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Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions

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Pietrzak, Robert H., Goldstein, Risë B., Southwick, Steven M., Grant, Bridget F.·2011·Journal of Anxiety Disorders

DOI 10.1016/j.janxdis.2010.11.010PMC PMC3051041

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Abstract

The present study used data from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,653) to examine lifetime Axis I psychiatric comorbidity of posttraumatic stress disorder (PTSD) in a nationally representative sample of U.S. adults. Lifetime prevalences ± standard errors of PTSD and partial PTSD were 6.4% ± 0.18 and 6.6% ± 0.18, respectively. Rates of PTSD and partial PTSD were higher among women (8.6% ± 0.26 and 8.6% ± 0.26) than men (4.1% ± 0.19 and 4.5% ± 0.21). Respondents with both PTSD and partial PTSD most commonly reported unexpected death of someone close, serious illness or injury to someone close, and sexual assault as their worst stressful experiences. PTSD and partial PTSD were associated with elevated lifetime rates of mood, anxiety, and substance use disorders, and suicide attempts. Respondents with partial PTSD generally had intermediate odds of comorbid Axis I disorders and psychosocial impairment relative to trauma controls and full PTSD.

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Marmar, C. R., Brown, A. D., Qian, M., LASKA, E. M., Siegel, C., Li, M., Amara, D. A., Tsiartas, A., Richey, C., Smith, J. G., et al. (2019) · Depression and Anxiety · doi:10.1002/da.22890 · Cited by 136
Subthreshold posttraumatic stress disorder: A meta-analytic review of DSM–IV prevalence and a proposed DSM–5 approach to measurement.
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Translation and validation of the Chinese ICD-11 International Trauma Questionnaire (ITQ) for the Assessment of Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD)
Ho, G. W. K., Karatzias, T., Cloître, M., Chan, A. C. Y., Bressington, D. T., Chien, W. T., Hyland, P., & Shevlin, M. E. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1608718 · Cited by 124
Augmenting Prolonged Exposure therapy for PTSD with intranasal oxytocin: a randomized, placebo-controlled pilot trial
Flanagan, J. C., Sippel, L. M., Wahlquist, A., Moran-Santa Maria, M. M., & Back, S. E. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2017.12.014 · Cited by 117
“…other psychiatric problems (e.g., depression, substance use disorder), neuropsychological impairment, suicidality, physical health problems and increased mortality, reduced resiliency, unemployment, and family/couples impairment (Marx et al., 2009; Monson et al., 2009; Pietrzak et al., 2009, 2011).”
Internet-based cognitive and behavioural therapies for post-traumatic stress disorder (PTSD) in adults
Simon, N. A., Robertson, L., Lewis, C., Roberts, N. P., Bethell, A., Dawson, S., & Bisson, J. I. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011710.pub3 · Cited by 118
Does time heal all wounds? A longitudinal study of the development of posttraumatic stress symptoms in parents of survivors of childhood cancer and bereaved parents
Ljungman, L., Hovén, E., Ljungman, G., Cernvall, M., & von Essen, L. (2015) · Psycho-Oncology · doi:10.1002/pon.3856 · Cited by 109
Gender difference in outcomes following trauma-focused interventions for posttraumatic stress disorder: systematic review and meta-analysis
Wade, D., Varker, T., Kartal, D., Hetrick, S., O'Donnell, M., & Forbes, D. (2016) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/tra0000110 · Cited by 111
The efficacy of initial hydrocortisone administration at preventing posttraumatic distress in adult trauma patients: A randomized trial
Delahanty, D. L., Gabert-Quillen, C., Ostrowski, S. A., Nugent, N. R., Fischer, B., Morris, A., Pitman, R. K., Bon, J., & Fallon, W. (2013) · CNS Spectrums · doi:10.1017/s1092852913000096 · Cited by 115
Examining mechanisms of change in a yoga intervention for women: the influence of mindfulness, psychological flexibility, and emotion regulation on PTSD symptoms
Dick, A. M., Niles, B. L., Street, A. E., DiMartino, D. M., & Mitchell, K. S. (2014) · Journal of Clinical Psychology · doi:10.1002/jclp.22104 · Cited by 112
“Subthreshold PTSD was defined by the presence of at least one symptom in each criterion “cluster,” or meeting full symptom criteria for at least two symptom clusters (Mitchell et al., 2012; Pietrzak et al., 2011; Schnurr, Friedman, & Rosenberg, 1993).”
Method
Physical health burden of PTSD, depression, and their comorbidity in the U.S. veteran population: Morbidity, functioning, and disability
Nichter, B., Norman, S. B., Haller, M. M., & Pietrzak, R. H. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.109744 · Cited by 115
Self-citation
Mindfulness and yoga for psychological trauma: systematic review and meta-analysis
Taylor, J., McLean, L., Korner, A., Stratton, E., & Glozier, N. (2020) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2020.1760167 · Cited by 110
“It has been causally associated with anxiety, mood, impulse, psychosis, substance, personality, and conduct disorders as well as lifetime suicidality (Kessler et al., 2005; Pietrzak et al., 2011).”
Background
