An introduction to veteran PTSD for GPs

Post-traumatic stress disorder (PTSD) is a common mental health condition in military populations. Almost 18% of ex-serving Australian Defence Force (ADF) members experience PTSD in any given year, compared with 6% of the general population.¹ General practitioners play a key role in recognising the signs, initiating important conversations, and guiding effective management for veteran patients experiencing trauma-related mental health concerns.

All veterans with a white or gold veteran card are eligible for mental health treatment.

Recognising the signs of PTSD in veterans

PTSD is a mental health condition that can follow exposure to life‑threatening events, including combat, military sexual trauma, training accidents, as well as any of the usual causes for civilians.² Veterans may present with a range of PTSD symptoms, including:

• re-experiencing the trauma (e.g. flashbacks, nightmares, intrusive thoughts)

• avoidance of reminders (e.g. reluctance to engage in conversations or social activities)

• negative mood and cognition (e.g. feelings of guilt, detachment, or hopelessness)

• hyperarousal (e.g. sleep difficulties, irritability, hypervigilance)

• heightened anger (e.g. aggression, difficulty managing emotions)

Symptoms may appear soon after trauma or surface months or even years later. PTSD often coexists with depression, anxiety, alcohol or drug use, and chronic pain. ³ 

Factors contributing to PTSD in veterans

PTSD in veterans can arise from a range of service-related and civilian exposures. While direct combat experiences are well-recognised, many veterans develop PTSD from non-combat-related traumas, which may be overlooked in civilian primary care. ^2,3 Understanding the broad spectrum of trauma exposure helps GPs more accurately assess, diagnose, and support veteran patients.⁴

Protective factors for PTSD

PTSD is more likely to develop when there is a perceived lack of control during the traumatic event or when another mental health condition, such as depression or anxiety, is present.⁵ 

Certain factors can protect against PTSD. These include strong social support networks and biological influences such as genetic variations that affect stress response. A sense of purpose and belonging, such as that often found during military service, can also act as a buffer.

Symptoms may emerge when protective factors are removed. For example, some veterans experience difficulties after leaving the military, during family disruption, or following other significant losses.⁵ In some cases, PTSD symptoms appear only once the individual feels safe enough to process the traumatic experience, which may occur months or years after the event.⁵

Understanding military culture in the context of PTSD

Veterans often report feeling misunderstood in civilian health settings.¹ Understanding the unique demands of military service and the distinct culture of the armed forces can help GPs recognise PTSD, which may present differently in veterans compared to civilian patients.²

Strategies to aid cultural understanding include:

• incorporating service milestones into psychosocial history: ask about key events (eg combat, deployments, relocations, discharge dates) to contextualise mental health concerns

• allowing more time for complex discussions: recognise that veterans may need extended or multiple appointments to disclose trauma. A trusting relationship often develops over multiple visits 

• acknowledging the transition phase as high risk: the post-discharge period is a known window for emerging distress, including PTSD symptoms and suicidal ideation¹ 

• understanding security concerns that may impact disclosures to civilians: veterans may need an understanding of confidentiality or for it to be acknowledged that they don’t need to give you all the details of their circumstances for you to be able to support them. Check that they are comfortable with what you record in your notes
  
  

Taking a trauma informed history

1. Set the scene for emotional and physical safety
Start taking the history in a calm, private setting. Minimise environmental stressors (e.g. noise, closed door) and invite the patient to choose how they begin — explaining the purpose of the consult and ensuring they feel in control.

2. Use empathetic, open-ended questioning
Begin with neutral, broad prompts such as: “Can you tell me about events during your service that still feel difficult now?”
This framing validates their experience and supports sharing without pressure. Veterans may also present with a history of trauma pre-dating their enlistment.

3. Explore triggers and context gently
Inquire about trauma triggers — reminders that might provoke a strong reaction (e.g. smells, sounds, anniversaries) — and understand their frequency and impact. This helps explain avoidance patterns and hyperarousal. 

4. Investigate symptom onset and course
Ask when symptoms first appeared and whether they emerged soon after discharge or years later. Assess how they affect daily functioning: mood, concentration, sleep, relationships, and vocational life.

5. Identify comorbid conditions and coping strategies
Ask about alcohol or drug use, sleep disturbance, persistent pain, or emotional symptoms such as shame, guilt, or moral distress. These often co-occur with — or mask — PTSD. 

6. Respect patient autonomy and pacing
Give control to the patient about depth and detail around their story. Don’t push for details that are not required. If they appear distressed, pause and return later.

7. Avoid retraumatising by retelling the story 
If the veteran is not prepared to share the details of their story, develop a patient-centered management plan that allows treatment to begin whilst continuing to build the therapeutic relationship in future consults.

Screen and assess early

Early intervention improves outcomes. Tools like the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) are brief, validated, and simple to use in general practice. A positive result should lead to a structured assessment — considering childhood, service history, trauma exposure, current stressors, and functional impact.

If PTSD is diagnosed, outline management options clearly and involve the patient in decision-making. The National Centre for PTSD treatment decision aid can help with this. Empathy, trust, and cultural understanding are essential to building engagement — especially as many veterans delay help-seeking due to stigma or previous negative experiences.

Refer for trauma-focused treatments

Trauma-focused psychological therapies are first-line treatments for PTSD.³ These include:

• cognitive processing therapy (CPT)
• prolonged exposure therapy (PE)
• trauma-focused cognitive behavioural therapy (TF-CBT)
• eye movement desensitisation and reprocessing (EMDR)

Pharmacotherapy (eg SSRIs, SNRIs) may also play a role — particularly for those who prefer medication or haven’t responded to psychological therapy. The Phoenix Australia PTSD guidelines give advice about first and second line treatments, as well as other therapies.³

Reinstitute protective factors

Encourage a healthy lifestyle and a recovery mindset.⁶

• Maintain daily routines to enhance stability and resilience
• Engage in regular physical activity to alleviate symptoms
• Prioritise restorative sleep and balanced nutrition
• Implement stress-reduction techniques such as mindfulness
• Limit alcohol, cannabis, and stimulants to prevent symptom exacerbation

Connect with trusted social and financial supports. Ensure the veteran knows that with treatment, PTSD can become symptom-free or symptoms can be well-managed.

Coordinate care and access veteran-specific supports

Many veterans benefit from a coordinated approach that includes mental health clinicians, peer support, and veteran services. Key supports for veterans and their families include:

• Open Arms – Veterans & Families Counselling: free, confidential support for veterans and their families
• Phoenix Australia: resources to support those who have experienced trauma and the health professionals caring for them

GPs can also develop a DVA mental health treatment plan, enabling eligible patients to access funded services through private registered psychologists and other mental health professionals (e.g. accredited mental health social workers and occupational therapists). Additional allied health supports can also be accessed such as exercise physiologists or dieticians as part of a mental health treatment plan. 

Expand your expertise with online training

Medcast’s Veterans Healthcare eLearning Platform (VETs HeLP) offers CPD-accredited courses designed to support your clinical decision-making when caring for veterans.

Explore further resources for your DVA patients:

• mental health care for veterans blog
• managing suicide ideation in veterans eLearning module
• wellbeing profile of Australia’s veterans blog

 Start learning at: medcast.com.au/veterans-health