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Comorbidity, impairment, and suicidality in subthreshold PTSD.
R D Marshall1, M Olfson, F Hellman
1New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York 10032, USA. randall@nyspi.cpmc.columbia.edu
The American Journal of Psychiatry
|September 5, 2001
Summary
Subthreshold posttraumatic stress disorder (PTSD) symptoms correlate with increased disability and suicidal risk. Even when accounting for depression, these symptoms significantly elevate suicide risk, highlighting the need for better identification.
Area of Science:
- Psychiatry
- Mental Health Research
- Clinical Psychology
Background:
- The categorical approach to psychiatric disorders overlooks conditions like subthreshold posttraumatic stress disorder (PTSD).
- Subthreshold PTSD, though not meeting full diagnostic criteria, is linked to significant disability and suicidal risk.
- The role of comorbidity in exacerbating impairment in subthreshold PTSD remains understudied.
Purpose of the Study:
- To investigate the association between the number of subthreshold PTSD symptoms and levels of impairment and suicidal risk.
- To examine the influence of comorbid anxiety and depressive disorders on impairment and suicidality in individuals with subthreshold PTSD.
Main Methods:
- A national screening of 2,608 individuals identified those with at least one PTSD symptom of 1-month duration.
- Participants were categorized based on the number of PTSD symptoms (0-4, with 4 indicating full PTSD).
- Impairment, comorbidity (anxiety, major depressive disorder), and suicidality were assessed, with regression analyses used to determine the contribution of subthreshold PTSD and comorbidities.
Main Results:
- A linear and significant increase in impairment, comorbidity, and suicidal ideation was observed with each additional subthreshold PTSD symptom.
- Individuals with subthreshold PTSD demonstrated a higher risk of suicidal ideation, even when major depressive disorder was controlled for.
- Comorbid disorders partially explained the disability and impairment associated with subthreshold PTSD.
Conclusions:
- Increasing numbers of subthreshold PTSD symptoms are associated with greater impairment, comorbidity, and suicidal ideation.
- While comorbidity contributes to impairment in subthreshold PTSD, the condition itself significantly increases suicidal risk independently.
- Further research and clinical efforts are crucial for identifying subthreshold PTSD in various populations due to its public health implications.
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