Psychiatric Comorbidity for Veterans With Posttraumatic Stress Disorder (PTSD): A Latent Profile Analysis and Implications for Treatment

Clinical Impact Statement Little is known about how well traditional psychological treatments can treat multiple disorders at the same time. This study investigated how veterans with multiple disorders (e.g., posttraumatic stress disorder, depression, and alcohol misuse) respond to treatment, and how this impacts their quality of life. The study found distinct groups of people with different constellations of disorders that respond differently to treatment. Specifically, those with more psychological problems did less well, and especially those with alcohol problems gained less from treatment than those without alcohol problems. More work is needed to test treatments that can be tailored for varying combinations of disorders. Background and Objective: Psychiatric comorbidity is common among veterans with posttraumatic stress disorder (PTSD), but there is little known about the patterns of co-occurring mental health problems and implications for treatment. The aim of this study was to identify comorbidity profiles among veterans at treatment intake and assess associations with PTSD and quality of life (QOL) outcomes. Method: The study included 2,522 veterans accessing outpatient treatment for PTSD in Australia who self-completed measures of comorbid issues including depression, anger, alcohol use problems, guilt, and dissociation. Latent Profile Analysis (LPA) was used to identify subgroups based on comorbidity profiles, and their association with outcomes. Results: LPA suggested 5 comorbidity profiles: (a) low comorbidity severity, (b) moderate comorbidity severity with low alcohol, (c) moderate comorbidity severity with high alcohol, (d) high comorbidity severity with low alcohol, and (e) high comorbidity severity with high alcohol. The absence of alcohol problems was associated with improved treatment outcomes when overall comorbidity severity was high but not moderate. While all profiles evidenced symptom improvement from intake to discharge and follow-up, this did not correspond to quality of life improvements equally across classes. The highest severity comorbidity class experienced no improvement on psychological quality of life. Conclusions: The comorbidity profiles of veterans in treatment for PTSD can be distinguished by levels of severity and the specific presence or absence of alcohol use problems. Alcohol use problems have discernible implications for treatment in the context of comorbidity. Group treatments for PTSD should consider tailoring interventions to comorbidity profiles.