Medical Comorbidity of Full and Partial Posttraumatic Stress Disorder in US Adults

Pietrzak, Robert H.; Goldstein, Risë B.; Southwick, Steven M.; Grant, Bridget F.

doi:10.1097/psy.0b013e3182303775

Cited by 151 publications

(65 citation statements)

References 78 publications

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“…This result was unexpected because some research has found subthreshold PTSD to be associated with physical health problems. 42 The 95% CI for the HR for the trauma/1–3 symptoms group was wide, however, and included values greater than 1. Further research that assesses all PTSD symptom criteria using a clinical interview is needed to better understand associations of full and partial PTSD diagnoses with CVD.…”

Section: Discussionmentioning

confidence: 99%

Trauma Exposure and Posttraumatic Stress Disorder Symptoms Predict Onset of Cardiovascular Events in Women

et al. 2015

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Background Psychological stress is a proposed risk factor for cardiovascular disease (CVD), and posttraumatic stress disorder (PTSD), the sentinel stress-related mental disorder, occurs twice as frequently in women as men. However, whether PTSD contributes to CVD risk in women is not established. Methods and Results We examined trauma exposure and PTSD symptoms in relation to incident CVD over a 20-year period in 49,978 women in the Nurses’ Health Study II. Proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD events confirmed by additional information or medical record review [n=548, including myocardial infarction (n=277) and stroke (n=271)]. Trauma exposure and PTSD symptoms were assessed using the Brief Trauma Questionnaire and a PTSD screen. Compared to no trauma exposure, endorsing 4 or more PTSD symptoms was associated with increased CVD risk after adjusting for age, family history, and childhood factors (HR=1.60 [95% CI, 1.20–2.13]). Being trauma-exposed and endorsing no PTSD symptoms was associated with elevated CVD risk (HR=1.45 [95% CI, 1.15–1.83]), although being trauma-exposed and endorsing 1–3 PTSD symptoms was not. After adjusting for adult health behaviors and medical risk factors, this pattern of findings was maintained. Health behaviors and medical risk factors accounted for 14% of the trauma/no symptoms-CVD association and 47% of the trauma/4+ symptoms-CVD association. Conclusion Trauma exposure and elevated PTSD symptoms may increase risk of CVD in this population of women. These findings suggest screening for CVD risk and reducing health risk behaviors in trauma-exposed women may be promising avenues for prevention and intervention.

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Section: Discussionmentioning

confidence: 99%

Trauma Exposure and Posttraumatic Stress Disorder Symptoms Predict Onset of Cardiovascular Events in Women

et al. 2015

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“…These results suggest the presence of insulin resistance with oral glucose challenge. Although a number of epidemiological studies have found an association between PTSD and diabetes as well as the metabolic syndrome (Lukaschek et al, 2013; Agyemang et al, 2012; Boyko et al, 2010; Goodwin et al, 2005; Pietrzak et al, 2011; Trief et al, 2006; Weiss et al, 2011; Heppner et al, 2009), factors such as medications and co-morbid health conditions may be significant confounders. A unique aspect of this current study is that the subjects are all free of medications, and do not have any chronic medical conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Individuals with PTSD are at increased risk for numerous medical illnesses, including diabetes mellitus (DM), cardiovascular disease, and rheumatoid arthritis (Boscarino, 2004; Weisberg et al, 2002; O’Toole et al, 2007; Bedi et al, 2007). Epidemiological studies have shown that PTSD is associated with a 2–4 fold increased risk of Type 2 diabetes, compared to individuals without PTSD (Lukaschek et al, 2013; Agyemang et al, 2012; Boyko et al, 2010; Goodwin et al, 2005; Pietrzak et al, 2011; Trief et al, 2006). These studies have been conducted in a wide range of samples, including asylum seekers in Europe, veterans in the US, and population based samples of middle-aged and elderly individuals in Germany (Lukaschek et al, 2013; Agyemang et al, 2012; Boyko et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Hyperinsulinemic response to oral glucose challenge in individuals with posttraumatic stress disorder

