The relation between posttraumatic stress and physical health is a fascinating one. On my ‘talent hunt’ at the ISTSS conference, I met Maria Pacella, who is currently completing her doctoral degree in Health Psychology at Kent State University, Ohio, USA. She examines the relation between traumatic stress and the development of mental and physical health problems in adults. Some fresh new findings below!
The following research describes a recent meta-analysis synthesizing the literature regarding PTSD/PTSD symptoms (PTSS) and comorbid physical health complaints. Related research conducted with samples of motor vehicle accident victims and people living with HIV is also discussed. For more information about our ongoing research studies, please see the Delahanty Stress and Health Lab website.
1. PTSD is associated with poor physical health
The relationship between PTSD and co-occurring mental health conditions — such as depression, substance use, and general anxiety — has received much attention in the literature. However, it is equally important to consider the impact of PTSD on physical health functioning. Given the biological alterations associated with PTSD, individuals with this disorder may be vulnerable to the development of, or worsening of, certain physical health conditions. A better understanding of the physical health consequences of PTSD will inform prevention and treatment practices, thereby reducing the economic burden created by the disorder.
Recently, we conducted a meta-analysis on the results of 62 empirical articles examining the relationship between PTSD and six physical health outcomes. Results revealed that individuals with PTSD suffered from greater health complaints in the following domains:
- Physical health-related quality of life
- General health symptoms
- Medical conditions
- Cardio-respiratory health
- Gastrointestinal health
- Musculoskeletal health
Though all relationships were significant, the largest effect size emerged for the health outcome of general health symptoms, and the smallest for the health outcome of cardio-respiratory symptoms.
2. The full disorder need not be present to experience the associated physical health consequences of PTSD symptoms.
We also found that the presence of PTSD symptoms (PTSS; hyperarousal, avoidance and numbing, and re-experiencing) is sufficient to experience the physical health consequences of trauma. More specifically, as compared to individuals with lower levels of PTSS, those with higher levels of PTSS also reported worse physical health complaints in all of the domains assessed.
Further, independent of the presence of PTSD, trauma history also impacts the experience of physical health complaints. To this end, research from our lab has revealed that in a sample of motor vehicle accident (MVA) victims, individuals with a more severe trauma history experienced greater physical health complaints 6-months post-MVA than those with a less severe trauma history.
In sum, these findings highlight the importance of assessing PTSS in individuals with a trauma history, as individuals with subthreshold PTSS suffer from similar physical health consequences as those who meet criteria for full PTSD.
3. Important moderating factors involved in the relationship between PTSD/PTSS and physical health
Research regarding PTSD/PTSS and physical health has varied greatly with respect to participants examined and methodologies employed. Given this variation, we sought to examine whether stronger relationships emerged for studies with the inclusion of the following characteristics (moderators) related to the sample or method:
- Males vs. females
- Veterans vs. civilians
- Recruitment from community vs. clinical centers
- Self-report vs. clinical interview
- Continuous vs. dichotomous measurement of PTSD/PTSS)
Results regarding sample type revealed that the relationship between PTSD/PTSS and physical health may be stronger for veterans, and for those individuals recruited from clinical centers. These findings suggest that screening for PTSD in primary care and VA hospitals may allow for the identification of individuals most likely to benefit from mental health treatment. Results also revealed that both males and females may have increased risk of physical health problems post-trauma. Therefore, the strength of relationship may depend on the health outcome being analyzed.
Regarding methodological characteristics, the effect sizes tended to be larger when PTSD/PTSS and health outcomes were measured via self-report as compared to interview methods. Further, stronger relationships emerged for the measurement of continuous PTSS versus the diagnostic disorder, suggesting that traumatic stress exposure may be more accurately represented on a continuum.
Though these moderation analyses were exploratory, they may aid in identifying specific groups that may respond best to effective prevention or treatment practices (Pacella et al. in press).
4) Where do we go from here? Suggestions for future research
A. Prospective, longitudinal designs.
Most studies included in this meta-analysis were cross-sectional in design, such that causality cannot be inferred. In order to conclude that PTSD/PTSS cause physical health complications, there is a need to examine the development of physical health complaints in recent trauma victims (i.e., prospective longitudinal designs).
B. Consideration of additional moderating factors.
Several factors related to PTSD and physical health that fell outside the scope of this review (such as age, race, income, elapsed time since trauma, and trauma type) may also serve as potential moderators of this relationship, and may aid in targeting individuals most likely to benefit from mental health treatment.
C. Treatment Implications.
Preliminary evidence suggests that individuals who have received successful treatment for PTSD may also experience indirect benefits in their physical health functioning. Additional research is necessary to replicate these findings, and to determine whether early PTSD intervention may prevent the development of subsequent physical health problems.
Finally, medically related PTSD (defined as PTSD stemming from the diagnosis of a life-threatening/chronic medical condition) might place individuals at a greater risk of either 1) developing physical health problems, or 2) experiencing a worsening of physical health symptoms. Given our recent findings that prolonged exposure treatment for PTSD was successful in a sample of people living with HIV, individuals with HIV and other life threatening/chronic diseases (such as cancer, myocardial infarction) may also display improvements in physical health following successful mental health treatment; however this has yet to be examined.
Useful Websites and main reference:
Pacella, M., Hruska, B., & Delahanty, D. (2012). The physical health consequences of PTSD and PTSD symptoms: A meta-analytic review Journal of Anxiety Disorders DOI: 10.1016/j.janxdis.2012.08.004