Posttraumatic Stress Disorder Symptoms, Functioning, and Suicidal Ideation in US Military Veterans: A Symptomics Approach

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Overview

How would you use a symptom-focused approach to provide a more nuanced method for the assessment, monitoring, and treatment of PTSD?

Abstract

Objective: To examine the association between individual symptoms of posttraumatic stress disorder (PTSD) and measures of functioning, quality of life, and suicidal ideation given that previous research has focused on PTSD diagnosis and symptom clusters.

Methods: Data from a large, contemporary, nationally representative sample of 1,484 US military veterans who participated in the National Health and Resilience in Veterans Study from September–October 2013 were analyzed to examine the association between individual DSM-5 PTSD symptoms and measures of mental, physical, and cognitive functioning; quality of life; and suicidal ideation.

Results: Nonspecific anhedonic and hyperarousal symptoms of PTSD were significantly associated with the various measures of functioning and explained a significant portion of variance across the different measures (P values < .05). Specifically, the following symptoms explained the most variance in physical functioning: loss of interest (12.4%), sleep difficulties (12.3%), and psychogenic amnesia (8.3%); mental functioning: concentration difficulties (11.4%), negative thoughts (9.2%), and difficulties experiencing positive affect (8.4%); cognitive functioning: concentration difficulties (18.6%), heightened startle (6.4%), and difficulty experiencing positive affect and risky/destructive behavior (both 6.3%); quality of life: concentration difficulties (11.5%), difficulty experiencing positive affect (11.1%), and sleep difficulties (9.4%); and suicidal ideation: difficulty experiencing positive affect (12.3%), negative thoughts (11.3%), and irritability/aggression (9.5%). These findings persisted after adjustment for lifetime trauma burden and severity of PTSD and depressive symptoms.

Conclusions: Nonspecific PTSD symptoms are most strongly related to measures of functioning, quality of life, and suicidal ideation in US veterans. These results underscore the potential clinical utility of a symptom-based approach to the assessment, monitoring, and treatment of PTSD.

To cite: Kachadourian LK, Harpaz-Rotem I, Tsai J, et al. Posttraumatic stress disorder symptoms, functioning, and suicidal ideation in US military veterans: a symptomics approach. Prim Care Companion CNS Disord. 2019;21(2):18m02402.

To share: https://doi.org/10.4088/PCC.18m02402


Read the whole article at psychiatrist.com here:
Posttraumatic Stress Disorder Symptoms, Functioning, and Suicidal Ideation in US Military Veterans: A Symptomics Approach

© Copyright 2019 Physicians Postgraduate Press, Inc.

Target Audience

Primary care clinicians

Learning Objectives

  • Use a symptom-focused approach for the assessment, monitoring, and treatment of PTSD
Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Activity opens: 
04/05/2019
Activity expires: 
04/30/2021
Cost:
$10.00
Rating: 
0

CME Background

Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results.

CME Objective

After studying this article, you should be able to:

  • Use a symptom-focused approach for the assessment, monitoring, and treatment of PTSD

Statement of Need and Purpose

Posttraumatic stress disorder is a common psychiatric condition. Individuals with PTSD also often have comorbidities such as depressive disorders, substance use disorders, and anxiety disorders. Unfortunately, many patients with PTSD are misdiagnosed or underdiagnosed, and for those who are diagnosed, clinicians may not personalize care to a patient’s specific symptoms and functional difficulties. Education is needed to help primary care providers overcome barriers to recognizing PTSD and tailoring treatment to patients’ individual symptom clusters

Release, Expiration, and Review Dates

This educational activity was published in April 2019 and is eligible for AMA PRA Category 1 Credit™ through April 30, 2021. The latest review of this material was April 2019.

Disclosure of Off-Label Usage

The authors have determined that, to the best of their knowledge, no investigational information about pharmaceutical agents that is outside US Food and Drug Administration–approved labeling has been presented in this article.

Funding/Support

This work was supported in part by Career Development Award no. IK2 CX-001259-01 from the US Department of Veterans Affairs Clinical Sciences R&D Service (Dr Kachadourian). The National Health and Resilience in Veterans Study is supported by the US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder.

Role of the sponsor

The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; or preparation, review, or approval of the manuscript.

Disclaimer

The views and opinions expressed in this report are those of the authors and should not be construed to represent the US government.

Faculty Affiliation

Lorig K. Kachadourian, PhD*
US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, and Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut

Ilan Harpaz-Rotem, PhD
US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven; Department of Psychiatry, Yale University School of Medicine, New Haven; and US Department of Veterans Affairs New England, Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut

Jack Tsai, PhD
US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven; Department of Psychiatry, Yale University School of Medicine, New Haven; and US Department of Veterans Affairs New England, Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut

Steven M. Southwick, MD
US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, and Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut

Robert H. Pietrzak, PhD, MPH
US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, and Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut

*Corresponding author: Lorig K. Kachadourian, PhD, US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, 950 Campbell Ave 116A-4, West Haven, CT 06516 (lorig.kachadourian@va.gov).

Financial Disclosure

All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Larry Culpepper, MD, MPH, Editor in Chief of The Primary Care Companion for CNS Disorders, has been a consultant for Alkermes, Harmony Biosciences, Merck, Shire, Supernus, and Sunovion. No member of the CME Institute staff reported any relevant personal financial relationships.

Dr Pietrzak is a scientific consultant to Cogstate, Ltd, for work that bears no relationship to the current project. Drs Kachadourian, Harpaz-Rotem, Tsai, and Southwick have no personal affiliations or financial relationships with any commercial interest to disclose relative to this article.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation

Price

Cost:
$10.00
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