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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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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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“Clinic-wide screening yielded 52 (50.4% positive rate) potentially eligible women, which is consistent with previous literature regarding rate of PTSD/SUD comorbidity [27].”
From Written exposure therapy for treatment of perinatal PTSD among women with comorbid PTSD and SUD: A pilot study examining feasibility, acceptability, and preliminary effectiveness (2023) · cites this paper as [27]
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Straud, C. L., Buccellato, K. H., Foa, E. B., Brown, L. A., McLean, C. P., Blount, T. H., Schobitz, R. P., DeBeer, B. B., Mignogna, J., Fina, B. A., et al. (2025) · Behavioral Sciences · doi:10.3390/bs15070954 · Cited by 2
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Self-citationIsrael, B. S., Wiprovnick, A. E., Belcher, A. M., Kleinman, M. B., Ramprashad, A., Spaderna, M., & Weintraub, E. (2022) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2022.05.003 · Cited by 2
Dowling, F. G., & Lowe, S. M. (2023) · Archives of Environmental & Occupational Health · doi:10.1080/19338244.2023.2180614 · Cited by 2
“While patients with mild SUD can be appropriately treated in primary care settings, those with more severe or complex presentations (e.g., elderly patients with co-occurring conditions) may require early specialist consultation or an integrated care approach.37 CPGs34,38 support the use of MAT for AUD and the use of p…”
BackgroundInfluentialIntellectual performance correlates of trauma exposure in adolescent psychiatric inpatients
Sadeghpour, A., Pogge, D. L., O’Donoghue, E. M., Bigdeli, T. B., Rothbaum, A. O., & Harvey, P. D. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115231 · Cited by 2
Lyons, R. C., Helm, J. L., Luciano, M. T., Haller, M. M., & Norman, S. B. (2022) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0001540 · Cited by 2
Posttraumatic Stress Disorder (PTSD) and Trauma
Crombie, K. M., Cisler, J. M., & Nemeroff, C. B. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-95702-1.00007-5 · Cited by 2
Kummar, A. S., Correia, H., Tan, J., & Fujiyama, H. (2023) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2929 · Cited by 4
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Ward, R. N., Lind, L. M., Rose, S. G., & Brown, L. M. (2024) · Clinical Gerontologist · doi:10.1080/07317115.2024.2305876 · Cited by 2
“Trauma history is associated with increased depressive symptoms in the general population (Blakey et al., 2019; Kessler et al., 2005; Pietrzak et al., 2011), although little is known about LTC residents with trauma histories.”
A Bifactor Evaluation of Self-Report and Clinician-Administered Measures of PTSD in Veterans
Raines, A. M., Clauss, K. E., Seidler, D. A., Allan, N. P., Elhai, J. D., Vasterling, J. J., Constans, J. I., Maieritsch, K. P., & Franklin, C. L. (2024) · Assessment · doi:10.1177/10731911241229568 · Cited by 2
“We also examined the predictive utility of lower-order factors in relation to depression, alcohol, and nonalcohol substance use symptom severity given their respective relations to PTSD (Pietrzak et al., 2011; Reynolds et al., 2011).”
Semenchenko, O., Zhdanovych, O. I., & Коломийченко, Т. В. (2023) · UKRAINIAN JOURNAL HEALTH OF WOMAN · doi:10.15574/hw.2023.169.39 · Cited by 3
Hinojosa, C. A., Sitar, S. I., Zhao, J. C., Barbosa, J. D., Hien, D. A., Welsh, J. W., Fani, N., & van Rooij, S. J. H. (2024) · Chronic Stress · doi:10.1177/24705470241258752 · Cited by 2
“20 30 Classical neurocircuitry models of PTSD highlight exaggerated activation of the amygdala, followed by poor regulatory control of the amygdala from prefrontal cortical regions.”
