Clinical Summary
Clinical Summary: Posttraumatic Stress Disorder in US Military Veterans: Results From the 2019–2020 National Health and Resilience in Veterans Study
Many US military veterans live with posttraumatic stress disorder, but trauma risk in this population extends beyond combat and may include direct and indirect exposures across the lifespan. This study updates national prevalence estimates and clarifies which trauma exposures are most strongly linked to PTSD and psychosocial impairment, helping clinicians target assessment beyond diagnosis alone.
Design
we analyzed data from the 2019–2020 National Health and Resilience in Veterans Study (NHRVS)
N
a nationally representative sample of 4,069 US military veterans
Population
US military veterans
Duration
conducted from November 2019 to March 2020
Key Findings
- A total of 9.4% (SE = 0.5; 95% CI, 8.5%–10.3%) screened positive for lifetime PTSD and 5.0% (SE = 0.4; 95% CI, 4.3%–5.7%) for past-month PTSD.
- Nearly all veterans in the sample (n = 3,847, 93.4%) reported exposure to at least 1 PTE; among trauma-exposed veterans, prevalence was 10.0% (SE = 0.5) for lifetime PTSD and 5.3% (SE = 0.4) for past-month PTSD.
- Serious harm, injury, or death you caused to someone else had the largest conditional probability of both lifetime (22.2%) and past-month (11.3%) PTSD, whereas disaster/accident had the lowest (10.2% lifetime, 5.4% past-month).
- Each additional direct PTE exposure was associated with increased odds of both lifetime (OR = 1.36; 95% CI, 1.30–1.42) and past-month (OR = 1.38; 95% CI, 1.31–1.46) PTSD, while indirect PTE exposures were not associated with lifetime (OR = 1.01; 95% CI, 1.00–1.03) or past-month (OR = 0.99; 95% CI, 0.97–1.00) PTSD.
- After adjustment for total PCL-5 scores, the effect of direct PTEs on overall functional impairment was no longer significant (B = −0.05, SE = 0.04, P = .24).
Clinical Bottom Line
In US military veterans, direct trauma exposure—not indirect exposure—tracks most strongly with PTSD and psychosocial impairment. Assessment should cover the full range of direct potentially traumatic events, especially experiences involving harm caused to others and subthreshold PTSD symptoms.
Practice Implications
- Screen broadly for potentially traumatic events rather than focusing on combat alone, because 93.4% of veterans reported at least 1 PTE and trauma exposure spanned multiple event types.
- Prioritize careful PTSD assessment when veterans report serious harm, injury, or death they caused to someone else, as this exposure carried the highest conditional probability of lifetime PTSD (22.2%) and past-month PTSD (11.3%).
- Use cumulative direct trauma burden to inform risk stratification, since each additional direct exposure increased odds of lifetime PTSD (OR = 1.36; 95% CI, 1.30–1.42) and past-month PTSD (OR = 1.38; 95% CI, 1.31–1.46).
- Evaluate functioning even when full PTSD criteria are not met, because direct PTE exposure was linked to impairment and the attenuation after adjusting for total PCL-5 score suggests subthreshold PTSD symptoms contribute to disability.
