Women with posttraumatic stress disorder (PTSD) have a greater number of
medical conditions such as arthritis, lower back pain, obesity, and
hypertension, and worse health status overall than women with only depression
or with neither disorder, according to a large new study of women
"While it is well established that depression is associated with poor
physical health, we found that women with PTSD in addition to their depression
had even worse physical health than women with depression alone," said
Susan Frayne, M.D., M.P.H., who is the study's lead investigator and an
advanced research career development fellow at the Center for Health Care
Evaluation at the VA Palo Alto Health Care System and Stanford University. The
finds are described in the June 28 Archives of Internal Medicine.
Frayne and her colleagues from the Veterans Affairs hospitals in Menlo
Park, Calif., and Bedford, Mass., examined survey data from about 30,800 women
veterans who responded to the 1999 Health Survey of Veterans to determine
whether a doctor had ever diagnosed them with PTSD, depression, or a number of
nonpsychiatric health problems such as chronic lower back pain, high blood
pressure, obesity, emphysema, or cancer.
A total of 4,348 women reported they had been diagnosed with PTSD, 7,580
with depression, and 18,937 reported that they'd never been diagnosed with
Nearly 90 percent of the women who reported ever having been diagnosed with
PTSD indicated that they had at least one medical condition, with arthritis,
chronic lower back pain, obesity, and hypertension topping the list.
Frayne and colleagues found that regardless of age, the number of medical
conditions was higher in women with PTSD than in women with depression alone
or with neither disorder.
For example, among women younger than age 45, the mean number of medical
conditions was 1.8 for women with PTSD, 1.5 for women with depression, and 1.1
for women with neither disorder.
Among women aged 65 and older, the mean number of medical conditions was
3.3 for women with PTSD, 3.1 for women with depression, and 2.6 for women with
Frayne also used information from the Veterans SF-36 instrument to obtain
information about four domains of physical health: physical functioning, role
limitations due to physical problems, bodily pain, and energy/vitality.
Each of these four scales is scored from 0 to 100, with 100 being the best
possible score in each area.
When Frayne examined role limitations due to physical problems, she found
that among women with PTSD under age 45, the mean score was 31. That score
jumped to 47.2 for women with depression and 69.1 for women with neither
Women with PTSD in the same age range also reported experiencing more
bodily pain and scored lower on the SF-36 instrument (39) in this domain than
women with depression (47.6) or neither condition (58.9). On this scale, which
ranges from 0 to 100, lower scores indicate greater bodily pain.
Frayne told Psychiatric News that while the study was not designed
to determine the nature of the link between PTSD and poor physical health,
several mechanisms may underlie the association.
"Other work has indicated that a history of trauma exposure can be
associated with chronic neuroendocrine dysregulation and with risky health
behaviors such as smoking or substance use, which can potentially contribute
to ill health," she said, adding that more research needs to be
conducted to explore this key link.
While recent research has pointed to the importance of access to mental
health services for veterans with PTSD, Frayne said her study "indicates
that attending to the physical health needs of women veterans with PTSD is
"Psychiatrists may be in an excellent position to connect women who
have PTSD with needed services for their comorbid medical conditions,"
she pointed out.
An abstract of the article, "Burden of Medical Illness in
Women With Depression and Posttraumatic Stress Disorder," is posted