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Posttraumatic stress disorder (PTSD) develops after exposure to a traumatic event, which can involve witnessing the traumatic event or directly experiencing the trauma.1 The prevalence of PTSD in the general population is approximately 7% to 8%.1 However, not everyone who experiences trauma develops PTSD since the majority of men and women experience at least 1 traumatic event in their lifetimes but do not develop PTSD.1
In order to be diagnosed with PTSD, a patient must meet several criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).2 The patient is required to have exposure to trauma, begin having a certain number of prespecified symptoms, and these symptoms must persist for at least a month.2 Symptoms of PTSD include re-experiencing the traumatic event, avoidance of stimuli associated with the trauma, negative cognitions and mood, and hyperarousal.3,4 The hyperarousal that is associated with PTSD has been theorized to be either a result of the trauma experienced or exacerbation of a pre-existing tendency.5 This can manifest in various ways, such as hypervigilance, exaggerated startle response, trouble sleeping, problems concentrating, or irritability.3,5 These symptoms can cause individuals with PTSD to have elevated levels of stress and to experience difficulties with completing everyday tasks.6
PTSD and Inflimmation-Related Medical Conditions
Posttraumatic stress disorder has been linked to various physical health problems. Studies have found that PTSD is often comorbid with cardiovascular, autoimmune, musculoskeletal, digestive, chronic pain and respiratory disorders.3,7-11 Inflammation may be a contributing factor in the associations between PTSD and these conditions.12-16 Studies have found that increases in pro-inflammatory cytokines and interferons are associated with PTSD, as well as changes in immune-related blood cells.12-16
Considering that PTSD has been linked to many medical conditions that have inflammatory components, especially cardiovascular disease, inflammatory markers may be early indicators of PTSD.12-16 Additionally, inflammatory markers such as cytokines and interferons can be targeted through medications, and potentially influence symptoms.13 However, the relation between PTSD and inflammation remains unclear. Associations between PTSD and inflammation-related medical conditions may be due to confounding variables, such as sociodemographic characteristics and health behaviors. Moreover, the list of inflammation-related medical conditions is long and there is no universal agreement of what conditions are related to inflammation.
We recently conducted an epidemiological study using a representative sample of residents living in New York City and found significant associations between PTSD and some inflammation-related medical conditions.8 We found that participants who had PTSD were more than 4 times more likely to report having had a heart attack or emphysema than were those without PTSD. In addition, participants with PTSD were 2 times more likely to report having hypercholesterolemia, insulin resistance, and angina than were those without PTSD. However, we also found that participants who had PTSD were less likely to develop other inflammation-related conditions like hypertension, type 1 diabetes mellitus, asthma, coronary heart disease, stroke, osteoporosis, and failing kidney.
Together, these associations suggest there is a strong link between PTSD and certain medical conditions, but the link may not be solely based on inflammation.8 Moreover, positive associations between PTSD and hypertension, asthma, and coronary heart disease disappeared when depression was controlled for. This finding points to depression as a major factor, consistent with previous findings that depression is associated with the development of various medical conditions and may be a stronger factor than PTSD.8
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.9 Specifically, 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.
Through their professional experiences, VA practitioners have knowledge of the link between PTSD and various medical conditions. The VA has already implemented screening for PTSD in primary care clinics, but it is important for mental health providers and medical practitioners to continue educating themselves about medical comorbidities and the possible exacerbation of medical conditions due to PTSD.21 Some physical manifestations of PTSD symptoms, such as sleep disturbances, avoidance of crowds, or hypervigilance, can affect overall health. Hypervigilance can result in over-activation of stress pathways, which puts patients with PTSD at a heighted risk for medical conditions.11 Additionally, some of the cognitive symptoms of PTSD, such as sleep problems, may worsen current health problems. Therefore, further collaboration between primary care physicians and mental health providers is beneficial in treating clients that have PTSD.
Conclusion
Posttraumatic stress disorder is a prevalent condition among veterans that is often comorbid with other medical conditions, which may have important implications for VA healthcare teams.3 It can manifest both psychologically and physiologically, and can greatly affect a patient’s quality of life.3 Veterans with PTSD may be at increased risk for certain medical conditions, such as cardiovascular disease.9,10,20 However, preventive screenings for medical conditions linked to PTSD and regular health assessments may reduce these risks.21 The VA’s infrastructure of integrated medical and mental healthcare can help provide comprehensive care to the many veterans who have both PTSD and serious medical conditions.21 While the relation between PTSD and inflammation remains unclear, it is clear that many people with PTSD have medical conditions that may be affected by PTSD symptoms.
