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. 2015 Feb 15;77(4):365-74.
doi: 10.1016/j.biopsych.2014.06.015. Epub 2014 Jun 28.

Elevated risk for autoimmune disorders in iraq and afghanistan veterans with posttraumatic stress disorder

Aoife O'Donovan  1 , Beth E Cohen  2 , Karen H Seal  2 , Dan Bertenthal  3 , Mary Margaretten  4 , Kristen Nishimi  2 , Thomas C Neylan  2
Affiliations

Elevated risk for autoimmune disorders in iraq and afghanistan veterans with posttraumatic stress disorder

Aoife O'Donovan et al. Biol Psychiatry. .

Abstract

Background: Posttraumatic stress disorder (PTSD) is associated with endocrine and immune abnormalities that could increase risk for autoimmune disorders. However, little is known about the risk for autoimmune disorders among individuals with PTSD.

Methods: We conducted a retrospective cohort study of 666,269 Iraq and Afghanistan veterans under age 55 who were enrolled in the Department of Veterans Affairs health care system between October 7, 2001, and March 31, 2011. Generalized linear models were used to examine if PTSD, other psychiatric disorders, and military sexual trauma exposure increased risk for autoimmune disorders, including thyroiditis, inflammatory bowel disease, rheumatoid arthritis, multiple sclerosis, and lupus erythematosus, adjusting for age, gender, race, and primary care visits.

Results: PTSD was diagnosed in 203,766 veterans (30.6%), and psychiatric disorders other than PTSD were diagnosed in an additional 129,704 veterans (19.5%). Veterans diagnosed with PTSD had significantly higher adjusted relative risk (ARR) for diagnosis with any of the autoimmune disorders alone or in combination compared with veterans with no psychiatric diagnoses (ARR = 2.00; 95% confidence interval, 1.91-2.09) and compared with veterans diagnosed with psychiatric disorders other than PTSD (ARR = 1.51; 95% confidence interval, 1.43-1.59; p < .001). The magnitude of the PTSD-related increase in risk for autoimmune disorders was similar in women and men, and military sexual trauma exposure was independently associated with increased risk in both women and men.

Conclusions: Trauma exposure and PTSD may increase risk for autoimmune disorders. Altered immune function, lifestyle factors, or shared etiology may underlie this association.

Keywords: Autoimmune disorders; Glucocorticoids; Immune system; Inflammation; Military sexual trauma; Posttraumatic stress disorder; Traumatic stress; Veterans.

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Figures

Figure 1
Figure 1
Flow chart detailing exclusion criteria applied to identify study population
Figure 2
Figure 2
Adjusted relative risk (ARR) for autoimmune disorder diagnoses in veterans without any psychiatric disorder (black), with psychiatric disorders other than PTSD (blue), and with PTSD with and without other psychiatric disorders (red) adjusted for age, gender, race and primary care visits. Dots represent ARR and lines represent 95% confidence intervals.
Figure 3
Figure 3
Percentage of female and male veterans with any autoimmune disorder. The absolute prevalence of autoimmune disorders was highest in women with PTSD at 5.4%, followed by women with psychiatric disorders other than PTSD at 3.1%, and women with no psychiatric disorders at 2.5%. Men with PTSD had the next highest prevalence at 1.7%, followed by men with psychiatric disorders other than PTSD at 1.2%, and finally men with no psychiatric disorders with the lowest prevalence of the autoimmune disorders at 0.9%
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