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Trauma, Posttraumatic Stress Disorder, and Physical Illness: Findings from the General Population

From the Department of Psychosomatic Medicine and Psychotherapy (C.S.), University Medical Center Hamburg-Eppendorf and Klinikum Eilbek (Schön Kliniken), Hamburg, Germany; Institute of Psychology (S.B.), Ruprecht-Karls University, Heidelberg, Germany; Institute for Community Medicine (H.V.), Institute of Epidemiology and Social Medicine (U.J.), and the Department of Psychiatry and Psychotherapy (H.J.F., H.J.G.), Ernst-Moritz-Arndt-University, Greifswald, Germany.

Address correspondence and reprint requests to Carsten Spitzer, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Klinikum Eilbek (Schön Kliniken), Martinistr. 52; 20246 Hamburg, Germany. E-mail: c.spitzer{at}uke.uni-hamburg.de

Objective: To determine in a general population sample the differential impact on physical health of exposure to traumatic experiences and posttraumatic stress disorder (PTSD). Trauma exposure and PTSD have been associated with physical illness in specific populations, such as veterans.

Methods: Medical histories including cardiovascular, endocrine, pulmonary, and other chronic diseases were obtained from 3171 adults living in the community. They were administered the PTSD module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), and were assigned to three groups: no trauma (n = 1440); trauma, but no PTSD (n = 1669); and trauma with subsequent PTSD (n = 62).

Results: After adjustments for sociodemographic factors, smoking, body mass index, blood pressure, depression, and alcohol use disorders, subjects with trauma history had higher odds ratios (ORs) for angina pectoris and heart failure (OR = 1.2; 95% Confidence Interval [CI] = 1.1–1.3), stroke (OR = 1.2; 95 CI = 1.0–1.5), bronchitis, asthma, renal disease, and polyarthritis (ORs between 1.1and 1.3) compared with nontraumatized participants. The PTSD positive subsample had increased ORs for angina (OR = 2.4; 95% CI = 1.3–4.5), heart failure (OR = 3.4; 95% CI = 1.9–6.0), bronchitis, asthma, liver, and peripheral arterial disease (ORs, range = 2.5–3.1).

Conclusions: Our findings suggest a strong association between PTSD and cardiovascular and pulmonary diseases. Particular diagnostic and treatment attention should be paid to physical illness in PTSD positive patients in primary care, medical, and mental health settings.

Key Words: trauma • posttraumatic stress disorder (PTSD) • physical health • cardiovascular and pulmonary disease • general population

Abbreviations: PTSD = posttraumatic stress disorder; SHIP = Study of Health in Pomerania; MMSE = Mini Mental State Examination; CID-S = Composite International Diagnostic-Screener; AUD = alcohol use disorder; BMI = body mass index; SPSS = Statistical Package for the Social Sciences.