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Comorbid medical conditions in women veterans with PTSD

Chiu V, Phibbs CS, Yu W, Yano E, Ananth L, Iqbal S, Thrailkill A, Frayne S. Comorbid medical conditions in women veterans with PTSD. Paper presented at: Society of General Internal Medicine California / Hawaii Regional Annual Meeting; 2007 Mar 22; San Francisco, CA.


Background The clinical presentation of posttraumatic stress disorder (PTSD) in the growing women veteran population is important to understand, especially because women are more likely than men to develop PTSD. To provide comprehensive care to this population, adequate mental health care and medical care are needed. In order to identify the medical conditions that they face, we characterized the prevalence of medical conditions in women veterans with a PTSD diagnosis compared to women veterans with no mental illness diagnoses. Methods Using the Veterans Health Administration's (VHA) national database, we examined the ICD-9 codes of all 44,017 women veterans who were regular users of the VHA nationally (3+ VHA primary care encounters in FY2002). The ICD-9 codes were classified into clinical conditions using a modified version of the Agency for Healthcare Research and Quality's Clinical Classifications Software. Using logistic regression, we determined age-adjusted odds ratio (AOR) and 95% CI of having medical conditions for those with PTSD versus those without mental illness. Results Women with PTSD (N = 7,238) were diagnosed with any medical condition at a higher rate than women without mental illness (AOR 2.0, [1.8-2.1]). Lifestyle-related conditions were more common in women with PTSD (COPD: AOR 2.1 [1.9-2.4]; hepatitis C: AOR 3.5 [3.0-4.1]), as were chronic pain conditions (lower back pain: AOR 2.1 [2.0-2.2]; arthritis: AOR 1.4 [1.4-1.5]; headache: AOR 1.7 [1.6-1.8]), gynecologic conditions (pelvic inflammatory diseases: AOR 1.3 [1.1-1.4]; menstrual disorders: AOR 1.4 [1.3-1.5]), and cardiovascular disease (ischemic heart disease: AOR 1.4 [1.3-1.6]; stroke: AOR 1.5 [1.1-1.9]). Musculoskeletal injury was also more common in women with PTSD (AOR 2.8 [2.7-3.0]) Conclusions Women with PTSD had an increased burden of medical illness across a wide range of conditions. This difference is especially marked for lifestyle-related conditions, chronic pain conditions, gynecologic conditions, cardiovascular disease, and injuries. To provide high quality care for women veterans already diagnosed with PTSD, their excess burden of comorbid medical conditions must be taken into account to ensure that adequate resources are applied to their care and appropriate clinical services are available. Services for high risk health behaviors, pain management, gender-specific conditions and cardiovascular preventive health should be emphasized. Assessment for injury risk (accidental or as a result of violence) should also be a priority. Also, clinicians caring for women veterans with a heavy burden of medical illness should consider the possibility of PTSD. PTSD may explain the presence of multiple comorbid, idiopathic illnesses. Lastly, mechanisms for the associations between specific medical conditions and PTSD should be explored, as they may point to promising interventions such as behaviorally-based services or interdisciplinary systems of care.

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