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.
2. Pai A, Suris AM, North CS. Posttraumatic stress disorder in the DSM-5: controversy, change, and conceptual considerations. Behav Sci (Basel). 2017;7(1):pii E7.
3. Gupta MA. Review of somatic symptoms in post-traumatic stress disorder. Int Rev Psychiatry. 2013;25(1):86-99.
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.
8. Tsai J, Shen J. Exploring the link between posttraumatic stress disorder and inflammation-related medical conditions: an epidemiological examination. Psychiatr Q. 2017;88(4):909-916.
9. Tulloch H, Greenman PS, Tassé V. Post-traumatic stress disorder among cardiac patients: Prevalence, risk factors, and considerations for assessment and treatment. Behav Sci (Basel). 2014;5(1):27-40.
10. Britvić D, Antičević V, Kaliterna M, et al. Comorbidities with posttraumatic stress disorder (PTSD) among combat veterans: 15 years postwar analysis. Int J Clin Health Psychol. 2015;15(2):81-92.
11. Pacella ML, Hruska B, Delahanty DL. The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review. J Anxiety Disord. 2013;27(1):33-46.
12. Brouwers C, Wolf J, von Känel R. Inflammatory markers in PTSD. In: Martin CR, Preedy VR, Patel VB, eds. Comprehensive Guide to Post-Traumatic Stress Disorder. Zürich, Switzerland: Springer; 2016:979-993.
13. Passos IC, Vasconcelos-Moreno MP, Costa LG, et al. Inflammatory markers in post-traumatic stress disorder: a systematic review, meta-analysis, and meta-regression. Lancet Psychiatry. 2015;2(11):1002-1012.
14. von Känel R, Begré S, Abbas CC, Saner H, Gander ML, Schmid JP. Inflammatory biomarkers in patients with posttraumatic stress disorder caused by myocardial infarction and the role of depressive symptoms. Neuroimmunomodulation. 2010;17(1):39-46.
15. Spitzer C, Barnow S, Völzke H, et al. Association of posttraumatic stress disorder with low-grade elevation of C-reactive protein: evidence from the general population. J Psychiatr Res. 2010;44(1):15-21.
16. Gola H, Engler H, Sommershof A, et al. Posttraumatic stress disorder is associated with an enhanced spontaneous production of pro-inflammatory cytokines by peripheral blood mononuclear cells. BMC Psychiatry. 2013;13:40.
17. Sidney S, Sorel ME, Quesenberry CP, et al. Comparative trends in heart disease, stroke, and all-cause mortality in the United States and a large integrated healthcare delivery system. Am J Med. 2018;131(7):829-836.e1.
18. US Department of Health and Human Service, Centers for Disease Control and Prevention, National Center for Health Statistics. Health, United States, 2016: with chartbook on long-term trends in health. https://www.cdc.gov/nchs/data/hus/hus16.pdf. Published May 2017. Accessed September 14, 2018.
19. Weiner J, Richmond TS, Conigliaro J, Wiebe DJ. Military veteran mortality following a survived suicide attempt. BMC Public Health. 2011;11:374.
20. Roy SS, Foraker RE, Girton RA, Mansfield AJ. Posttraumatic stress disorder and incident heart failure among a community-based sample of US veterans. Am J Public Health. 2015;105(4):757-763.
21. Trivedi RB, Post EP, Sun H, et al. Prevalence, comorbidity, and prognosis of mental health among US veterans. Am J Public Health. 2015;105(12):2564-2569.
22. Richardson LK, Frueh BC, Acierno R. Prevalence estimates of combat-related post-traumatic stress disorder: a critical review. Aust N Z J Psychiatry. 2010;44(1):4-19.
23. US Department of Veterans Affairs. In the spotlight: VA uses technology to provide rural veterans greater access to specialty care services. https://www.patientcare.va.gov/In_the_Spotlight.asp. Updated June 3, 2015. Accessed September 14, 2018.
