TY - JOUR
T1 - Subthreshold PTSD and PTSD in a prospective-longitudinal cohort of military personnel
T2 - Potential targets for preventive interventions
AU - Fink, David S.
AU - Gradus, Jaimie L.
AU - Keyes, Katherine M.
AU - Calabrese, Joseph R.
AU - Liberzon, Israel
AU - Tamburrino, Marijo B.
AU - Cohen, Gregory H.
AU - Sampson, Laura
AU - Galea, Sandro
N1 - Funding Information:
This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Joint Warfighter Medical Research Program (Grants W81XWH-15-1-0080, W81XWH-07-1-0409, and W81XWH-10-1-0579 to J.R.C., I.L., M.T.B., and S.G.) and National Institute on Drug Abuse at the National Institutes of Health (Grant T32DA031099 to D.S.F.). The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702–5014, is the awarding and administering acquisition office. Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense.
Funding Information:
This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Joint Warfighter Medical Research Program (Grants W81XWH-15-1-0080, W81XWH-07-1-0409, and W81XWH-10-1-0579 to J.R.C., I.L., M.T.B., and S.G.) and National Institute on Drug Abuse at the National Institutes of Health (Grant T32DA031099 to D.S.F.). The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702– 5014, is the awarding and administering acquisition office. Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense.
Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2018/11
Y1 - 2018/11
N2 - 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.
AB - 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.
KW - PTSD/posttraumatic stress disorder
KW - anxiety/anxiety disorder
KW - epidemiology
KW - life events/stress
KW - trauma
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U2 - 10.1002/da.22819
DO - 10.1002/da.22819
M3 - Article
C2 - 30099820
AN - SCOPUS:85052372293
SN - 1091-4269
VL - 35
SP - 1048
EP - 1055
JO - Depression and Anxiety
JF - Depression and Anxiety
IS - 11
ER -