Subsyndromal posttraumatic stress disorder symptomatology in primary care military veterans: Treatment implications.

Abstract

Subsyndromal posttraumatic stress disorder (PTSD) is highly prevalent in Veterans Affairs Medical Centers' primary-care clinics and is associated with significant impairment. We used a cross-sectional design to examine PTSD symptoms and depressive disorders endorsed by two cohorts of Veterans meeting less than full PTSD criteria who presented to primary care at the Philadelphia VA Medical Center (i.e., those from Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) and non-OEF/OIF/OND Veterans). The Philadelphia VA Behavioral Health Lab (BHL) assessed 141 Veterans who screened positive for subsyndromal PTSD. Avoidance was endorsed significantly less often than arousal in the total group. When the groups were split by cohort era, higher levels of avoidance and lower levels of arousal were reported in the non-OEF/OIF/OND group than the OEF/OIF/OND group. Comorbid depression was present in 43.9% of the total group with no significant differences between groups. Exposure-based treatments for PTSD offered in specialty mental health clinics target avoidance symptoms. Because the endorsement of avoidance symptoms was low in both of the cohorts that were studied this may not be the most effective treatment target for Veterans with subsyndromal PTSD receiving treatment in primary care settings. For these Veterans, treatments that target reexperiencing and arousal symptoms and/or comorbid depression may be more effective.

Comparing Response to Cognitive Processing Therapy in Military Veterans With Subthreshold and Threshold Posttraumatic Stress Disorder

“…In addition, although the present study suggests that CPT is effective for reducing subthreshold PTSD symptoms, our findings do not provide information as to the relative efficacy of CPT versus other short-term therapy interventions, such as those tailored to meet the needs of primary care populations (Kornfield et al, 2012). Therefore, randomized controlled studies are needed to understand the comparative efficacy of CPT and other treatments for subthreshold PTSD and whether severity of avoidance symptoms influences the degree to which individuals respond to these treatment approaches.…”

“…Taken together, these results suggest that CPT is an effective form of treatment for subthreshold PTSD. Moreover, our findings help allay concern that evidence-based, trauma-focused therapy may be less effective among subthreshold populations (Kornfield et al, 2012). Given the increased risk for psychological and functional impairment conferred by subthreshold PTSD status, including increased risk for suicidal ideation (Jakupcak et al, 2007(Jakupcak et al, , 2011Pietrzak et al, 2009), this is an important finding with direct clinical implications.…”

Psychological Sequelae of Surgery in a Prospective Cohort of Patients From Three Intraoperative Awareness Prevention Trials

“…[31][32][33][34][35] The screening and analytic approaches used in Psych-SOS allowed for the fact that all participants in the study had the a The MPlus bias-corrected bootstrapped point estimate with 99% two-sided confidence interval for the effect of awareness (on PTSD) via dissociation is 0.211 [0.036-0.470]. The "p < 0.01" is reported based on the 99% confidence interval not including 0.…”

Examining PTSD treatment choice among individuals with subthreshold PTSD

“…Little is known regarding treatment seeking behaviors or effective treatment options for those with subthreshold PTSD (Kornfield, Klaus, McKay, Helstrom, & Oslin, 2012). There is some evidence, however, to suggest that patterns of treatment seeking may be comparable, as indicated by a survey of a random sample of community members in which individuals with full and subthreshold PTSD were identified, then asked about whether they had sought help following their traumatic experience (Stein et al, 1997).…”