Efficacy and acceptability of interventions for co-occurring PTSD and SUD: A meta-analysis
Simpson, T. L., Goldberg, S. B., Louden, D. N., Blakey, S. M., Hawn, S. E., Lott, A. M. K., Browne, K. C., Lehavot, K., & Kaysen, D. L. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102490 · Cited by 108
Psychiatric Co-Morbidities in Post-Traumatic Stress Disorder: Detailed Findings from the Adult Psychiatric Morbidity Survey in the English Population
Qassem, T., Aly-ElGabry, D., Alzarouni, A., Abdel-Aziz, K., & Arnone, D. (2021) · Psychiatric Quarterly · doi:10.1007/s11126-020-09797-4 · Cited by 107
Concurrent treatment with prolonged exposure for co-occurring full or subthreshold posttraumatic stress disorder and substance use disorders: a randomized clinical trial
Ruglass, L. M., Lopez-Castro, T., Papini, S., Killeen, T., Back, S. E., & Hien, D. A. (2017) · Psychotherapy and Psychosomatics · doi:10.1159/000462977 · Cited by 105
A meta-analytic review of exposure in group cognitive behavioral therapy for posttraumatic stress disorder
Barrera, T. L., Mott, J. M., Hofstein, R. F., & Teng, E. J. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.09.005 · Cited by 103
Epigenetic mechanisms of alcoholism and stress-related disorders
Palmisano, M., & Pandey, S. C. (2017) · Alcohol · doi:10.1016/j.alcohol.2017.01.001 · Cited by 108
Posttraumatic Stress Disorder
Schmertz, S. K., & Gerardi, M. A. (2013) · Wiley eBooks · doi:10.1002/9781118528563.wbcbt43 · Cited by 102
Physical Health Consequences of Interpersonal Trauma: A Systematic Review of the Role of Psychological Variables
López-Martínez, A. E., Serrano-Ibáñez, E. R., Ruiz-Párraga, G. T., Gómez-Pérez, L., Ramírez-Maestre, C., & Esteve, R. (2018) · Trauma, Violence, & Abuse · doi:10.1177/1524838016659488 · Cited by 99
EEG correlates of the severity of posttraumatic stress symptoms: A systematic review of the dimensional PTSD literature
Lobo, I., Portugal, L. C. L., Figueira, I. L. D. V., Volchan, E., David, I. A., Pereira, M. G., & Oliveira, L. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.05.015 · Cited by 95
“Although these “clean” profiles are quite unusual in PTSD studies (Pietrzak et al., 2011), it is important to know the behavior of the relevant biomarkers in these cases, especially when considering using these biomarkers in people with acute PTSD to investigate vulnerability to develop chronic…”
Background
Neuroclinical Framework for the Role of Stress in Addiction
Kwako, L. E., & Koob, G. F. (2017) · Chronic Stress · doi:10.1177/2470547017698140 · Cited by 105
Trauma exposure and stress-related disorders in a large, urban, predominantly African-American, female sample
Gluck, R. L., Hartzell, G., Dixon, H. D., Michopoulos, V., Powers, A. D., Stevens, J. S., Fani, N., Carter, S. E., Schwartz, A. C., Jovanović, T., et al. (2021) · Archives of Women s Mental Health · doi:10.1007/s00737-021-01141-4 · Cited by 93
“time PTSD (54% compared with 6–8%) (Pietrzak et al. 2011).”
Relationships among trauma exposure, familial characteristics, and PTSD: A case-control study of women in prison and in the general population
Grella, C. E., Lovinger, K., & Warda, U. S. (2013) · Women & Criminal Justice · doi:10.1080/08974454.2013.743376 · Cited by 92
Impact of emotional approach coping and hope on PTSD and depression symptoms in a trauma exposed sample of Veterans receiving outpatient VA mental health care services
Hassija, C. M., Luterek, J. A., Naragon‐Gainey, K., Moore, S. A., & Simpson, T. L. (2011) · Anxiety Stress & Coping · doi:10.1080/10615806.2011.621948 · Cited by 92
“Compared with those who have not experienced trauma, trauma-exposed individuals are at elevated risk for developing mental health conditions, most commonly, posttraumatic stress disorder (PTSD), depression and substance use disorders (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995 ; Pietrzak, Goldstein, Southwick, &…”
Background
Latent profile analyses of posttraumatic stress disorder, depression and generalized anxiety disorder symptoms in trauma-exposed soldiers
Contractor, A. A., Elhai, J. D., Fine, T. H., Tamburrino, M., Cohen, G. H., Shirley, E. R., Chan, P. K., Liberzon, I., Galea, S., & Calabrese, J. R. (2015) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2015.05.014 · Cited by 94
Prevalence of Posttraumatic Stress Disorder and Psychological Comorbidities Among U.S. Active Duty Service Members, 2006–2013
Walter, K. H., Levine, J. A., Highfill‐McRoy, R. M., Navarro, M., & Thomsen, C. J. (2018) · Journal of Traumatic Stress · doi:10.1002/jts.22337 · Cited by 90
Application of Noninvasive Vagal Nerve Stimulation to Stress-Related Psychiatric Disorders
Bremner, J. D., Gurel, N. Z., Wittbrodt, M. T., Shandhi, M. M. H., Rapaport, M. H., Nye, J. A., Pearce, B. D., Vaccarino, V., Shah, A. J., Park, J., et al. (2020) · Journal of Personalized Medicine · doi:10.3390/jpm10030119 · Cited by 100
“Similarly, PTSD affects 6% of the population at some time in their lives [7].”
Background
Posttraumatic Stress, Heart Rate Variability, and the Mediating Role of Behavioral Health Risks
Dennis, P. A., Watkins, L. L., Calhoun, P. S., Oddone, A. E., Sherwood, A., Dennis, M. F., Rissling, M. B., & Beckham, J. C. (2014) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000110 · Cited by 97
“Individuals with PTSD are at least twice as likely as nonaffected individuals to smoke (51,52), 1.”