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Innovative outpatient treatment for veterans and service members and their family members
Hoover, G. G., Teer, A. P., Lento, R. M., Ward, P., Zakarian, R. J., Tinney, W. J., Sanders, W., Echevarria, K., Bonvie, J. L., Dunford, K., et al. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1377433 · Cited by 5
Subjective sleep parameters: A marker to PTSD symptoms evolution? A 4-year longitudinal study
Bertolazi, A. N., Bertolazi, L. N., Pillonetto, J., Lidtke, G. D. S., Mann, K. C., Calegaro, V. C., Hidalgo, M. P. L., & John, Â. B. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.07.049 · Cited by 2
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“The frequent comorbidity of PTSD-AUD is well-established (e.g., Debell et al., 2014; Kachadourian et al., 2014; Pietrzak et al., 2011) and particularly frequent in veteran populations (e.g., Blakey et al., 2022; Jakupcak et al., 2010).”
Perceived posttraumatic growth: positive change occurring because of or despite the trauma?
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“…has been shown to have far-reaching effects upon depression-suicidality, non-depressive mental health problems, burnout, alcohol-use disorders, sleep quality, and somatic disorders (Goldstein et al., 2016; Kearns et al., 2018; Pietrzak et al., 2011; Rytwinski, Scur, Feeny, & Youngstrom, 2013).”
Kobrinsky, V., & Siedlecki, K. L. (2024) · Current Psychology · doi:10.1007/s12144-024-07051-9 · Cited by 2
“Trauma-exposed individuals who develop PTSD symptoms, compared to those who do not, exhibit elevated rates of suicide planning (Tar-rier & Gregg, 2004 ) and are two to five times more likely to attempt suicide (Pietrzak et al., 2011).”
Bichon, J. A., Ellis, R. A., Merker, J. B., Webber, T. K., & Seligowski, A. V. (2024) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2436245 · Cited by 2
Lee, S., Heesch, C. B., Allison, K., Binns, L., Straw-Wilson, K., & Wendel, C. S. (2017) · Europe PMC (PubMed Central) · Cited by 2
Attitude and knowledge on PTSD of nursing and paramedic students in Korea
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“4%로 추정되지만[9], 경찰, 소방관, 간호사, 응급구조요원들은 업무의 성격상 일반인에 비해 외상에 노출될 위험이 높고 PTSD에 이환될 위험이 높은 PTSD 고위험군(high risk group)에 속하는 집단으로 알려져 있다.”
Askari, S., Beheshtinasab, M., Ghanbari, S., Bahmaei, H., Boostani, H., Afshari, P., & Abedi, P. (2021) · Family Medicine & Primary Care Review · doi:10.5114/fmpcr.2021.105904 · Cited by 2
“PTSD has many overlaps with other psychiatric disorders that cause a person to endure additional stress in addition to the injury [4].”
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Complex Comorbidity of Substance Use Disorders with Anxiety Disorders: Diagnosis and Treatment
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“3% of them met criteria for substance dependence [65].”
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Rosellini, A. J., Fayyad, J. A., Koenen, K. C., & Kessler, R. C. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107445130.017 · Cited by 2
“…predictors of PTSD recovery: trauma type characteristics, PTSD symptom severity, and history of comorbid mental disorders (Breslau et al., 1998; Pietrzak et al., 2011; Chapman et al., 2012), while prospective naturalistic studies have identified socio- demographic factors and childhood…”
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Traumatic Stress in Older Adults
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Pathways of Internalizing and Posttraumatic Stress Symptoms Across Childhood and Adolescence
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Gulliyev, C., Kalkan, Ö., Tekin, K., Tuna, Z. O., & Ögel, K. (2020) · Anatolian Journal of Psychiatry · doi:10.5455/apd.14413 · Cited by 2
Treatment of substance use disorder and psychological trauma: outcomes of the women of worth program
Berger, L., Lemke, M. A., Koningsveld, C. V., Yonkoski, S., Feinberg, F., Brondino, M. J., & Galbis-Reig, D. (2021) · Journal of Social Work Practice in the Addictions · doi:10.1080/1533256x.2021.1933852 · Cited by 2
“Yet, 46.4% of individuals with lifetime PTSD or partial PTSD had an alcohol use disorder and 43.3% had a drug use disorder (Pietrzak et al., 2011).”
