•The burden associated with PTSD/MDD comorbidity is substantially greater than PTSD or MDD alone.•Veterans with co-occurring PTSD/MDD evidence the poorest mental functioning and quality of ...life.•Co-occurring PTSD/MDD is associated with greater risk for suicidality compared to PTSD alone.
Emerging evidence suggests that comorbid posttraumatic stress disorder (PTSD) and major depressive disorder (PTSD/MDD) may impose an even greater burden than either disorder alone. However, nearly all previous studies examining these associations have relied on treatment-seeking samples. This study examined the mental health burden associated with co-occurring PTSD/MDD compared to PTSD and MDD alone using a nationally representative sample of U.S. veterans.
Data were analyzed from National Health and Resilience in Veterans Study, a nationally representative survey of U.S. veterans (n = 2,732). Analyses (a) estimated the current prevalence of PTSD only, MDD only, and comorbid PTSD/MDD; (b) compared demographic/military variables by PTSD/MDD status; and (c) examined associations between PTSD/MDD status and suicidality, functioning, psychiatric comorbidities, and service utilization.
The current prevalences of probable PTSD only, probable MDD only, and probable comorbid PTSD/MDD were 1.7%, 4.8%, and 3.4%. Compared to all other groups, the PTSD/MDD group was more likely to screen positive for current suicidal ideation, lifetime suicide attempts, probable generalized anxiety and social anxiety disorders, and ever utilize mental health services. They also scored lower on measures of mental health functioning (d = 1.49), cognitive functioning (d = 1.03), and quality of life (d = 0.84). Veterans with comorbid PTSD/MDD were more than twice as likely as those with PTSD only to have attempted suicide.
The cross-sectional design of this study precludes causal inference.
Results provide a population-based characterization of the psychological burden of PTSD/MDD comorbidity in U.S. veterans. Findings further underscore the importance of screening, monitoring, and treatment of the comorbid manifestation of these disorders.
Synaptic loss and deficits in functional connectivity are hypothesized to contribute to symptoms associated with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). The ...synaptic vesicle glycoprotein 2A (SV2A) can be used to index the number of nerve terminals, an indirect estimate of synaptic density. Here, we used positron emission tomography (PET) with the SV2A radioligand
CUCB-J to examine synaptic density in n = 26 unmedicated individuals with MDD, PTSD, or comorbid MDD/PTSD. The severity of depressive symptoms was inversely correlated with SV2A density, and individuals with high levels of depression showing lower SV2A density compared to healthy controls (n = 21). SV2A density was also associated with aberrant network function, as measured by magnetic resonance imaging (MRI) functional connectivity. This is the first in vivo evidence linking lower synaptic density to network alterations and symptoms of depression. Our findings provide further incentive to evaluate interventions that restore synaptic connections to treat depression.
Although it is well-established that posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are associated with physical health difficulties among U.S. veterans, the incremental ...burden of having both disorders relative to either one alone remains largely unknown. The goal of this study was to provide the first population-based characterization of the burden of medical illness associated with PTSD, MDD, and their comorbidity among U.S. veterans.
Data were from National Health and Resilience in Veterans Study, a nationally representative survey of U.S. veterans (n = 2732). Analyses (a) examined the magnitude of medical comorbidity and disability associated with PTSD, MDD, and co-occurring PTSD/MDD; and (b) compared physical functioning by PTSD/MDD status.
After adjusting for sociodemographic characteristics and substance use disorders, veterans with comorbid PTSD/MDD were more likely to be diagnosed with heart disease, migraine, fibromyalgia, and rheumatoid arthritis compared to those with MDD-only. Conversely, they were at greater odds of being diagnosed with hypercholesterolemia and hypertension relative to those with PTSD-only. Comorbid PTSD/MDD status was associated with approximately three times greater odds of disability compared to MDD alone. Veterans with co-occurring PTSD/MDD and PTSD-only exhibited worse physical functioning than those with MDD-only.
Findings indicate that veterans with co-occurring PTSD/MDD represent a high-risk group for cardiovascular disease and other health problems, and therefore deserve careful attention from healthcare systems. Further research is needed to investigate mechanisms underlying associations between PTSD/MDD and physical health morbidities, as well as whether treatment of PTSD/MDD can reduce risk for comorbid medical conditions.
