Kathryn M. Magruder

Subthreshold PTSD in primary care: prevalence, psychiatric disorders, healthcare use, and functional status.

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.

Delayed-onset post-traumatic stress disorder among war veterans in primary care clinics

BACKGROUND Only limited empirical data support the existence of delayed-onset post-traumatic stress disorder (PTSD). AIMS To expand our understanding of delayed-onset PTSD prevalence and phenomenology. METHOD A cross-sectional, epidemiological design (n = 747) incorporating structured interviews to obtain relevant information for analyses in a multisite study of military veterans. RESULTS A small percentage of veterans with identified current PTSD (8.3%, 7/84), current subthreshold PTSD (6.9%, 2/29), and lifetime PTSD only (5.4%, 2/37) met criteria for delayed onset with PTSD symptoms initiating more than 6 months after the index trauma. Altogether only 0.4% (3/747) of the entire sample had current PTSD with delayed-onset symptoms developing more than 1 year after trauma exposure, and no PTSD symptom onset was reported more than 6 years post-trauma. CONCLUSIONS Retrospective reports of veterans reveal that delayed-onset PTSD (current, subthreshold or lifetime) is extremely rare 1 year post-trauma, and there was no evidence of PTSD symptom onset 6 or more years after trauma exposure.

Trauma-related Mental Health Needs and Service Utilization Among Female Veterans

Women constitute a growing segment of the military veteran population and researchers have begun to examine the extent to which their mental health needs are appropriately addressed within the Veterans Affairs (VA) healthcare system. Existing research documents high rates of both military and non-military trauma among female veterans; however, little has been done to examine the extent to which female veterans exposed to trauma receive treatment for trauma-related problems such as posttraumatic stress disorder (PTSD) and substance abuse within the VA system. This article reviews the literature documenting a high rate of trauma exposure among female veterans and examines evidence that trauma-related mental health problems, such as PTSD and substance-use problems, are under-diagnosed and under-treated among female veterans in VA healthcare settings. The few available studies examining general service utilization among female veterans are also reviewed, and implications for future research and clinical practice in the area of female veterans’ trauma-related mental health needs and service use patterns are discussed. In order to provide more accurate assessments of female veterans’ trauma-related mental health needs, researchers are encouraged to implement comprehensive trauma assessments as well as clinically valid PTSD and substance abuse diagnostic assessments. Researchers are also encouraged to examine the availability and efficacy of both VA and non-VA mental health services to determine the appropriateness of women’s VA service use patterns. Clinicians providing VA mental health services for women are encouraged to include comprehensive, behaviorally-specific trauma interviews and diagnostic evaluations for PTSD and substance-related problems in their standard assessment protocols.

Levels of symptom severity and functioning in four different definitions of subthreshold posttraumatic stress disorder in primary care veterans.

Abstract Four definitions of subthreshold posttraumatic stress disorder (PTSD) were compared in 815 veterans seen in Veterans Affairs Medical Center primary care clinics. We compared PTSD Checklist (PCL) scores and Short Form 36 (SF-36) scores between participants meeting criteria for one of the subthreshold PTSD definitions (based on Schnurr, Marshall, Blanchard, or Stein) to those with and without PTSD. Using regression, those meeting subthreshold criteria by any of the four definitions had lower mental and physical health functioning and higher PCL scores relative to those without PTSD; they also had higher mental health functioning and lower PCL scores relative to those with PTSD. With SF-36 physical functioning scores, only those meeting the Stein definition differed from the group with PTSD. Thus, these definitions appear to distinguish individuals who are qualitatively different from individuals with no PTSD or with PTSD and are nearly equivalent in their ability to discriminate individuals.

Mental Health Epidemiology (Psychiatric Epidemiology)

This article presents an overview of the epidemiology of mental and substance abuse disorders. It contains background information on the development of the field of mental health epidemiology and the advancement in assessment instruments used to conduct population surveys. Recent key epidemiological studies are described with important findings on prevalence of disorders, use of services, and public health burden. It includes a discussion of the important issues facing the field for the future.