Key Takeaways
Extended Takeaways
- In this nationally representative sample of 4,069 US military veterans, 5.0% screened positive for past-month PTSD; among trauma-exposed veterans, the corresponding estimate was 5.3%, indicating that current symptom burden remains substantial even when analyses are limited to those with Criterion A exposure.
- Trauma exposure was nearly ubiquitous, with 93.4% of veterans reporting at least 1 potentially traumatic event and an average of 8.9 (SD = 8.5) exposures across trauma type-by-exposure combinations; routine trauma history should therefore extend beyond combat alone.
- Serious harm, injury, or death you caused to someone else carried the highest conditional probability of PTSD despite being infrequently endorsed, with 22.2% lifetime and 11.3% past-month PTSD; veterans reporting this exposure may warrant especially careful assessment for moral injury-related distress and PTSD symptoms.
- Cumulative direct trauma burden, but not indirect trauma burden, was associated with PTSD in adjusted models: each additional direct exposure was linked to 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).
- PTSD was significantly associated with impairment across all 7 psychosocial domains, but direct trauma exposure also showed independent associations with romantic, parenting, family, and self-care functioning; functional assessment in veterans should not stop at diagnosis alone.
- When lifetime PCL-5 total score replaced lifetime PTSD status in the impairment model, the association between direct trauma exposure and overall functional impairment was no longer significant (B = −0.05, SE = 0.04, P = .24), suggesting subthreshold PTSD symptoms may account for part of the disability seen after direct trauma exposure.
