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Wednesday, May 31, 2006

APA Meeting: Worse Physical Health Follows Combat PTSD

Last week in Toronto, at the American Psychiatric Association's 2006 Annual Meeting, medical researchers presented data to their peers on a recently completed study of US Army combat veterans. The study revealed a connection between the incidence of PTSD and decreased physical health.

Click on 'Article Link' below tags for more...

First a few details on the meeting:

The American Psychiatric Association (APA), the leading psychiatric medical society in the United States, convenes its 159th Annual Meeting this weekend in Toronto, Canada, from May 20-25. ... The APA Annual Meeting, which assembles during Mental Health Month, continues to be the largest gathering of psychiatric physicians on the globe and attracts more than a thousand clinical papers, symposia, new research poster sessions and workshops.

A few study specifics from MedPage Today:

Combat troops meeting the criteria for post-traumatic stress disorder (PTSD) who are still on active duty are much more likely to have physical health problems than their comrades, according to research presented here.

Most earlier studies of PTSD have focused on veterans many years after they have returned from combat and found strong associations between the disorder and poor physical health, said Artin Terhakopian, M.D., of the Walter Reed Army Medical Center in Silver Spring, Md., at the American Psychiatric Association meeting here. The new research is on active duty personnel—"working soldiers"—he added.

The researchers studied 2,863 soldiers of U.S. Army combat brigades that had been rotated back to the U.S. after duty in Iraq, Dr. Terhakopian and colleagues found dramatic differences between the 16% who were diagnosed as suffering from PTSD and those who were not.

Using an anonymous survey a year after the soldiers' return from combat duty in Iraq, Dr. Terhakopian and colleagues examined PTSD symptoms, self-rated health, sick call visits, and missed work days, as well as physical symptoms evaluated on a 15-point Patient Health Questionnaire (PHQ-15).

Stats arrived at following the study:

  • 16.6% (468 of 2,815) of survey respondents had PTSD
  • 46.7% of those with PTSD (vs. 19.8% without) rated their health as fair or poor
  • 37.6% with PTSD (vs. 20.5% without) had 2 or more recent medical care visits
  • 11.8% with PTSD (vs. 6.5% without) recently missed 2 or more days of work due to illness
  • 34.4% with PTSD (vs. 5.2% without) had a PHQ-15 score indicating ill health
Continuing MedPage Today's excellent coverage:
Dr. Terhakopian noted that the study was cross-sectional, so that no conclusion can be drawn about whether PTSD causes ill health or vice versa. But he added that the clinical implication is that veterans with ill health without other obvious causes should be suspected of suffering form PTSD and offered treatment.

The Walter Reed researchers did not report the effect of injury on PTSD, but scientists from the Naval Medical Center at San Diego showed that battlefield injuries are more highly linked to PTSD than the usual run of medical conditions that can cause soldiers to be evacuated from a war zone.

In a retrospective chart review, David Oliver, M.D., and colleagues at the center, analyzed the relationship of PTSD with both branch of service and reason for being evacuated from the war zone. Since 2004, the San Diego center has been the receiving station for military personnel medevaced from Iraq, he said.

The majority of the personnel with PTSD or acute stress syndrome were marines, Dr. Oliver said, and most of the remainder were sailors, many of them hospital corpsmen. However, there was no statistically significant link between branch of service and the chance of having PTSD, he said.

On the other hand, the researchers found, there was a significant link to the reason for evacuation. Those who came home because of a battlefield injury or for psychiatric reasons were significantly more likely to suffer from PTSD, compared to those with non-battlefield injuries or other medical circumstances.

Specifically, 26% of those with battlefield injuries and 48% of those with psychiatric issues had PTSD, compared with 17% of those with non-battlefield injuries or other medical concerns.

USA Today also reported on the study:
A year after combat soldiers leave Iraq, those with symptoms of post-traumatic stress disorder say they're in worse physical health, suffer more pain and are more likely to miss work than veterans without PTSD symptoms, according to a military study out Monday.

The anonymous survey of nearly 3,000 Iraq veterans is the first to look at a link between PTSD and physical symptoms. ... "Their mental health problems may be taking a toll," says psychiatrist Charles Hoge, chief of psychiatry and neuroscience at the Walter Reed Army Institute of Research in Washington, D.C. Physical complaints may send a disproportionate number of these stressed soldiers to primary-care doctors, he says. ...

Anxiety can contribute to these health problems, Hoge says. Also, nightmares and flashbacks — symptoms of PTSD — can interfere with sleep, leading to worse health, he adds. About one out of five soldiers without PTSD symptoms said they were in fair to poor health, compared with nearly half of those with PTSD symptoms.

Soldiers are screened for mental and physical problems when they leave Iraq, then three and six months later, Hoge says. New "practice guidelines" are alerting military and Veterans Affairs doctors to possible ties between physical and mental symptoms in soldiers, says Charles Engel, director of the Deployment Health Clinical Center at Walter Reed Army Medical Center.

Soldiers sometimes downplay their stress reactions, so the number of soldiers with PTSD who also have physical health problems is, "if anything, conservative," says psychologist Charles Figley, a traumatic-stress expert at Florida State University. "When they come in with back pain, doctors are going to have to keep asking what happened to them in the war, not just now but five years from now."

There's strong evidence in civilian studies that trauma survivors use more health care at a higher cost, says University of Tulsa psychologist Elana Newman, who has studied health and traumatic stress.

As the costs associated with warfare mount, we need to be vigilant in our advocacy for proper veteran healthcare funding.

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