Biological and epigenetic pathways linking PTSD to accelerated aging: a systematic review and narrative synthesis

Post-traumatic stress disorder (PTSD) may accelerate biological aging, but the pathways and evidence remain uncertain. We systematically reviewed associations between PTSD and epigenetic and other aging biomarkers.

We searched PubMed, Embase, Web of Science, and Scopus through 1 March 2026 for studies of adults with validated PTSD assessment. Two reviewers screened records and extracted data. Risk of bias was assessed with the Newcastle-Ottawa Scale. Findings were synthesized narratively because study designs and outcomes were heterogeneous.

Twenty-four studies including 512,768 participants met the inclusion criteria. Twenty-two (91.7%) reported positive associations between PTSD and accelerated biological aging across epigenetic clocks, telomere length, and transcriptional measures; GrimAge acceleration ranged from 1.83 to 2.53 years in veterans. Epigenome-wide association study findings implicated immune- and inflammation-related genes. Longitudinal and twin studies supported temporal precedence and partial independence from genetic confounding. However, 79.2% of studies were United States-based, 45.8% involved military or veteran samples, and most were cross-sectional, limiting generalizability and causal inference.

PTSD is associated with faster biological aging across several biomarkers, but diverse longitudinal and intervention studies are needed before causality or reversibility can be established. More diverse long-term studies and treatment trials areneeded before these measures can guide routine care.