The prevalence and clinical impairment of subthreshold PTSD using DSM‐5 criteria in a national sample of Korean firefighters

Abstract

Background Firefighters are at high risk for subthreshold and full‐threshold posttraumatic stress disorder (PTSD) due to their frequent exposure to various traumatic events. Although individuals with subthreshold PTSD have increased impairment, often needing treatment, the rates of subthreshold PTSD in firefighters remain unknown. Moreover, there is currently no consensus regarding the definition of subthreshold PTSD. The purpose of this study was to investigate the rates and clinical impairment of subthreshold PTSD according to various definitions in a national sample of firefighters. Methods A total of 45,698 Korean firefighters completed self‐reported questionnaires to assess the severity of PTSD symptoms, suicidal behavior, depression, alcohol use problems, and PTS‐related functional impairment. Six different definitions used in the literature were used to calculate the prevalence rate of subthreshold PTSD. Multivariable linear regression and analysis of variance were performed to identify the relationship of subthreshold PTSD with suicidal behavior, depression, alcohol use problems, and PTS‐related functional impairment. Results The rate of full‐threshold PTSD was 2.63%, and the rate of subthreshold PTSD ranged from 1.79% to 17.98%. The individuals with subthreshold PTSD most commonly failed the D criteria, which included negative alterations in cognition and mood. Regardless of the definition used, subthreshold PTSD was found to be associated with increased suicidal behavior, depression, alcohol use problems, and functional impairment. Conclusions Subthreshold PTSD appears to be equal to or more frequent than full‐threshold PTSD in Korean firefighters and associated with various negative clinical outcomes. Further effort to detect and treat subthreshold PTSD in firefighters may be essential.

Prevalence of lifetime psychiatric disorders and suicidality in adults with subthreshold posttraumatic stress disorder: A population-based nationwide study in Korea.

“…For symptomatology, several symptoms of the diagnostic criteria for PTSD may overlap with those of depression and anxiety disorders (Pietrzak et al, 2011). Unlike previous studies that have reported higher odds ratios for alcohol abuse in individuals with subthreshold PTSD (R. E. Adams et al, 2006; Jeon et al, 2007; Kim et al, 2020), we found no association between subthreshold PTSD and alcohol use disorders.…”

Time course of symptoms in posttraumatic stress disorder with delayed expression: A systematic review

“… 80 For instance, a Korean cross‐sectional study of 45 698 current firefighters found a prevalence of PTSD according to DSM‐5 criteria of 2.6% and subthreshold PTSD defined by 6 different sets of symptoms in 1.8–18%. 81 Subthreshold PTSD by all definitions was significantly associated with suicidal behavior, depression, alcohol use problems, and functional impairment—even in the most relaxed definitions of subthreshold PTSD based upon at least one DSM‐5 symptom from each of the five symptom clusters, B‐F rated 2 or higher (moderately to extremely). Similarly, McLaughlin et al found that the presence of two DSM‐5 symptoms from any of the symptom clusters was strongly related to clinically significant distress or impairment and comorbid disorders with odds ratios 9.7 (95% CI 2.2–42.7) and 3.0 (95% CI 1.7–5.2), respectively.…”

Neurobiological mechanisms underlying delayed expression of posttraumatic stress disorder: A scoping review

“…Subthreshold PTSD symptoms may indicate clinically significant distress and functional impairment. Findings from a Korean cross-sectional study among 45,698 active firefighters indicated that the presence of subthreshold PTSD symptoms was associated with suicidal behavior, depression, alcohol use problems, and functional impairment[ 48 ]. Assessment of a history of TBI is mandatory in help-seeking, trauma-exposed individuals, specifically in soldiers and veterans, who are at increased risk of PTSD with delayed expression[ 2 - 4 ].…”