Article

Quality of Life Research

, Volume 23, Issue 5, pp 1579-1591

First online:

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)

  • Jack GoldbergAffiliated withSeattle Epidemiologic Research and Information Center (S-152-E), VA Puget Sound Health Care SystemDepartment of Epidemiology, University of Washington Email author 
  • , Kathryn M. MagruderAffiliated withMental Health Service, Ralph H. Johnson VA Medical CenterDepartment of Psychiatry, Medical University of South Carolina
  • , Christopher W. ForsbergAffiliated withSeattle Epidemiologic Research and Information Center (S-152-E), VA Puget Sound Health Care System
  • , Lewis E. KazisAffiliated withCenter for Health Quality, Outcomes and Economic Research (CHQOER), Bedford VAMCDepartment of Health Policy and Management, Boston University School of Public Health
  • , T. Bedirhan ÜstünAffiliated withClassifications and Terminology Team, World Health Organization
  • , Matthew J. FriedmanAffiliated withDepartment of Veterans Affairs, National Center for Posttraumatic Stress DisorderDepartments of Psychiatry and Pharmacology & Toxicology, Geisel School of Medicine at Dartmouth
  • , Brett T. LitzAffiliated withMassachusetts Epidemiology Research and Information Center, VA Boston Healthcare SystemBoston University School of Medicine
  • , Viola VaccarinoAffiliated withDepartment of Epidemiology, Emory University
  • , Patrick J. HeagertyAffiliated withDepartment of Biostatistics, University of Washington
    • , Theresa C. GleasonAffiliated withCooperative Studies Program, VA Office of Research and Development
    • , Grant D. HuangAffiliated withCooperative Studies Program, VA Office of Research and Development
    • , Nicholas L. SmithAffiliated withSeattle Epidemiologic Research and Information Center (S-152-E), VA Puget Sound Health Care SystemDepartment of Epidemiology, University of Washington

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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.

Keywords

PTSD Vietnam-era Veterans VR-36 WHODAS 2.0