Subthreshold PTSD and PTSD in a Prospective-longitudinal Cohort of Military Personnel: Potential Targets for Preventive Interventions

Overview

Journal Depress Anxiety

Publisher Wiley

Date 2018 Aug 13

PMID 30099820

Citations 14

Authors

David S Fink

Jaimie L Gradus

Katherine M Keyes

Joseph R Calabrese

Israel Liberzon

Marijo B Tamburrino

Gregory H Cohen

Laura Sampson

Sandro Galea

Affiliations

Soon will be listed here.

Abstract

Background: Prevention of PTSD requires identification of subpopulations contributing most to the population burden of PTSD. This study examines the relative contribution of subthreshold PTSD and probable PTSD on future PTSD in a representative military cohort.

Methods: We analyze data on 3,457 U.S. National Guard members from the state of Ohio, assessed by telephone annually from 2008 to 2014. At each wave, participants were classified into one of three groups based on the PTSD Checklist: probable PTSD (DSM-IV-TR criteria), subthreshold PTSD (Criterion A1, at least one symptom in each cluster, symptom lasting longer than 30 days, and functional impairment), and no PTSD. We calculated the exposure rate, risk ratio (RR), and population attributable fraction (PAF) to determine the burden of future probable PTSD attributable to subthreshold PTSD compared to probable PTSD.

Results: The annualized prevalence of subthreshold PTSD and probable PTSD was respectively 11.9 and 5.0%. The RR for probable PTSD was twice as great among respondents with probable PTSD the prior interview than that of those with subthreshold PTSD (7.0 vs. 3.4); however, the PAF was considerably greater in participants with subthreshold PTSD the prior interview (PAF = 35%; 95% confidence interval (CI) = 26.0-42.9%) than in those with probable PTSD (PAF = 28.0%; 95% CI = 21.8-33.8%). Results were robust to changes in subthreshold PTSD definition.

Conclusions: Subthreshold PTSD accounted for a substantial proportion of this population's future PTSD burden. Population-based preventive interventions, compared to an approach focused exclusively on cases of diagnosable PTSD, is likely to affect the greatest reduction in this population's future PTSD burden.

Citing Articles

Novel Pharmacological Targets of Post-Traumatic Stress Disorders.

Marazziti D, Carmassi C, Cappellato G, Chiarantini I, Massoni L, Mucci F Life (Basel). 2023; 13(8).

PMID: 37629588 PMC: 10455314. DOI: 10.3390/life13081731.

Posttraumatic stress, visual working memory, and visual imagery in military personnel.

Russell B, Mussap A Curr Psychol. 2023; :1-18.

PMID: 36845204 PMC: 9942044. DOI: 10.1007/s12144-023-04338-1.

Insomnia severity predicts depression, anxiety, and posttraumatic stress disorder in veterans with spinal cord injury or disease: a cross-sectional observational study.

Kelly M, Zeineddine S, Mitchell M, Sankari A, Pandya N, Carroll S J Clin Sleep Med. 2023; 19(4):695-701.

PMID: 36661092 PMC: 10071376. DOI: 10.5664/jcsm.10410.

Development and pilot testing of a five item traumatic stress screener for use with adolescents in pediatric primary care.

Ng L, Oblath R, Brigham R, Tai M, Coles M Child Adolesc Psychiatry Ment Health. 2022; 16(1):71.

PMID: 35999580 PMC: 9397184. DOI: 10.1186/s13034-022-00501-x.

Childhood Physical Abuse and Antisocial Traits: Mediating Role of Posttraumatic Stress Symptom Clusters.

Harris C, Allbaugh L, Kaslow N J Child Adolesc Trauma. 2022; 15(2):249-259.

PMID: 35600521 PMC: 9120298. DOI: 10.1007/s40653-021-00364-y.

