Summary: Women who experience PTSD and depression have a four-fold higher risk of early death from health problems, including cardiovascular disease and type 2 diabetes than those who do not have the mental health disorders.
Women with post-traumatic stress disorder (PTSD) and depression have an almost fourfold greater risk of early death from cardiovascular disease, respiratory disease, type 2 diabetes, accidents, suicide, and other causes than women without trauma exposure or depression, according to a large long-term study conducted by researchers at Harvard T.H. Chan School of Public Health.
“The study examines longevity–in a way, the ultimate health outcome–and the findings strengthen our understanding that mental and physical health are tightly interconnected,” said Andrea Roberts, lead author of the study and a senior research scientist in the Department of Environmental Health. “This is particularly salient during the pandemic, which is exposing many Americans and others across the world to unusual stress while at the same time reducing social connections, which can be powerfully protective for our mental health.”
The study, which is the first study of co-occurring PTSD and depression in a large population of civilian women, will be published online December 4, 2020 in JAMA Network Open. Previous research on PTSD and depression has primarily focused on men in the military.
Roberts and her colleagues studied more than 50,000 women at midlife (ages 43 to 64 years) and found that women with both high levels of PTSD and depression symptoms were nearly four times more likely to die from nearly every major cause of death over the following nine years than women who did not have depression and had not experienced a traumatic event.
The researchers examined whether health risk factors such as smoking, exercise, and obesity might explain the association between PTSD and depression and premature death, but these factors only explained a relatively small part. This finding suggests that other factors, such as the effect of stress hormones on the body, may account for the higher risk of early death in women with the disorders.
Treatment of PTSD and depression in women with symptoms of both disorders may reduce their substantial increased risk of mortality, the researchers said.
“These findings provide further evidence that mental health is fundamental to physical health–and to our very survival. We ignore our emotional well-being at our peril,” said Karestan Koenen, senior author of the study and professor of psychiatric epidemiology in the Department of Epidemiology and Department of Social and Behavioral Sciences.
Other Harvard Chan School authors included Laura Kubzansky, Lori Chibnik, and Eric Rimm.
Funding: This study was supported by the National Institutes of Health (NIH R01MH101269-07 and U01 CA176726).
About this mental health research news
Contact: Nicole Rura – Harvard
Image: The image is in the public domain
Original Research: Open access.
“Association of posttraumatic stress and depressive symptoms with mortality in women: A 9-year prospective cohort study” by Andrea L. Roberts, Laura D. Kubzansky, Lori Chibnik, Eric B. Rimm, Karestan C. Koenen. JAMA Open Network
Association of posttraumatic stress and depressive symptoms with mortality in women: A 9-year prospective cohort study
Consistent evidence has found associations between posttraumatic stress disorder (PTSD) and increased risk of chronic disease and greater prevalence of health risk factors. However, the association between PTSD and all-cause mortality has not been thoroughly investigated in civilians.
To investigate the association between PTSD symptoms, with or without comorbid depressive symptoms, and risk of death.
Design, Setting, and Participants
This prospective cohort study was conducted using data on female US nurses in the Nurses’ Health Study II followed up from 2008 to 2017. Women who responded to a 2008 questionnaire querying PTSD and depressive symptoms were included. Data were analyzed from September 2018 to November 2020.
Symptoms of PTSD, measured using the short screening scale for Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) PTSD, and depression symptoms, measured using the Center for Epidemiologic Studies Depression Scale–10 in 2008.
Main Outcomes and Measures
All-cause mortality was determined via National Death Index, US Postal Service, or report of participant’s family. The hypothesis being tested was formulated after data collection. Trauma exposure and PTSD symptoms were jointly coded as no trauma exposure (reference), trauma and no PTSD symptoms, 1 to 3 PTSD symptoms (subclinical), 4 to 5 PTSD symptoms (moderate), and 6 to 7 PTSD symptoms (high).
Among 51 602 women (50 137 [97.2%] White individuals), the mean (range) age was 53.3 (43-64) years at study baseline in 2008. PTSD and probable depression were comorbid; of 4019 women with high PTSD symptoms, 2093 women (52.1%) had probable depression, while of 10 105 women with no trauma exposure, 1215 women (12.0%) had probable depression. Women with high PTSD symptoms and probable depression were at nearly 4-fold greater risk of death compared with women with no trauma exposure and no depression (hazard ratio [HR], 3.80; 95% CI, 2.65-5.45; P < .001). After adjustment for health factors, women with these conditions had a more than 3-fold increased risk (HR, 3.11; 95% CI, 2.16-4.47, P < .001). Women with subclinical PTSD symptoms without probable depression had increased risk of death compared with women with no trauma exposure and no depression (HR, 1.43; 95% CI, 1.06-1.93; P = .02). Among 7565 women with PTSD symptoms and probable depression, 109 deaths (1.4%) occurred for which we obtained cause of death information, compared with 124 such deaths (0.6% ) among 22 215 women with no depression or PTSD symptoms. Women with PTSD symptoms and probable depression, compared with women with no PTSD or depression, had higher rates of death from cardiovascular disease (17 women [0.22%] vs 11 women [0.05%]; P < .001), diabetes (4 women [0.05%] vs 0 women; P < .001), unintentional injury (7 women [0.09%] vs 7 women [0.03%]; P = .03), suicide (9 women [0.12%] vs 1 woman [<0.01%]; P < .001), and other causes of death (14 women [0.19%] vs 17 women [0.08%]; P = .01).
Conclusions and Relevance
These findings suggest that at midlife, women with high PTSD symptoms and co-occurring probable depression are at increased risk of death compared with women without these disorders. Treatment of PTSD and depression in women with symptoms of both disorders and efforts to improve their health behaviors may reduce their increased risk of mortality.