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Original Investigation |

Chronicity of Posttraumatic Stress Disorder and Risk of Disability in Older Persons

Amy L. Byers, PhD, MPH1,2; Kenneth E. Covinsky, MD, MPH2,3; Thomas C. Neylan, MD1,2; Kristine Yaffe, MD1,2,4
[+] Author Affiliations
1Department of Psychiatry, University of California, San Francisco
2San Francisco Veterans Affairs Medical Center, San Francisco, California
3Division of Geriatrics, Department of Medicine, University of California, San Francisco
4Departments of Neurology and Epidemiology and Biostatistics, University of California, San Francisco
JAMA Psychiatry. 2014;71(5):540-546. doi:10.1001/jamapsychiatry.2014.5.
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Importance  Little is known about the association between posttraumatic stress disorder (PTSD) and disability into later life. Most studies of late-life psychiatric disorders and function have focused on depression and generalized anxiety disorder.

Objectives  To determine the association between PTSD and disability among older adults and investigate if association differs by chronicity of PTSD.

Design, Setting, and Participants  In total, 3287 participants 55 years and older (mean [SD] age, 66.0 [8.7] years, 60.1% women) involved in the Collaborative Psychiatric Epidemiology Surveys (2001-2003), including 3 aggregated, nationally representative studies (National Comorbidity Survey Replication, National Survey of American Life, and National Latino and Asian American Study). Analyses used weights and complex design-corrected statistical tests to infer generalizability to the US population.

Main Outcomes and Measures  Disability defined by 5 domains (out of role, self-care, mobility, cognition, and social) using the World Health Organization Disability Assessment Schedule.

Results  Of the 3.7% older adults who had a history of PTSD defined by DSM-IV criteria, 1.8% had persistent PTSD into later life (age of onset <55 years as well as a recent diagnosis). Frequency of any disability was 79.7% for persistent PTSD, 69.6% for pre–late life (age of onset <55 years and age at last diagnosis <55 years), and 36.9% for no PTSD (P < .001). In logistic regression analyses, adjusting for demographics, smoking, individual medical conditions, depression, generalized anxiety disorder, and substance use disorders, respondents with persistent PTSD were 3 times more likely to have any disability than were respondents with no PTSD (odds ratio, 3.18; 95% CI, 1.32-7.64). Global disability results were nonsignificant for pre–late life relative to no PTSD (odds ratio, 1.99; 95% CI, 0.97-4.08).

Conclusions and Relevance  Disability in older Americans is strongly associated with PTSD, particularly PTSD that persists into later life. These findings suggest that monitoring and treatment of PTSD are important over the long term.

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Prevalence of Any Difficulty in Individual Domains of Disability Across Posttraumatic Stress Disorder (PTSD) Occurrence

The error bars indicate 95% CIs.aP < .001 (based on Rao-Scott weighted analyses).bP < .05 (based on Rao-Scott weighted analyses).

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