Greater medical burden seen in Veterans with PTSD
A large study by a VA and Stanford University team shows that
among the newest generation of Veterans enrolled in VA health
care, those with a mental health condition—especially posttraumatic
stress disorder (PTSD)—tend to have more physical ailments.
The results, published online Sept. 18 in the Journal of General
Internal Medicine, are not surprising in light of past research on
the link between emotional stress and physical illness. But the
findings may help guide VA as it continues expanding services to
care for returning Veterans.
"In caring for Veterans returning with PTSD, we should account
not only for their mental health needs, but also for their increased
medical needs," says lead author Susan Frayne, MD, MPH, with
the VA Palo Alto Health Care System and Stanford University.
She says examples of areas where VA needs to assure ample
capacity, based on the study results, include physical therapy and
pain clinics to address high levels of musculoskeletal conditions;
behavioral medicine and nutrition services to help with common
conditions such as obesity; and clinics that specialize in women's
health care to respond to the particularly heavy burden of medical
illness seen in women with PTSD.
Findings based on 90,000 VA patients
The researchers examined the records of more than 90,000 Iraq
and Afghanistan Veterans who used VA outpatient care in fiscal
year 2006–2007. The majority had received a diagnosis of at least
one mental health condition. About 35 percent of men and 27
percent of women had PTSD.
The link between PTSD and medical (non-mental) illness was
stronger among women than among men. Women with PTSD had a
median of 7 medical conditions, versus 4.5 for women with no mental
health diagnosis. The most common physical ailments for women
were lower-back problems, headaches and lower-extremity joint
disorders. Men with PTSD had a median of 5 medical conditions,
versus 4 for men with no mental health diagnosis. The most common
complaints for men were similar to those of women—for example,
back and knee problems—but also included hearing loss.
Frayne, who conducts research for VA's Center for Health Care
Evaluation and Women's Health Center of Excellence, both based
in Palo Alto, says her team's study is among the first to provide a
broad overview of the significant medical burden among newly
returned Veterans with PTSD. The study checked for 222 specific
medical conditions, from cancer to digestive trouble.
Related research by a team at the San Francisco VA Medical
Center, published in January 2010, also in the Journal of General
Internal Medicine, yielded similar findings: Iraq and Afghanistan
Veterans with mental health conditions, particularly PTSD, used
significantly more non-mental health services than those with no
mental health diagnosis. The study was based on the records of
nearly 250,000 Veterans who used VA care for the first time
between 2001 and 2007.
In light of the trend seen across both studies, Frayne notes that
early intervention for both physical and mental illness will be
critical in helping Veterans avoid longterm
As to the reasons underlying the
connection between PTSD and medical
illnesses, Frayne offers several theories.
"One possibility," she says, "is that
PTSD itself leads to increased risk of
medical illness. One way this could happen
is that PTSD can cause changes in the
neuroendocrine system in the body, which
might affect other biological processes."
Another possibility is that "PTSD itself
does not cause medical conditions, but
that whatever caused the PTSD also
simultaneously caused the medical
condition." An example would be a
service member who was exposed to a
blast that broke a bone and also caused
Despite the trends seen in the study,
Frayne emphasizes that not all Veterans
with PTSD have a greater array of health
"While it's important to take medical
conditions in patients with PTSD very
seriously," she says, "it's also important
not to assume that all returning Veterans
have these conditions."
This article originally appeared in the October-November 2010 issue of VA Research Currents.