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:
US National Center for PTSD: PTSD & Physical Health
American Psychosomatic Society: Educational Resources
NIH: Behavioral Interventions in Primary Care
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
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This blog post was very informative. It stressed the importance and the dangers that PTSD has on a person. PTSD relates to chapter 13 psychological disorders. In this chapter, PTSD is briefly discussed. It defines PTSD, describes what it is relatable too, gives a few statistics and symptoms, and describes treatment options. This brief overview is nice if you are just trying to get a general understanding but this blog post goes into detail about things the book may not have talked about. I found interesting that PTSD is associated with poor psyichal health. Now that it has been described in detail which diseases cause PTSD I found it even more fascinating that the largest effected size emerged for the health outcome of general health symptoms, and the smallest for the health outcome of cardio-respiratory symptoms. In chapter 13, it is described that PTSD can come from serious injur possibly from a car accident but in this blog post it is much more detailed. I found it interesting that individuals with a more severe trauma history experienced greater physical health complaints 6-months after the accident than those with a less severe trauma history. All of the details in this blog post and in my chapter make sense once explained but it is nice to have them clarified and a few extra statistics to help a better understanding.
I appreciate your comment, Nicole. PTSD stems from motor vehicle accidents, but also from events such as combat, interpersonal traumas, natural disasters, and life-threatening medical conditions, just to name a few. I’m glad that this post was helpful for you.
Very good blog. But one thing that you did not talk about much would be that most men suffering from PTSD develop it from war. Veterans of military conflict in Iraq have a higher prevalence of PTSD than nonveterans. One severe symptom of PTSD is flashbacks. Veterans will often have flashbacks of a bad time in war which can lead to hurting themselves or someone. Nightmares can especially be dangerous for a significant other sleeping in the same bed as someone suffering from PTSD.
Five years after 9/11, more than 11% of workers met the criteria for PTSD. Thats a rate comparable to that of soldiers returning from active duty in Iraq and Afghanistan.
Thanks for the comment, Alexa. While Veterans display elevated rates of PTSD, it would certainly be interesting to examine the interaction between gender and veteran status as well—and to determine whether certain symptom clusters (like re-experiencing; the cluster that includes nightmares/flashbacks) are more prevalent in veterans versus victims of other traumas.
You also bring up an interesting point about rescue workers—there was actually a recent meta-analysis conducted on this topic (see Berger and colleagues, 2012: Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers) in which the authors reported that rescue workers experience higher rates of the disorder than the general population.
I have recently read about PTSD in my Psych 101 class. I think this is an important area of study because there are so many victims of it. It seems to be inescapable. Terrorists try to inflict it. Soldiers fight wars so I don’t have to deal with it, but many of them get it. Even away from the war zone countless people get it from automobile accidents. We should try to understand this syndrome better and have sympathy for those who suffer from it until we learn how to cure it.
Thanks for your beautiful comment Jake. I agree, traumatic exposure is very common and we don’t have a full understanding of how to help yet… Yesterday, there was an interesting post (on kids) on that point at the ‘Mental Elf’ blog: http://bit.ly/QWk6sx.
Thanks for you comment, Jake. I agree with you and Eva that we should direct more resources to trying to understand how to prevent/treat the disorder in individuals exposed to traumatic events. I hope that you will keep an interest in this topic!