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Disaster-Related Posttraumatic Stress Disorder and Physical Health

From the Netherlands Institute for Health Services Research (NIVEL) (A.J.E.D., J.Y.), Utrecht, Netherlands; Institute for Psychotrauma (IVP) (P.G.v.d.V.), Zaltbommel, Netherlands; Center for Environmental Health Research (L.G.), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.

Address correspondence and reprint requests to Anja J. E. Dirkzwager, Netherlands Institute for Health Services Research, Utrecht, Netherlands. E-mail: a.dirkzwager{at}nivel.nl

Objective: To examine the relationship between posttraumatic stress disorder (PTSD) and self-reported as well as physician-recorded physical health in a sample of survivors (n = 896) of a man-made disaster, using a longitudinal design that included predisaster health data. Most studies on the relationship between PTSD and physical health are cross-sectional and use self-reported physical health outcomes.

Methods: A surveillance using the electronic medical records of survivors' family practitioners (FPs), 1 year predisaster until 4 years postdisaster, was combined with a survey, 3 weeks and 18 months postdisaster. Self-reported PTSD and self-reported physical health were assessed at 18 months postdisaster. FP-recorded physical health problems in the subsequent 2 years were classified according to the International Classification of Primary Care. Multiple regression analyses were used to describe the relationships between PTSD and physical health.

Results: After adjusting for demographics, smoking behavior, and predisaster physical health, PTSD was significantly associated with FP-recorded vascular, musculoskeletal, and dermatological problems, and with all self-reported physical health aspects. Prospectively, PTSD signaled an increased risk of new vascular problems (odds ratio = 1.92; 1.04–3.55).

Conclusions: This study suggests an effect of PTSD in the development of vascular problems. The results imply that clinicians should be alert that disaster survivors with PTSD can suffer from comorbid medical problems as well.

Key Words: posttraumatic stress disorder • physical health • cardiovascular • disaster • prospective

Abbreviations: EMRs = electronic medical records; FP = family practitioner; ICPC = International Classification of Primary Care; PTSD = posttraumatic stress disorder; srs-PTSD = Self-Rating Scale for Posttraumatic Stress Disorder; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; SCL-90-R = Symptom Checklist-90 Revision; RAND-36 = Short Form Health Survey-36.

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