Traumatic Events Linked to a Wide Variety of Physical Illnesses

Deborah Brauser

May 16, 2011

May 16, 2011 (Honolulu, Hawaii) — Experiencing trauma and/or witnessing traumatic events may significantly increase the risk of developing physical disease, including diabetes, obesity, and cardiovascular disease (CVD), new research suggests.

A national study presented here at the American Psychiatric Association 2011 Annual Meeting shows undergoing injurious or psychological trauma or directly witnessing a traumatic event were all associated with a significant unadjusted risk for CVD, arteriosclerosis or hypertension, gastrointestinal (GI) disease, diabetes, arthritis, and obesity.

In addition, experiencing a natural disaster or terrorism was associated with all these conditions except for obesity, whereas combat trauma was associated with cardiovascular and GI disease only.

"We found that a variety of events were significantly associated with a number of physical conditions, which, based on past research, was expected," principal investigator Natalie Husarewycz, MD, told Medscape Medical News.

Injurious (or direct) trauma included accidents or physical attacks; psychological trauma included neglect, being stalked, or threatened with a weapon; and combat-related trauma included events experienced by active military personnel, peacekeepers, unarmed civilians in war time, and refugees.

Clinical Implications

Although the study could not establish causation, Dr. Husarewycz said the findings have important clinical implications.

Dr. Natalie Husarewycz

"Even in individuals with a trauma history that don't fulfill Axis I or II disorder criteria, we should perhaps consider screening for physical health conditions. And there may be reason for primary care physicians seeing people with multiple somatic conditions to consider screening for past traumatic events."

Dr. Husarewycz reported that patients with peptic ulcer disease, CVD, asthma, or diabetes have increased odds of having a mood or anxiety disorder.

According to the presentation, past research has suggested an association between posttraumatic stress disorder (PTSD) and chronic pain conditions, CVD, GI disease, and cancer. Other findings have suggested that physical and sexual abuse is significantly associated with health conditions that include neurologic, musculoskeletal, and GI disorders.

"However, there has been a dearth of population-based research examining whether the nature of trauma experienced may be related to physical health conditions," the study authors report.

"Our questions were: is there a cumulative effect of multiple traumatic events that would predict these physical conditions? And is it the nature of the trauma that was experienced or a mental disorder that would drive the relationship to physical health conditions?" added Dr. Husarewycz.

The researchers evaluated data on 34,653 patients older than 20 years from the US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Wave II.

Lifetime trauma experiences and past-year physician-diagnosed medical conditions were reported by all NESARC participants in a face-to-face interview.

Significant Physical Conditions

Results showed substantial overlap between the groups, with 30.68% of the participants experiencing an injurious trauma, 17.32% a psychological trauma, 16.10% a natural disaster or terrorism-related trauma, and 7.53% a combat-related trauma. A total of 71.57 reported witnessing a traumatic event.

Overall, there was "an increased likelihood of suffering from physical health conditions with increased exposure to traumatic events, in a linear pattern," reported Dr. Husarewycz.

After adjusting for sociodemographic factors only, the odds ratios (ORs) were significant for experiencing all physical health conditions by those who underwent injurious (ORs ranging from 1.24 to 1.89) or psychological trauma (ORs, 1.17 – 1.77) or witnessed trauma (ORs, 1.30 – 1.78); were significant for experiencing all but obesity by those who underwent trauma involving natural disaster or terrorism (ORs, 1.20 – 1.55); and were significant for experiencing CVD (OR, 1.36) and GI disease (OR, 1.39) for those with combat trauma.

After also adjusting for any Axis I or Axis II mental disorders in a second model, the findings were similar except that combat trauma was negatively associated with obesity and actually offered a protective effect (OR, 0.87).

In a third study model that adjusted also for all other trauma groups to account for event overlap, the findings were similar to the second model except that psychological trauma was no longer associated with arteriosclerosis/hypertension or obesity and natural disaster/terrorism was no longer associated with arteriosclerosis/hypertension or diabetes.

In addition, in this model, combat trauma lost association with all physical health conditions except for offering a protective effect for obesity.

Biological Changes

When discussing possible reasons for the various associations found, Dr. Husarewycz explained that alterations in hormones and other mediators are commonly seen in patients with PTSD, including cortisol levels. However, some research has found that even without PTSD, survivors of trauma have increased autonomic reactivity.

Dr. Jerald Block

"It's likely that trauma itself is associated with biological changes," said Dr. Husarewycz.

She noted that "the main reason" why the association between the physical conditions and combat-related trauma disappeared in the last adjustments was because "the other types of trauma, which were controlled for only in the final model, likely mediated the relationship."

She also voiced the possibility of a "healthy warrior" effect. "This is the idea that perhaps chronically ill soldiers are selectively withheld from deployment while physically healthier soldiers may be deployed and would then experience the trauma."

Study limitations cited included its retrospective design and that participants self-reported their physical conditions, which may have led to some recall bias.

During a question and answer session following the presentation, session moderator Jerald Block, MD, asked Dr. Husarewycz if perhaps the investigators were "measuring a somatic preoccupation in patients exposed to trauma" — and therefore getting more medical diagnoses.

"As with anything that is self-reported, there is certainly that potential. In these data, it's supposedly physician diagnosed, but there wasn't any way to know that for sure," replied Dr. Husarewycz.

"Traumatic events related to physical conditions is a finding that's been talked about for years and years and goes back to psychoanalytic theory about PTSD and such. So I think it's helpful and good to see confirmation in these sorts of findings," Dr. Block, clinical director for the Rural Mental Health Program for the Portland VA in Oregon, later told Medscape Medical News.

"It's certainly an important area of study but at this early phase I'd be cautious about drawing too much from the specifics in this research. Still, I think it's very worthwhile to pursue it more," concluded Dr. Block.

The study authors and Dr. Block have disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2011 Annual Meeting: Scientific and Clinical Report Session 6, No. 3. Presented May 14, 2011.

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