Trauma, posttraumatic stress disorder, and incident chronic disease

Posttraumatic stress disorder (PTSD) is associated with chronic disease risk, particularly cardiovascular disease (CVD). However, few studies have combined detailed measurements of trauma exposure and PTSD with incident chronic disease outcomes assessed using electronic health records (EHRs).

Our study examined associations between traumatic stress (combat exposure, lifetime trauma exposure, PTSD symptoms, and PTSD diagnosis) and chronic disease outcomes, including 7 clinical risk factors and 11 major chronic disease diagnoses assessed using EHRs.

Participants included 3696 post-9/11 US veterans enrolled in the VISN 6 (Veterans Integrated Service Networks 6) MIRECC (Mental Illness Research, Education, and Clinical Center)'s Post-Deployment Mental Health Study cohort who averaged 38.1 years old at baseline with 13.3 years of follow-up.

At baseline, greater PTSD symptoms were associated with higher body mass, more alcohol use, higher rates of smoking, hypertension, and hyperlipidemia. Over follow-up, veterans with more combat exposure (HR, 1.11; 95% CI, 1.04-1.19; P = .002), trauma exposure (HR, 1.15; 95% CI, 1.08-1.23; P < .001), PTSD symptoms (HR, 1.22; 95% CI, 1.14-1.30; P < .001), or a diagnosis of PTSD (HR, 1.39; 95% CI, 1.21-1.59; P < .001) developed more chronic disease. PTSD symptoms and diagnostic status showed consistent associations with incident onset of CVD, diabetes, and pulmonary disease, and associations remained when accounting for non-PTSD psychiatric diagnoses. Compared to veterans with current PTSD, veterans with past PTSD had reduced risk of developing chronic diseases.

Future research should examine if treating PTSD and the sequelae of trauma has the potential to reduce risk for chronic disease, particularly CVD, diabetes, and pulmonary disease.