PTSD: National Center for PTSD

Epidemiology and Impact of PTSD

Paula P. Schnurr, PhD

Estimates of the prevalence of PTSD depend on both sample characteristics and study methods. Sample characteristics include the population of study (e.g., general population, Veterans; U.S. versus other countries; treatment-seeking versus not treatment-seeking). Study methods include the sampling strategy and the method of PTSD assessment and diagnosis. In addition, various risk and protective factors modify prevalence estimates such as military factors (e.g., service era, branch of service, time since deployment, combat exposure), type and amount of trauma exposure, and demographic factors (e.g., age, gender, race/ethnicity). Available studies are often limited in regard to diversity and inclusivity. For example, studies that point to gender differences are generally limited to binary gender classifications. As the field evolves, reliable prevalence estimates of more diverse populations will become available.

General Population

The Wave 3 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) study found a lifetime PTSD prevalence according to DSM-5 criteria of 6% overall in a sample of over 36,000 U.S. adults.(1) The sample was surveyed in 2012-2013 as a representative sample that reflected the population based on characteristics including region, age, gender, and race/ethnicity. Lifetime PTSD prevalence was higher in women (8%) than in men (4%). Past 12-month prevalence was 5%, and like lifetime prevalence, higher in women (6%) than in men (3%).(2,3)

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U.S. Veterans

According to the NESARC-III survey, which included over 3,100 Veterans among the total participants, the lifetime prevalence of PTSD among Veterans is 7%. Lifetime prevalence was higher among female Veterans (13%) than male Veterans (6%). Lifetime prevalence also was higher among Veterans younger than 65 (15% ages 18-29, 10% ages 30-44, and 9% ages 45-64) than among Veterans 65 or older (4%). Past-year prevalence of PTSD was higher in women (11%) than among men (5%).(2) In another nationally representative sample of over 4,000 U.S. Veterans surveyed in 2019-2020, the National Health and Resilience in Veterans Study (NHRVS), past-month prevalence of PTSD according to DSM-5 was 5% overall, and higher among women (11%) than among men (4%).(4)

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Veteran Service Era

In the NHVRS sample, both current and lifetime prevalence of PTSD were lower in WWII/Korean War and Vietnam War Veterans relative to Persian Gulf War and Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) Veterans. (5) For WWII/Korean War, Vietnam War, Persian Gulf War, and OEF/OIF, current prevalence was 2%, 5%, 14% and 15%; lifetime prevalence was 3%, 10%, 21%, and 29% respectively. The estimates are likely affected by differential mortality across cohorts and should be interpreted with caution. However, despite the lower prevalence of PTSD in older Veterans, these data indicate that some Veterans continue to experience PTSD into old age.

Other data, not quite as recent as the NHRVS data, suggest a higher prevalence of PTSD in Vietnam Veterans. Approximately 40 years after the Vietnam War, the National Vietnam Veterans Longitudinal Study (NVVLS), a follow-up of the historic National Vietnam Veterans Readjustment Study (NVVRS; 6), reported a prevalence of current war-zone-related PTSD as 4% in men and 6% in women based on the Clinician Administered PTSD Scale for DSM-5. Prevalence of lifetime war-zone-related PTSD was 17% in men and 15% in women.(7) The prevalence of current PTSD from any cause was estimated as 12% for male and 8% for female theatre Veterans.(7) A national survey conducted in 2016-2017 estimated the prevalence of current PTSD in Vietnam Theater Veterans to be even higher—18%—but the estimate is not comparable to the NVVLS estimate because the survey used a brief screening questionnaire and the NVVLS used the CAPS-5 gold-standard interview.(8)

The Health of Vietnam-Era Women's Study examined the prevalence of PTSD in Vietnam-era women Veterans.(9) The prevalence of current PTSD according to DSM-5 was 16%, 8% and 9% for the Vietnam, near-Vietnam, and U.S. cohorts who served stateside, respectively. The prevalence of lifetime PTSD was 20%, 12%, and 14%, respectively. It is not clear why the estimates of current and lifetime PTSD are higher in this study than in the NVVLS, but methodologic differences between studies (e.g., use of clinician interview in the NVVLS and lay interview in the all-women's study) may account for the difference. One of the most telling findings was that sexual discrimination or harassment, which is not thought of as war zone exposure, was higher among deployed women and significantly associated with the development of PTSD.

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Users of Care in the Veterans Health Administration

Estimates of PTSD prevalence in the overall Veteran population do not generalize to Veterans who use VA health care. According to the NHRVS national survey of Veterans, the prevalence of lifetime PTSD was 23% in VA users and 7% in Veterans who do not use VA.(4) The prevalence of current PTSD was 13% in VA users and 4% in Veterans who do not use VA.

