Posttraumatic Stress Symptomatology as a Mediator of the Relationship Between Warzone Exposure and Physical Health Symptoms in Men and Women

Abstract

The mediating role of posttraumatic stress symptomatology (PSS) on the association between warzone exposure and physical health symptoms in 7 bodily systems (cardiovascular, dermatological, gastrointestinal, genitourinary, musculoskeletal, neurological, and pulmonary) was examined. We also examined if mediation effects varied as a function of sex. A sample of 317 U.S. Gulf war veterans was assessed for warzone exposure, PSS, and physical health symptoms 10 years after deployment. PSS was significantly associated with postdeployment physical health in all symptom categories when accounting for predeployment health (with effect sizes ranging from a 1.27-1.64 increase in the likelihood of postdeployment physical health symptoms with a 1 standard deviation increase in the PSS symptoms). PSS severity mediated the relationship between warzone exposure and postdeployment symptoms in all physical health domains (with percent mediation ranging 44%-75%). A significant Warzone Exposure × PSS interaction emerged for 5 outcomes such that the effect of PSS on physical health was stronger for veterans reporting lower warzone exposure. No significant interactions with sex emerged. These findings suggest the important influence of PSS on physical health symptoms for both men and women.

Physical Injury and Somatic Complaints: The Mediating Role of Posttraumatic Stress Symptoms in Young Survivors of a Terror Attack

“…Some of the findings from the causal mediation analysis are in accordance with the well‐established hypothesis that PTSS may act as a mediator between exposure to trauma and poor physical health (Eadie, Runtz, & Spencer‐Rodgers, ; Green & Kimerling, ; Schnurr & Green, ; Schnurr & Jankowski, ; Wachen et al., ). We believe that there is a lack of research on whether PTSS may act as a mediator linking physical injury specifically to somatic complaints.…”

“…On the other hand, exposure to physical injury has been closely associated with posttraumatic stress symptoms (PTSS) after a range of traumatic events (Bonanno, Galea, Bucciarelli, & Vlahov, 2006;Bugge et al, 2015;Hsu, Chong, Yang, & Yen, 2002;Kuo, Wu, Ma, Chiu, & Chou, 2007;Neria, DiGrande, & Adams, 2011;Perlman et al, 2011). Also, a significant association between PTSS and poorer physical health has been found in several studies, and the mediating role of PTSS between trauma exposure and poorer somatic health was hypothesized early on (Green & Kimerling, 2004;Gupta, 2013;Pacella, Hruska, & Delahanty, 2013;Wachen et al, 2013;Zatzick, Russo, & Katon, 2003;Zatzick et al, 2008). However, research on the relationship between exposure to traumatic events, posttraumatic stress (PTS), and somatic complaints has been limited.…”

“…The overall lack of longitudinal study designs has made it difficult to come to any conclusions about causality (Afari et al., ; Gupta, ; Pacella et al., ; van den Berg et al., ; Wachen et al., ). Further, studies have been limited because they lack a measure of sustained physical injury, even after events with presumably many injured survivors (Afari et al., ; Pacella et al., ; van den Berg et al., ; Wachen et al., ). As a consequence, possible mechanisms, such as the potential mediating role of PTSS linking injury to later poor physical health, have been inadequately investigated.…”

Associations between Lifetime Traumatic Events and Subsequent Chronic Physical Conditions: A Cross-National, Cross-Sectional Study

“…This mediation is highly plausible because PTSD and other mental disorders have been repeatedly associated with concurrent and subsequent poor physical health [2]–[6]. Despite this, the role of PTSD remains unclear, because although many studies have found PTSD to mediate associations between traumatic event exposures and physical health [7]–[14], other studies have suggested that trauma exposure has independent associations with physical health problems [15]–[22]. This question of whether traumatic stress is associated with increased risk of physical ill-health independently of PTSD has important implications for the mechanisms linking trauma and physical health and for treatment.…”

Emergence Delirium With Post-traumatic Stress Disorder Among Military Veterans

“…The prevalence of ED in the general population was reported at 4.7% [1], while at 20% to 27% in combat veterans in the military population [4], PTSD was found to be significantly associated with both post-deployment physical and chronic mental health disorders [5]. Patients with PTSD were reported to experience flashbacks related to PTSD incidents, and the U.S. Department of Veterans Affairs reported 11% to 20% of combat veterans of Iraq and Afghanistan may undergo PTSD-related flashbacks for years [6].…”