Subthreshold PTSD and PTSD in a prospective‐longitudinal cohort of military personnel: Potential targets for preventive interventions
Open accessAbstract
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.
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The existence of differential relations between CPA and later AS traits based upon individual PTSS clusters is supported by a substantial literature that emphasizes the predictive utility of evaluating PTSD symptoms dimensionally and at the cluster level, rather than focusing exclusively on PTSD diagnoses.
“The existence of differential relations between CPA and later AS traits based upon individual PTSS clusters is supported by a substantial literature that emphasizes the predictive utility of evaluating PTSD symptoms dimensionally and at the cluster level, rather than focusing exclusively on PTSD diagnoses (Fink et al., 2018).”
From Childhood Physical Abuse and Antisocial Traits: Mediating Role of Posttraumatic Stress Symptom Clusters (2022) · cites this paper as Fink et al., 2018
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- Authors
- Fink, D. S., Gradus, J. L., Keyes, K. M., Calabrese, J. R., Liberzon, I., Tamburrino, M. B., Cohen, G. H., Sampson, L., & Galea, S.
- Affiliations
- Columbia University (US)
- Boston University (US)
- Case Western Reserve University (US)
- University of Michigan (US)
- University of Toledo (US)
- Corresponding author
- Fink, David S.
- ORCID
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2018-08-12
- Volume
- 35
- Issue
- 11
- Pages
- 1048-1055
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- PMC
- PMC6212313
- OpenAlex
- W2885996441
- Cited by
- 41
- References
- 39
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 2 · 2023: 5 · 2022: 5 · 2021: 10 · 2020: 7 · 2019: 2 · 2018: 1
- FWCI
- 5.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- National Institute on Drug Abuse (T32DA031099)
- Congressionally Directed Medical Research Programs (W81XWH‐07‐1‐0409, W81XWH‐10‐1‐0579, W81XWH‐15‐1‐0080)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- subthreshold PTSD, post-traumatic stress disorder, military personnel, National Guard, PTSD prevention, population attributable fraction, PTSD risk, PTSD Checklist, PTSD prevalence, preventive interventions
- MeSH terms
- Adolescent, Adult, Female, Humans, Male, Middle Aged, Military Personnel, Ohio, Stress Disorders, Post-Traumatic, Cohort Studies, Prevalence, Young Adult
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