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Factors associated with persistent posttraumatic stress disorder among U.S. military service members and veterans

APA Citation:

Armenta, R. F., Rush, T., Leardmann, C. A., Millegan, J., Cooper, A., & Hoge, C. W. (2018). Factors associated with persistent posttraumatic stress disorder among U.S. military service members and veterans. BMC Psychiatry, 18(1). https://doi.org/10.1186/s12888-018-1590-5

Abstract Created by REACH:

Posttraumatic Stress Disorder (PTSD) is a difficulty faced by 5-20% of military personnel and is associated with numerous mental, physical, emotional, and relational health issues. If left untreated for long periods of time, these issues could worsen. Therefore, it is helpful to understand factors related to persistent PTSD. To that end, data from 2,409 service members from various branches of the military were examined for factors linked to persistent PTSD symptomology. Bivariate and multivariate logistic regressions were used with data from three time points between 2001 and 2013. Military (e.g., combat exposure, rank) and non-military (e.g., race, age) variables were related to higher odds of persistent PTSD symptoms.


Mental health

Branch of Service:

Air Force
Coast Guard
Marine Corps
Multiple branches

Military Affiliation:

Active Duty

Subject Affiliation:

Active duty service member
Guard/Reserve member


Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)


Longitudinal Study
Quantitative Study


Armenta, Richard F., Rush, Toni, LeardMann, Cynthia A., Cooper, Adam, Hoge, Charles W., Millegan, Jeffrey


Background: Posttraumatic stress disorder (PTSD) can have long-term and far-reaching impacts on health and social and occupational functioning. This study examined factors associated with persistent PTSD among U.S. service members and veterans. Methods: Using baseline and follow-up (2001–2013) questionnaire data collected approximately every 3 years from the Millennium Cohort Study, multivariable logistic regression was conducted to determine factors associated with persistent PTSD. Participants included those who screened positive for PTSD using the PTSD Checklist–Civilian Version at baseline (N= 2409). Participants were classified as having remitted or persistent PTSD based on screening negative or positive, respectively, at follow-up. Results: Almost half of participants (N= 1132; 47%) met criteria for persistent PTSD at the first follow-up; of those, 804 (71%) also screened positive for PTSD at the second follow-up. Multiple factors were independently associated with persistent PTSD in an adjusted model at the first follow-up, including older age, deployment with high combat exposure, enlisted rank, initial PTSD severity, depression, history of physical assault, disabling injury/illness, and somatic symptoms. Among those with persistent PTSD at the first follow-up, additional factors of less sleep, separation from the military, and lack of social support were associated with persistent PTSD at the second follow-up. Conclusions: Combat experiences and PTSD severity were the most salient risk factors for persistent PTSD. Comorbid conditions, including injury/illness, somatic symptoms, and sleep problems, also played a significant role and should be addressed during treatment. The high percentage of participants with persistent PTSD supports the need for more comprehensive and accessible treatment, especially after separation from the military. Keywords: Post-traumatic stress disorder, PTSD, Military, Combat, Veterans

Publisher/Sponsoring Organization:

BMC Psychiatry

Publication Type:

REACH Publication

Author Affiliation:

Deployment Health Research Department, Naval Health Research Center, RFA
Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, TR
Deployment Health Research Department, Naval Health Research Center, CAL
Directorate of Mental Health, Naval Medical Center San Diego, JM
Deployment Health Research Department, Naval Health Research Center, AC
Walter Reed Army Institute of Research, CWH


chronic mental illness, combat, mental health, military, military personnel, military veterans, post-traumatic stress disorder, PTSD, veterans

View Research Summary:

REACH Publication Type:

Research Summary


The Millennium Cohort Study is funded through the Military Operational Medicine Research Program, United States Army Medical Research and Materiel Command (Fort Detrick, Maryland).

REACH Newsletter:

  January 2019

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