Physical health burden of PTSD, depression, and their comorbidity in the U.S. veteran population: Morbidity, functioning, and disability

Brandon Nichter; Sonya Norman; Moira Haller; Robert H Pietrzak

doi:10.1016/j.jpsychores.2019.109744

Physical health burden of PTSD, depression, and their comorbidity in the U.S. veteran population: Morbidity, functioning, and disability

J Psychosom Res. 2019 Sep:124:109744. doi: 10.1016/j.jpsychores.2019.109744. Epub 2019 Jun 17.

Authors

Brandon Nichter¹, Sonya Norman², Moira Haller³, Robert H Pietrzak⁴

Affiliations

¹ VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA. Electronic address: bnichter@ucsd.edu.
² VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA.
³ VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA.
⁴ National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.

PMID: 31443821
DOI: 10.1016/j.jpsychores.2019.109744

Abstract

Objective: Although it is well-established that posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are associated with physical health difficulties among U.S. veterans, the incremental burden of having both disorders relative to either one alone remains largely unknown. The goal of this study was to provide the first population-based characterization of the burden of medical illness associated with PTSD, MDD, and their comorbidity among U.S. veterans.

Methods: Data were from National Health and Resilience in Veterans Study, a nationally representative survey of U.S. veterans (n = 2732). Analyses (a) examined the magnitude of medical comorbidity and disability associated with PTSD, MDD, and co-occurring PTSD/MDD; and (b) compared physical functioning by PTSD/MDD status.

Results: After adjusting for sociodemographic characteristics and substance use disorders, veterans with comorbid PTSD/MDD were more likely to be diagnosed with heart disease, migraine, fibromyalgia, and rheumatoid arthritis compared to those with MDD-only. Conversely, they were at greater odds of being diagnosed with hypercholesterolemia and hypertension relative to those with PTSD-only. Comorbid PTSD/MDD status was associated with approximately three times greater odds of disability compared to MDD alone. Veterans with co-occurring PTSD/MDD and PTSD-only exhibited worse physical functioning than those with MDD-only.

Conclusion: Findings indicate that veterans with co-occurring PTSD/MDD represent a high-risk group for cardiovascular disease and other health problems, and therefore deserve careful attention from healthcare systems. Further research is needed to investigate mechanisms underlying associations between PTSD/MDD and physical health morbidities, as well as whether treatment of PTSD/MDD can reduce risk for comorbid medical conditions.

Keywords: Depression; Disability; Disease burden; Functioning; Medical comorbidity; Physical health; Posttraumatic stress disorder.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
Aged
Aged, 80 and over
Comorbidity*
Depression / epidemiology*
Disabled Persons / psychology*
Disabled Persons / statistics & numerical data
Female
Health Status*
Humans
Male
Middle Aged
Migraine Disorders / epidemiology
Stress Disorders, Post-Traumatic / epidemiology*
Substance-Related Disorders / epidemiology
United States / epidemiology
Veterans / psychology*
Veterans / statistics & numerical data*
Young Adult