Posttraumatic stress disorder (PTSD) remains one of the most clinically important and disabling psychiatric conditions among US military veterans. Veterans are exposed to a broad range of potentially traumatic events across the lifespan, including combat-related trauma, interpersonal violence, serious accidents, life-threatening illness or injury, sudden traumatic loss, and other civilian traumas. Prior waves of the National Health and Resilience in Veterans Study (NHRVS) estimated lifetime PTSD prevalence among US veterans at approximately 8% to 9% and past-month PTSD prevalence at approximately 5%. However, the veteran population is changing in age, sex, race/ethnicity, service era, health care utilization, and trauma exposure patterns. Updated national surveillance data are therefore important for clinicians, health systems, and policymakers who care for veterans with trauma-related symptoms.

This study analyzed data from the 2025–2026 NHRVS, a nationally representative, web-based survey of 2,636 US veterans conducted between December 2025 and January 2026. PTSD symptoms were assessed with the PTSD Checklist for DSM-5 (PCL-5), using a cut score of 38 to identify probable lifetime and past-month PTSD and to preserve comparability with prior NHRVS waves. It is important to note that this threshold is more conservative than the cut score of 33 more commonly used in clinical and research settings, which means the study’s estimates are likely conservative. Participants also reported lifetime exposure to potentially traumatic events (PTEs), identified their perceived worst (index) trauma, and completed measures of functional disability using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Weighted prevalence estimates were compared with prior NHRVS waves from 2011, 2013, and 2019–2020.

The weighted prevalence of PTSD was higher in 2025–2026 than in any prior NHRVS wave. Lifetime PTSD prevalence was 14.4% (95% CI, 12.6%–16.4%), compared with 8.0% in 2011, 8.1% in 2013, and 9.4% in 2019–2020. Past-month PTSD prevalence was 7.3% (95% CI, 6.0%–8.9%), compared with 4.8%, 4.7%, and 5.0% in those earlier waves, respectively. Using 2024 US Census veteran population benchmarks, the authors estimated that these findings correspond to approximately 2.5 million US veterans with lifetime PTSD and 1.2 million with current PTSD symptoms.

PTSD prevalence varied substantially across demographic and clinical subgroups. Veterans aged 18–44 years had the highest rates, with lifetime PTSD reported in 35.3% and past-month PTSD in 16.1%, compared with 5.7% and 2.8%, respectively, among veterans aged 60 years and older. Female veterans were more likely than male veterans to screen positive for both lifetime PTSD (28.5% vs 12.6%) and past-month PTSD (12.5% vs 6.7%). Higher rates were also observed among racial and ethnic minority veterans, combat-exposed veterans, and veterans who used the VA as their primary source of health care.

Potentially traumatic event exposure was common: 84.2% of veterans reported at least one such event, with a mean of 3.0 distinct trauma categories endorsed. It is important to distinguish between the most prevalent exposures and those most commonly identified as the “worst” (index) trauma, as these differ meaningfully.

The most commonly experienced potentially traumatic exposures were natural disasters (41.3%), sudden death of a close family member or friend (40.3%), and witnessing someone being badly injured or killed (38.4%). However, when veterans were asked to identify their single worst or most distressing trauma (the index event used for PTSD symptom assessment), the most commonly nominated events were sudden death of a close family member or friend (26.4%), life-threatening illness or injury (11.8%), and witnessing serious injury or death (11.5%). While there is overlap, these two lists are distinct: prevalence of exposure reflects how many veterans experienced each event at all, whereas index trauma identification reflects which event was subjectively most distressing.

Conditional PTSD risk—the probability of PTSD given a specific index trauma—was highest following forced sexual experiences, with lifetime PTSD identified in 65.5% of veterans who reported forced sex during childhood as their index trauma and 48.9% of those who reported forced sex during adulthood as their index trauma. Military-related traumatic experiences were also associated with elevated conditional PTSD risk (33.0%). Notably, these high-risk traumas are relatively uncommon as index events, which underscores the importance of proactive screening even when such events are infrequently volunteered.

Functional impairment was strongly linked to both PTSD and cumulative trauma burden. In adjusted analyses, cumulative trauma exposure and past-month PTSD were each independently associated with higher WHODAS 2.0 disability scores. Veterans with past-month PTSD had markedly greater functional disability than those without current PTSD. Importantly, cumulative trauma burden remained associated with disability even after adjustment for PTSD, psychiatric and substance use diagnoses, physical health conditions, combat exposure, and demographic variables. This finding suggests that the functional consequences of trauma exposure may extend beyond the presence or absence of a categorical PTSD diagnosis.

Clinicians should interpret these findings in light of three methodological limitations. First, PTSD symptoms, trauma exposure, and functional impairment were all assessed via self-report rather than clinician-administered interviews, which may introduce reporting bias and either over- or underestimate true prevalence. Second, the study used a PCL-5 cut score of 38 to maintain comparability with earlier NHRVS waves; this threshold is more conservative than the cut score of 33 commonly used in clinical and research settings, which enhances specificity but may result in lower prevalence estimates than would be obtained using the standard clinical cutoff. Third, the cross-sectional design precludes causal inference about the relationships among trauma exposure, PTSD, and functional disability. Longitudinal research is needed to clarify the trajectories of risk, persistence, and recovery.

For clinicians, these findings reinforce the importance of routine, trauma-informed assessment in veterans, particularly among younger veterans, women, racial and ethnic minority veterans, combat-exposed veterans, and those presenting with high functional impairment. Assessment should not be limited to current PTSD symptoms alone; cumulative lifetime trauma exposure, index trauma type, comorbid psychiatric and medical conditions, substance use, and day-to-day functioning are all clinically relevant. The distinction between commonly experienced traumas and those that confer the highest conditional PTSD risk is also clinically significant: events such as forced sexual experiences may be infrequently reported yet carry disproportionate risk, highlighting the need for sensitive screening, careful attention to stigma and underreporting, and access to evidence-based trauma-focused interventions.

This updated national survey suggests that PTSD represents a growing and substantial public health burden among US veterans. The findings emphasize the need for ongoing surveillance, early identification, evidence-based PTSD treatment, and integrated rehabilitation strategies that address both symptoms and functional recovery.

Reference:
Pietrzak RH et al. J Clin Psychiatry 2026;87(3):26m16378 Abstract