Subthreshold PTSD and PTSD in a prospective‐longitudinal cohort of military personnel: Potential targets for preventive interventions

Fink, David S.; Gradus, Jaimie L.; Keyes, Katherine M.; Calabrese, Joseph R.; Liberzon, Israel; Tamburrino, Marijo; Cohen, Gregory H.; Sampson, Laura; Galea, Sandro

doi:10.1002/da.22819

Cited by 34 publications

(29 citation statements)

References 37 publications

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“…To this date, only two longitudinal studies have examined the long‐term course of subthreshold PTSD. Cukor et al (2010) found that 14.1% of subthreshold PTSD among rescue workers who worked at the World Trade Center following 9/11 progressed to PTSD, and Fink et al (2018) reported that 15.9–17.3% of subthreshold PTSD in a military cohort advanced to probable PTSD per year. Goodwin et al (2012) found that delayed‐onset PTSD, defined as the onset of PTSD at least 6 months after a traumatic event represented nearly half of all PTSD cases assessed within their study.…”

Section: Discussionmentioning

confidence: 99%

“…Previous literature has found that subthreshold PTSD is as prevalent and sometimes even more prevalent than full‐threshold PTSD in community samples (Mitchell, Mazzeo, Schlesinger, Brewewrton, & Smith, 2012, Pietrzak, Goldstein, Southwick, & Grant, 2011a). Studies on military personnel and the police, who are inevitably exposed to trauma due to the nature of their occupation, found an even higher rate of subthreshold PTSD than reported in community samples (Fink et al, 2018; Pietrzak et al, 2012). In 1988, the first major study on subthreshold PTSD by Kulka et al (1988) reported that 11% of male Vietnam veterans and 7.8% of female veterans currently suffered from subthreshold PTSD.…”

Section: Introductionmentioning

confidence: 93%

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The prevalence and clinical impairment of subthreshold PTSD using DSM‐5 criteria in a national sample of Korean firefighters

Kim

Park

et al. 2020

Depression and Anxiety

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Background Firefighters are at high risk for subthreshold and full‐threshold posttraumatic stress disorder (PTSD) due to their frequent exposure to various traumatic events. Although individuals with subthreshold PTSD have increased impairment, often needing treatment, the rates of subthreshold PTSD in firefighters remain unknown. Moreover, there is currently no consensus regarding the definition of subthreshold PTSD. The purpose of this study was to investigate the rates and clinical impairment of subthreshold PTSD according to various definitions in a national sample of firefighters. Methods A total of 45,698 Korean firefighters completed self‐reported questionnaires to assess the severity of PTSD symptoms, suicidal behavior, depression, alcohol use problems, and PTS‐related functional impairment. Six different definitions used in the literature were used to calculate the prevalence rate of subthreshold PTSD. Multivariable linear regression and analysis of variance were performed to identify the relationship of subthreshold PTSD with suicidal behavior, depression, alcohol use problems, and PTS‐related functional impairment. Results The rate of full‐threshold PTSD was 2.63%, and the rate of subthreshold PTSD ranged from 1.79% to 17.98%. The individuals with subthreshold PTSD most commonly failed the D criteria, which included negative alterations in cognition and mood. Regardless of the definition used, subthreshold PTSD was found to be associated with increased suicidal behavior, depression, alcohol use problems, and functional impairment. Conclusions Subthreshold PTSD appears to be equal to or more frequent than full‐threshold PTSD in Korean firefighters and associated with various negative clinical outcomes. Further effort to detect and treat subthreshold PTSD in firefighters may be essential.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

The prevalence and clinical impairment of subthreshold PTSD using DSM‐5 criteria in a national sample of Korean firefighters

Kim

Park

et al. 2020

Depression and Anxiety

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“…Soldiers who have served in current‐era conflicts have PTSD estimates of 13.5% among all veterans and 15.8% among OEF/OIF veterans . Further, it is estimated that approximately 25% of veterans and 12% of current Guard soldiers experience subclinical PTSD symptomatology . These symptoms have also been shown to be associated with poor physical and mental health …”

