Objective: To determine whether the prevalence of physical comorbidities in Australian Vietnam War veterans with post-traumatic stress disorder (PTSD) is higher than in trauma-exposed veterans without PTSD.
Design, setting and participants: Cross-sectional analysis of the health status (based on self-reported and objective clinical assessments) of 298 Australian Vietnam War veterans enrolled by the Gallipoli Medical Research Institute (Brisbane) during February 2014 – July 2015, of whom 108 were confirmed as having had PTSD and 106 served as trauma-exposed control participants.
Main outcomes and measures: Diagnostic psychiatric interview and psychological assessments determined PTSD status, trauma exposure, and comorbid psychological symptoms. Demographic data, and medical and sleep history were collected; comprehensive clinical examination, electrocardiography, spirometry, liver transient elastography, and selected pathology assessments and diagnostic imaging were performed. Outcomes associated with PTSD were identified; regression analysis excluded the effects of potentially confounding demographic and risk factors and comorbid symptoms of depression and anxiety.
Results: The mean total number of comorbidities was higher among those with PTSD (17.7; SD, 6.1) than in trauma-exposed controls (14.1; SD, 5.2; P < 0.001). For 24 of 171 assessed clinical outcomes, morbidity was greater in the PTSD group, including for conditions of the gastrointestinal, hepatic, cardiovascular, and respiratory systems, sleep disorders, and laboratory pathology measures. In regression analyses including demographic factors, PTSD remained positively associated with 17 adverse outcomes; after adjusting for the severity of depressive symptoms, it remained significantly associated with ten.
Conclusion: PTSD in Australian Vietnam veterans is associated with comorbidities in several organ systems, independent of trauma exposure. A comprehensive approach to the health care of veterans with PTSD is needed.
- 1. O’Toole BI, Marshall RP, Grayson DA, et al. The Australian Vietnam Veterans Health Study: III. Psychological health of Australian Vietnam veterans and its relationship to combat. Int J Epidemiol 1996; 25: 331-340.
- 2. Marmar CR, Schlenger W, Henn-Haase C, et al. Course of posttraumatic stress disorder 40 years after the Vietnam War: findings from the National Vietnam Veterans Longitudinal Study. JAMA Psychiatry 2015; 72: 875-881.
- 3. Dobson AT, Zheng W, Anderson R, et al. The Middle East Area of Operations (MEAO) Health Study: census study summary report. Dec 2012. Brisbane: University of Queensland, Centre for Military and Veteran Health, 2012. http://www.defence.gov.au/Health/Home/Docs/MEAOCensusStudyReportVolI.pdf (accessed Nov 2016).
- 4. Forbes D, O’Donnell M, Brand RM, et al. The long-term mental health impact of peacekeeping: prevalence and predictors of psychiatric disorder. B J Psych Open 2016; 2: 32-37.
- 5. Boscarino JA. Diseases among men 20 years after exposure to severe stress: implications for clinical research and medical care. Psychosom Med 1997; 59: 605-614.
- 6. Boscarino JA. A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: implications for surveillance and prevention. Psychosom Med 2008; 70: 668-676.
- 7. O’Toole BI, Catts SV. Trauma, PTSD, and physical health: an epidemiological study of Australian Vietnam veterans. J Psychosom Res 2008; 64: 33-40.
- 8. Spitzer C, Koch B, Grabe HJ, et al. Association of airflow limitation with trauma exposure and post-traumatic stress disorder. Eur Respir J 2011; 37: 1068-1075.
- 9. Boscarino JA. Posttraumatic stress disorder and physical illness: results from clinical and epidemiologic studies. Ann N Y Acad Sci 2004; 1032: 141-153.
- 10. Edmondson D, Kronish IM, Shaffer JA, et al. Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review. Am Heart J 2013; 166: 806-814.
- 11. Jaoude P, Vermont LN, Porhomayon J, El-Solh AA. Sleep-disordered breathing in patients with post-traumatic stress disorder. Ann Am Thorac Soc 2015; 12: 259-268.
- 12. Zen AL, Whooley MA, Zhao S, Cohen BE. Post-traumatic stress disorder is associated with poor health behaviors: findings from the heart and soul study. Health Psychol 2012; 31: 194-201.
- 13. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Statist Soc B 1995; 57: 289-300.
- 14. Bartoli F, Crocamo C, Alamia A, et al. Posttraumatic stress disorder and risk of obesity: systematic review and meta-analysis. J Clin Psychiatry 2015; 76: e1253-e1261.
- 15. Irwin C, Falsetti SA, Lydiard RB, et al. Comorbidity of posttraumatic stress disorder and irritable bowel syndrome. J Clin Psychiatry 1996; 57: 576-578.
- 16. Pinto-Sanchez MI, Ford AC, Avila CA, et al. Anxiety and depression increase in a stepwise manner in parallel with multiple FGIDs and symptom severity and frequency. Am J Gastroenterol 2015; 110: 1038-1048.
- 17. Ford AC, Quigley EMM, Lacy BE, et al. Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 1350-1365.
- 18. Iorio N, Makipour K, Palit A, Friedenberg FK. Post-traumatic stress disorder is associated with irritable bowel syndrome in African Americans. J Neurogastroenterol Motil 2014; 20: 523-530.
- 19. White DL, Savas LS, Daci K, et al. Trauma history and risk of the irritable bowel syndrome in women veterans. Aliment Pharmacol Ther 2010; 32: 551-561.
- 20. Cohen H, Jotkowitz A, Buskila D, et al. Post-traumatic stress disorder and other co-morbidities in a sample population of patients with irritable bowel syndrome. Eur J Intern Med 2006; 17: 567-571.
- 21. Frueh BC, Hamner MB, Cahill SP, et al. Apparent symptom overreporting in combat veterans evaluated for PTSD. Clin Psychol Rev 2000; 20: 853-885.
- 22. Beristianos MH, Yaffe K, Cohen B, Byers AL. PTSD and risk of incident cardiovascular disease in aging veterans. Am J Geriatr Psychiatry 2016; 24: 192-200.
- 23. Ahmadi N, Hajsadeghi F, Mirshkarlo HB, et al. Post-traumatic stress disorder, coronary atherosclerosis, and mortality. Am J Cardiol 2011; 108: 29-33.
- 24. Sager HB, Nahrendorf M. Inflammation: a trigger for acute coronary syndrome. Q J Nucl Med Mol Imaging 2016; 60: 185-193.
- 25. Flory J, Yehuda R. Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations. Dialogues Clin Neurosci 2015; 17: 141-150.
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