A Late Effect of Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) is defined as a state of anxiety associated with serious traumatic events, and is characterized by such symptoms as survivor guilt, reliving the trauma in dreams, numbness and lack of involvement with reality, or recurrent thoughts and images.  In other words, it’s more or less a purely psychiatric disorder.  So a paper given by a Veterans Affairs physician at the recent American Society of Anesthesiology meeting caused considerable surprise. 

The US Veterans Affairs medical database was used to extract data on veterans that required non-emergency surgery between 1996 and 2008 at the San Francisco VA hospital. Known chronic health factors for these veterans were available, along with post-operative complications and mortality, and 1- and 5-year mortality.  There were over 10,000 male veterans in the analysis. 

The numbers in the abstract for the meeting (see first link, above) do not agree with those in later press releases.  However, the conclusions appear to be the same.  There was a startling 25% increase in 1-year mortality in the PTSD patients, compared with the other veterans; this was the case even if the surgery was done years after the men had finished military service.  After adjusting for age and known co-existing disorders, the odds of a veteran with PTSD dying within a year of surgery were2.2 times greater than those for non-PTSD veterans.

The unexpected features of this finding are: 1) the magnitude of the effect of PTSD – about twice that for the effect of diabetes, and: 2) the role of PTSD, a “psychiatric” disorder, in accelerating death without having obvious somatic (bodily) features.  The large numbers of veterans returning from Iraq and Afghanistan give these results even greater importance.