Comorbidity of posttraumatic stress disorder, anxiety and depression: A 20-year longitudinal study of war veterans

Background: This study aims to: (a) follow-up the prevalence of comorbidity of posttraumatic stress disorder (PTSD), anxiety and depression; (b) determine the chronological relations between these disorder; and (c) examine whether PTSD comorbid with anxiety and depression is implicated in more impaired functioning than PTSD by itself. Methods: 664 war veterans were followed up 1, 2, and 20 years after their participation in the 1982 Lebanon War. Comorbidity was assessed by self reported PTSD, anxiety, and depression symptoms; impairment in psychosocial functioning was assessed by self reported problems in occupational, social, sexual and family functioning. Results: At each point of assessment, rates of triple comorbidity (PTSD, anxiety and depression; 26.7-30.1%) were higher than rates of PTSD, either by itself (9.3-11.1%), or comorbid with depression (1.2-4.5%) or anxiety (2.9-4.5%). PTSD predicted depression, anxiety, and comorbid disorders, but not vice versa. At time 1 and 2 assessments, triple comorbidity was associated with more impaired functioning than PTSD alone. In addition, triple comorbidity at Time 2 was associated with more impaired functioning than double comorbidity. Limitations: Since measurements did not cover the entire span of 20 years since the war, the entire spectrum of changes could not be monitored. Conclusions: Almost one half of war veterans would endorse a lifetime triple comorbidity, and those who do, are likely to have more impaired functioning. The findings support the perspective that views PTSD as the dominant disorder following traumatic events, which impels the development of comorbid anxiety and depression. (C) 2009 Elsevier B.V. All rights reserved.