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From the Health Services Research and Development (L.S.K., K.A.B., M.B.M., C.L.B.), Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Health Services (L.S.K., K.A.B.), University of Washington, Seattle, Washington; Department of Medicine (K.A.B., C.L.B.), University of Washington, Seattle, Washington; Department of Psychiatry and Behavioral Sciences (W.J.K., E.L.), University of Washington, Seattle, Washington; Center for Health Studies (E.L.), Group Health Cooperative of Puget Sound, Seattle, Washington; VA Center of Excellence for Substance Abuse Treatment and Education (K.A.B.), Seattle, Washington; Primary and Specialty Medical Care (K.A.B.), VA Medical Center, Seattle, Washington.
Address correspondence and reprint requests to Leslie S. Kinder, 8506 SE 72nd Street, Mercer Island, WA 98040. E-mail: lskinder{at}stanfordalumni.org
Objective: To determine whether a history of depression and/or posttraumatic stress disorder (PTSD) is associated with all-cause mortality in primary care patients over an average of 2 years.
Methods: Patients from seven Department of Veterans Affairs medical centers completed mailed questionnaires. Depression and PTSD status were determined from patient self-report of a prior diagnosis and/or electronic administrative data. Date of death was ascertained from Veterans Health Information Systems and Technology Architecture and the Department of Veterans Affairs' Beneficiary Identification and Records Locator System.
Results: Among 35,715 primary care patients, those with a history of depression without a history of PTSD (n = 6876) were at increased risk of death over an average of 2 years compared with patients with neither depression nor PTSD after adjustment for demographic variables, health behaviors, and medical comorbidity (hazard ratio (HR) = 1.17; 95% Confidence Interval (CI) = 1.06–1.28). However, patients with a history of PTSD without a history of depression (n = 748) were not at increased risk of death compared with patients with neither depression nor PTSD (HR = 0.84; 95% CI = 0.63–1.13). Patients with a history of both (n = 3762) were at increased risk of death after adjustment for demographic factors, although not after additional adjustment for health behaviors and medical comorbidity (HR = 0.90; 95% CI = 0.78–1.04).
Conclusions: In a large sample of veterans, a prior diagnosis of depression, but not PTSD, was associated with an increased risk of death over an average of 2 years after adjusting for age, demographic variables, health behaviors, and medical comorbidity.
Key Words: depression • posttraumatic stress disorder • mortality • veterans
Abbreviations: PTSD = posttraumatic stress disorder; VA= Department of Veterans Affairs; ACQUIP = Ambulatory Care Quality Improvement Project; MHI-5 = Mental Health Inventory; CHF = congestive heart failure; MI = heart attack/myocardial infarction.
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