BackgroundInfluentialEvidence for PTSD as a Systemic Disorder
Bukhbinder, A. S., & Schulz, P. E. (2016) · Springer eBooks · doi:10.1007/978-3-319-08359-9_106 · Cited by 2
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Comorbid Post-Traumatic Stress Disorder, Pain, and Opiate Addiction
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Trauma- and Stressor-Related Disorders
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Effectiveness of Psychoeducation for Adult Survivors of Sexual and Domestic Violence
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Posttraumatic Stress Disorder: Assessment and Treatment
Kulkarni, M. R., Barrad, A., & Cloître, M. (2014) · Wiley eBooks · doi:10.1002/9781118775349.ch50 · Cited by 2
Trauma and Posttraumatic Stress Disorder
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Ambulatory assessment of physiological arousal, emotion, and alcohol use
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“It has been proposed that the observed co-occurrence of alcohol misuse and PTSD may arise from individual efforts to self-medicate symptoms among those with PTSD or an increased risk of trauma among those who misuse substances (Pietrzak et al., 2011).”
BackgroundTiêt, Q. Q., Davis, L., Rosen, C. S., Norman, S. B., Leyva, Y. E., & Duong, H. (2024) · Journal of Dual Diagnosis · doi:10.1080/15504263.2024.2348105 · Cited by 1
“In the general population, research indicates that 46.6% of individuals with lifetime PTSD also meet the criteria for SUD (Pietrzak et al., 2011).”
BackgroundInfluentialAn Analysis of the Etiology of Post-Traumatic Stress Disorder
Hu, K. (2024) · SHS Web of Conferences · doi:10.1051/shsconf/202419303006 · Cited by 1
Lee, C., House, S. L., Beaudoin, F. L., Neylan, T. C., Clifford, G. D., Linnstaedt, S. D., Germine, L. T., Rauch, S. L., Haran, J. P., Storrow, A. B., et al. (2024) · Psychiatric Research and Clinical Practice · doi:10.1176/appi.prcp.20240017 · Cited by 1
“Ten most common/burdensome APNS symptoms across traditional domain were selected based on review of prior studies: pain (19), depressive symptoms (20), sleep discontinuity (21), nightmares (22), somatic symptoms (23), concentration/thinking/fatigue (24), avoidance, re ‐ experiencing, anxiety, and…”
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Examining Posttraumatic Stress Symptoms and Substance Use in Latine College Students
O’Connell, D., Vujanovic, A. A., Hernández, A. E., Miciak, J., Colunga-Rodríguez, C., Mercado, A., & Venta, A. C. (2025) · Substance Use & Misuse · doi:10.1080/10826084.2025.2497949 · Cited by 1
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InfluentialAzubuike, C. A. T., Crenshaw, A. O., & Monson, C. M. (2025) · Behavioral Sciences · doi:10.3390/bs15060719 · Cited by 1
“Meanwhile, epidemiological and observational studies demonstrate that up to half of those with PTSD also suffer from depression (Pietrzak et al., 2011; Rytwinski et al., 2013).”
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“Our primary covariates of interest were SUD, trauma/stressor-related disorders, and the interaction be - tween SUD and trauma/stressor-related disorders.”
InfluentialLeung, C., Marel, C., Teesson, M., Wilson, J., Darke, S. G., Haber, P., & Mills, K. L. (2025) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2025.209772 · Cited by 1
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“Notably, PTSD frequently co-occurs in individuals seeking treatment for substance use problems (Pietrzak et al. 2011 ).”
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“PTSD often co-occurs with other mental health conditions including depression, anxiety, and substance use disorder (Facer-Irwin et al., 2019; Pietrzak et al., 2011).”
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Boffa, J. W., Short, N. A., Albanese, B. J., Dillon, K. H., Kearns, J. C., & Schmidt, N. B. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121581 · Cited by 1
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Mei, X., Wu, H., Yuan, T., Samsom, J., Ying, S., Liu, X., Xu, T., Liu, F., & Shen, Y. (2026) · Molecular Psychiatry · doi:10.1038/s41380-026-03538-y · Cited by 1
“These symptoms may affect one ’ s ability to work, maintain relationships, and engage in social activities [5].”
