Research in Context

What is the Relation Between PTSD and Medical Conditions?

Fed Pract. 2018 September;35(9):[e-pub ahead of print]

References

1. US Department of Veteran Affairs. How common is PTSD? https://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp. Updated October 3, 2016. Accessed September 14, 2018.

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4. Tsai J, Harpaz-Rotem I, Armour C, Southwick SM, Krystal JH, Pietrzak RH. Dimensional structure of DSM-5 posttraumatic stress disorder symptoms: results from the National Health and Resilience in Veterans Study. J Clin Psychiatry. 2015;76(5):546-553.

5. Schalinski I, Elbert TR, Schauer M. Cardiac defense in response to imminent threat in women with multiple trauma and severe PTSD. Psychophysiology. 2013;50(7):691-700.

6. National Institute of Mental Health. Post-traumatic stress disorder. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml. Updated February 2016. Accessed September 14, 2018.

7. Sledjeski EM, Speisman B, Dierker LC. Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R). J Behav Med. 2008;31(4):341-349.

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Nonetheless, findings concerning the increased risk for heart problems among adults with PTSD are striking and important given that heart disease is one of the main causes of death in the United States. ⁹Specifically, well over half a million people in the United States die of heart disease annually as the leading cause of death. ¹⁷ Heart disease has been one of the top 2 leading causes of death for Americans since 1975. ¹⁸

In the veteran population, heart disease has also been found to be a leading cause of death, accounting for 20 percent of all deaths in veterans from 1993 to 2002. ¹⁹ Posttraumatic stress disorder has been linked to a 55% increase in the chance of developing heart disease or dying from a heart-related medical problem. ⁹ For example, data from the World Trade Center Registry showed that on average adults who developed PTSD from the 9/11 terrorist attack had a heightened risk for heart disease for 3 years after the event. ⁹ Other studies of the U.S. veteran population have shown that veterans with PTSD are more likely to experience heart failure, myocardial infarction, and cardiac arrhythmia than other veterans. ^10,20

Veteran-Specific Issues

In the US veteran population, there is a higher prevalence of PTSD and physical health conditions when compared with the general population. ^21,21 The prevalence of combat-related PTSD in veterans ranges from 2% to 17%, compared with a 7% to 8% prevalence of PTSD in the general population. ^1,22 In a study of veterans who were seen in patient-aligned care teams (PACTs) > 1 year, 9.3% were diagnosed with PTSD and many of those with PTSD also had other medical conditions. ²¹ It was found that 43% of veterans seen by PACTs with chronic pain had PTSD, 33% with hypertension had PTSD, and 32% with diabetes mellitus had PTSD. ²¹ In another study of combat veterans it was found that those who were trauma-exposed had more physical health problems, regardless of the amount of time spent in combat. ¹⁹ Consequentially, veterans with PTSD have been found to make more frequent visits to primary care and specialty medical care clinics. ²¹

Integrated healthcare has been a main service model for the Department of Veteran Affairs (VA) and several programs have been created to integrate mental health and primary care. For example, the VA primary care-mental health integration (PCMHI) program places mental health services within primary care services. ²¹ Assessments of this program have demonstrated that it improves the screening of psychological disorders and preventive care of patients who have psychological disorders. ²¹ Specifically, it has been found that contact with PCMHI diminishes risks for poor outcomes among psychiatric patients. ²¹ Another program called SCAN-ECHO, provides specialized training for VA general practitioners on treating specific health conditions through a specialty care team and video conferencing. ²³ This VA program allows for patients in more remote locations to receive specialty care from generalists. ²³ While there has not yet been a focus in SCAN-ECHO on PTSD, this may be considered in the future as a way to better train primary care and mental health providers about PTSD and common comorbid medical conditions.