The association between post-traumatic stress disorder and lifetime DSM-5 psychiatric disorders among veterans: Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III)

Abstract

This study examined the prevalence, correlates and psychiatric comorbidity of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) posttraumatic stress disorder (PTSD) in a nationally representative sample of U.S. veterans using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (n=3119 veteran respondents). The overall prevalence of lifetime PTSD was 6.9%. Lifetime PTSD prevalence was higher among veterans who were female (13.2%), aged 18–29 years (15.3%), Native American (24.1%) or Black (11.0%), previously or never married (9.6% and 11.2, respectively), had incomes less than $70,000 (7.2%–10.1%) and had >2 traumatic events (5.2%–14.7%). After adjusting for sociodemographic characteristics, comorbidity between lifetime PTSD and other psychiatric disorders was highest for any personality disorder (adjusted odds ratio [AOR] =11.1, 95% confidence interval [CI], 5.7, 21.5), any mood disorder (AOR=9.7, 95% CI, 4.6, 20.4) and any anxiety disorder (AOR=9.6, 95% CI, 5.1, 17.7), followed by nicotine, drug, and alcohol use disorders (AOR= 3.4, 95% CI,1.8, 6.5; AOR= 3.1, 95% CI, 2.0, 5.9; 2.1, 95% CI, 1.5, 3.1, respectively). Associations remained with any mood, anxiety, and personality disorders after controlling for other psychiatric disorders (AOR= 3.7, 95% CI, 1.2, 10.9; AOR= 3.5, 95% CI, 1.6, 7.4; AOR=4.5, 95% CI, 2.3, 8.7, respectively). Veterans who sought treatment for PTSD had more comorbid conditions, although treatment was only associated with comorbid drug use disorder (AOR=2.4, 95% CI, 1.0, 5.7). In U.S. veterans, PTSD is highly comorbid with other psychiatric disorders. Although many veterans remain untreated, comorbidity may influence treatment seeking.

Do trauma type, stressful life events, and social support explain women veterans’ high prevalence of PTSD?

“…Respondents further had to report symptom duration of ≥1 month and clinically significant impairment or distress. The requirement of ≥3 D and E symptoms is higher than the 2 symptoms from each cluster required for DSM-5 criteria [17], but has been used in other studies based on NESARC-III data [8, 15, 41]. Test–retest reliability of past-year PTSD was fair (0.41) and reliability of the dimensional PTSD criteria scale was good [intraclass correlation coefficient (ICC) = 0.69] [42].…”

Community Treatment for Opioid Use Disorders in Urban and Rural Veterans

“…This study reported a 33.2% prevalence of alcohol use disorders in community veterans without posttraumatic stress disorder (PTSD), and a rate of 54.5% in those with PTSD. Similarly, the investigators reported an 8.3% prevalence of drug use disorder in veterans without PTSD, which rises to 27.2% in veterans with PTSD . In a recent analysis of the NESARC data, a comparison between veteran and community samples revealed veteran rates were roughly similar to those of the community sample for street drugs and prescription use, but they were far higher for alcohol and tobacco use.…”

“…A recent review of the epidemiology of SUDs in US veterans found widely varying estimates based on type of data (administrative vs direct diagnostic assessment) and whether or not the sample targeted both treated and untreated SUD . There are a range of community‐based studies of both treated and untreated SUD that determine veteran status based on self‐report . These studies can help inform VHA about veteran SUD and treatment in the community and complement prevalence and treatment estimates based on VHA administrative data.…”

“…Similarly, the investigators reported an 8.3% prevalence of drug use disorder in veterans without PTSD, which rises to 27.2% in veterans with PTSD. 24 In a recent analysis of the NESARC data, 10 a comparison between veteran and community samples revealed veteran rates were roughly similar to those of the community sample for street drugs and prescription use, but they were far higher for alcohol and tobacco use. Golub and associates 7 determined unmet need for treatment of SUD in years 2004 through 2010 in 3,826 veterans participating in the National Survey on Drug Use and Health.…”

“…6 There are a range of community-based studies of both treated and untreated SUD that determine veteran status based on self-report. 7,11,17,[19][20][21][22][23][24] These studies can help inform VHA about veteran SUD and treatment in the community and complement prevalence and treatment estimates based on VHA administrative data. They can also identify potential resources to promote overall access to care for veterans with SUDs.…”