatric problems, such as depression, anxiety, or alcohol and drug problems, and 9.7 to 11.8 times more likely to endorse suicidal thoughts and behaviors. However, veterans who endorsed protective psychological and social factors, such as greater resilience, community integration, and supportive relationships, were less likely to report PTSD symptoms.

This study indicates that PTSD is a prevalent disorder among both combat and noncombat veterans in the United States, particularly among female and younger veterans, and is associated with high rates of co-occurring psychiatric problems. Interventions designed to increase protective psychosocial factors may help mitigate PTSD risk among US veterans, although further research is needed to examine this possibility.

Financial disclosure:Drs Wisco and Marx had no relevant personal financial relationships to report. Dr Pietrzak is a consultant for Cogstate and has received grant/research support from NIH and DoD. ​