State of the Science: The epidemiology of posttraumatic stress disorder
Flesaker, M., Slimovitch, R., Shiner, B. R., Sumner, J. A., & Gradus, J. L. (2026) · Journal of Traumatic Stress · doi:10.1002/jts.70091 · Cited by 2
“The lifetime prevalence of PTSD from NESARC-II was 6.4% (Pietrzak et al., 2011).”
InfluentialCorticotropin-Releasing Hormone Receptor 1 (CRHR1) Polymorphisms and Post-Traumatic Stress Disorder
Lind, M. J., Sawyers, C. K., Sheerin, C. M., & Amstadter, A. B. (2016) · Springer eBooks · doi:10.1007/978-3-319-08359-9_9 · Cited by 1
Feldner, M. T., Leen‐Feldner, E. W., Knapp, A. A., Dutton, C. E., & Bujarski, S. J. (2014) · Addiction Research & Theory · doi:10.3109/16066359.2014.920014 · Cited by 1
Current Treatment Approaches for PTSD-Substance Use Disorder Comorbidity
Hruska, B. J., & Delahanty, D. L. (2013) · Journal of Traumatic Stress Disorders & Treatment · doi:10.4172/2324-8947.1000e105 · Cited by 1
“However, despite the effectiveness of treatments including PE, efforts to treat PTSD are often complicated by the presence of comorbidities; perhaps most commonly, comorbid substance use disorder (SUD) which affects nearly 50% of people with PTSD [3].”
BackgroundPalmer, G. A., Happe, M. C., Paxson, J. M., Jurek, B. K. W., & Olson, S. A. (2015) · Military Behavioral Health · doi:10.1080/21635781.2015.1133349 · Cited by 1
Brown, K. L. (2013) · OhioLink ETD Center (Ohio Library and Information Network) · Cited by 1
Suicidal Behavior in Posttraumatic Stress Disorder: Focus on Combat Exposure
Dobry, Y., & Sher, L. (2017) · Springer eBooks · doi:10.1007/978-1-4939-7148-0_8 · Cited by 1
Unzipping PTSD: Criteria and Screeners
Pagel, J. F. (2020) · Springer eBooks · doi:10.1007/978-3-030-55909-0_2 · Cited by 1
Kahn, Z. A., & Hoffman, L. (2021) · Journal of Psycholinguistic Research · doi:10.1007/s10936-021-09770-7 · Cited by 1
RetractedMay, K., Hooff, M. V., Doherty, M., & Iannos, M. (2021) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00255 · Cited by 2
“Both definitions emphasize high levels of comorbidity between PTSD and other diagnoses, such as alcohol and substance abuse, depression, and anxiety.(3) For the purpose of this review, PTSD will encompass two further inclusions: i) ‘‘post-traumatic stress’’ (ie, removal of ‘‘disorder,’’ which has Correspondence: Karen…”
BackgroundPosttraumatische Belastungsstörung
Böttche, M., Stammel, N., & Knaevelsrud, C. (2021) · Springer eBooks · doi:10.1007/978-3-662-45995-9_9-1 · Cited by 1
Zhou, K., Chi, H., Wang, J., Zheng, Y., Pan, J., Yu, D., Xu, J., Zhu, H., Li, J., Chen, S., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.918679 · Cited by 1
Alternative Approaches for Expanding the Air Force's Task Force True North Program
Schaefer, A. G., Ausink, J. A., Goughnour, T., Gore, K. L., Jackson, K., & Emslie, P. (2022) · Rand health quarterly · doi:10.7249/rhq-10-03-07 · Cited by 1
Sauer, K. S., Wendler-Bödicker, C., Boos, A., Niemeyer, H., Palmer, S., Rojas, R., Hoyer, J., & Hitzler, M. (2023) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443/a000686 · Cited by 4
Moreland, A. D., Hubel, G. S., Goodrum, N. M., & Stevens, A. E. (2023) · Journal of Child and Family Studies · doi:10.1007/s10826-023-02572-6 · Cited by 1
“comorbid diagnosis of PTSD (Pietrzak et al., 2011; Vujanovic et al., 2016), previous research has not examined the”
BackgroundTomko, C. A., Schneider, K. E., Nestadt, D. F., Zemlak, J. L., & Sherman, S. G. (2023) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-023-01169-w · Cited by 1
“In general, PTSD is further associated with significantly increased risk for broader drug use disorders and poorer physical and mental health (Mills et al., 2005; Pietrzak et al., 2011).”
