Emergence of probable PTSD among U.S. veterans over the military-to-civilian transition.

OBJECTIVE: Despite theorizing that posttraumatic stress disorder (PTSD) symptomatology may be exacerbated during the military-to-civilian transition, little research has delved into the trajectory of trauma-related symptomatology or the impact of diverse factors on timing of PTSD onset. To understand risk and protective factors for PTSD during the transition into civilian life, this study examined demographic, experiential, and psychosocial characteristics that may explain variation in PTSD symptoms and timing of onset. METHOD: A nationwide sample representing 48,965 U.S. veterans separating from military service in fall 2016 responded to six Web-based surveys over 3 years. Assessments included PTSD symptoms, stress, warfare exposures, military sexual trauma, moral injury events, resilience, and social support. Multivariable models estimated covariates of positive PTSD screen or symptoms. RESULTS: Trauma exposure during military service was high at 59%. Probable PTSD was detected in 26% of the sample at baseline, with additional cases in each survey wave for an overall rate of 30%. Meeting criteria for probable PTSD covaried with current stress, female gender, and minority race/ethnicity; baseline psychological resilience and concurrent social support mitigated the risk. PTSD symptoms correlated positively with stress levels at current and previous time points. Social support was protective but only when contemporaneous with the PTSD symptoms. CONCLUSIONS: This study illustrates the need for ongoing social support for veterans coping with symptoms of PTSD, life stressors, and postmilitary trauma, suggesting a countervailing influence of psychological resilience and contemporaneous (but not historical) social support on symptom exacerbation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Demographic Variation in the Use of Prazosin for Treatment of Sleep Disturbance in Combat Veterans with PTSD.

Objectives: Off-label use of prazosin for posttraumatic stress disorder-related sleep disturbances (PTSD-SD) is widespread in Veterans Health Administration (VA) settings, but clinical trials have had mixed results. Trial criteria may exclude significant sub-groups, and therefore a 2018 study may not provide the final evidence of prazosin efficacy for PTSD-SD. This study analyzed correlates of prazosin use in Vietnam era (VNE) and Operations Enduring Freedom/Iraqi Freedom (OEF/OIF) cohorts to illustrate patterns of usage in this heterogeneous population. Method: Data extracted on patients with PTSD-SD prescribed prazosin in 2015 described the proportion of days covered (PDC) ≥ 80% and daily dose ≥ 6 mg (therapeutic target dose) over the next 12 months. Results: Both VNE (n = 41,365) and OEF/OIF (n = 62,984) cohorts had high rates of comorbidity (N = 104,349; 46% hypertension, 22% alcohol use disorder, 14% drug use disorder). Adherence and dosing were low: 19% of veterans achieved PDC ≥ 80%; 7% achieved ≥ 6mg/day (average 2.6 mg/day). In covariate-adjusted models, VNE veterans had better adherence, VNE women had lower rates of therapeutic dosing, and minority race/ethnicity was a strong risk factor for non-adherence. PDC correlated inversely with alcohol/drug disorders. Conclusion: Prazosin is prescribed for PTSD-SD to a diverse clinical population with multiple comorbidities and concurrent medications and is characterized by poor adherence and sub-optimal dosing. Future work should clarify the efficacy of prazosin for subgroups of veterans with PTSD-SD, notably women and racial/ethnic minorities.