Study Shows OEF/OIF/OND Veterans with PTSD at Greater Risk of Autoimmune Disorders
Emerging data suggest high rates of PTSD, other psychiatric disorders, and military sexual trauma (MST) among OEF/OIF/OND Veterans. Also, PTSD is associated with a number of biological abnormalities that could increase the risk for autoimmune disorders. This retrospective cohort study examined whether PTSD, other psychiatric disorders (i.e., depression, anxiety, psychosis, alcohol use disorder, substance use disorder), and MST increase the risk for autoimmune disorders. For this study, autoimmune disorders included those with definitive diagnostic criteria or tests: thyroiditis, inflammatory bowel disease, rheumatoid arthritis, multiple sclerosis, and lupus. Using VA data, investigators identified 666,269 OEF/OIF/OND Veterans, under age 55, who were enrolled in the VA healthcare system between 10/01 and 3/11. Veterans were then classified into three groups: 1) Veterans with PTSD alone or combined with other psychiatric disorders (n=203,766 or 31%); 2) Veterans with psychiatric disorders other than PTSD (n=129,704 or 20%); and 3) Veterans with no psychiatric disorders (n=332,799 or 50%). Demographics and the number of primary care visits also were measured.
- Veterans diagnosed with PTSD had significantly higher risk for diagnosis of any of the autoimmune disorders – alone or in combination – compared to Veterans with no psychiatric diagnoses. Veterans with PTSD had twice the risk of being diagnosed with an autoimmune disorder compared to those without any psychiatric disorders, and 51% increased risk compared to Veterans with psychiatric disorders other than PTSD.
- Veterans with a higher number of comorbid psychiatric diagnoses also were more likely to be diagnosed with an autoimmune disorder, but high levels of comorbidity did not entirely account for the effect of PTSD on increased risk.
- The magnitude of the association between PTSD and autoimmune disorders was similar in women and men. However, overall, women had almost three times higher prevalence of autoimmune disorders.
- MST was much more common in women than men (13% vs. 0.5%), and was independently associated with increased risk for autoimmune disorders in both women and men.
- Due to the design of this study, no causal relationship can be shown.
- The use of codes rather than clinical diagnoses may lead to misclassification errors, and data may be at risk of bias due to under- or over-reporting of symptoms by Veterans seeking VA care.
- Veterans with PTSD are known to be at increased risk for other chronic physical diseases, and investigators did not adjust for the presence of these disorders.
- Findings underscore the need to identify and treat PTSD and other psychiatric disorders in Veterans in order to enhance not only mental but also physical health.
O’Donovan A, Cohen B, Seal K, et al. Elevated Risk for Autoimmune Disorders in Iraq and Afghanistan Veterans with Post-Traumatic Stress Disorder. Biological Psychiatry. February 15, 2015;77(4):365-74.