Academic journal article International Journal of Clinical and Health Psychology

Comorbidities with Posttraumatic Stress Disorder (PTSD) among Combat Veterans: 15 Years Postwar Analysis

Academic journal article International Journal of Clinical and Health Psychology

Comorbidities with Posttraumatic Stress Disorder (PTSD) among Combat Veterans: 15 Years Postwar Analysis

Article excerpt

Numerous studies with divergent results have examined the connection between physical and mental health, and the impact of stress and traumatic events on the hypothalamicpituitary- adrenal (HPA) axis, with the consequent metabolic disorders and impairments of cortisol secretion and lipid status (Ginzburg & Solomon, 2011), or physical health in combat veterans with PTSD (O'Toole & Catts, 2008; Vasterling et al., 2008). These contradictory results support the complexity of this relationship, in addition to the important influences of genetic vulnerability, the HPA axis changes, smoking and substance abuse (Qureshi, Pyne, Magruder, Schultz, & Kunik, 2009; Zen, Whooley, Zhao, & Cohen, 2012). Some studies reported a higher incidence of arthritis, pulmonary disease (O'Toole & Catts, 2008), dermatological disorders (eczema), back and other musculoskeletal disorders, genitourinary disorders in the general population with PTSD (Glaesmer, Brähler, Gündel, & Riedel-Heller, 2011) and veterans (O'Toole & Catts, 2008), while others showed a significant association between PTSD and diabetes (Boyko et al., 2010), psoriasis, thyroid disease (Boscarino, 2004), cardiovascular diseases (Coughlin, 2011; Edmundson & Cohen, 2013) and ulcers (Fink, 2011). The fact that over 50% of veterans with PTSD also have another psychiatric diagnosis (Ginzburg, Ein-Dor, & Solomon, 2010) raises the question of the impact of psychiatric comorbidity on the occurrence of physical illnesses. We are not aware of any previous studies investigating the differences in the prevalence of somatic disorders among veterans with PTSD, with or without comorbid diagnoses. Given the large numbers of veterans with PTSD in Croatia in the aftermath of the 1991-1995 war, who undoubtedly represent a significant public health problem, there is a need to study their physical health.

The aim of this study was to investigate the differences in the prevalence of somatic diseases among combat veterans and their contemporaries who were not exposed to the traumatic experience in the battlefield, and to determine whether socio-demographic factors (education, marital status, employment status), the effects of combat exposure to wartime trauma, and/or injury might be used as predictors of development of somatic diseases. The hypothesis was that veterans will have higher prevalence of somatic disorders compared to the general population matched for age and sex, and that those injuries and traumatic experiences will significantly influence the occurrence of somatic illnesses in veterans. Another aim was to elucidate a prevalence of somatic diseases among veterans with PTSD and psychiatric comorbidities, compared to subjects without comorbid diagnoses.

Method

Participants and instruments

This case control study included 1,558 subjects living in central Dalmatia in the region of Split-Dalmatia County. The test group consists of male combat veterans, 36 to 65 years of age, diagnosed with PTSD resulting from the combat experience after the Homeland war in Croatia, who were in outpatient treatment. The group was formed from a sample of all combat veterans who were diagnosed and/or treated at the Regional Center for Psychotrauma, Split Clinical Hospital Center, from May 2010 to May 2011. A total of 1,023 veterans were examined, of whom 759 were diagnosed with PTSD and 501 agreed to participate in the study. The remaining 258 were excluded from the study due to various reasons; 108 of them did not accepted to participate in the study, with the other 150 questionnaires were not properly filled, (49 of them Mississippi scale was not properly filled, and in 101 the data were insufficient). The diagnosis of PTSD was established according to the diagnostic criteria for PTSD based on the ICD-10 criteria (World Health Organization, 1992), but also with a Structured Clinical Interview (SCID) for DSM-IV (First, Spitzer, Gibbon, & Williams, 2000). All participants were assessed systematically. …

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