References

Hobfoll S, Watson P, Bell C, Bryant R, Brymer M, Friedman M . Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence. Psychiatry. 2008; 70(4):283-315. DOI: 10.1521/psyc.2007.70.4.283. View

Marshall R, Olfson M, Hellman F, Blanco C, Guardino M, STRUENING E . Comorbidity, impairment, and suicidality in subthreshold PTSD. Am J Psychiatry. 2001; 158(9):1467-73. DOI: 10.1176/appi.ajp.158.9.1467. View

Pietrzak R, Goldstein M, Malley J, Johnson D, Southwick S . Subsyndromal posttraumatic stress disorder is associated with health and psychosocial difficulties in veterans of Operations Enduring Freedom and Iraqi Freedom. Depress Anxiety. 2009; 26(8):739-44. DOI: 10.1002/da.20574. View

Cukor J, Wyka K, Jayasinghe N, Difede J . The nature and course of subthreshold PTSD. J Anxiety Disord. 2010; 24(8):918-23. DOI: 10.1016/j.janxdis.2010.06.017. View

Wun L, Ezzati-Rice T, Diaz-Tena N, Greenblatt J . On modelling response propensity for dwelling unit (DU) level non-response adjustment in the Medical Expenditure Panel Survey (MEPS). Stat Med. 2007; 26(8):1875-84. DOI: 10.1002/sim.2809. View

Brunello N, Davidson J, Deahl M, Kessler R, Mendlewicz J, Racagni G . Posttraumatic stress disorder: diagnosis and epidemiology, comorbidity and social consequences, biology and treatment. Neuropsychobiology. 2001; 43(3):150-62. DOI: 10.1159/000054884. View

Jakupcak M, Hoerster K, Varra A, Vannoy S, Felker B, Hunt S . Hopelessness and suicidal ideation in Iraq and Afghanistan War Veterans reporting subthreshold and threshold posttraumatic stress disorder. J Nerv Ment Dis. 2011; 199(4):272-5. DOI: 10.1097/NMD.0b013e3182124604. View

Hobfoll S, Blais R, Stevens N, Walt L, Gengler R . Vets prevail online intervention reduces PTSD and depression in veterans with mild-to-moderate symptoms. J Consult Clin Psychol. 2015; 84(1):31-42. DOI: 10.1037/ccp0000041. View

Zou G . A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004; 159(7):702-6. DOI: 10.1093/aje/kwh090. View

10.

Fergusson D, Horwood L, Ridder E, Beautrais A . Subthreshold depression in adolescence and mental health outcomes in adulthood. Arch Gen Psychiatry. 2005; 62(1):66-72. DOI: 10.1001/archpsyc.62.1.66. View

11.

Rockhill B, Newman B, WEINBERG C . Use and misuse of population attributable fractions. Am J Public Health. 1998; 88(1):15-9. PMC: 1508384. DOI: 10.2105/ajph.88.1.15. View

12.

Calabrese J, Prescott M, Tamburrino M, Liberzon I, Slembarski R, Goldmann E . PTSD comorbidity and suicidal ideation associated with PTSD within the Ohio Army National Guard. J Clin Psychiatry. 2011; 72(8):1072-8. DOI: 10.4088/JCP.11m06956. View

13.

Breslau N, Kessler R, Chilcoat H, Schultz L, Davis G, Andreski P . Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry. 1998; 55(7):626-32. DOI: 10.1001/archpsyc.55.7.626. View

14.

Mota N, Tsai J, Sareen J, Marx B, Wisco B, Harpaz-Rotem I . High burden of subthreshold DSM-5 post-traumatic stress disorder in U.S. military veterans. World Psychiatry. 2016; 15(2):185-6. PMC: 4911785. DOI: 10.1002/wps.20313. View

15.

Stein M, Walker J, Hazen A, Forde D . Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry. 1997; 154(8):1114-9. DOI: 10.1176/ajp.154.8.1114. View

16.

Fine T, Contractor A, Tamburrino M, Elhai J, Prescott M, Cohen G . Validation of the telephone-administered PHQ-9 against the in-person administered SCID-I major depression module. J Affect Disord. 2013; 150(3):1001-7. DOI: 10.1016/j.jad.2013.05.029. View

17.

Angst J, Merikangas K . The depressive spectrum: diagnostic classification and course. J Affect Disord. 1997; 45(1-2):31-9; discussion 39-40. DOI: 10.1016/s0165-0327(97)00057-8. View

18.

Gray M, Litz B, Hsu J, Lombardo T . Psychometric properties of the life events checklist. Assessment. 2004; 11(4):330-41. DOI: 10.1177/1073191104269954. View

19.

Breslau N, Lucia V, Davis G . Partial PTSD versus full PTSD: an empirical examination of associated impairment. Psychol Med. 2005; 34(7):1205-14. DOI: 10.1017/s0033291704002594. View

20.

Wilson J . The historical evolution of PTSD diagnostic criteria: from Freud to DSM-IV. J Trauma Stress. 1994; 7(4):681-98. DOI: 10.1007/BF02103015. View