•The burden associated with PTSD/MDD comorbidity is markedly greater than PTSD or MDD alone.•Veterans with co-occurring PTSD/MDD represent a high-risk group for cardiovascular disease.•Veterans with PTSD/MDD and PTSD-only exhibit worse physical functioning than those with MDD-only.
There has been a decade-long federal commitment to prevent and end homelessness among U.S. military veterans. Substantial progress has been made; so, a question that stakeholders ask is: Is veteran ...homelessness still a problem?
To answer this question, 2 different data sources were analyzed in 2020: (1) a nationally representative community survey of 4,069 veterans conducted in 2019 and (2) national administrative data from the U.S. Department of Veterans Affairs on >6 million healthcare and homeless services in 2019.
In the community sample, the lifetime prevalence of adult homelessness was 10.2%, with the highest prevalence found in participants aged 30–44 years (19.9% prevalence). In the Veterans Affairs administrative data, 4.2% of all Veterans Affairs service users used homeless services (n=290,515 Veterans Affairs homeless services); 27.9% of these were first-time Veterans Affairs homeless service users. Veterans who were racial/ethnic minorities were more likely to report any lifetime adult homelessness, more likely to be identified as homeless in Veterans Affairs records, and more likely to have used any Veterans Affairs homeless program. There was no sex difference in the lifetime prevalence of homelessness, but Veterans Affairs records showed that male veterans were more likely to be identified as homeless and to use homeless programs, suggesting possible underidentification of female veteran homelessness. Across age, sex, and racial/ethnic groups, 35.1% of Veterans Affairs homeless service users used emergency department services in the same year.
There is a continued need to dedicate resources to address veteran homelessness across sociodemographic groups, and these data serve as a benchmark before and after the onset of the COVID-19 pandemic.
Highlights • We used a nationally representative sample of trauma-exposed military veterans (NHRVS) and selected 221 who reported clinically significant DSM-5 PTSD symptoms. • We estimated two ...networks; a DSM-5 PTSD network and a DSM-5 PTSD network with clinically significant covariates. • The networks revealed that symptoms were positively connected with especially strong connections emerging between several items. • Incorporation of clinically relevant covariates into the PTSD network revealed paths between PTSD’s symptom of self-destructive behavior and suicidal ideation amongst others.
Background
Recent research suggests that exposure to potentially morally injurious experiences (PMIEs) may be associated with increased risk for suicidal behavior among US combat veterans, but ...population‐based data on these associations are scarce. This study examined the association between PMIEs with current suicidal ideation (SI), lifetime suicide plans (SP), and suicide attempts (SA) in a contemporary, nationally representative sample of combat veterans.
Methods
Data were analyzed from the 2019–2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of US combat veterans (n = 1321). PMIEs were assessed using the Moral Injury Events Scale (MIES). Multivariable logistic regression analyses were conducted to examine associations between MIES total scores and specific types of PMIEs with suicidal behavior.
Results
Thirty‐six point three percent of veterans reported at least one PMIE. Perceived transgressions by self, others, and betrayal were associated with SI, SP, and SA (odds ratios ORs = 1.21–1.27, all p s < .05), after adjusting for sociodemographic, trauma, and psychiatric characteristics. MIES total scores were significantly, albeit weakly, associated with SP (OR = 1.03, p < .01), but not SI/SA. Depression, posttraumatic stress disorder (PTSD), and age emerged as the strongest correlates of SI/SP/SA (14.9%–38.1% of explained variance), while PMIEs accounted for a comparatively modest amount of variance (3.3%–8.9%).
Conclusions
Reports of potentially morally injurious experiences are prevalent among US combat veterans, and associated with increased risk for suicidal behavior, above and beyond severity of combat exposure, PTSD, and depression. Implications for clinical practice and future research are discussed, including the need for methodological advancements in the measurement of moral injury.
Posttraumatic stress disorder (PTSD) is a chronic and disabling disorder, for which available pharmacotherapies have limited efficacy. The authors' previous proof-of-concept randomized controlled ...trial of single-dose intravenous ketamine infusion in individuals with PTSD showed significant and rapid PTSD symptom reduction 24 hours postinfusion. The present study is the first randomized controlled trial to test the efficacy and safety of repeated intravenous ketamine infusions for the treatment of chronic PTSD.
