Subthreshold posttraumatic stress disorder: A meta-analytic review of DSM–IV prevalence and a proposed DSM–5 approach to measurement.

Abstract

Subthreshold posttraumatic stress disorder (PTSD) is a chronic condition that is often ignored, the cumulative effects of which can negatively impact an individual's quality of life and overall health care costs. However, subthreshold PTSD prevalence rates and impairment remain unclear due to variations in research methodology. This study examined the existing literature in order to recommend approaches to standardize subthreshold PTSD assessment. We conducted (a) a meta-analysis of subthreshold PTSD prevalence rates and (b) compared functional impairment associated with the 3 most commonly studied subthreshold PTSD definitions. Meta-analytic results revealed that the average prevalence rate of subthreshold PTSD across studies was 14.7%, with a lower rate (12.6%) among the most methodologically rigorous studies and higher rate (15.6%) across less rigorous studies. There were significant methodological differences among reviewed studies with regard to definition, measurement, and population. Different definitions led to prevalence rates ranging between 13.7% and 16.4%. Variability in prevalence rates most related to population and sample composition, with trauma type and community (vs. epidemiological) samples significantly impacting heterogeneity. Qualitative information gathered from studies presenting functional correlates supported current evidence that psychological and behavioral parameters were worse among subthreshold PTSD groups compared with no-PTSD groups, but not as severe as impairment in PTSD groups. Several studies also reported significant increased risk of suicidality and hopelessness as well as higher health care utilization rates among those with subthreshold PTSD (compared with trauma exposed no-PTSD samples). Based on findings, we propose recommendations for developing a standard approach to evaluation of subthreshold PTSD.

Rates of Subthreshold PTSD Among U.S. Military Veterans and Service Members: A Literature Review

“…A recent meta-analysis on subthreshold PTSD provided estimated prevalence of and recommendations regarding standardized assessment methods of subthreshold PTSD (Brancu et al, 2016). Examining subthreshold PTSD prevalence across a variety of samples (e.g., civilian, military), using one of three definitions based on DSM-IV PTSD criteria, and including articles that contained the term “subthreshold PTSD” or “partial PTSD,” they found an overall prevalence estimate of 14.7%.…”

The Frequency of PTSD and Subthreshold PTSD among African–American Women with Depressive Symptoms in a Disadvantaged Urban Neighborhood: Pilot Study

“…Women in a disadvantaged neighborhood with increased exposures to traumatic events may fall into this Bsubthreshold^category of PTSD and experience increased psychological distress despite not having the Bfull-blown^PTSD diagnosis. Future work is needed to identify and support these individuals who do not meet criteria for PTSD diagnosis but still suffer with psychological distress that can deteriorate their mental health [13][14][15].…”

“…Only a few studies have explicitly examined the impact of disadvantaged neighborhood on PTSD symptoms [4]. This is concerning given that these individuals have an increased likelihood of experiencing distress from trauma, and untreated PTSD symptoms have adverse effects on mental health, quality of life, and functioning [12].Some individuals who do not meet diagnostic and statistical manual of mental disorders (DSM) criteria for PTSD diagnosis can still experience PTSD symptomatology [13][14][15]. The concept of subthreshold PTSD has been explored in hope of capturing the need of these individuals in distress with PTSD symptomatology.…”

“…Some individuals who do not meet diagnostic and statistical manual of mental disorders (DSM) criteria for PTSD diagnosis can still experience PTSD symptomatology [13][14][15]. The concept of subthreshold PTSD has been explored in hope of capturing the need of these individuals in distress with PTSD symptomatology.…”

“…One meta-analysis showed that the prevalence rate of subthreshold PTSD across studies that examined people exposed to traumatic events ranges between 14 and 16% [15]. Yet, due to the restrictiveness of DSM criteria, individuals who fail to meet criteria for a PTSD diagnosis may be hindered from receiving appropriate treatments and suffer from significant psychological distress [13][14][15]. This brief report examined the frequency of DSM-IV PTSD diagnosis and subthreshold PTSD among a cohort of African-American women with depressive symptoms from an urban neighborhood.…”