Journal of General Internal Medicine

, Volume 26, Issue 1, pp 33–39 | Cite as

Medical Care Needs of Returning Veterans with PTSD: Their Other Burden

  • Susan M. Frayne
  • Victor Y. Chiu
  • Samina Iqbal
  • Eric A. Berg
  • Kaajal J. Laungani
  • Ruth C. Cronkite
  • Joanne Pavao
  • Rachel Kimerling
Original Research



There has been considerable focus on the burden of mental illness (including post-traumatic stress disorder, PTSD) in returning Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, but little attention to the burden of medical illness in those with PTSD.


(1) Determine whether the burden of medical illness is higher in women and men OEF/OIF veterans with PTSD than in those with No Mental Health Conditions (MHC). (2) Identify conditions common in those with PTSD.


Cross-sectional study using existing databases (Fiscal Year 2006–2007).


Veterans Health Administration (VHA) patients nationally.


All 90,558 OEF/OIF veterans using VHA outpatient care nationally, categorized into strata: PTSD, Stress-Related Disorders, Other MHCs, and No MHC.


(1) Count of medical conditions; (2) specific medical conditions (from ICD9 codes, using Agency for Health Research and Quality’s Clinical Classifications software framework).


The median number of medical conditions for women was 7.0 versus 4.5 for those with PTSD versus No MHC (p < 0.001), and for men was 5.0 versus 4.0 (p < 0.001). For PTSD patients, the most frequent conditions among women were lumbosacral spine disorders, headache, and lower extremity joint disorders, and among men were lumbosacral spine disorders, lower extremity joint disorders, and hearing problems. These high frequency conditions were more common in those with PTSD than in those with No MHC.


Burden of medical illness is greater in women and men OEF/OIF veteran VHA users with PTSD than in those with No MHC. Health delivery systems serving them should align clinical program development with their medical care needs.


stress disorders post-traumatic veterans Afghan campaign 2001- Iraq War 2003- women 

Supplementary material

11606_2010_1497_MOESM1_ESM.pdf (54 kb)
Appendix 1Mental Health Condition Specifications (PDF 54.4 KB)
11606_2010_1497_MOESM2_ESM.pdf (485 kb)
Appendix 2Gender-stratified Frequency of all 222 Medical Conditions, by PTSD Status, in OEF/OIF Veterans Health Administration Patients; Frequency Rank for Women and Men with PTSD (with 1 indicating most frequent); and Age-Adjusted Odds Ratio (PTSD vs No MHC)* (PDF 484 KB)
11606_2010_1497_MOESM3_ESM.pdf (296 kb)
Appendix 3Cumulative Medical Condition Count by PTSD Status by Gender, Sensitivity Analysis 1-4, truncated at 25 conditions. (PDF 295 KB)
11606_2010_1497_MOESM4_ESM.pdf (119 kb)
Appendix 4Definition of VA Outpatient Face-to-Face Visits (Technical specifications: clinic “stop” codes used to define face-to-face visits.) (PDF 118 KB)
11606_2010_1497_MOESM5_ESM.pdf (13 kb)
Appendix 5Definition of Primary Care Clinic Stops. (Technical specifications: Clinic stop codes used to define primary care encounters.) (PDF 13.2 KB)


