Recent proposals for revisions to the 11th edition of the International Classification of Diseases (ICD-11) posttraumatic stress disorder (PTSD) diagnostic criteria have argued that the current symptom constellation under the Diagnostic and Statistical Manual of Mental Disorders-5 is unwieldy and includes many symptoms that overlap with other disorders. The newly proposed criteria for the ICD-11 include only six symptoms. However, restricting the symptoms to those included in the ICD-11 has implications for PTSD diagnosis prevalence estimates, and it remains unclear whether these six symptoms are most strongly associated with a diagnosis of PTSD. Network analytic methods, which assume that psychiatric disorders are networks of interrelated symptoms, provide information regarding which symptoms are most central to a network. We estimated network models of PTSD in a national sample of veterans of the Iraq and Afghanistan wars. In the full sample, the most central symptoms were persistent negative emotional state, efforts to avoid external reminders, efforts to avoid thoughts or memories, inability to experience positive emotions, distressing dreams, and intrusive distressing thoughts or memories; i.e., three of the six most central items to the network would be eliminated from the diagnosis under the current proposal for ICD-11. An empirically-defined index summarizing the most central symptoms in the network performed comparably to an index reflecting the proposed ICD-11 PTSD criteria at identifying individuals with an independently-assessed DSM-5 defined PTSD diagnosis. Our results highlight the symptoms most central to PTSD in this sample, which may inform future diagnostic systems and treatment.

Most research on exceptional longevity has investigated biomedical factors associated with survival, but recent work suggests nonbiological factors are also important. Thus, we tested whether higher optimism was associated with longer life span and greater likelihood of exceptional longevity. Data are from 2 cohorts, women from the Nurses’ Health Study (NHS) and men from the Veterans Affairs Normative Aging Study (NAS), with follow-up of 10 y (2004 to 2014) and 30 y (1986 to 2016), respectively. Optimism was assessed using the Life Orientation Test–Revised in NHS and the Revised Optimism–Pessimism Scale from the Minnesota Multiphasic Personality Inventory-2 in NAS. Exceptional longevity was defined as survival to age 85 or older. Primary analyses used accelerated failure time models to assess differences in life span associated with optimism; models adjusted for demographic confounders and health conditions, and subsequently considered the role of health behaviors. Further analyses used logistic regression to evaluate the likelihood of exceptional longevity. In both sexes, we found a dose-dependent association of higher optimism levels at baseline with increased longevity (Ptrend < 0.01). For example, adjusting for demographics and health conditions, women in the highest versus lowest optimism quartile had 14.9% (95% confidence interval, 11.9 to 18.0) longer life span. Findings were similar in men. Participants with highest versus lowest optimism levels had 1.5 (women) and 1.7 (men) greater odds of surviving to age 85; these relationships were maintained after adjusting for health behaviors. Given work indicating optimism is modifiable, these findings suggest optimism may provide a valuable target to test for strategies to promote longevity.

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