Health Services Research & Development

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Hoerster KD, Campbell S, Dolan M, Stappenbeck CA, Yard S, Simpson T, Nelson KM. PTSD is associated with poor health behavior and greater Body Mass Index through depression, increasing cardiovascular disease and diabetes risk among U.S. veterans. Preventive medicine reports. 2019 Sep 1; 15:100930.
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Abstract: Posttraumatic stress disorder (PTSD) is a risk factor for cardiovascular disease (CVD) and diabetes. Dedert and colleagues hypothesized a model whereby PTSD leads to poor health behaviors, depression, and pre-clinical disease markers, and that these factors lead to CVD and diabetes (, 2010, 61-78). This study provides a preliminary test of that model. Using data from a mailed cross-sectional survey conducted 2012-2013, path analysis was conducted among N?=?657 with complete demographic data. We first analyzed the hypothesized model, followed by four alternatives, to identify the best-fitting model. The alternate model that specified pathways from depression to health behaviors had the best fit. Contrary to hypotheses, higher PTSD symptoms were associated with physical activity and diet quality. Of the specific indirect pathways from PTSD to Body Mass Index (BMI), only the path through depression was significant. Higher depression symptoms were significantly associated with less physical activity, poorer diet, and greater likelihood of smoking. In addition, the specific indirect effect from depression to BMI through physical activity was significant. Current smoking and higher BMI were associated with greater likelihood of diabetes, and hypertension was associated with greater likelihood of CVD. PTSD symptoms may increase risk for CVD and diabetes through the 'negative impact of depression on health behaviors and BMI. With or without PTSD, depression may be an important target in interventions targeting cardiovascular and metabolic diseases among veterans.