Nancy A. Melville

April 09, 2013

LA JOLLA, California — Individuals with posttraumatic stress disorder (PTSD) have an increased risk for earlier onset of some health conditions compared with those without the disorder, new research suggests.

PTSD is known to be associated with an elevated risk for physical health conditions; however, research is lacking on whether the disorder is linked to having the conditions at an earlier age or across the adult lifespan.

For the study, researchers evaluated data on 34,653 community-dwelling adults older than 20 years from Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

The results showed that those with PTSD had greater odds of having conditions, including gastrointestinal disorders, across all age groups and of having conditions such as arthritis at a younger age compared with those without the disorder.

"Results of this research indicate that PTSD may be associated with an earlier onset of several physical health conditions," said first author Kristin A. Reynolds, of the University of Manitoba, Winnipeg, in Canada.

"Whereas clinicians and the general public tend to focus on the mental health consequences of disorders such as PTSD, our findings highlight the importance of viewing this problem from a mind-body connectionist perspective," she told Medscape Medical News.

The findings were presented here at the Anxiety and Depression Association of America (ADAA) 33rd Annual Conference.

All Ages Equally Affected

In evaluating the data, the investigators categorized the patients into age groups of 20-34, 35-49, 50-64, and 65 years or older.

The respondents were interviewed about whether they had been diagnosed with any of 17 medical conditions during the past year.

The analysis showed the prevalence of PTSD in the past year to be 4.3%, 5.3%, 5.0%, and 2.6% across the 4 age groups.

The odds ratio of having a gastrointestinal disorder was specifically 1.4 to 2.1 among adults with PTSD across all age groups, compared with those without PTSD, and adults with PTSD were more likely to report being diagnosed with cardiovascular disease (odds ratios, 1.4 - 2.3) across the age groups, with the exception of ages 50 to 64 years.

"The effect for the 50- to 64-year-old group was nearly significant, and not out of line with other age groups," Reynolds noted.

The risk for an arthritis diagnosis among patients with PTSD was increased among adults aged 35 years and older (odds ratios, 1.6 - 1.8).

Interestingly, in the 35- to 49-year-old age group only, patients with PTSD were more likely to report being diagnosed with hepatic disease (odds ratio = 2.2) and stroke (odds ratio = 4.3), whereas those in the 50- to 64-year-old age group with PTSD were more likely to report being diagnosed with diabetes (odds ratio = 1.6).

The similar odds of health conditions across age spans among people with PTSD were particularly notable, Reynolds said.

"I was most surprised by the fact that although having past-year PTSD increased the risk of having a past-year physical health condition in general, that the risk was not higher for adults aged 65 years and older with PTSD than the younger and middle-aged adults with PTSD," Reynolds said.

"Also of interest is that the unique associations with age were found in the middle-aged group, which might be related to evidence of especially poor mental health in general in that age group."

Potential Mechanisms

Although underscoring the fact that her research did not explore the mechanisms behind the higher risk for health conditions, Reynolds noted that the literature indicates that gastrointestinal disorder with PTSD may be associated the hyperarousal symptoms of PTSD, including difficulty falling asleep or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance, and exaggerated startle response.

"These symptoms are associated with prolonged stress and emotional reactivity and increased cortical arousal, which may result in the experience of enhanced sensations in the gut," she said.

"With regard to cardiovascular disease, a similar stress-related mechanism is possible."

Unhealthy behaviors, including smoking, substance use, poor diet, and lack of physical activity, are prevalent among adults with PTSD, she added, and those behaviors are risk factors for the development of cardiovascular disease.

In addition, an association between PTSD, markers of inflammation, and cardiovascular disease has also been noted in epidemiologic research, Reynolds explained.

"When examining mechanisms related to arthritis and PTSD, the shared vulnerability model indicates that there is a common and heightened sensitivity to anxiety among adults with PTSD and musculoskeletal diseases."

Collaboration With Primary Care

Psychologist Sonya B. Norman, PhD, an assistant professor with the University of California, San Diego, School of Medicine, speculated that one of the explanations of the higher risk for health conditions that seems most plausible is the concept of allostatic load.

"The theory basically suggests that for any animal, the more stress to their system, the more the system gets taxed and overtired, increasing the risk of getting sick," she told Medscape Medical News.

"So if you think about PTSD as a response to a very significant stressor or trauma and living with the disorder day in and day out, people have that elevated stress level and have a very high allostatic load, so they may become more vulnerable to these conditions earlier in life."

She said the findings underscore the need to consider possible medical health issues in the evaluation of PTSD patients.

"When we see PTSD, we're usually focused on mental health, and we may not be thinking so much of the physical burden, but this is good evidence that we should be working with primary care to make sure someone is getting physicals and getting screened for these things maybe earlier than normal."

"On the flip side, we know that a lot of PTSD does present to primary care, possibly in ways we wouldn't necessarily identify if we weren't screening, so it's important to be aware on that level as well."

Dr. Reynolds and Ms. Norman report no relevant financial relationships.

Anxiety and Depression Association of America (ADAA) 33rd Annual Conference. Abstract 78. Presented April 6, 2013.

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