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

Abstract

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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