Individuals with chronic PTSD (N=30) were randomly assigned (1:1) to receive six infusions of ketamine (0.5 mg/kg) or midazolam (0.045 mg/kg) (psychoactive placebo control) over 2 consecutive weeks. Clinician-rated and self-report assessments were administered 24 hours after the first infusion and at weekly visits. The primary outcome measure was change in PTSD symptom severity, as assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), from baseline to 2 weeks (after completion of all infusions). Secondary outcome measures included the Impact of Event Scale-Revised, the Montgomery-Åsberg Depression Rating Scale (MADRS), and side effect measures.
The ketamine group showed a significantly greater improvement in CAPS-5 and MADRS total scores than the midazolam group from baseline to week 2. At week 2, the mean CAPS-5 total score was 11.88 points (SE=3.96) lower in the ketamine group than in the midazolam group (d=1.13, 95% CI=0.36, 1.91). Sixty-seven percent of participants in the ketamine group were treatment responders, compared with 20% in the midazolam group. Among ketamine responders, the median time to loss of response was 27.5 days following the 2-week course of infusions. Ketamine infusions were well tolerated overall, without serious adverse events.
This randomized controlled trial provides the first evidence of efficacy of repeated ketamine infusions in reducing symptom severity in individuals with chronic PTSD. Further studies are warranted to understand ketamine's full potential as a treatment for chronic PTSD.
•1 in 5 U.S. military veterans have experienced childhood physical or sexual abuse.•Childhood sexual abuse heightens veterans’ susceptibility to combat exposure and increases risk for SI.•Childhood ...sexual abuse is associated with lifetime suicide attempt(s), above and beyond combat exposure.
Military veterans with a history of childhood abuse are at increased risk for suicidality. To date, however, little research has examined whether exposure to childhood abuse may heighten veterans’ susceptibility to the effects of combat exposure and increase risk for suicidal behavior. This study examined whether childhood abuse has an additive or interactive effect on the association between combat exposure and suicide-related outcomes in a national sample of veterans.
Data were from the National Health and Resilience in Veterans Study, a nationally representative survey of U.S. veterans (n = 3,157). Analyses compared veterans with/without current suicidal ideation and lifetime suicide attempts (SI/SA) on sociodemographic, military, and clinical characteristics; and examined the unique contribution of childhood physical and sexual abuse and combat exposure, and their interaction, with SI/SA.
After adjusting for sociodemographic characteristics and lifetime trauma burden, a significant interaction emerged between childhood sexual abuse and combat exposure predicting SI, such that combat-exposed veterans with histories of abuse were nearly three times more likely to currently be contemplating suicide relative to those without such histories. Childhood sexual abuse predicted lifetime suicide attempt, above and beyond sociodemographic characteristics, lifetime trauma burden, and combat exposure. LIMITATIONS: Cross-sectional design precludes causal inference.
Results indicate that childhood sexual abuse exposure may operate both independently and synergistically with combat exposure to increase risk for suicidality among veterans. Findings suggest that veterans who experience childhood sexual abuse represent a subgroup that may be especially vulnerable to experiencing suicidal ideation following combat exposure.
Converging evidence suggests that veterans with co-occurring PTSD/MDD represent a high-risk group for poor mental health compared to those with PTSD alone. To date, however, little is known about the ...specific factors that may increase vulnerability for and buffer risk for comorbid PTSD/MDD. The purpose of this study was to provide a population-based characterization of sociodemographic, risk, and protective variables associated with comorbid PTSD/MDD among U.S. military veterans. Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative survey of U.S. military veterans (n = 2,732). Analyses (1) compared veterans with PTSD alone and co-occurring PTSD/MDD on sociodemographic, military, and psychosocial characteristics; and (2) examined variables independently associated with PTSD/MDD status. Multivariable logistic regression analyses revealed that racial/ethnic minority status (odds ratio OR = 12.5), number of lifetime traumas (OR = 1.3), and time spent engaged in private religious/spiritual activities (OR = 1.8) were associated with PTSD/MDD status, while higher scores on measures of community integration (OR = 0.6) and dispositional optimism (OR = 0.7) were negatively associated with comorbid PTSD/MDD status. Relative importance analyses revealed that dispositional optimism (34%) and community integration (24%) explained the largest proportions of variance in PTSD/MDD comorbidity. Taken together, results of this study suggest that racial/ethnic minority status, greater lifetime trauma burden, and engagement in private religious/spiritual activities are key distinguishing characteristics of U.S. military veterans with comorbid PTSD/MDD vs. PTSD alone. They further underscore the need to study whether targeting community integration and optimism in prevention and treatment efforts may enhance clinical outcomes in this population.
PDF