Background
Killing and latent classes of PTSD symptoms in Iraq and Afghanistan veterans
Maguen, S., Madden, E., Bosch, J. O., Galatzer‐Levy, I. R., Knight, S. J., Litz, B. T., Marmar, C. R., & McCaslin, S. E. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.08.021 · Cited by 89
Trauma and posttraumatic stress disorder in Japan: Results from the World Mental Health Japan Survey
Kawakami, N., Tsuchiya, M., Umeda, M., Koenen, K. C., & Kessler, R. C. (2014) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2014.01.015 · Cited by 92
“…exposures and/or a conditional risk of PTSD by the type of trauma exposure (Breslau et al., 1998; Bruce et al., 2001; Kessler et al., 1995; Norris et al., 2003; Pietrzak et al., 2011; Zlotnick et al., 2006), both of which could vary among countries depending on the social and cultural background.”
BackgroundMethodResultInfluential
Presenting Concerns of Veterans Entering Treatment for Posttraumatic Stress Disorder
Rosen, C. S., Adler, E. P., & Tiêt, Q. Q. (2013) · Journal of Traumatic Stress · doi:10.1002/jts.21841 · Cited by 88
Primitive mechanisms of trauma response: an evolutionary perspective on trauma-related disorders.
Baldwin, D. V. (2013) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.06.004 · Cited by 85
Posttraumatic stress disorder and symptoms among American Indians and Alaska Natives: a review of the literature
Bassett, D. R., Buchwald, D., & Manson, S. M. (2013) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-013-0759-y · Cited by 97
“patients with full PTSD, as diagnosed by DSM-IV criteria [6].”
BackgroundMethodInfluential
Trauma and Stressor-Related Disorders
Walsh, K., Wells, J. B., Lurie, B., & Koenen, K. C. (2015) · Springer eBooks · doi:10.1007/978-3-319-13060-6_6 · Cited by 85
Acceptability of internet-based cognitive behavioural therapy (i-CBT) for post-traumatic stress disorder (PTSD): A systematic review
Simon, N., McGillivray, L., Roberts, N. P., Barawi, K., Lewis, C. E., & Bisson, J. I. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1646092 · Cited by 84
“…is a considerable reduction, or perhaps no engagement with a therapist, tolerability may be problematic, particularly when concerning exposure work in i-CBT with a trauma-focus, which may require an individual to recount distressing trauma memories (Pietrzak, Goldstein, Southwick, & Grant, 2011).”
Background
Predictors and mental health outcomes of potentially traumatic event exposure
Overstreet, C. M., Berenz, E. C., Kendler, K. S., Dick, D. M., & Amstadter, A. B. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.10.047 · Cited by 96
“, 2011), and negative mental health outcomes as evidenced by previous work (Pietrzak et al., 2011) and the present study, a history of trauma pre-college entry among many students raises clinical implications regarding university Overstreet et al.”
Result
Post-traumatic stress disorder in older adults: a systematic review of the psychotherapy treatment literature
Dinnen, S., Simiola, V., & Cook, J. M. (2014) · Aging & Mental Health · doi:10.1080/13607863.2014.920299 · Cited by 92
Comorbid mood and anxiety disorders and severity of posttraumatic stress disorder symptoms in treatment-seeking veterans.
Knowles, K. A., Sripada, R. K., Defever, M. E., & Rauch, S. A. M. (2018) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000383 · Cited by 91
“Given that comorbid substance use is typically high among individuals with PTSD (e.g., Pietrzak et al., 2011), this is a significant limitation of the current article, which considers only mood and anxiety comorbidities.”
Post-traumatic stress disorder (PTSD) as a systemic disorder: Pathways to cardiovascular disease.
Krantz, D. S., Shank, L. M., & Goodie, J. L. (2021) · Health Psychology · doi:10.1037/hea0001127 · Cited by 92
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Affective vulnerability in substance use disorders
McHugh, R. K., & Kneeland, E. T. (2019) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2019.01.011 · Cited by 80
“Co-occurring mood, anxiety and traumatic-stress related disorders are highly prevalent among people with SUDs [3, 4], and are also prospectively associated with risk for the development of problematic substance use and SUDs [5].”
Background
The Psychedelic Future of Post-Traumatic Stress Disorder Treatment
Zaretsky, T. G., Jagodnik, K. M., Barsic, R., Antonio, J. H., Bonanno, P. A., MacLeod, C., Pierce, C., Carney, H., Morrison, M. T., Saylor, C. F., et al. (2024) · Current Neuropharmacology · doi:10.2174/1570159x22666231027111147 · Cited by 92
Written Exposure Therapy vs Prolonged Exposure Therapy in the Treatment of Posttraumatic Stress Disorder: A Randomized Clinical Trial
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“I Wouldn't Start From Here”-An Alternative Perspective on PTSD From the ICD-11 : Comment on Friedman (2013)
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An experience sampling study of PTSD and alcohol-related problems.
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Initial Assessment of Post-traumatic Stress in a US Cohort of Inflammatory Bowel Disease Patients
Taft, T., Bedell, A., Craven, M. R. A., Guadagnoli, L. A., Quinton, S., & Hanauer, S. B. (2019) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izz032 · Cited by 79

