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. 2020 Jan 15;20(1):23.
doi: 10.1186/s12888-020-2432-9.

Posttraumatic stress disorder and risk of selected autoimmune diseases among US military personnel

Deborah Boggs Bookwalter  1   2 , Kimberly A Roenfeldt  1   3 , Cynthia A LeardMann  4   5 , So Yeon Kong  1 , Mark S Riddle  6 , Rudolph P Rull  1
Affiliations

Posttraumatic stress disorder and risk of selected autoimmune diseases among US military personnel

Deborah Boggs Bookwalter et al. BMC Psychiatry. .

Abstract

Background: Increasing evidence suggests a link between posttraumatic stress disorder (PTSD) and physical health. Stress disorders may lead to impairment of the immune system and subsequent autoimmune disease. This study investigated the association between PTSD and risk of selected autoimmune diseases (i.e. rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel diseases, and multiple sclerosis) among US active duty service members.

Methods: Using data from the Millennium Cohort Study, incident autoimmune cases between study initiation and September 2015 were identified from medical encounter records in the Military Health System Data Repository (MDR). Participants were classified as having a history of PTSD if they self-reported receiving a health care provider's diagnosis of PTSD or if they screened positive using the PTSD Checklist-Civilian Version. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression models adjusted for demographics and history of another mental health condition.

Results: Among 120,572 participants followed for a mean of 5.2 years, risk of any of the selected autoimmune diseases was 58% higher for those with a history of PTSD (HR = 1.58, 95% CI: 1.25, 2.01) compared with no history of PTSD. Further adjustment for BMI, smoking status, and alcohol use had little impact on the effect estimates, and results were not appreciably different according to combat experience and history of physical or sexual trauma.

Conclusions: Active duty military personnel with PTSD may have an elevated risk of a range of autoimmune diseases, regardless of combat experience or prior trauma. Future research is needed to understand potential mechanisms which may inform future mitigative strategies in reducing extra-neuropsychiatric health problems among those with PTSD.

Keywords: Autoimmune disease; Cohort studies; Military; Posttraumatic stress disorder (PTSD).

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Conflict of interest statement

The authors declare that they have no competing interests.

I am a military service member or employee of the U.S. Government. This work was prepared as part of my official duties. Title 17, U.S.C. §105 provides that copyright protection under this title is not available for any work of the U.S. Government. Title 17, U.S.C. §101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties. Report Number 19–29 was supported by the Military Operational Medicine Research Program, Defense Health Board, and Veterans Affairs under work unit no. 60002. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of the Army, Department of Defense, nor the U.S. Government. Human subjects participated in this study after giving their free and informed consent. This research has been conducted in compliance with all applicable federal regulations governing the protection of human subjects in research (Protocol NHRC.2000.0007).

References

    1. Kang HK, Hyams KC. Mental health care needs among recent war veterans. N Engl J Med. 2005;352(13):1289. doi: 10.1056/NEJMp058024. - DOI - PubMed
    1. Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004;351(1):13–22. doi: 10.1056/NEJMoa040603. - DOI - PubMed
    1. Roberts AL, Gilman SE, Breslau J, Breslau N, Koenen KC. Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychol Med. 2011;41(1):71–83. doi: 10.1017/S0033291710000401. - DOI - PMC - PubMed
    1. Ramchand R, Rudavsky R, Grant S, Tanielian T, Jaycox L. Prevalence of, risk factors for, and consequences of posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan. Curr Psychiatry Rep. 2015;17(5):37. doi: 10.1007/s11920-015-0575-z. - DOI - PubMed
    1. Kang H, Dalager N, Mahan C, Ishii E. The role of sexual assault on the risk of PTSD among gulf war veterans. Ann Epidemiol. 2005;15(3):191–195. doi: 10.1016/j.annepidem.2004.05.009. - DOI - PubMed

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