  1. 1.
    Seal KH, Bertenthal D, Miner CR, Sen S, Marmar C. Bringing the war back home: mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Arch Intern Med. 2007;167(5):476–482.PubMedCrossRefGoogle Scholar
  2. 2.
    Hoge CW, Auchterlonie JL, Milliken CS. Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA. 2006;295(9):1023–1032.PubMedCrossRefGoogle Scholar
  3. 3.
    Kang HK, Hyams KC. Mental health care needs among recent war veterans. N Engl J Med. 2005;352(13):1289.PubMedCrossRefGoogle Scholar
  4. 4.
    Schnurr PP, Green BL. Trauma and Health, Physical Health Consequences of Exposure to Extreme Stress. Washington, DC: American Psychological Association; 2004.CrossRefGoogle Scholar
  5. 5.
    Lang AJ, Rodgers CS, Laffaye C, Satz LE, Dresselhaus TR, Stein MB. Sexual trauma, posttraumatic stress disorder, and health behavior. Behav Med. Winter. 2003;28(4):150–158.CrossRefGoogle Scholar
  6. 6.
    Geuze E, Westenberg HG, Jochims A, et al. Altered pain processing in veterans with posttraumatic stress disorder. Arch Gen Psychiatry. 2007;64(1):76–85.PubMedCrossRefGoogle Scholar
  7. 7.
    Kimerling R, Ouimette P, Wolfe J, eds. Gender and PTSD. New York: The Guilford Press; 2002.Google Scholar
  8. 8.
    Friedman MJ, Schnurr PP, McDonagh-Coyle A. Post-traumatic stress disorder in the military veteran. Psychiatr Clin North Am. 1994;17(2):265–277.PubMedGoogle Scholar
  9. 9.
    Yano EM, Bastian LA, Frayne SM, et al. Toward a VA women’s health research agenda: Setting evidence-based priorities to improve the health and health care of women veterans. J Gen Intern Med. 2006;21(s3):S93–S101.PubMedCrossRefGoogle Scholar
  10. 10.
    VIREC, VIREC Research User Guide: FY2006 VHA Medical SAS Outpatient Datasets. Hines, IL: Edward J. Hines, Jr. VA Hospital (151 V); September 2007 2007.Google Scholar
  11. 11.
    Elixhauser A, Steiner C, Palmer L. Clinical Classifications Software (CCS), 2008. (accessed August 13, 2010);
  12. 12.
    Kimerling R, Ouimette P, Prins A, et al. Brief report: Utility of a short screening scale for DSM-IV PTSD in primary care. J Gen Intern Med. 2005;21(1):65–67.CrossRefGoogle Scholar
  13. 13.
    Schnurr PP, Ford JD, Friedman MJ, Green BL, Dain BJ, Sengupta A. Predictors and outcomes of posttraumatic stress disorder in World War II veterans exposed to mustard gas. J Consult Clin Psychol. 2000;68(2):258–268.PubMedCrossRefGoogle Scholar
  14. 14.
    Stephens M. EDF statistics for goodness of fit and some comparisons. Journal of the American Statistical Association. 1974;69:730–737.CrossRefGoogle Scholar
  15. 15.
    Beckham JC, Moore SD, Feldman ME, Hertzberg MA, Kirby AC, Fairbank JA. Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder. Am J Psychiatry. 1998;155(11):1565–1569.PubMedGoogle Scholar
  16. 16.
    Frayne SM, Seaver MR, Loveland S, et al. Burden of medical illness in women with depression and posttraumatic stress disorder. Arch Intern Med. 2004;164(12):1306–1312.PubMedCrossRefGoogle Scholar
  17. 17.
    Hoge CW, Terhakopian A, Castro CA, Messer SC, Engel CC. Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. Am J Psychiatry. 2007;164(1):150–153.PubMedCrossRefGoogle Scholar
  18. 18.
    Wagner AW, Wolfe J, Rotnitsky A, Proctor SP, Erickson DJ. An investigation of the impact of posttraumatic stress disorder on physical health. J Trauma Stress. 2000;13(1):41–55.PubMedCrossRefGoogle Scholar
  19. 19.
    Wolfe J, Proctor SP, Erickson DJ, et al. Relationship of psychiatric status to Gulf War veterans’ health problems. Psychosom Med. 1999;61(4):532–540.PubMedGoogle Scholar
  20. 20.