Posttraumatic stress disorder (PTSD) develops after exposure to a traumatic event, which can involve witnessing the traumatic event or directly experiencing the trauma.1 The prevalence of PTSD in the general population is approximately 7% to 8%.1 However, not everyone who experiences trauma develops PTSD since the majority of men and women experience at least 1 traumatic event in their lifetimes but do not develop PTSD.1
In order to be diagnosed with PTSD, a patient must meet several criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).2 The patient is required to have exposure to trauma, begin having a certain number of prespecified symptoms, and these symptoms must persist for at least a month.2 Symptoms of PTSD include re-experiencing the traumatic event, avoidance of stimuli associated with the trauma, negative cognitions and mood, and hyperarousal.3,4 The hyperarousal that is associated with PTSD has been theorized to be either a result of the trauma experienced or exacerbation of a pre-existing tendency.5 This can manifest in various ways, such as hypervigilance, exaggerated startle response, trouble sleeping, problems concentrating, or irritability.3,5 These symptoms can cause individuals with PTSD to have elevated levels of stress and to experience difficulties with completing everyday tasks.6
PTSD and Inflimmation-Related Medical Conditions
Posttraumatic stress disorder has been linked to various physical health problems. Studies have found that PTSD is often comorbid with cardiovascular, autoimmune, musculoskeletal, digestive, chronic pain and respiratory disorders.3,7-11 Inflammation may be a contributing factor in the associations between PTSD and these conditions.12-16 Studies have found that increases in pro-inflammatory cytokines and interferons are associated with PTSD, as well as changes in immune-related blood cells.12-16
Considering that PTSD has been linked to many medical conditions that have inflammatory components, especially cardiovascular disease, inflammatory markers may be early indicators of PTSD.12-16 Additionally, inflammatory markers such as cytokines and interferons can be targeted through medications, and potentially influence symptoms.13 However, the relation between PTSD and inflammation remains unclear. Associations between PTSD and inflammation-related medical conditions may be due to confounding variables, such as sociodemographic characteristics and health behaviors. Moreover, the list of inflammation-related medical conditions is long and there is no universal agreement of what conditions are related to inflammation.
We recently conducted an epidemiological study using a representative sample of residents living in New York City and found significant associations between PTSD and some inflammation-related medical conditions.8 We found that participants who had PTSD were more than 4 times more likely to report having had a heart attack or emphysema than were those without PTSD. In addition, participants with PTSD were 2 times more likely to report having hypercholesterolemia, insulin resistance, and angina than were those without PTSD. However, we also found that participants who had PTSD were less likely to develop other inflammation-related conditions like hypertension, type 1 diabetes mellitus, asthma, coronary heart disease, stroke, osteoporosis, and failing kidney.
Together, these associations suggest there is a strong link between PTSD and certain medical conditions, but the link may not be solely based on inflammation.8 Moreover, positive associations between PTSD and hypertension, asthma, and coronary heart disease disappeared when depression was controlled for. This finding points to depression as a major factor, consistent with previous findings that depression is associated with the development of various medical conditions and may be a stronger factor than PTSD.8
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.9 Specifically, 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.
Through their professional experiences, VA practitioners have knowledge of the link between PTSD and various medical conditions. The VA has already implemented screening for PTSD in primary care clinics, but it is important for mental health providers and medical practitioners to continue educating themselves about medical comorbidities and the possible exacerbation of medical conditions due to PTSD.21 Some physical manifestations of PTSD symptoms, such as sleep disturbances, avoidance of crowds, or hypervigilance, can affect overall health. Hypervigilance can result in over-activation of stress pathways, which puts patients with PTSD at a heighted risk for medical conditions.11 Additionally, some of the cognitive symptoms of PTSD, such as sleep problems, may worsen current health problems. Therefore, further collaboration between primary care physicians and mental health providers is beneficial in treating clients that have PTSD.
Conclusion
Posttraumatic stress disorder is a prevalent condition among veterans that is often comorbid with other medical conditions, which may have important implications for VA healthcare teams.3 It can manifest both psychologically and physiologically, and can greatly affect a patient’s quality of life.3 Veterans with PTSD may be at increased risk for certain medical conditions, such as cardiovascular disease.9,10,20 However, preventive screenings for medical conditions linked to PTSD and regular health assessments may reduce these risks.21 The VA’s infrastructure of integrated medical and mental healthcare can help provide comprehensive care to the many veterans who have both PTSD and serious medical conditions.21 While the relation between PTSD and inflammation remains unclear, it is clear that many people with PTSD have medical conditions that may be affected by PTSD symptoms.