Section: Introductionmentioning

confidence: 99%

Drug use and hazardous drinking are associated with PTSD symptoms and symptom clusters in US Army Reserve/National Guard Soldiers

et al. 2018

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Background and Objectives: There is strong evidence of the association between Posttraumatic Stress Disorder (PTSD) symptoms and substance use. Previous work has found sex differences in these associations. With revisions to the DSM, it is important to understand how overall PTSD symptoms and the new symptom clusters relate to substance use among Reserve/Guard soldiers-a high risk group. Methods: Data are from the baseline assessment of Operation: SAFETY (Soldiers and Families Excelling Through the Years), a longitudinal study of US Army Reserve/National Guard (USAR/NG) soldiers (N ¼ 389 males, N ¼ 84 females). We examined associations between current substance use (drug use, hazardous drinking, and smoking) and overall PTSD symptoms, and symptom clusters. Additionally, we examined PTSD by sex interactions. Results: Greater overall PTSD symptoms were associated with higher odds of drug use (OR ¼ 1.08; 95%CI: 1.05, 1.12) and hazardous drinking (OR ¼ 1.04; 95%CI: 1.02, 1.07). Greater individual symptom cluster scores were associated with higher odds of drug use (ps < .001) and hazardous drinking (ps < .01). Interaction models revealed no differences in these associations on the basis sex (ps > .05). There were no associations between PTSD symptoms or symptom clusters on smoking (ps > .05). Discussion and Conclusion: Soldiers experiencing PTSD symptoms are reporting current drug and hazardous alcohol use, suggestive of self-medication. Scientific Significance: It is imperative to consider the impact of PTSD on substance use broadly, as this work shows that overall symptoms and symptom clusters have an impact on male and female USAR/NG soldiers.

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“…7 Brancu et al 11 performed a meta-analysis of the literature on sub-syndromal PTSD in civilian and military populations, noting five possible definitions for the condition and an average prevalence rate of 14.7%. Furthermore, a large prospective study of US National Guard personnel 12 found 12% screened positive for sub-syndromal PTSD and only 5% with probable PTSD. Finally, Van Hooff et al 13 suggested that as many as 38% of a large cohort who had transitioned from the Australian Defence Force and 20.2% of current serving personnel surveyed in 2015 could be considered to have sub-threshold PTSD based upon scores in the moderate to very high bands of the PCL-C that was performed anonymously and thus free of the risk of minimisation of symptoms, a problem seen in identified military screening.…”

Section: Prevalence Of Sub-syndromal Ptsdmentioning

confidence: 99%

“…Identifying and effectively treating those with sub-syndromal PTSD should be a priority because of its association with delayed-onset PTSD and other conditions. Fink et al 12 suggested that effective treatment of a cohort of US National Guard personnel with sub-syndromal PTSD could theoretically reduce the population burden of future diagnosable PTSD by over a third. However, currently there are no clear guidelines as only a few studies have assessed treatment for sub-syndromal PTSD in veterans.…”

Section: Treatment and Sub-syndromal Ptsdmentioning

confidence: 99%

Sub-syndromal PTSD: what is important to know in military personnel and veterans?

Wallace¹,

Moss²,

Hodges³

2019

Australas Psychiatry

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Objective: To assist healthcare professionals in their management of military personnel and veterans by providing information on the importance of sub-syndromal PTSD. Conclusion: Sub-syndromal PTSD occurs when persons experience many of the symptoms of PTSD, with some impairment, but do not meet full diagnostic criteria. Found to be associated with a range of mental health conditions including alcohol abuse, higher rates of suicidal ideas and delayed-onset PTSD, it should be seen as ‘symptoms that are predictive of later disorder’. Patients with this condition need accurate assessment, trauma-focused therapy and follow-up to address the symptoms and, potentially, prevent development of PTSD.

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Subthreshold PTSD and PTSD in a prospective‐longitudinal cohort of military personnel: Potential targets for preventive interventions

Cited by 34 publications

References 37 publications

The prevalence and clinical impairment of subthreshold PTSD using DSM‐5 criteria in a national sample of Korean firefighters

The prevalence and clinical impairment of subthreshold PTSD using DSM‐5 criteria in a national sample of Korean firefighters

Drug use and hazardous drinking are associated with PTSD symptoms and symptom clusters in US Army Reserve/National Guard Soldiers

Sub-syndromal PTSD: what is important to know in military personnel and veterans?

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