Subthreshold PTSD in Primary Care: Prevalence, Psychiatric Disorders, Healthcare Use, and Functional Status
Abstract
The purpose of this study is to determine the prevalence of subthreshold posttraumatic stress disorder (PTSD) and its association with specific traumas, other psychiatric diagnoses, healthcare use, and functional status among 669 veterans in four VA Medical Centers. A cross-sectional, epidemiological design incorporating self-report measures, structured interviews, and chart reviews was used to obtain relevant information for analyses. Comparisons across three trauma-exposed groups (PTSD, subthreshold PTSD, no PTSD) revealed that veterans in the subthreshold PTSD group did not use mental health services more often than those in the no PTSD group despite the presence of additional mental health diagnoses and worse functional status. These data indicate that clinicians may be overlooking a subset of individuals suffering from subsyndromal PTSD, suggesting the need to detect and serve these individuals better within healthcare settings.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Veterans with subthreshold PTSD do not utilize mental health services more than those with no PTSD despite significant impairment.
“some studies found that veterans with subthreshold PTSD did not utilize mental health services more than those with no PTSD, despite their significant impairment [11].”
From Effects of mindfulness-based cognitive therapy for Chinese adults with PTSD symptoms: protocol for a randomised controlled trial (2024) · cites this paper as [11]
Cites
(1992) · PubMed · Cited by 33,716 · see citing works
The MOS 36-ltem Short-Form Health Survey (SF-36): I. Conceptual Framework and Item Selection
Ware, J. E., & Sherbourne, C. D. (1992) · Medical Care · doi:10.1097/00005650-199206000-00002 · Cited by 30,033 · see citing works
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139 · see citing works
Posttraumatic Stress Disorder in the National Comorbidity Survey
Kessler, R. C. (1995) · Archives of General Psychiatry · doi:10.1001/archpsyc.1995.03950240066012 · Cited by 10,379 · see citing works
Lecrubier, Y., Sheehan, D., Weiller, E., Amorim, P., Bonora, I., Sheehan, K. H., Janavs, J., & Dunbar, G. (1997) · European Psychiatry · doi:10.1016/s0924-9338(97)83296-8 · Cited by 3,513 · see citing works
Clinician-administered PTSD scale: A review of the first ten years of research
Weathers, F. W., Keane, T. M., & Davidson, J. R. T. (2001) · Depression and Anxiety · doi:10.1002/da.1029 · Cited by 1,903 · see citing works
Risk factors for adolescent substance abuse and dependence: Data from a national sample.
Kilpatrick, D. G., Acierno, R. E., Saunders, B. A., Resnick, H. S., Best, C. L., & Schnurr, P. P. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.68.1.19 · Cited by 1,165 · see citing works
A prospective examination of post‐traumatic stress disorder in rape victims
Rothbaum, B. O., Foa, E. B., Riggs, D. S., Murdock, T., & Walsh, W. (1992) · Journal of Traumatic Stress · doi:10.1002/jts.2490050309 · Cited by 1,097 · see citing works
Full and partial posttraumatic stress disorder: findings from a community survey
(1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.8.1114 · Cited by 1,013 · see citing works
Risk factors for adolescent substance abuse and dependence: Data from a national sample.
Kilpatrick, D. G., Acierno, R. E., Saunders, B. E., et al. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.1.19 · Cited by 857 · see citing works
Weathers, F. W., Ruscio, A. M., & Keane, T. M. (1999) · Psychological Assessment · doi:10.1037/1040-3590.11.2.124 · Cited by 707 · see citing works
Comorbidity In Post‐Traumatic Stress Disorder An Analysis of Community and Clinical Studies1
Keane, T. M., & Wolfe, J. (1990) · Journal of Applied Social Psychology · doi:10.1111/j.1559-1816.1990.tb01511.x · Cited by 343 · see citing works
Ruscio, A. M., Ruscio, J., & Keane, T. M. (2002) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.111.2.290 · Cited by 319 · see citing works
Does "subthreshold" posttraumatic stress disorder have any clinical relevance?
