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The association of PTSD with physical and mental health functioning and disability (VA Cooperative Study #569: the course and consequences of posttraumatic stress disorder in Vietnam-era Veteran twins)

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Abstract

Purpose

To assess the relationship of posttraumatic stress disorder (PTSD) with health functioning and disability in Vietnam-era Veterans.

Methods

A cross-sectional study of functioning and disability in male Vietnam-era Veteran twins. PTSD was measured by the Composite International Diagnostic Interview; health functioning and disability were assessed using the Veterans RAND 36-Item Health Survey (VR-36) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). All data collection took place between 2010 and 2012.

Results

Average age of the 5,574 participating Veterans (2,102 Vietnam theater and 3,472 non-theater) was 61.0 years. Veterans with PTSD had poorer health functioning across all domains of VR-36 and increased disability for all subscales of WHODAS 2.0 (all p < .001) compared with Veterans without PTSD. Veterans with PTSD were in poorer overall health on the VR-36 physical composite summary (PCS) (effect size = 0.31 in theater and 0.47 in non-theater Veterans; p < .001 for both) and mental composite summary (MCS) (effect size = 0.99 in theater and 0.78 in non-theater Veterans; p < .001 for both) and had increased disability on the WHODAS 2.0 summary score (effect size = 1.02 in theater and 0.96 in non-theater Veterans; p < .001 for both). Combat exposure, independent of PTSD status, was associated with lower PCS and MCS scores and increased disability (all p < .05, for trend). Within-pair analyses in twins discordant for PTSD produced consistent findings.

Conclusions

Vietnam-era Veterans with PTSD have diminished functioning and increased disability. The poor functional status of aging combat-exposed Veterans is of particular concern.

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Acknowledgments

Dr. Goldberg had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The funding source was involved in the design and conduct of the study, and the interpretation, preparation, review, and approval of the manuscript. The authors were responsible for the collection, management, analysis, and interpretation of the data and for the preparation of the manuscript and its submission for publication. The authors gratefully acknowledge the continued cooperation and participation of the members of the VET Registry: without their contribution this research would not have been possible. The authors would also like to thank the members of the Department of Veterans Affairs Cooperative Study #569 Group (in addition to the authors): I. Curtis, A. Ali, B. Majerczyk, B. Harp, K. Moore, A. Fox, M. Tsai, A. Mori, J. Sporleder, P. Terry, Seattle, WA; D. Yeager, Charleston, SC. Executive Committee: S. Eisen, Washington, DC; A. Snodgrass, Albuquerque, NM. Data Monitoring Committee: J. Vasterling, Boston, MA; M. Stein, La Jolla, CA; B. Booth, Little Rock, AR; J. Westermeyer, Minneapolis, MN. Planning Committee: M. McFall, Seattle, WA; T. O’Leary, S. Eisen, Washington, DC; M. Smith, Palo Alto, CA; K. Swanson, Albuquerque, NM. SF-36® is a registered trademark of the Medical Outcomes Trust. The Cooperative Studies Program (CSP) of the Office of Research and Development, Clinical Science Research and Development, of the United States Department of Veterans Affairs (VA), has provided financial support for Cooperative Study #569 and the development and maintenance of the Vietnam Era Twin (VET) Registry. Dr. Viola Vaccarino was supported in part by a National Institutes of Health award, K24 HL077506

Author information

Authors and Affiliations

  1. Seattle Epidemiologic Research and Information Center (S-152-E), VA Puget Sound Health Care System, 1600 South Columbian Way, Seattle, WA, 98108, USA

    Jack Goldberg, Christopher W. Forsberg & Nicholas L. Smith

  2. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Jack Goldberg & Nicholas L. Smith

  3. Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, SC, USA

    Kathryn M. Magruder

  4. Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA

    Kathryn M. Magruder

  5. Center for Health Quality, Outcomes and Economic Research (CHQOER), Bedford VAMC, Bedford, MA, USA

    Lewis E. Kazis

  6. Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA

    Lewis E. Kazis

  7. Classifications and Terminology Team, World Health Organization, Geneva, Switzerland

    T. Bedirhan Üstün

  8. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, White River Junction, VT, USA

    Matthew J. Friedman

  9. Departments of Psychiatry and Pharmacology & Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA

    Matthew J. Friedman

  10. Massachusetts Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA

    Brett T. Litz

  11. Boston University School of Medicine, Boston, MA, USA

    Brett T. Litz

  12. Department of Epidemiology, Emory University, Atlanta, GA, USA

    Viola Vaccarino

  13. Department of Biostatistics, University of Washington, Seattle, WA, USA

    Patrick J. Heagerty

  14. Cooperative Studies Program, VA Office of Research and Development, Washington, DC, USA

    Theresa C. Gleason & Grant D. Huang

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  1. Jack Goldberg
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  2. Kathryn M. Magruder
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  3. Christopher W. Forsberg
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  8. Viola Vaccarino
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  12. Nicholas L. Smith
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Correspondence to Jack Goldberg.

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The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.

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Goldberg, J., Magruder, K.M., Forsberg, C.W. et al. The association of PTSD with physical and mental health functioning and disability (VA Cooperative Study #569: the course and consequences of posttraumatic stress disorder in Vietnam-era Veteran twins). Qual Life Res 23, 1579–1591 (2014). https://doi.org/10.1007/s11136-013-0585-4

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