Publication year
2010
Citation Title
Association between posttraumatic stress disorder and primary care provider-diagnosed disease among Iraq and Afghanistan veterans.
Journal Name
Psychosomatic Medicine
Journal Volume
72
Issue Number
5
Page Numbers
498-504
DOI
10.1097/PSY.0b013e3181d969a1
Summary
The Veterans Hospital's Association (VHA) administrative records of 4,416 OIF/OEF Veterans using the upstate New York Veterans Affairs (VA) healthcare system were analyzed to determine if a diagnosis of posttraumatic stress disorder (PTSD) was associated with primary care provider-diagnosed physical disease in the first 5 years postdeployment. Veterans with a diagnosis of PTSD were at elevated risk of early-onset primary care providers (PCP)-diagnosed hypertensive, circulatory, digestive, nervous system, and musculoskeletal disease.
Key Findings
Veterans with a diagnosis of PTSD were at elevated risk of early-onset PCP-diagnosed hypertensive, circulatory, digestive, nervous system, and musculoskeletal disease.
PTSD is a unique contributor to disease even after controlling factors known to have a significant impact on physical disease onset and severity (e.g., depressive and substance use disorders).
This wide range of health outcomes associated with PTSD is apparent in multiple body systems within a relatively short time period after diagnosis.
Implications for Program Leaders
Offer classes for Service members with PTSD about wellness, healthy nutrition, and exercise
Provide workshops that have family-based educational experiences for Service members with PTSD encouraging families to work together to build and sustain healthy habits
Disseminate information regarding the negative impact PTSD can have on Service members physical health outcomes
Implications for Policy Makers
Recommend the development of partnerships between mental health professionals and those in primary care to provide collaborative care for Service members with PTSD
Recommend professional education for community providers regarding the common physical health conditions among Service members with PTSD, in hopes that early detection of problems may prevent the development of long-term disabling conditions
Continue to support programs that assess and provide service to Service members coping with PTSD symptoms
Methods
OEF/OIF Veterans who sought primary care treatment within the Upstate New York VA Healthcare network from 9/11/2001-12/31/2007 were identified in an administrative database.
Participants were followed from their first visit during this period until the study end date and their demographic characteristics, mental (depression, PTSD and substance abuse), and medical diagnoses were extracted from the database.
Regression analyses assessed the time from the initial medical visit to PCP-assigned disease diagnosis according to PTSD status.
Participants
Participants included 4,416 OEF/OIF Veterans (89% male).
There were 68% participants who were 20-29 years old, 18% 30-39, 48% single/never married, 38% married, 9% divorced.
The demographic composition of the particiapnts included: 85% White, 8% Black, and 3% Latino.
Participants represented different branches of the military including: 67% Army, 16% Marine, 9% Navy, 8% Air Force, and 53% Active Duty.
Limitations
Results are not generalizable to Veterans who are not enrolled in the VA upstate New York healthcare system.
ICD-9 medical diagnoses may be overdiagnosed or misclassified; PTSD may be underdiagnosed.
Unmeasured variables may have influenced these findings.
This study can not determine causation.
Avenues for Future Research
Examine whether empirically supported treatments for PTSD positively affect the health status of returning Veterans
Replicate these results in a larger and more representative sample of Service members, Veterans and/or civilians
Explore whether early identification and treatment of PTSD symptoms reduces Service members risk for other negative health outcomes
Focus
Multiple Branches
Target Population
Population Focus
Military Component
Abstract
Objective: To determine if a diagnosis of posttraumatic stress disorder (PTSD) was associated with primary care provider-diagnosed physical disease in the first 5 years post deployment. Methods: An examination of medical records of 4416 veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) was conducted. Participants were veterans who served between September 11, 2001 and December 31, 2007, without prior combat exposure, and who utilized primary care services within the VA Healthcare Network of Upstate New York. Primary care provider-diagnosed International Statistical Classification of Diseases and Related Health Problems, Revision 9 (ICD-9) physical diseases were examined. Results: Adjusting for demographic characteristics and clinical factors (e.g., age, gender, depression, and substance use), PTSD was significantly associated with an almost two-fold increase of developing nervous system (odds ratio [OR], 1.98), musculoskeletal disease (OR, 1.84), and signs and ill-defined conditions of disease (OR, 1.78). A diagnosis of PTSD was significantly associated with increased odds of developing circulatory (OR, 1.29), hypertensive (OR, 1.38), and digestive system disease (OR, 1.34). Survival analyses showed that veterans with PTSD experienced early onset disease compared with veterans without PTSD; hypertensive (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.19-2.04), circulatory, (HR, 1.36; 95% CI, 1.11-1.67), digestive (HR, 1.24; 95% CI, 1.08-1.43), nervous (HR, 1.81; 95% CI, 1.59-2.06), musculoskeletal disease (HR, 1.49; 95% CI, 1.32-1.67), and signs and ill-defined disease (HR, 1.70; 95% CI, 1.51-1.92). Conclusions: PTSD is associated with increased prevalence and onset of physical disease among OEF/OIF veterans within the early years post military service. Rising rates of PTSD may foreshadow an increase in lifespan morbidity and healthcare utilization in the coming years among OEF/OIF veterans.
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