Authors: Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F.
Affiliations: Yale University (US)
National Institutes of Health (US)
Corresponding author: Pietrzak, Robert H.
ORCID: Pietrzak, Robert H.
Goldstein, Risë B.
Southwick, Steven M.
Venue: Journal of Anxiety Disorders
Publisher: Elsevier BV
Published: 2011-04
Volume: 25
Issue: 3
Pages: 456-465
ISSN: 0887-6185 (ISSN-L)
DOI: 10.1016/j.janxdis.2010.11.010
PMC: PMC3051041
OpenAlex: W1969551391
Cited by: 963
References: 87
Citations by year: 2026: 32 · 2025: 55 · 2024: 69 · 2023: 69 · 2022: 88 · 2021: 79 · 2020: 102 · 2019: 84 · 2018: 75 · 2017: 70 · 2016: 64 · 2015: 56 · 2014: 51 · 2013: 40 · 2012: 18
FWCI: 24.53
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Journal of Anxiety Disorders (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Alcohol Abuse and Alcoholism (NIAAA)
National Institute on Drug Abuse (NIDA)
Intramural Program of the National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism
National Center for Posttraumatic Stress Disorder
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Keywords: post-traumatic stress disorder, PTSD prevalence, psychiatric comorbidity, Axis I disorders, mood disorders, anxiety disorders, substance use disorders, suicide attempts, sex differences, trauma exposure, sexual assault, unexpected death, psychosocial impairment, NESARC
MeSH terms: Adult, Female, Health Surveys, Humans, Life Change Events, Male, Middle Aged, Psychiatric Status Rating Scales, Sex Factors, Stress Disorders, Post-Traumatic, United States, Comorbidity, Prevalence, Mood Disorders, Substance-Related Disorders

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Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions

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