Posttraumatic stress disorder (PTSD) develops after exposure to a traumatic event, which can involve witnessing the traumatic event or directly experiencing the trauma.1 The prevalence of PTSD in the general population is approximately 7% to 8%.1 However, not everyone who experiences trauma develops PTSD since the majority of men and women experience at least 1 traumatic event in their lifetimes but do not develop PTSD.1
In order to be diagnosed with PTSD, a patient must meet several criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).2 The patient is required to have exposure to trauma, begin having a certain number of prespecified symptoms, and these symptoms must persist for at least a month.2 Symptoms of PTSD include re-experiencing the traumatic event, avoidance of stimuli associated with the trauma, negative cognitions and mood, and hyperarousal.3,4 The hyperarousal that is associated with PTSD has been theorized to be either a result of the trauma experienced or exacerbation of a pre-existing tendency.5 This can manifest in various ways, such as hypervigilance, exaggerated startle response, trouble sleeping, problems concentrating, or irritability.3,5 These symptoms can cause individuals with PTSD to have elevated levels of stress and to experience difficulties with completing everyday tasks.6
PTSD and Inflimmation-Related Medical Conditions
Posttraumatic stress disorder has been linked to various physical health problems. Studies have found that PTSD is often comorbid with cardiovascular, autoimmune, musculoskeletal, digestive, chronic pain and respiratory disorders.3,7-11 Inflammation may be a contributing factor in the associations between PTSD and these conditions.12-16 Studies have found that increases in pro-inflammatory cytokines and interferons are associated with PTSD, as well as changes in immune-related blood cells.12-16
Considering that PTSD has been linked to many medical conditions that have inflammatory components, especially cardiovascular disease, inflammatory markers may be early indicators of PTSD.12-16 Additionally, inflammatory markers such as cytokines and interferons can be targeted through medications, and potentially influence symptoms.13 However, the relation between PTSD and inflammation remains unclear. Associations between PTSD and inflammation-related medical conditions may be due to confounding variables, such as sociodemographic characteristics and health behaviors. Moreover, the list of inflammation-related medical conditions is long and there is no universal agreement of what conditions are related to inflammation.
We recently conducted an epidemiological study using a representative sample of residents living in New York City and found significant associations between PTSD and some inflammation-related medical conditions.8 We found that participants who had PTSD were more than 4 times more likely to report having had a heart attack or emphysema than were those without PTSD. In addition, participants with PTSD were 2 times more likely to report having hypercholesterolemia, insulin resistance, and angina than were those without PTSD. However, we also found that participants who had PTSD were less likely to develop other inflammation-related conditions like hypertension, type 1 diabetes mellitus, asthma, coronary heart disease, stroke, osteoporosis, and failing kidney.
Together, these associations suggest there is a strong link between PTSD and certain medical conditions, but the link may not be solely based on inflammation.8 Moreover, positive associations between PTSD and hypertension, asthma, and coronary heart disease disappeared when depression was controlled for. This finding points to depression as a major factor, consistent with previous findings that depression is associated with the development of various medical conditions and may be a stronger factor than PTSD.8
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.9 Specifically, 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.
Through their professional experiences, VA practitioners have knowledge of the link between PTSD and various medical conditions. The VA has already implemented screening for PTSD in primary care clinics, but it is important for mental health providers and medical practitioners to continue educating themselves about medical comorbidities and the possible exacerbation of medical conditions due to PTSD.21 Some physical manifestations of PTSD symptoms, such as sleep disturbances, avoidance of crowds, or hypervigilance, can affect overall health. Hypervigilance can result in over-activation of stress pathways, which puts patients with PTSD at a heighted risk for medical conditions.11 Additionally, some of the cognitive symptoms of PTSD, such as sleep problems, may worsen current health problems. Therefore, further collaboration between primary care physicians and mental health providers is beneficial in treating clients that have PTSD.
Conclusion
Posttraumatic stress disorder is a prevalent condition among veterans that is often comorbid with other medical conditions, which may have important implications for VA healthcare teams.3 It can manifest both psychologically and physiologically, and can greatly affect a patient’s quality of life.3 Veterans with PTSD may be at increased risk for certain medical conditions, such as cardiovascular disease.9,10,20 However, preventive screenings for medical conditions linked to PTSD and regular health assessments may reduce these risks.21 The VA’s infrastructure of integrated medical and mental healthcare can help provide comprehensive care to the many veterans who have both PTSD and serious medical conditions.21 While the relation between PTSD and inflammation remains unclear, it is clear that many people with PTSD have medical conditions that may be affected by PTSD symptoms.