Zlotnick, C., Franklin, C. L., & Zimmerman, M. (2002) · Comprehensive Psychiatry · doi:10.1053/comp.2002.35900 · Cited by 283 · see citing works
The prevalence of lifetime and partial post-traumatic stress disorder in Vietnam theater veterans
Weiss, D. S., Marmar, C. R., Schlenger, W. E., Fairbank, J. A., Jordan, B. K., Hough, R. L., & Kulka, R. A. (1992) · Journal of Traumatic Stress · doi:10.1002/jts.2490050304 · Cited by 283 · see citing works
Psychological morbidity associated with motor vehicle accidents
Blanchard, E. B., Hickling, E. J., Taylor, A. E., Loos, W. R., & Gerardi, R. J. (1994) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)90123-6 · Cited by 268 · see citing works
Health Care Costs Associated With Posttraumatic Stress Disorder Symptoms in Women
Walker, E. A., Katon, W. J., Russo, J. E., Ciechanowski, P. S., Newman, E., & Wagner, A. W. (2003) · Archives of General Psychiatry · doi:10.1001/archpsyc.60.4.369 · Cited by 234 · see citing works
Steinglass, P., & Gerrity, E. T. (1990) · Journal of Applied Social Psychology · doi:10.1111/j.1559-1816.1990.tb01509.x · Cited by 228 · see citing works
Partial Posttraumatic Stress Disorder (PTSD)
Carlier, I. V. E., & Gersons, B. P. R. (1995) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199502000-00008 · Cited by 147 · see citing works
Schützwohl, M., & Maercker, A. R. A. (1999) · Journal of Traumatic Stress · doi:10.1023/a:1024706702133 · Cited by 143 · see citing works
Assessment of social functioning in combat veterans with ptsd
Frueh, B. C., Turner, S. M., Beidel, D. C., & Cahill, S. P. (2001) · Aggression and Violent Behavior · doi:10.1016/s1359-1789(99)00012-9 · Cited by 84 · see citing works
Self-citationFranklin, C. L., Sheeran, T. F., & Zimmerman, M. A. (2002) · Psychological Assessment · doi:10.1037//1040-3590.14.4.467 · Cited by 77 · see citing works
Franklin, C. L., Sheeran, T. F., & Zimmerman, M. A. (2002) · Psychological Assessment · doi:10.1037/1040-3590.14.4.467 · Cited by 63 · see citing works
Richardson, R. D., Engel, C. C., Hunt, S. C., McKnight, K., & McFall, M. (2002) · Psychosomatic Medicine · doi:10.1097/01.psy.0000021941.35402.18 · Cited by 21 · see citing works
Posttraumatic stress disorder in callers to the Anxiety Disorders Association of America
Zhang, W., Ross, J., & Davidson, J. R. T. (2004) · Depression and Anxiety · doi:10.1002/da.10138 · Cited by 17 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.11.010 · Cited by 963 · see citing works
Campbell, D. G., Felker, B. L., Liu, C.-F., Yano, E. M., Kirchner, J. E., Chan, D., Rubenstein, L. V., & Chaney, E. F. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-006-0101-4 · Cited by 458 · see citing works
Eating disorders, trauma, and comorbidity: focus on PTSD
Brewerton, T. D. (2007) · Eating Disorders · doi:10.1080/10640260701454311 · Cited by 442 · see citing works
Prevalence, detection and correlates of PTSD in the primary care setting : a systematic review
Greene, T., Neria, Y., & Gross, R. (2016) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-016-9449-8 · Cited by 238 · see citing works
The nature and course of subthreshold PTSD
Cukor, J., Wyka, K., Jayasinghe, N., & Difede, J. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.06.017 · Cited by 197 · see citing works
Women reporting intimate partner violence in India: Associations with PTSD and depressive symptoms
Chandra, P. S., Satyanarayana, V. A., & Carey, M. P. (2009) · Archives of Women's Mental Health · doi:10.1007/s00737-009-0065-6 · Cited by 143 · see citing works