VA's Northeast Program Evaluation Center produces an annual data sheet that provides an overview of the PTSD patient population receiving health care in the VA. Veterans are defined as meeting a diagnosis of PTSD if they had received at least 2 visits or one inpatient/residential stay with a diagnosis of PTSD in the prior year. Of the 6 million total Veterans served, about 11% who used VA health care in fiscal year 2021 were diagnosed with PTSD: approximately 10% of men and 19% of women.(10) Prevalence data in 2021 was much higher among those Veterans who served in Iraq and/or Afghanistan: 24% overall, and 24% and 25% in men and women, respectively.(11)

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Impact

PTSD can affect all aspects of a person's functioning and well-being. For example, in the NESARC-III study, PTSD was associated with greater likelihood of comorbid substance use disorder, mood disorder, anxiety disorder, and personality disorder.(1) PTSD also was associated with greater impairment of functioning. There are specific increased risks of co-occurring depression and SUD.(1) In addition, PTSD is associated with poorer perceived physical health, increased morbidity, and greater health care utilization for physical problems.(12) Findings on mortality are mixed, but generally show that PTSD is associated with increased overall mortality and mortality due to accidental causes.

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References

1. Goldstein, R. B., Smith, S. M., Chou, S. P., Saha, T. D., Jung, J., Zhang, H., Pickering, R. P., Ruan, W. J., Huang, B. & Grant, B. F. (2016). The epidemiology of DSM-5 posttraumatic stress disorder in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Social Psychiatry and Psychiatric Epidemiology, 51(8),1137-1148. https://doi.org/10.1007/s00127-016-1208-5.
2. Lehavot, K., Goldberg, S. B., Chen, J. A., Katon, J. G., Glass, J. E., Fortney, J. C., Simpson, T. L., & Schnurr, P. P. (2018). Do trauma type, stressful life events, and social support explain women Veterans' high prevalence of PTSD? Social Psychiatry Psychiatric Epidemiology, 53(9), 943-953. https://doi.org/10.1007/s00127-018-1550-x
3. Goldberg, S. B., Simpson, T. L., Lehavot, K., Katon, J. G., Chen, J. A., Glass, J. E., Schnurr, P. P, Sayer. N. A., & Fortney, J. C. (2019). Mental health treatment delay: A comparison among civilians and Veterans of different service eras. Psychiatric Services, (70)5, 358-366. https://doi.org/10.1176/app1.ps.201800444
4. Wisco, B. E., Nomamiukor, F. O., Marx, B. P., Krystal, J. H., Southwick, S. M., & Pietrzak, R. H. (2022). Posttraumatic stress disorder in US military Veterans: Results from the 2019-2020 National Health and Resilience in Veterans Study. Journal of Clinical Psychiatry, 83(2), 29m14029. https://doi.org/10.4088/JCP.20m14029
5. Na, P. J., Schnurr, P. P., & Pietrzak, R. H. (2023). Mental health of U.S. combat Veterans by war era: Results from the National Health and Resilience in Veterans Study. Journal of Psychiatric Research, 158, 36-40. https://doi.org/10.1016/j.jpsychires.2022.12.019
6. Kulka, R., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., & Weiss, D. D. (1988). National Vietnam Veterans Readjustment Study (NVVRS): Description, current status, and initial PTSD prevalence estimates. Washington, D.C.: Veterans Administration.
7. Marmar, C. R., Schlenger, W., Henn-Haase, C., Qian, M., Purchia, E., Li, M., Corry, N., Williams, C. S., Ho, C., Horesh, D., Karstoft, K., Shalev, A., & Kulka, R. A. (2015). Course of posttraumatic stress disorder 40 years after the Vietnam War: Findings from the National Vietnam Veterans Longitudinal Study. JAMA Psychiatry, 72(9), 875-881. https://doi.org/10.1001/jamapsychiatry.2015.0803
8. Cypel, Y., Schnurr, P. P., Schneiderman, A. I., Culpepper, W. J., Akhtar, F. Z., Morley, S. W., Fried, D. A., Ishii, E. K., & Davey, V. J. (2022). The mental health of Vietnam theater Veterans--the lasting effects of the war: 2016-2017 Vietnam Era Health Retrospective Observational Study. Journal of Traumatic Stress, 35(2),605-618. https://doi.org/10.1002/jts.22775.
9. Magruder, K., Serpi, T., Kimerling, R., Kilbourne, A. M., Collins, J. F., Cypel, Y., Frayne, S. M., Furey, J., Huang, G. D., Gleason, T., Reinhard, J., Spiro, A. & Kang, H. (2015). Prevalence of posttraumatic stress disorder in Vietnam-era women Veterans: The Health of Vietnam-Era Women's Study (HealthVIEWS). JAMA Psychiatry, 72(11), 1127-1134. https://doi.org/10.1001/jamapsychiatry.2015.1786.
10. Greenberg, C., Hoff, R. (2022). FY 2021 Veterans with PTSD Data Sheet: National, VISN, and Healthcare System Tables. West Haven, CT: Northeast Program Evaluation Center.
11. Harpaz-Rotem, I. & Hoff, R. (2022). FY2021 Overview of PTSD Patient Population Data Sheet. VA Office of Mental Health and Suicide Prevention (11MHSP). West Haven, CT: Northeast Program Evaluation Center.
12. Schnurr, P. P., Lunney, C. A., Bovin, M. J., & Marx, B. P. (2009). Posttraumatic stress disorder and quality of life: Extension of findings to Veterans of the wars in Iraq and Afghanistan. Clinical Psychology Review, 29(8), 727-735. https://doi.org/10.1016/j.cpr.2009.08.006.

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