Veterans with PTSD at higher risk for death from preventable causes
Veterans seeking treatment for posttraumatic stress disorder (PTSD) are at increased risk of death compared with the general population, according to a new study published in the American Journal of Preventative Medicine.
This retrospective cohort study identified the leading causes of death among 491,040 veterans who initiated PTSD treatment at any Department of Veterans Affairs Medical Center from 2008 to 2013. According to the data, 5,215 died within the first year of care. The mean age was 48.5 years old, 90.7 percent were male, 63.5 percent were of white race, and 34.9 percent served in the wars in Iraq and Afghanistan, according to the study abstract.
Causes of death during the first year of treatment were grouped according to age, 18-34, 35-64, and 65 or older. To statistically compare the observed mortality among Veterans in PTSD treatment with the general population, standardized mortality ratios were calculated from age- and sex-matched mortality tables of the 2014 U.S. population.
The study found that veterans with PTSD are twice as likely to die from suicide, accidental injury, and viral hepatitis than the general population, and are also more likely to die from diabetes and chronic liver disease than the general population, according to lead investigator Jenna Forehand, MD, MPH, of the Veterans Affairs Medical Center White River Junction in Hartford, Vermont.
With advances in medicine and technology, veterans who served in recent conflicts are more likely to survive combat injuries than previous generations. As a result, the prevalence of PTSD, pain disorders, and opioid use has increased among survivors. As Veterans with PTSD and comorbid pain may be at increased risk of opioid use disorder, the investigators posit that opioids may play a role in accidental injury, suicide, and hepatitis-related deaths, especially in young veterans with PTSD. Understanding the complex nature of PTSD and its associated mortality risks is important for developing targeted interventions in this age group, researchers said.
Future studies should develop preventive interventions that target PTSD and comorbid depression, pain disorder, and substance use to lessen the risk of suicide, accidental poisoning, and viral hepatitis in veterans with PTSD, Forehand said. Similarly, lifestyle modifications may reduce the risk of diabetes and chronic liver disease in this patient population.
“Veterans seeking treatment for PTSD should receive comprehensive education on the benefits of diet and exercise and the risks of chronic stress and substance use," she said.