Abstract
BackgroundAssociations between lifetime traumatic event (LTE) exposures and subsequent physical ill-health are well established but it has remained unclear whether these are explained by PTSD or other mental disorders. This study examined this question and investigated whether associations varied by type and number of LTEs, across physical condition outcomes, or across countries.MethodsCross-sectional, face-to-face household surveys of adults (18+) were conducted in 14 countries (n = 38, 051). The Composite International Diagnostic Interview assessed lifetime LTEs and DSM-IV mental disorders. Chronic physical conditions were ascertained by self-report of physician's diagnosis and year of diagnosis or onset. Survival analyses estimated associations between the number and type of LTEs with the subsequent onset of 11 physical conditions, with and without adjustment for mental disorders.FindingsA dose-response association was found between increasing number of LTEs and odds of any physical condition onset (OR 1.5 [95% CI: 1.4–1.5] for 1 LTE; 2.1 [2.0–2.3] for 5+ LTEs), independent of all mental disorders. Associations did not vary greatly by type of LTE (except for combat and other war experience), nor across countries. A history of 1 LTE was associated with 7/11 of the physical conditions (ORs 1.3 [1.2–1.5] to 1.7 [1.4–2.0]) and a history of 5+ LTEs was associated with 9/11 physical conditions (ORs 1.8 [1.3–2.4] to 3.6 [2.0–6.5]), the exceptions being cancer and stroke.ConclusionsTraumatic events are associated with adverse downstream effects on physical health, independent of PTSD and other mental disorders. Although the associations are modest they have public health implications due to the high prevalence of traumatic events and the range of common physical conditions affected. The effects of traumatic stress are a concern for all medical professionals and researchers, not just mental health specialists.
Highlights
A mounting body of research has documented associations between traumatic event exposures and poor physical health
Traumatic events are associated with adverse downstream effects on physical health, independent of posttraumatic stress disorder (PTSD) and other mental disorders
Timing information was collected allowing survival analyses of the retrospective data to examine predictive associations between lifetime traumatic event (LTE) and the subsequent diagnosis or onset of physical conditions, independent of PTSD and other mental disorders. In this analysis our objectives were to examine: (i) whether there are associations between LTEs and physical conditions independent of mental disorders; (ii) whether associations vary by type and number of LTEs; (iii) whether the associations of LTEs with physical health vary by type of physical condition; (iv) whether associations vary across countries
Summary
A mounting body of research has documented associations between traumatic event exposures and poor physical health Up until recently these associations have been considered to be mediated by posttraumatic stress disorder (PTSD)[1]. Associations between lifetime traumatic event (LTE) exposures and subsequent physical ill-health are well established but it has remained unclear whether these are explained by PTSD or other mental disorders. This study examined this question and investigated whether associations varied by type and number of LTEs, across physical condition outcomes, or across countries
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