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PTSD in older patients linked to multiple past traumas, comorbidity

Posttraumatic stress disorder in older patients is more prevalent than previously reported and is associated with a significant number of comorbid psychiatric disorders, according to researchers.

Robert H. Pietrzak, PhD, MPH, and colleagues analyzed data obtained from face-to-face interviews with 9,463 adults aged 60 years and older. The interviews were part of Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. The same collection of survey data was used in a study examining the relationship between physical health conditions and posttraumatic stress disorder (PTSD) in older patients, published in the Journal of the American Geriatrics Society.

Participants were diagnosed with PTSD based on criteria from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). During the interviews, participants were asked to enumerate potentially traumatic event types, and based on the number of symptoms they identified, the participants were classified as having either PTSD or partial PTSD. Additional psychiatric disorders were also diagnosed based on the DSM-IV symptom criteria, and psychosocial functioning was assessed using the 12-Item Short-Form Health Survey, version 2.

Results showed that 4.5% of participants had PTSD, and 5.5% had partial PTSD. Rates of PTSD and partial PTSD were higher in women (5.7% and 6.5%, respectively) than in men (3.1% and 4.3%). According to researchers, participants most frequently reported the unexpected death of someone close, serious illness or injury to someone close and their own serious or life-threatening illness as their most stressful events. Those participants without full or partial PTSD, as well as participants with partial PTSD, identified the unexpected death of someone close, serious illness or injury of someone close and an indirect experience of the Sept. 11, 2001, terrorist attacks as their most stressful events.

The researchers also found that PTSD was associated with greater odds of lifetime mood, anxiety, drug use and borderline and narcissistic personality disorders. Partial PTSD, they wrote, was associated with higher odds of mood, anxiety and narcissistic and schizotypal personality disorders. Both PTSD and partial PTSD diagnoses were associated with decreased psychosocial functioning.

“These findings underscore the importance of comprehensively assessing both trauma exposure and Axis I and II disorders in older adults,” the researchers wrote, adding that additional research is needed to examine the relationship between trauma exposure, PTSD and co-concurring psychiatric disorders.

Disclosure: Preparation of this study was supported in part by the U.S. Department of Veterans Affairs’ National Center for Posttraumatic Stress Disorder, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse. Dr. Pietrzak reports no relevant financial disclosures.