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.
2. Pai A, Suris AM, North CS. Posttraumatic stress disorder in the DSM-5: controversy, change, and conceptual considerations. Behav Sci (Basel). 2017;7(1):pii E7.
3. Gupta MA. Review of somatic symptoms in post-traumatic stress disorder. Int Rev Psychiatry. 2013;25(1):86-99.
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.
8. Tsai J, Shen J. Exploring the link between posttraumatic stress disorder and inflammation-related medical conditions: an epidemiological examination. Psychiatr Q. 2017;88(4):909-916.
9. Tulloch H, Greenman PS, Tassé V. Post-traumatic stress disorder among cardiac patients: Prevalence, risk factors, and considerations for assessment and treatment. Behav Sci (Basel). 2014;5(1):27-40.
10. Britvić D, Antičević V, Kaliterna M, et al. Comorbidities with posttraumatic stress disorder (PTSD) among combat veterans: 15 years postwar analysis. Int J Clin Health Psychol. 2015;15(2):81-92.
11. Pacella ML, Hruska B, Delahanty DL. The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review. J Anxiety Disord. 2013;27(1):33-46.
12. Brouwers C, Wolf J, von Känel R. Inflammatory markers in PTSD. In: Martin CR, Preedy VR, Patel VB, eds. Comprehensive Guide to Post-Traumatic Stress Disorder. Zürich, Switzerland: Springer; 2016:979-993.
13. Passos IC, Vasconcelos-Moreno MP, Costa LG, et al. Inflammatory markers in post-traumatic stress disorder: a systematic review, meta-analysis, and meta-regression. Lancet Psychiatry. 2015;2(11):1002-1012.
14. von Känel R, Begré S, Abbas CC, Saner H, Gander ML, Schmid JP. Inflammatory biomarkers in patients with posttraumatic stress disorder caused by myocardial infarction and the role of depressive symptoms. Neuroimmunomodulation. 2010;17(1):39-46.
15. Spitzer C, Barnow S, Völzke H, et al. Association of posttraumatic stress disorder with low-grade elevation of C-reactive protein: evidence from the general population. J Psychiatr Res. 2010;44(1):15-21.
16. Gola H, Engler H, Sommershof A, et al. Posttraumatic stress disorder is associated with an enhanced spontaneous production of pro-inflammatory cytokines by peripheral blood mononuclear cells. BMC Psychiatry. 2013;13:40.
17. Sidney S, Sorel ME, Quesenberry CP, et al. Comparative trends in heart disease, stroke, and all-cause mortality in the United States and a large integrated healthcare delivery system. Am J Med. 2018;131(7):829-836.e1.
18. US Department of Health and Human Service, Centers for Disease Control and Prevention, National Center for Health Statistics. Health, United States, 2016: with chartbook on long-term trends in health. https://www.cdc.gov/nchs/data/hus/hus16.pdf. Published May 2017. Accessed September 14, 2018.
19. Weiner J, Richmond TS, Conigliaro J, Wiebe DJ. Military veteran mortality following a survived suicide attempt. BMC Public Health. 2011;11:374.
20. Roy SS, Foraker RE, Girton RA, Mansfield AJ. Posttraumatic stress disorder and incident heart failure among a community-based sample of US veterans. Am J Public Health. 2015;105(4):757-763.
21. Trivedi RB, Post EP, Sun H, et al. Prevalence, comorbidity, and prognosis of mental health among US veterans. Am J Public Health. 2015;105(12):2564-2569.
22. Richardson LK, Frueh BC, Acierno R. Prevalence estimates of combat-related post-traumatic stress disorder: a critical review. Aust N Z J Psychiatry. 2010;44(1):4-19.
23. US Department of Veterans Affairs. In the spotlight: VA uses technology to provide rural veterans greater access to specialty care services. https://www.patientcare.va.gov/In_the_Spotlight.asp. Updated June 3, 2015. Accessed September 14, 2018.
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.
2. Pai A, Suris AM, North CS. Posttraumatic stress disorder in the DSM-5: controversy, change, and conceptual considerations. Behav Sci (Basel). 2017;7(1):pii E7.
3. Gupta MA. Review of somatic symptoms in post-traumatic stress disorder. Int Rev Psychiatry. 2013;25(1):86-99.
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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