Physical Ailments Begin Immediately After Deployment in Young Veterans with PTSD, Substance Abuse Disorders

by U.S. Medicine

July 14, 2011

WASHINGTON — Young veterans returning from Iraq and Afghanistan who are diagnosed with PTSD or substance-use disorders (SUD) are more likely to suffer from a host of physical ailments, particularly musculoskeletal disorders, according to study data recently released by VA researchers in the Palo Alto VA Healthcare System.

The study, presented this spring at the American Psychosomatic Society’s 69th Annual Scientific Meeting, suggests that young male veterans with PTSD, or PTSD and SUD, had a 150% increased risk of having a medical diagnosis compared with their counterparts without PTSD or PTSD with SUD, and that women veterans had a 200% increase.

The cross-sectional study looked at 73,720 Iraq and Afghanistan veterans enrolled in primary care at VA facilities, 15% of whom were women. VA researchers looked at 10 specific medical condition categories, obtaining clinically-diagnosed mental health and medical conditions from ICD-9 codes. They calculated the adjusted odds ratios (AOR) for four groups of veterans: those with PTSD, those with SUD, those with comorbid PTSD and SUD, and those with no mental health conditions.

The AOR for men with PTSD or PTSD/SUD compared with men having no mental health conditions were between 1.57 and 1.53 respectively. The AOR for women was 2.2. The three most frequent medical conditions among men were diseases of the musculoskeletal, nervous and digestive systems, while the three most frequent among women were musculoskeletal, nervous and genitourinary systems.   

Musculoskeletal problems were the most common among all four categories of veterans, which could lead to chronic pain later in life—something commonly seen in older veterans.

Disproportionate Physical Problems

While it is widely understood that veterans with PTSD suffer from a disproportionate amount of physician problems, this study was the first that looked at veterans so soon after redeployment.

“This study was informed by both previous research as well as my own clinical work with veterans,” explained Deborah Nazarian, PhD, lead investigator of the study. “With respect to the research, there is a large body of evidence that suggests veterans from past conflicts, such as Vietnam and the Persian Gulf War, have high rates of co-occurring mental health and medical conditions. Much of this past research, however, has been conducted several years following deployment. In my clinical work, I also noticed that many of the returning OEF/OIF men and women veterans were often coping with both mental health and medical issues, such as posttraumatic stress disorder and chronic pain.  One of the main reasons we were interested in examining this association among OEF/OIF veterans is that the large majority of these veterans are young, so this presents a really unique window of opportunity to identify and prevent and reduce the late-life burden of medical illness that is often seen among older veterans from previous cohorts.”

Aside from being timelier than previous studies, this research also includes a larger proportion of women. “This was also an opportunity to gain an increased understanding of the distinct mental health and medical needs of women veterans,” Nazarian said.

Other recent studies have shown that women may react differently to combat trauma, presenting a different range or proportion of mental and physical ailments. For example, one VA study found that women are 20% more likely than men to present with musculoskeletal disorders when being treated at VA.

Despite previous research and the anecdotal evidence that she had seen in her clinical work, Nazarian said she was surprised by the sheer number of physical ailments in this cohort, particularly given their young age. “It was noteworthy, given the relatively recent time frame that many of these men and women returned from deployment in the current conflicts in Iraq and Afghanistan, since women and men must meet annual fitness standards to remain in the armed forces,” she said.

In A Position To Help

Previous studies have made note of the frequent comorbidity of PTSD and musculoskeletal disorders in veterans and non-veteran cohorts. A study looking at a sample of 129 Vietnam veterans with PTSD found that 80% reported the presence of a chronic pain condition. Another VA study looking at 543 veterans treated for PTSD found that 60% had a diagnosed medical problem, with one in four having a musculoskeletal or pain problem.

Research has indicated that the presence of PTSD and chronic pain can have profound impacts on patients’ life-long health and that they are more likely to experience intense pain and affective distress and greater disability than patients without PTSD or trauma. 

VA is in a unique position to help these veterans because of experience with past generations of veterans with comorbid mental health and physical conditions, Nazarian said.

“By identifying the relationship between PTSD, substance-use disorders and medical conditions among the most recent veteran cohort, I hope that this research may inform the development of interventions that could prevent the onset of long-term chronic diseases associated with PTSD among returning veterans,” she added.

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