PTSD as a pathway to chronic health conditions

Post-traumatic stress disorder is a mental health problem that can occur after a stressful event like war, assault or disaster. It’s becoming more evident that PTSD can be a pathway to other health problems among those who suffer from it, including active duty U.S. military personnel and veterans.

Steven S. Coughlin, PhD, MPH, is a senior epidemiologist in the Environmental Epidemiology Service in the Department of Veterans Affairs and adjunct professor of epidemiology at Emory University. Author of “Post-Traumatic Stress Disorder and Chronic Health Conditions” from APHA Press, Coughlin talks with Public Health Newswire about the relationship between PTSD and health conditions such as chronic pain, obesity, diabetes and substance abuse.

Q: Post-traumatic stress disorder is a growing public health concern that affects more than 5 million U.S. adults each year, but is there a lack of understanding about the way PTSD can be a pathway to other health problems?

A: That is an important question but, first, let me say that many people who are exposed to extremely stressful events do not develop PTSD, and that among those who develop PTSD at least half eventually recover from their illness. Although there is substantial evidence from clinical and public health research about the inter-relationships between PTSD and some co-occurring health conditions, for others the pathways and causality of associations identified in initial studies have yet to be determined. A wealth of information about PTSD and related physical and mental health conditions can be found on the U.S. Department of Veterans Affairs’ National Center for PTSD website.

Q: PTSD among veterans and returning military personnel seems to be increasingly part of the national conversation, from Denver Post photographer Craig F. Walker’s 2012 Pulitzer Prize for his photos chronicling a combat veteran’s readjustment to civilian life after return from Iraq to news stories about how persons suffering from severe depression can reach out for help and get well. How can a better understanding about the link between PTSD and chronic health problems help veterans and military personnel?

A: The Department of Veterans Affairs is a veteran-centric organization, so we strive to do everything possible to support male and female veterans such as those who have returned from the conflicts in Iraq and Afghanistan, and those who served during earlier eras. I am hopeful that this collaborative book will help military service men and women, veterans and civilians who suffer from PTSD by providing an up-to-date summary of the burgeoning scientific literature on the relationships between PTSD and chronic health conditions, such as major depression, coronary heart disease, chronic pain and traumatic brain injury. The book provides an up-to-date review of studies of PTSD and traumatic brain injury in both veteran and non-veteran samples. The Department of Veteran Affairs, Department of Defense and leading universities have several initiatives underway to gain a better understanding of these co-occurring health conditions.

Q: Among the PTSD treatments mentioned in the book are psychotherapy, medication such as selective serotonin reuptake inhibitors and patient education on anxiety self-management but also family and peer support. Do you think increasing awareness about PTSD helps more people access that type of support?

A: I am not a clinician, so I personally do not want to recommend specific treatments. Patients should consult with their personal physicians. The Department of Veterans Affairs and most major health care providers have clinical experts who can recommend specific therapies. The departments of Veterans Affairs and Defense clinical practice guidelines for PTSD can be found online. Patients and family and friends who care about them should appreciate that effective therapies are available, PTSD is a treatable condition and it is important for everyone to take steps to combat the stigma that sometimes surrounds mental health conditions. I do worry that, in low- and middle-income countries, many persons living with PTSD or other mental health conditions may not have access to care.

Q: Can you discuss how resilience factors research may help pave the way for PTSD prevention?

A: Public health is all about prevention, whether it is primary, secondary or tertiary prevention. I find it very exciting to hear about national and international efforts to gain a better understanding of how PTSD or chronic health conditions that can co-occur with PTSD can be prevented. Eliminating barriers that prevent some persons who suffer from PTSD or other psychological health conditions from earning a living is a great example of this. People who are employed tend to be happier, healthier and have increased quality of life. One of the Department of Veterans Affairs’ new, innovative outreach campaigns designed to encourage veterans to seek mental health treatment to overcome PTSD and other life challenges can be found at http://www.maketheconnection.net/.

For more on veterans’ struggles with PTSD, read this article from the April 2012 issue of The Nation’s Health, and the American Journal of Public Health offers open access to key articles addressing suicide among veterans.