Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions

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Abstract

The present study used data from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,653) to examine lifetime Axis I psychiatric comorbidity of posttraumatic stress disorder (PTSD) in a nationally representative sample of U.S. adults. Lifetime prevalences ± standard errors of PTSD and partial PTSD were 6.4% ± 0.18 and 6.6% ± 0.18, respectively. Rates of PTSD and partial PTSD were higher among women (8.6% ± 0.26 and 8.6% ± 0.26) than men (4.1% ± 0.19 and 4.5% ± 0.21). Respondents with both PTSD and partial PTSD most commonly reported unexpected death of someone close, serious illness or injury to someone close, and sexual assault as their worst stressful experiences. PTSD and partial PTSD were associated with elevated lifetime rates of mood, anxiety, and substance use disorders, and suicide attempts. Respondents with partial PTSD generally had intermediate odds of comorbid Axis I disorders and psychosocial impairment relative to trauma controls and full PTSD.

Research highlights

▶ This study is the first to examine the prevalence and Axis I comorbidity of DSM-IV diagnosis of posttraumatic stress disorder. ▶ The lifetime prevalence of posttraumatic stress disorder (PTSD) among U.S. adults was 6.4%. ▶ An additional 6.6% of U.S. adults had subthreshold, partial PTSD in their lifetimes. ▶ Lifetime full and partial PTSD are associated with elevated rates of Axis I disorders and suicide attempt. ▶ Lifetime full and partial PTSD are related to poorer past-month psychosocial functioning.

Section snippets

Sample

The 2004–2005 Wave 2 NESARC (Grant, Kaplan, & Stinson, 2005) is the second wave follow-up of the Wave 1 NESARC conducted in 2001–2002 and described elsewhere (Grant et al., 2003, Grant et al., 2004a). The Wave 1 NESARC surveyed a representative sample of the civilian, noninstitutionalized U.S. population aged 18 years and older, residing in households and group quarters. Blacks, Hispanics, and individuals 18–24 years old were oversampled. The housing unit sampling frame was the Census

Prevalence

In the total sample (N = 34,653), lifetime prevalences of PTSD and partial PTSD were 6.4% (SE = 0.18) and 6.6% (SE = 0.18), respectively. Rates were higher among women [8.6% (SE = 0.26) and 8.6% (SE = 0.26)] than men [4.1% (SE = 0.19) and 4.5% (SE = 0.21)], χ2(3) = 167.02, p < 0.0001.

Sociodemographic characteristics by PTSD status are shown in Table 1. Odds of PTSD were greater for individuals who were younger, female, previously married, and with lower incomes, but lower among Asian/Hawaiian/Pacific Islanders

Discussion

The lifetime prevalence of PTSD (6.4%) observed in the current study is consistent with that reported in the NCS (7.8%; Kessler et al., 1995) and NCS-R (6.8%; Kessler et al., 2005). The higher prevalence of PTSD in women is also consistent with these surveys, though not entirely understood, as it is not fully explained by higher occurrences of sexual assault and rape, preexisting depression or anxiety disorders, or sex-related bias in symptom reporting (Chung and Breslau, 2008, Tolin and Foa,

Conclusions

This study extends previous epidemiologic research on PTSD by being the first to use DSM-IV criteria to diagnose comorbid disorders and providing up-to-date estimates of the prevalence of PTSD and comorbid Axis I disorders in a large, nationally representative U.S. sample. The NESARC's high response rate and large sample permitted quantification of associations between PTSD and comorbid disorders while adjusting for sociodemographic characteristics and additional comorbidities. This study is

Conflict of interest

None of the authors has any financial conflict of interest to report. Dr. Pietrzak receives partial salary support from CogState, Inc., for work which bears no relationship to the present study.

Acknowledgements

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) is funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) with supplemental support from the National Institute on Drug Abuse (NIDA). This research was supported in part by the Intramural Program of the National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. Preparation of this manuscript was supported in part by the National Center for Posttraumatic Stress Disorder and a

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