PTSD: National Center for PTSD

Trauma, PTSD, and Physical Health

Jennifer Wachen, PhD, Sadie Larsen, PhD, and Paula Schnurr, PhD

Exposure to psychological trauma is known to negatively affect physical health, especially when such trauma leads to PTSD. Physical health may be assessed by a health care provider or by self-report, and PTSD has been linked to both objective and subjective measures. This article provides information on the relationships among trauma, PTSD, and physical health.

Is exposure to psychological trauma related to poor physical health?

Exposure to a psychological trauma is associated with poorer health in general. This is true for both self-reported health and for objective indicators of health (1,2). This relationship extends to most studies, finding increases in mortality for those with trauma exposure (3-5), though this association may be accounted for by other health-related variables (6).

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Is PTSD related to general physical health?

Beyond the direct effect of psychological trauma on physical health, it appears that there may be a particularly deleterious effect when trauma exposure leads to PTSD. In other words, it may be that PTSD mediates the relationship between trauma exposure and poor physical health (7). Indeed, PTSD has been found to predict poor health across a range of health conditions (see below), whether health is indicated by self-report or by objective indicators (8-10). PTSD is also associated with increased health care utilization and health care costs (5,11-13). Most studies have found that PTSD is related to excess mortality, both due to chronic health conditions as well as to substance use, suicide, and accidents (14). However, at least one study showed a more complex relationship, finding that PTSD was related to higher mortality among younger Veterans but lower mortality among older Veterans (ages 60 and above), in part because among older Veterans, those with PTSD had more contact with the health care system (15). A meta-analysis of 24 articles found that in general, PTSD increased mortality risk by at least 30% (16), with the largest effect for external causes of death.

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What specific health problems are related to PTSD?

Although PTSD appears to have an effect on physical health broadly speaking (17), research has identified some specific types of health problems that are more consistently associated with PTSD.

• Cardiovascular disease. Cardiovascular health has been a frequent topic of research, including conditions such as myocardial infarction, stroke, and coronary artery disease. A meta-analysis of 20 observational studies (both cross-sectional and longitudinal) found that people with PTSD had an increased risk of any cardiovascular disease, including myocardial infarction and stroke (18).
• Diabetes. A meta-analysis of 9 studies found that people with PTSD had a 50% greater risk of having diabetes than people without PTSD (19). Most studies relied on self-report measures of diabetes, but the risk of diabetes was higher in those that used gold standard blood glucose measures.
• Chronic pain. People with chronic pain have elevated rates of PTSD, and the comorbidity can be related to worse health outcomes. For more information on this link see our article, Chronic Pain and PTSD.
• Metabolic syndrome. A meta-analysis of 9 observational studies connected PTSD and metabolic syndrome, finding that 38.7% of PTSD populations had metabolic syndrome, with the relative risk in PTSD populations being 1.82 compared to matched controls (20). There may be sex differences in the association between PTSD and some health risk factors. For instance, PTSD was shown to be related to hypertension in male Veterans but not female Veterans (21).
• Cancer. This has been somewhat less studied, although the existing research does not support a strong association between PTSD and cancer risk. One nation-wide study of the Danish population did not find a connection between PTSD and cancer (22). A meta-analysis of 8 studies of the relationship between PTSD and cancer incidence found no overall relationship, although PTSD was associated with elevated risk of ovarian cancer (23).
• Autoimmune disorders. Likewise, there is relatively less information on PTSD and autoimmune disorders. A meta-analysis including 8 studies found that PTSD was associated with a small but meaningful increase in risk (RR = 1.29) for autoimmune disorders varying in risk from irritable bowel disease to multiple sclerosis (24).
• Gastrointestinal disorders. Earlier studies have found conflicting evidence of PTSD’s relationship to gastrointestinal (GI) disorders. A population-based study using Danish medical registry data found that PTSD was associated with overall risk for GI disorders, but that the risk varied significantly by specific diagnosis, which may account for some of the earlier conflicting findings (25).

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How is PTSD related to physical health?

PTSD can impact physical health through several potential pathways.

