Psychiatric Quarterly

, Volume 90, Issue 2, pp 275–291 | Cite as

Multimorbidity among Veterans Diagnosed with PTSD in the Veterans Health Administration Nationally

  • Kathryn HefnerEmail author
  • Robert Rosenheck
Original Paper


Over 30% of veterans treated for psychiatric disorders in the Veterans Health Administration (VHA) are diagnosed with Post-Traumatic Stress Disorder (PTSD), with most receiving treatment for war-zone stress they experienced decades previously. We examined psychiatric multimorbidity among these patients and consider its implications for treatment and research. Using national VHA data from Fiscal Year 2012 on all veterans diagnosed with PTSD, we compared those with PTSD only to those with one, two, and three or more concurrent (non-substance use) psychiatric disorders. Comparisons of these four groups on sociodemographic characteristics, medical and substance use co-morbidities, health service use, and psychotropic prescription fills were conducted using bi-variate and ordinal logistic regression methods. Of 638,451 veterans diagnosed with PTSD in FY2012, only 29.8% had PTSD alone; 36.7% had one concurrent psychiatric diagnosis, 21.3% had two, and 12.2% had three or more. Anxiety disorder and major depressive disorder were the most common concurrent diagnoses. Veterans with higher levels of multimorbidity were younger, had greater likelihood of recent homelessness, substance use disorder, and diverse medical diagnoses, along with increased mental health and medical service use and greater psychotropic medication use. Psychiatric multimorbidity is highly prevalent among VHA patients diagnosed with PTSD, and may represent an underappreciated and poorly understood clinical complication that poses unique challenges to effective treatment. Clinical attention and both epidemiological and interventional research on multimorbidity in PTSD patients are needed in order to better understand and treat this common but understudied phenomenon.


Veterans PTSD Multimorbidity Comorbidity War zone trauma 



This work was funded by the VA New England Mental Illness Research, Education and Clinical Center (MIRECC), which had no role in the study design, data collection, analysis, or interpretation, writing of the report or decision to submit the manuscript for publication.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in the present study were in accordance with the ethical standards of the VA Connecticut IRB and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflicts of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychiatryYale School of MedicineNew HavenUSA
  2. 2.VA Connecticut Healthcare SystemWest HavenUSA
  3. 3.Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University of the Health SciencesBethesdaUSA

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