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In this nationally representative sample of US military veterans, 9.4% screened positive for lifetime PTSD (95% CI, 8.5%–10.3%) and 5.0% screened positive for past-month PTSD (95% CI, 4.3%–5.7%). Among veterans who had been exposed to at least 1 potentially traumatic event, the corresponding prevalences were 10.0% for lifetime PTSD and 5.3% for past-month PTSD.

The study found that both lifetime and past-month PTSD were more common among female, younger, and non-White veterans. The authors reported these differences in stratified analyses by sex, age, and race.

Trauma exposure was nearly universal in this sample: 93.4% of veterans (n = 3,847) reported at least 1 potentially traumatic event. On average, veterans reported 8.9 exposures (SD = 8.5) across trauma type-by-exposure combinations, with direct exposures most commonly endorsed (mean = 3.2, SD = 3.5).

The most frequently endorsed potentially traumatic events were transportation accidents (81.8%) and natural disasters (71.7%). The least frequently endorsed were serious injury, harm, or death caused to someone else (17.2%) and captivity (12.2%).

Serious harm, injury, or death you caused to someone else had the highest conditional probability of PTSD in this study. The conditional probability was 22.2% for lifetime PTSD and 11.3% for past-month PTSD, whereas disaster/accident had the lowest conditional probability at 10.2% for lifetime PTSD and 5.4% for past-month PTSD.

Yes. The study found that conditional probability of past-month PTSD was higher for direct than indirect exposure for all potentially traumatic event types. For lifetime PTSD, direct exposure had a higher conditional probability than indirect exposure for interpersonal violence and combat/captivity.

In adjusted logistic regression models, each additional direct potentially traumatic event exposure was associated with higher 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), while indirect exposures were not associated with lifetime PTSD (OR = 1.01; 95% CI, 1.00–1.03) or past-month PTSD (OR = 0.99; 95% CI, 0.97–1.00).

The study defined direct exposure as an event that “happened to me” on the Life Events Checklist-5. Indirect exposure was defined as any other DSM-5 Criterion A exposure type, including witnessing the trauma, learning that it happened to a close family member or friend, or being exposed to aversive details as part of one’s job.

Yes. PTSD was significantly associated with overall psychosocial functional impairment and with impairment in each of the 7 domains measured by the Brief Inventory of Psychosocial Functioning. These domains were romantic relationships, parenting, family relationships, friendship and socializing, work, education, and self-care.

The study found that direct potentially traumatic event exposure was associated with overall functional impairment and with impairment in 4 domains: romantic relationships, parenting, family relationships, and self-care, even after adjustment for sociodemographic variables and lifetime psychiatric comorbidities. Indirect trauma exposure was associated with impairment in only 2 domains: romantic relationships and work.

However, when the analysis substituted total lifetime PCL-5 score for lifetime PTSD status, the association between direct trauma exposure and overall functional impairment was no longer significant (B = −0.05, SE = 0.04, P = .24), which the authors interpreted as suggesting that subthreshold PTSD symptoms may account for part of this impairment.

Yes. The findings suggest that assessment in veterans should extend beyond combat because 93.4% of participants reported at least 1 potentially traumatic event and the most commonly endorsed events were transportation accidents and natural disasters, not combat alone. The study also found that direct trauma exposure, especially experiences involving harm caused to others, was more strongly associated with PTSD and psychosocial impairment than indirect exposure.

This was a cross-sectional, retrospective analysis of data from the 2019–2020 National Health and Resilience in Veterans Study, a nationally representative web-based survey of 4,069 US military veterans conducted from November 2019 to March 2020. PTSD symptoms were measured with a modified self-report PTSD Checklist for DSM-5, trauma exposure was assessed with the Life Events Checklist-5, and psychosocial functioning was assessed with the Brief Inventory of Psychosocial Functioning.

The main limitations were that the study was cross-sectional, retrospective, and based on self-report measures of trauma exposure, PTSD symptoms, and functional impairment. The authors noted that although the PCL-5 is well validated, diagnostic interviews are preferable for diagnostic assessment.

The study also used a conservative PCL-5 cutoff score of 38 rather than lower cutoffs used in some studies, and most veterans reported both direct and indirect potentially traumatic events, creating overlap between those exposure categories.