Proportionality and combat trauma
Wood, N. G. (2024) · Philosophical Studies · doi:10.1007/s11098-024-02100-2 · Cited by 1
Mukadam, A. A., & Chester, J. A. (2024) · Behavioural Brain Research · doi:10.1016/j.bbr.2024.114899 · Cited by 1
Dodge, J., Kintzle, S. M., Sullivan, K., & Castro, C. A. (2024) · Journal of Military Social Work and Behavioral Health Services · doi:10.1080/21635781.2024.2331717 · Cited by 5
“This is almost three times the rate in the over-all population which experiences a 6.4% lifetime prevalence of PTSD (Pietrzak et al., 2011).”
InfluentialBlakey, S. M., Dillon, K. H., McFARLANE, A. C., & Beckham, J. C. (2024) · Springer eBooks · doi:10.1007/978-3-030-51366-5_59 · Cited by 1
Transcranial Magnetic Stimulation for Posttraumatic Stress Disorder and Generalized Anxiety Disorder
Cilli, S. L., Goldberg, M. A., Cosmo, C. S. A., Arulpragasam, A. R., Vakili, A. Z., Berlow, Y. A., & Philip, N. S. (2024) · Current topics in behavioral neurosciences · doi:10.1007/7854_2024_540 · Cited by 2
Benfield, R. D., Dingley, C., Reyes, A. T., Serafica, R. C., & Brown, A. (2025) · Canadian Journal of Nursing Research · doi:10.1177/08445621241309148 · Cited by 1
“…and impulsivity co-exist and increase the burden of illness for PTSD patients and families, leading to poor quality of life and negative outcomes (Felson & Staff, 2010; Kessler et al., 2005; Modesto-Lowe et al., 2006; Pietrzak et al., 2011; Price & van Stolk-Cooke, 2015; Tull et al., 2007).”
Ertl, V. (2025) · SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice · doi:10.1024/0939-5911/a000945 · Cited by 1
Implications for optimizing treatment timing: day of week variation in PTSD symptom clusters
Biggs, Q. M., Wang, J., Fullerton, C. S., Amin, R., Hooke, J. A., Dhanraj, N., & Ursano, R. J. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1599424 · Cited by 1
Jaffe, A. E. (2017) · Lincoln (University of Nebraska) · Cited by 1
Posttraumatic stress disorder — the neuroscientific basis of evidence-based treatments
Jaskiw, G. E. (2017) · Proceedings of the Shevchenko Scientific Society Medical Sciences · doi:10.25040/ntsh2017.02.023 · Cited by 1
“A similar self-reinforcing interaction is seen with substance use disorders; these are both more prevalent in PTSD (Duncan et al., 1996; Pietrzak et al., 2011; Wisco et al., 2016) and associated with chronicity and poor treatment response (McCauley et al., 2012).”
BackgroundTrauma and Addiction—How to Treat Co-occurring PTSD and Substance Use Disorders
Vojvoda, D., & Petrakis, I. L. (2018) · Elsevier eBooks · doi:10.1016/b978-0-323-54856-4.00013-4 · Cited by 1
Computer-Based Perspective Broadening Support for Appraisal Training
Beer, U. M., Neerincx, M. A., Nexhmedin Morina, B., & Brinkman, W. (2020) · International Journal of Technology and Human Interaction · doi:10.4018/ijthi.2020070106 · Cited by 1
Metadata
- 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.
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2011-04
- Volume
- 25
- Issue
- 3
- Pages
- 456-465
- ISSN
- 0887-6185 (ISSN-L)
- 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
- 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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