    Engel CC Jr, Liu X, McCarthy BD, Miller RF, Ursano R. Relationship of physical symptoms to posttraumatic stress disorder among veterans seeking care for Gulf War-related health concerns. Psychosom Med. 2000;62(6):739–745.PubMedGoogle Scholar
  21. 21.
    Barrett DH, Doebbeling CC, Schwartz DA, et al. Posttraumatic stress disorder and self-reported physical health status among US Military personnel serving during the Gulf War period: a population-based study. Psychosomatics. May-Jun. 2002;43(3):195–205.CrossRefGoogle Scholar
  22. 22.
    Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in US Soldiers returning from Iraq. N Engl J Med. 2008;358(5):453–463.PubMedCrossRefGoogle Scholar
  23. 23.
    Cohen BE, Gima K, Bertenthal D, Kim S, Marmar CR, Seal KH. Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans. J Gen Intern Med. 2010;25(1):18–24.PubMedCrossRefGoogle Scholar
  24. 24.
    Helmer DA, Chandler HK, Quigley KS, Blatt M, Teichman R, Lange G. Chronic widespread pain, mental health, and physical role function in OEF/OIF veterans. Pain Med. 2009;10(7):1174–1182.PubMedCrossRefGoogle Scholar
  25. 25.
    Wolfe J, Schnurr PP, Brown PJ, Furey J. Posttraumatic stress disorder and war-zone exposure as correlates of perceived health in female Vietnam War veterans. J Consult Clin Psychol. 1994;62(6):1235–1240.PubMedCrossRefGoogle Scholar
  26. 26.
    Taft CT, Stern AS, King LA, King DW. Modeling physical health and functional health status: the role of combat exposure, posttraumatic stress disorder, and personal resource attributes. J Trauma Stress. 1999;12(1):3–23.PubMedCrossRefGoogle Scholar
  27. 27.
    Dobie DJ, Kivlahan DR, Maynard C, Bush KR, Davis TM, Bradley KA. Posttraumatic stress disorder in female veterans: association with self-reported health problems and functional impairment. Arch Intern Med. 2004;164(4):394–400.PubMedCrossRefGoogle Scholar
  28. 28.
    Kazis LE, Miller DR, Clark J, et al. Health-related quality of life in patients served by the Department of Veterans Affairs: results from the Veterans Health Study. Arch Intern Med. 1998;158(6):626–632.PubMedCrossRefGoogle Scholar
  29. 29.
    Redelmeier DA, Tan SH, Booth GL. The treatment of unrelated disorders in patients with chronic medical diseases. N Engl J Med. 1998;338(21):1516–1520.PubMedCrossRefGoogle Scholar
  30. 30.
    Schnurr PP, Friedman MJ, Sengupta A, Jankowski MK, Holmes T. PTSD and utilization of medical treatment services among male Vietnam veterans. J Nerv Ment Dis. 2000;188(8):496–504.PubMedCrossRefGoogle Scholar
  31. 31.
    Sheehan B, Lall R, Bass C. Does somatization influence quality of life among older primary care patients? Int J Geriatr Psychiatry. 2005;20(10):967–972.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Susan M. Frayne
    • 1
    • 2
    • 3
    • 4
  • Victor Y. Chiu
    • 1
  • Samina Iqbal
    • 2
    • 4
  • Eric A. Berg
    • 1
    • 2
  • Kaajal J. Laungani
    • 1
  • Ruth C. Cronkite
    • 1
    • 3
    • 5
  • Joanne Pavao
    • 6
  • Rachel Kimerling
    • 1
    • 4
    • 6
  1. 1.Center for Health Care Evaluation, VA Palo Alto Health Care SystemMenlo ParkUSA
  2. 2.Division of General Internal Medicine, Stanford UniversityStanfordUSA
  3. 3.Center for Primary Care and Outcomes Research, Stanford UniversityStanfordUSA
  4. 4.Center of Excellence in Women’s Health , VA Palo Alto Health Care SystemPalo AltoUSA
  5. 5.Department of Sociology, Stanford UniversityStanfordUSA
  6. 6.National Center for PTSD, VA Palo Alto Health Care SystemMenlo ParkUSA

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