Abstract
This study examined the role of comorbid depression in the somatic complaints of 32 individuals with civilian-based posttraumatic stress disorder (PTSD) while restricting the influence of detectable pathophysiology and additional psychiatric conditions. It was hypothesized that depressive symptomatology would mediate the relationship between PTSD and somatic symptom reporting. Participants were administered structured clinical interviews, a physical examination, and an electrocardiogram. Results of this study supported the hypothesis that depressive symptoms mediate the relationship between PTSD and physical complaints. These results add to a growing body of literature that suggests psychological factors play an influential role in the physical symptom reports of individuals with PTSD.
Similar content being viewed by others
References
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.
Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.
Beckham, J. C., Moore, S. D., Feldman, M. E., Hertzberg, M. A., Kirby, A. C., & Fairbank, J. A. (1998). Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder. American Journal of Psychiatry, 155, 1565–1569.
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Klauminzer, G., Charney, D. S., et al. (1990). A clinician rating scale for assessing current and lifetime PTSD: The CAPS-1. Behavior Therapist, 13, 187–188.
Burnam, M. A., Stein, J. A., Golding, J. M., Siegel, J. M., Sorenson, S. B., Forsythe, A. B., et al. (1988). Sexual assault and mental disorders in a community population. Journal of Consulting and Clinical Psychology, 56, 843–850.
Esterling, B. A., L'Abate, L., Murray, E. J., & Pennebaker, J. W. (1999). Empirical foundations for writing in prevention and psychotherapy: Mental and physical health outcomes. Clinical Psychology Review, 19, 79–96.
Golding, J. M., Cooper, M. L., & George, L. K. (1997). Sexual assault history and health perceptions: Seven general population studies. Health Psychology, 16, 417–425.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.
Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278–296.
Hyer, L., Stranger, E., & Boudewyns, P. (1999). The interaction of posttraumatic stress disorder and depression among older combat veterans. Journal of Clinical Psychology, 55, 1073–1083.
Kaplan, G. A., & Camacho, T. (1983). Perceived health and mortality: A nine-year follow-up of the Human Population Laboratory cohort. American Journal of Epidemiology, 117, 292–304.
Katon, W., Kleinman, A., & Rosen, G. (1982). Depression and somatization: A review. American Journal of Medicine, 72, 127–135.
Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.
Litz, B., Keane, T., Fisher, L., Marx, B., & Monaco, V. (1992). Physical health complaints in combat-related post-traumatic stress disorder: A preliminary report. Journal of Traumatic Stress, 5, 131–141.
Litz, B. T., Schlenger, W. E., Weathers, F. W., Kaddell, J. M., Fairbank, J. A., & LaVange, L. M. (1997). Predictors of emotional numbing in posttraumatic stress disorder. Journal of Traumatic Stress, 10, 607–618.
McFarlane, A. C., Atchison, M., Rafalowicz, E., & Papay, P. (1994). Physical health complaints in posttraumatic stress disorder. Journal of Psychosomatic Research, 38, 715–726.
Miranda, R., Jr., Meyerson, L. A., Marx, B. P., Long, P. J., Orsillo, S. M., & Jones, D. (2000). Combat-related posttraumatic stress disorder and physical complaints: The influence of psychological factors. Manuscript submitted for publication.
Orsillo, S. M., Weathers, F. W., Litz, B. T., Steinberg, H. R., Huska, J. A., & Keane, T. M. (1996). Current and lifetime psychiatric disorders among veterans with war-zone related posttraumatic stress disorder. Journal of Nervous and Mental Disease, 184, 307–313.
Pelcovitz, D., van der Kolk, B., Roth, S., Mandel, F., & Kaplan, S. (1997). Development and validation of the structured interview for measurement of disorders of extreme stress. Journal of Traumatic Stress, 10, 3–16.
Pennebaker, J. W. (1993). Overcoming inhibition: Rethinking the roles of personality, cognition, and social behavior. In H. C. Traue & J. W. Pennebaker (Eds.), Emotion inhibition and disease (pp. 100–115). Kirkland, WA: Hogrefe & Huber.
Reynolds, W. M., & Kobak, K. A. (1995). Reliability and validity of the Hamilton Depression Inventory: A paper and pencil version of the Hamilton Depression Rating Scale clinical interview. Psychological Assessment, 7, 472–483.
Schnurr, P. P., & Jankowski, M. K. (1999). Physical health and post-traumatic stress disorder: Review and synthesis. Seminars in Clinical Neuropsychiatry, 4, 295–304.
Schnurr, P. P., Spiro, A., III, Aldwin, C. M., & Stukel, T. A. (1998). Physical symptom trajectories following trauma exposure: Longitudinal findings from the Normative Aging Study. Journal of Nervous and Mental Disease, 186, 522–528.
Schnurr, P. P., Spiro, A., III, & Paris, A. H. (2000). Physician-diagnosed medical disorders in relation to PTSD symptoms in older military veterans. Health Psychology, 19, 91–97.
Shalev, A. Y., Freedman, S., Peri, T., Brandes, D., Sahar, T., Orr, S. P., et al. (1998). Prospective study of posttraumatic stress disorder and depression following trauma. American Journal of Psychiatry, 155, 630–637.
Sloan, D. M., Strauss, M. E., & Wisner, K. L. (2001). Diminished response to pleasant stimuli by depressed women. Journal of Abnormal Psychology, 110, 488–493.
Sobel, M. E. (1982). Asymptomatic confidence intervals for indirect effects in structural equation models. In S. Leinhart (Ed.), Sociological methodology (pp. 290–312). San Francisco: Jossey-Bass.
Spitzer, R. L., Williams, J. B. W., Gibbon, M., & First, M. B. (1988). Structured Clinical Interview for DSM-III-R patient version. New York: Biometrics Research Department, New York State Psychiatric Institute.
Taft, C. T., Stern, A. S., King, L. A., & King, D. W. (1999). Modeling physical health and functional health status: The role of combat exposure, posttraumatic stress disorder, and personal resource attributes. Journal of Traumatic Stress, 12, 3–23.
Weathers, F. W., Blake, D. D., Krinsley, K. E., Haddad, W., Huska, J. A., & Keane, T. M. (1992, November). The Clinician Administered PTSD Scale: Reliability and construct validity. Paper presented at the Association for the Advancement of Behavior Therapy, Boston.
Wells, K. B., Stewart, A., Hays, R., Burnam, M. A., Rogers, W., Daniels, M., et al. (1989). The functioning and well-being of depressed patients: Results from the medical outcomes study. JAMA, 262, 914–919.
Williams, J. B. W., Gibbon, M., First, M. B., Spitzer, R. L., Davies, M., Borus, J., et al. (1992). The structured clinical interview for DSM-III-R (SCID). II: Multisite test-retest reliability. Archives of General Psychiatry, 49, 630–636.
Zlotnick, C., & Pearlstein, T. (1997). Validation of the structured interview for disorders of extreme stress. Comprehensive Psychiatry, 38, 243–247.
Author information
Authors and Affiliations
About this article
Cite this article
Miranda, R., Meyerson, L.A., Marx, B.P. et al. Civilian-Based Posttraumatic Stress Disorder and Physical Complaints: Evaluation of Depression as a Mediator. J Trauma Stress 15, 297–301 (2002). https://doi.org/10.1023/A:1016299711568
Issue Date:
DOI: https://doi.org/10.1023/A:1016299711568