Comparing probable subthreshold and full PTSD prevalence in older versus younger veterans

The prevalence of posttraumatic stress disorder (PTSD) is lower in older adults compared to younger adults. Although some evidence suggests that subthreshold PTSD may be more common in older adults, comparisons across age groups are limited, as many studies do not stratify results by age, and definitions of subthreshold PTSD vary widely. Consequently, it remains unclear whether older adults are more likely to experience subthreshold PTSD versus full PTSD, and how these patterns compare to younger cohorts. Given that subthreshold PTSD is often linked to functional impairment, accurate identification is clinically important. To address this gap, the present study used an empirically derived definition of subthreshold PTSD based on the PTSD Checklist for DSM-5, incorporating criteria for symptom duration and distress or impairment. The prevalence of PTSD and subthreshold PTSD was examined across age groups in a nationally representative sample of U.S. military veterans (n = 4069). Results revealed that the prevalence of both full and subthreshold PTSD declined with age. Using a definition of subthreshold PTSD that included duration and distress or impairment, subthreshold PTSD and full PTSD were equally likely in each age group. Psychiatric comorbidities generally followed a gradient, being most common in veterans with full PTSD, followed by those with subthreshold PTSD, and least common in those without PTSD, with no significant differences by age group. These findings underscore the importance of identifying and characterizing subthreshold PTSD across all age groups, since clinically significant symptoms may exist even in the absence of a PTSD diagnosis.