Quality of Life Research

, Volume 23, Issue 5, pp 1579–1591

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 Goldberg
  • Kathryn M. Magruder
  • Christopher W. Forsberg
  • Lewis E. Kazis
  • T. Bedirhan Üstün
  • Matthew J. Friedman
  • Brett T. Litz
  • Viola Vaccarino
  • Patrick J. Heagerty
  • Theresa C. Gleason
  • Grant D. Huang
  • Nicholas L. Smith



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


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.


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.


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


PTSD Vietnam-era Veterans VR-36 WHODAS 2.0 

Supplementary material

11136_2013_585_MOESM1_ESM.docx (34 kb)
Supplementary material 1 (DOCX 33 kb)


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Copyright information

© Springer Science+Business Media Dordrecht (outside the USA) 2013

Authors and Affiliations

  • Jack Goldberg
    • 1
    • 2
  • Kathryn M. Magruder
    • 3
    • 4
  • Christopher W. Forsberg
    • 1
  • Lewis E. Kazis
    • 5
    • 6
  • T. Bedirhan Üstün
    • 7
  • Matthew J. Friedman
    • 8
    • 9
  • Brett T. Litz
    • 10
    • 11
  • Viola Vaccarino
    • 12
  • Patrick J. Heagerty
    • 13
  • Theresa C. Gleason
    • 14
  • Grant D. Huang
    • 14
  • Nicholas L. Smith
    • 1
    • 2
  1. 1.Seattle Epidemiologic Research and Information Center (S-152-E)VA Puget Sound Health Care SystemSeattleUSA
  2. 2.Department of EpidemiologyUniversity of WashingtonSeattleUSA
  3. 3.Mental Health ServiceRalph H. Johnson VA Medical CenterCharlestonUSA
  4. 4.Department of PsychiatryMedical University of South CarolinaCharlestonUSA
  5. 5.Center for Health Quality, Outcomes and Economic Research (CHQOER)Bedford VAMCBedfordUSA
  6. 6.Department of Health Policy and ManagementBoston University School of Public HealthBostonUSA
  7. 7.Classifications and Terminology TeamWorld Health OrganizationGenevaSwitzerland
  8. 8.Department of Veterans AffairsNational Center for Posttraumatic Stress DisorderWhite River JunctionUSA
  9. 9.Departments of Psychiatry and Pharmacology & ToxicologyGeisel School of Medicine at DartmouthHanoverUSA
  10. 10.Massachusetts Epidemiology Research and Information CenterVA Boston Healthcare SystemBostonUSA
  11. 11.Boston University School of MedicineBostonUSA
  12. 12.Department of EpidemiologyEmory UniversityAtlantaUSA
  13. 13.Department of BiostatisticsUniversity of WashingtonSeattleUSA
  14. 14.Cooperative Studies ProgramVA Office of Research and DevelopmentWashingtonUSA

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