Posttraumatic Stress Disorder Symptoms, Functioning, and Suicidal Ideation in US Military Veterans: A Symptomics Approach

Objective: To examine the association between individual symptoms of posttraumatic stress disorder (PTSD) and measures of functioning, quality of life, and suicidal ideation given that previous research has focused on PTSD diagnosis and symptom clusters.

Methods: Data from a large, contemporary, nationally representative sample of 1,484 US military veterans who participated in the National Health and Resilience in Veterans Study from September-October 2013 were analyzed to examine the association between individual DSM-5 PTSD symptoms and measures of mental, physical, and cognitive functioning; quality of life; and suicidal ideation.

Results: Nonspecific anhedonic and hyperarousal symptoms of PTSD were significantly associated with the various measures of functioning and explained a significant portion of variance across the different measures (P values < .05). Specifically, the following symptoms explained the most variance in physical functioning: loss of interest (12.4%), sleep difficulties (12.3%), and psychogenic amnesia (8.3%); mental functioning: concentration difficulties (11.4%), negative thoughts (9.2%), and difficulties experiencing positive affect (8.4%); cognitive functioning: concentration difficulties (18.6%), heightened startle (6.4%), and difficulty experiencing positive affect and risky/destructive behavior (both 6.3%); quality of life: concentration difficulties (11.5%), difficulty experiencing positive affect (11.1%), and sleep difficulties (9.4%); and suicidal ideation: difficulty experiencing positive affect (12.3%), negative thoughts (11.3%), and irritability/aggression (9.5%). These findings persisted after adjustment for lifetime trauma burden and severity of PTSD and depressive symptoms.

Conclusions: Nonspecific PTSD symptoms are most strongly related to measures of functioning, quality of life, and suicidal ideation in US veterans. These results underscore the potential clinical utility of a symptom-based approach to the assessment, monitoring, and treatment of PTSD.