Price, M., Gros, D. F., Strachan, M., Ruggiero, K. J., & Acierno, R. (2013) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0026244 · Cited by 136 · see citing works
Morey, R. A., Petty, C. M., Cooper, D. A., LaBar, K. S., & McCarthy, G. (2008) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2007.07.007 · Cited by 131 · see citing works
Pietrzak, R. H., Goldstein, M. B., Malley, J. C., Johnson, D. C., & Southwick, S. M. (2009) · Depression and Anxiety · doi:10.1002/da.20574 · Cited by 121 · see citing works
Brancu, M., Mann-Wrobel, M., Beckham, J. C., Wagner, H. R., Elliott, A., Robbins, A. T., Wong, M., Berchuck, A. E., & Runnals, J. J. (2016) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/tra0000078 · Cited by 120 · see citing works
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 · see citing works
Hien, D. A., Morgan-López, A. A., Saavedra, L. M., Ruglass, L. M., Ye, A., López-Castro, T., Fitzpatrick, S., Killeen, T. K., Norman, S. B., Ebrahimi, C. T., et al. (2023) · American Journal of Psychiatry · doi:10.1176/appi.ajp.22010071 · Cited by 99 · see citing works
Attendance and substance use outcomes for the Seeking Safety program: sometimes less is more
Hien, D. A., Morgan-Lopez, A. A., Campbell, A. N. C., Saavedra, L. M., Wu, E., Cohen, L., Ruglass, L., & Nunes, E. V. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0026361 · Cited by 50 · see citing works
Associations between posttraumatic stress disorder symptom clusters and cigarette smoking
Greenberg, J. B., Ameringer, K. J., Trujillo, M. A., Sun, P., Sussman, S., Brightman, M., Pitts, S. R., & Leventhal, A. M. (2012) · Psychology of Addictive Behaviors · doi:10.1037/a0024328 · Cited by 41 · see citing works
Mak, B. S. W., Zhang, D., Powell, C. L. Y. M., Leung, M. K. W., Lo, H. H. M., Yang, X., Yip, B. H. K., Lee, E. K. P., Xu, Z., & Wong, S. Y. S. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05840-x · Cited by 2 · see citing works
- Authors
- Grubaugh, A. L., Magruder, K. M., Waldrop, A. E., Elhai, J. D., Knapp, R. G., & Frueh, B. C.
- Affiliations
- Medical University of South Carolina (US)
- University of South Dakota (US)
- Corresponding author
- Grubaugh, Anouk L.
- Magruder, Kathryn M.
- Frueh, B Christopher
- Venue
- The Journal of Nervous and Mental Disease
- Published
- 2005-10
- Volume
- 193
- Issue
- 10
- Pages
- 658-664
- ISSN
- 0022-3018 (ISSN-L)
- OpenAlex
- W1991732362
- Cited by
- 159
- References
- 25
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 5 · 2022: 3 · 2021: 7 · 2020: 5 · 2019: 8 · 2018: 8 · 2017: 10 · 2016: 10 · 2015: 14 · 2014: 12 · 2013: 6 · 2012: 6
- FWCI
- 6.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Nervous and Mental Disease (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R21MH065248, R21-MH065248-02S1)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- subsyndromal PTSD, veterans, primary care, mental health service utilization, functional status, psychiatric comorbidity, trauma exposure, Veterans Affairs hospitals
- MeSH terms
- Adult, Aged, Mental Disorders, Cross-Sectional Studies, Disability Evaluation, Female, Follow-Up Studies, Health Status, Humans, Interviews as Topic, Life Change Events, Male, Middle Aged, Primary Health Care, Psychiatric Status Rating Scales, Stress Disorders, Post-Traumatic, Veterans, Comorbidity, Prevalence, Logistic Models
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review