PTSD and Physical Health
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Purpose of Review
We review evidence linking PTSD to physical health symptoms and specific disorders, highlighting areas with multiple studies and objective measures of disease states when available. We also examine evidence for biological, behavioral, and psychosocial mechanisms underlying these associations and discuss the clinical implications of recent research.
Recent meta-analyses have found that evidence is particularly strong for increased risk of cardiovascular, metabolic, and musculoskeletal disorders among patients with PTSD. Numerous studies have found alterations in the hypothalamic-pituitary-adrenal axis, sympathetic nervous system, inflammation, and health behaviors that could increase risk of illness, but few studies have simultaneously incorporated measures of mechanisms and disease outcomes.
Future research should focus on expanding the diversity of populations studied, particularly with respect to underrepresented racial and ethnic groups. Longitudinal studies that incorporate repeated measures of PTSD, pathogenic mechanisms of disease, and physical health outcomes and the addition of physical health outcomes to PTSD treatment trials will be most informative for the field.
KeywordsPosttraumatic stress disorder Physical health Chronic disease Comorbidity Cardiovascular disease Mechanisms
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 3.Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. Prevalence and axis I comorbidity of full and partial posttraumatic stress disorder in the united states: results from wave 2 of the national epidemiologic survey on alcohol and related conditions. J Anxiety Disord. 2011;25(3):456–65.PubMedGoogle Scholar
- 10.• Schry AR, Rissling MB, Gentes EL, Beckham JC, Kudler HS, Straits-Tröster K, et al. The relationship between post-traumatic stress symptoms and physical health in a survey of U.S. iraq and afghanistan era veterans. Psychosomatics. 2015;56(6):674–84 This is one of the first studies to examine the association between PTSD and physical health in a cohort of relatively younger veterans. PubMedPubMedCentralGoogle Scholar
- 13.• El-Gabalawy R, Blaney C, Tsai J, Sumner JA, Pietrzak RH. Physical health conditions associated with full and subthreshold PTSD in U.S. military veterans: Results from the national health and resilience in veterans study. J Affect Disord. 2018;227:849–53 This is the most recent study to examine the association between PTSD and physical health in U.S. military veterans. PubMedGoogle Scholar
- 30.Scherrer JF, Salas J, Lustman PJ, van den Berk-Clark C, Schnurr PP, Tuerk P, et al. The role of obesity in the association between posttraumatic stress disorder and incident diabetes. JAMA Psychiatry. 2018.Google Scholar
- 31.• O'Doherty DC, Chitty KM, Saddiqui S, Bennett MR, Lagopoulos J. A systematic review and meta-analysis of magnetic resonance imaging measurement of structural volumes in posttraumatic stress disorder. Psychiatry Res. 2015;232(1):1–33 Recent systematic review and meta-analysis of structural brain changes in PTSD. PubMedGoogle Scholar
- 33.Vasterling JJ, Brailey K. Neuropsychological findings in adults with PTSD. In J. J. Vasterling & C. R. Brewin (Eds.), Neuropsychology of PTSD: Biological, cognitive, and clinical perspectives. New York, NY, US: Guilford Press; 2005. p.178–207.Google Scholar
- 37.O’Donovan A. PTSD is associated with elevated inflammation. any impact on clinical practice? Evid Based Ment Health. 2016;19(4):102376.Google Scholar
- 39.Cohen BE, Maguen S, Bertenthal D, Shi Y, Jacoby V, Seal KH. Reproductive and other health outcomes in iraq and afghanistan women veterans using VA health care: association with mental health diagnoses. Womens Health Issues. 2012;22(5):461.Google Scholar
- 40.Bradley CS, Nygaard IE, Hillis SL, Torner JC, Sadler AG. Longitudinal associations between mental health conditions and overactive bladder in women veterans. Am J Obstet Gynecol. 2017;217(4):430.e8.Google Scholar
- 41.• Shaw JG, Asch SM, Katon JG, Shaw KA, Kimerling R, Frayne SM, et al. Post-traumatic stress disorder and antepartum complications: a novel risk factor for gestational diabetes and preeclampsia. Paediatr Perinat Epidemiol. 2017;31(3):185–94 This study examines the association between antenatal PTSD and spontaneous pre-term birth in an unprecedented number of deliveries covered by the Veterans Health Administration. PubMedGoogle Scholar
- 45.Schnurr PP, Wachen JS, Green BL, Kaltman S. Trauma exposure, PTSD, and physical health. In M. J. Friedman, T. M. Keane, & P. A. Resick (Eds.), Handbook of PTSD: Science and practice. New York, NY, US: Guilford Press; 2014. p. 502–21. Google Scholar
- 50.Rogers KM, Bonar CA, Estrella JL, Yang S. Inhibitory effect of glucocorticoid on coronary artery endothelial function. Am J Physiol Heart Circ Physiol. 2002;283(5):1922.Google Scholar
- 51.Esler M. The 2009 Carl Ludwig lecture: Pathophysiology of the human sympathetic nervous system in cardiovascular diseases: the transition from mechanisms to medical management. J Appl Physiol (1985). 2010;108(2):227–37.Google Scholar
- 57.Fagundes CP, Glaser R, Kiecolt-Glaser JK. Stressful early life experiences and immune dysregulation across the lifespan. Brain Behav Immun. 2013;27C:8–12.Google Scholar
- 59.Miller AM. Role of IL-33 in inflammation and disease. J Inflamm (Lond). 2011;8(1):22.Google Scholar
- 67.• van den Berk-Clark C, Secrest S, Walls J, Hallberg E, Lustman PJ, Schneider FD, et al. Association between posttraumatic stress disorder and lack of exercise, poor diet, obesity, and co-occuring smoking: a systematic review and meta-analysis. Health Psychol. 2018;37(5):407–16 Recent meta-analysis of PTSD and behavioral risk factors for cardiovascular disease. PubMedGoogle Scholar
- 76.Weitlauf JC, Jones S, Xu X, Finney JW, Moos RH, Sawaya GF, et al. Receipt of cervical cancer screening in female veterans: impact of posttraumatic stress disorder and depression. Womens Health Issues. 2013;23(3):153.Google Scholar
- 78.Manser SS, Houck K, Kramer MD, Tabas IA, Brown CVR, Coopwood B. Do screening and a randomized brief intervention at a level 1 trauma center impact acute stress reactions to prevent later development of post traumatic stress disorder? J Trauma Acute Care Surg. 2018;85(3):466-475.Google Scholar