Prevalence, Correlates, and Burden of Subthreshold PTSD in US Veterans

Ian C. Fischer, PhD; Peter J. Na, MD, MPH; Ilan Harpaz-Rotem, PhD; Brian P. Marx, PhD; Robert H. Pietrzak, PhD, MPH

J Clin Psychiatry 2024;85(4):24m15465

Abstract

Objectives: To provide an up-to-date estimate of subthreshold posttraumatic stress disorder (PTSD) in US military veterans based on a recently proposed working case definition of subthreshold PTSD and identify sociodemographic, psychiatric, and functional correlates of subthreshold PTSD relative to full PTSD.

Methods: Data were analyzed from a nationally representative sample of US veterans. Probable lifetime subthreshold PTSD was operationalized as self reported endorsement of a potentially traumatic event (Criterion A); any 2 or 3 PTSD symptom clusters (Criteria B–E); symptom duration of more than 1 month (Criterion F); and PTSD symptom-related distress or functional impairment (Criterion G).

Results: The prevalence of lifetime full PTSD was 8.4% (95% CI, 7.2%–9.7%) and the prevalence of subthreshold PTSD was 3.9% (95% CI, 3.2%–4.8%). Subthreshold PTSD was associated with intermediately elevated odds of current and lifetime psychiatric disorders and clinical problems relative to veterans with no PTSD (adjusted odds ratios [OR] ranged from 1.7 for current alcohol use disorder and 3.3 for lifetime major depressive disorder [MDD]). Full PTSD was associated with even greater odds for most outcomes (OR ranges from 1.7 for current drug use disorder to 11.1 for lifetime MDD). Veterans with subthreshold PTSD reported intermediate-level reductions in mental, psychosocial, and cognitive functioning relative to veterans with no PTSD and full PTSD.

Conclusions: Subthreshold PTSD is prevalent and associated with considerable psychiatric and functional distress/impairment among US veterans. Efforts to identify and treat veterans with subthreshold PTSD may lead to improvements in mental health and functioning in this population.

J Clin Psychiatry 2024;85(4):24m15465

Author affiliations are listed at the end of this article.

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