Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3009 — Self-Report and Physician Rated Health in Women with PTSD and Depression

Calhoun PS (VISN-6 Mental Illness Research, Education, and Clinical Center; VA Center for Excellence in Primary Care; Durham VAMC, Duke University Medical Center) , Wiley M (Durham VAMC), Feldman MD (Duke University Medical Center), Beckham JC (VISN-6 Mental Illness Research, Education, and Clinical Center; Durham VAMC, Duke University Medical Center)

Objectives:
Posttraumatic stress disorder (PTSD) and depression are important women’s health issues. Increasing evidence suggests that PTSD is associated with poor physical health. Depression, which is highly comorbid with PTSD, is also associated with poor health, and may be responsible for the apparent relationship between PTSD and health outcomes. Little research has examined the relationship between health and PTSD while controlling for the possible effects of depression. This study examined health risk behaviors, self-reported health complaints, and physician diagnosed medical conditions in women with PTSD and compared them to women with PTSD and co-morbid depression, depression alone, or neither depression and PTSD.

Methods:
Women were recruited through advertisements on bulletin boards at VA and community hospitals. The 148 study participants were classified into groups (PTSD only (n=40), PTSD and depression (n=32), depression only (n=24), neither disorder (n=52)) based on clinical structured interviews (i.e., the Clinician Administered PTSD Scale and the Structured Clinical Interview for DSM-IV). Outcomes included hip-to-waist ratio, lifetime alcohol/drug dependence, health habits, total self-reported health complaints, number of health complaints in the past 12 months, and physician diagnosed medical problems. Overdispersed count data (e.g., number of health complaints and physician diagnosed medical problems) were analyzed using negative binomial regression models.

Results:
After controlling for age and race, all three psychiatric groups had fewer positive health habits, increased total health complaints, increased health complaints in the past 12 months and increased physician diagnosed medical problems compared to controls. PTSD, but not depression, was associated with increased hip-to-waist ratio. Comorbid depression was associated with fewer positive health habits and increased health complaints in the past 12 months for women with PTSD. In a multivariate model examining physician diagnosed medical problems, PTSD was associated with a 78% increase in physician diagnosed medical conditions compared to controls (IRR=1.78, 95% CI 1.06 – 2.99) even after accounting for demographic variables, health risk variables, and depression.

Implications:
Depression does not fully account for the relationship between PTSD and poor health. Comorbid depression is associated with increased subjective past year health complaints but not physician diagnosed medical morbidity in women with PTSD.

Impacts:
PTSD increases the risk of poor health among women.