Rao

Chau

Madden

et al. 2014

Psychoneuroendocrinology

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Summary Background Posttraumatic stress disorder (PTSD) is associated with a 2–4 fold increased risk of developing Type 2 diabetes mellitus. However, detailed assessments of glucose metabolism and insulin secretion in a study designed to minimize confounders are lacking. Furthermore, few studies examine potential mechanisms involved. We analyzed data from a case-control study of medically healthy, medication-free adults to determine whether individuals with PTSD had abnormal glucose or insulin response to oral glucose tolerance test (OGTT) compared to controls. Secondarily, we assessed potential mediators such as sleep, cortisol and adiponectin. Methods Data was analyzed from 92 age and gender-matched subjects (44 PTSD, 48 controls). Chronic PTSD was diagnosed using the Structured Clinical Interview for DSM-IV and Clinician Administered PTSD Scale. Subjects underwent 75-gram OGTT, actigraphy and sleep diary (to quantify sleep duration), polysomnography (to assess slow wave sleep [SWS] and delta power), and overnight blood sampling (for cortisol and adiponectin). Results At baseline, individuals with PTSD had mildly increased insulin levels (by 19%, compared to controls, p=0.048) that was mediated primarily by weight. In response to OGTT, the PTSD group had higher levels of insulin at 120 min (by 44%, p=0.03) and insulin AUC (by 43%, p=0.015) compared to controls, after adjusting for confounders. Glucose levels were similar in the two groups. Although self-reported sleep duration, SWS, and delta power differed between PTSD subjects and controls, they did not mediate the effects of PTSD status on insulin response. Conclusion In this case-control study, individuals with PTSD had a hyperinsulinemic response to oral glucose challenge compared to controls, suggestive of insulin resistance.

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“…Although subthreshold PTSD is associated with both functional impairment and physical conditions (Pietrzak et al, 2011), comorbidity studies have largely focused on those who meet full diagnostic criteria for PTSD. The importance of examining subthreshold PTSD is high, given that PTSD presentations are heterogeneous (Yehuda and McFarlane, 1995), and the specific symptom clusters (e.g., arousal, reexperiencing) linked to physical conditions are unknown.…”

Section: Introductionmentioning

confidence: 99%

Physical health conditions associated with full and subthreshold PTSD in U.S. military veterans: Results from the National Health and Resilience in Veterans Study

El‐Gabalawy

Blaney

Tsai

et al. 2018

Journal of Affective Disorders

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Background: While both full and subthreshold posttraumatic stress disorder (PTSD) may be linked to physical conditions, contemporary population-based data on these associations in military veterans are scarce. Further, little is known about how component aspects of PTSD, which is a heterogeneous disorder, may relate to physical conditions in this population. Methods: Data were analyzed from a population-based sample of 3157 U.S. military veterans who participated in the 2011 National Health and Resilience in Veterans Study. Multiple logistic regression analyses evaluated associations between full and subthreshold PTSD, and physical conditions. Results: A total 6.1% of the sample met screening criteria for full PTSD and 9.0% for subthreshold PTSD. Both full and subthreshold PTSD were associated with increased odds of sleep disorder (adjusted odds ratio [AOR] = 3.52 and 2.10, respectively) and respiratory conditions (AOR = 2.60 and 1.87, respectively). Full PTSD was additionally associated with increased odds of osteoporosis or osteopenia (AOR = 2.72) and migraine (AOR = 1.91), while subthreshold PTSD only was associated with increased odds of diabetes (AOR = 1.42). Analyses of PTSD symptom clusters revealed that all of these associations were primarily driven by dysphoric arousal symptoms, which are characterized by sleep difficulties, anger/irritability, and concentration problems. Limitations: The study used self-report measures for health conditions and DSM-IV diagnostic criteria for PTSD. Conclusion: Results of this study provide a characterization of physical conditions associated with full and subthreshold PTSD in U.S. military veterans. They highlight the potential importance of PTSD dysphoric arousal in risk models of certain physical conditions in this population.

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Medical Comorbidity of Full and Partial Posttraumatic Stress Disorder in US Adults

Cited by 151 publications

References 78 publications

Trauma Exposure and Posttraumatic Stress Disorder Symptoms Predict Onset of Cardiovascular Events in Women

Trauma Exposure and Posttraumatic Stress Disorder Symptoms Predict Onset of Cardiovascular Events in Women

Hyperinsulinemic response to oral glucose challenge in individuals with posttraumatic stress disorder

Physical health conditions associated with full and subthreshold PTSD in U.S. military veterans: Results from the National Health and Resilience in Veterans Study

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