• Health risk behaviors. PTSD is associated with health risk behaviors such as smoking and substance misuse (26), as well as factors that may contribute to poor health such as obesity (26). Additionally, trauma exposure and PTSD may contribute to reduced engagement in preventive health behaviors such as physical activity, healthy diet, and medical screenings that may impact physical health (26,27).
• Depression. Depression also plays a role as it is associated with PTSD and can lead to poor health (28-31).
• Biological factors. PTSD is also related to various biological factors that increase risk for poor health. For instance, as mentioned above, PTSD is related to higher levels of metabolic syndrome (20,32), low-grade inflammation (33), and accelerated cellular aging (34). All of these factors lead to biological stress on the body and are consistent with the idea that PTSD’s negative effects on physical health may be explained by the concept of increased allostatic load (the wear and tear on the body resulting from continued stress). Some studies have found increased allostatic load in those with PTSD (35,36).

In sum, the ways in which PTSD may lead to poor physical health are myriad and complex, as illustrated by Scherer and colleagues (2019), who found a range of mediators between PTSD and cardiovascular health, to include depression, smoking, substance use, anxiety disorder, sleep disorder, obesity, diabetes, hypertension, and hyperlipidemia (29).

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Continuing Education Course

PTSD and Physical Health

This online course discusses research on the effects of trauma on physical health and describes potential mechanisms through which PTSD leads to poorer health.

Does treating PTSD improve physical health?

Despite the evidence suggesting that PTSD leads to poor health, there is limited information on the question of whether treating PTSD improves health. Several studies have shown improvements in self-reported health symptoms following trauma-focused treatment for PTSD (e.g. 37-39) and on functioning (40,41). PTSD treatment may benefit objectively measured health outcomes as well. A large study examining Veterans Health Administration (VHA) medical record data found that PTSD treatment (psychotherapy or medication) reduced risk of hypertension (42). A review found that treatments such as cognitive behavioral therapy and Prolonged Exposure were associated with some improved cardiovascular outcomes such as heart rate variability, blood pressure, and cardiovascular-related mortality, though not all risk factors studied were improved (43). Given the small sample sizes of the included studies, additional research is needed to further explore these associations.

Beyond simply receiving treatment, the amount of PTSD symptom improvement resulting from treatment has been shown to be related to health outcomes (39,41,44). One large study found that VHA patients with a clinically meaningful reduction in PTSD symptoms were less likely to develop type 2 diabetes and had a lower risk of hypertension compared to those without a clinically meaningful decrease (45,46). However, PTSD improvement was not related to risk of cardiovascular disease or other cardiovascular outcomes (myocardial infarction or revascularization procedure, all-cause mortality, and stroke) in some large studies of VHA patients (47,48). Notably, although treatment of PTSD may improve physical health in some ways, once physical health is worsened, it may lead to problems that can no longer be reversed solely through PTSD reduction.

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What are the implications for health care providers?

The close link between PTSD and physical health has implications for mental health care providers and for medical clinics.

For mental health providers

Those who provide PTSD treatment may want to consider identifying health issues and risky health behaviors that may be addressed along with mental health symptoms. For instance, there is some evidence that treatment of PTSD along with smoking or alcohol use can improve both outcomes (49-51).

For medical care providers

For providers in medical clinics, screening for PTSD may be indicated, as PTSD is often undiagnosed in primary care settings. There are several brief PTSD screening measures (including the Primary Care PTSD Screen, or PC-PTSD-5) for use in primary care settings. Of course, a screen does little good unless providers know how to help those with PTSD, and research continues to inform this process. Models that integrate mental health providers or care managers directly into medical care seem to have most promise for expanding access and increasing engagement in treatment for mental health conditions (52,53), though some trials have not found benefit for PTSD outcomes (54,55). Additionally, educating patients about the potential physical health benefits of PTSD treatment may increase motivation and encourage engagement in care. If nothing else, primary care providers can provide education about PTSD and recommend mobile apps that can provide some self-help (e.g., PTSD Coach). Medical providers can also be educated in providing trauma-informed care, which involves interacting with patients in ways that are sensitive, patient-centered, and designed to help patients feel safe and in control of their health care.

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Conclusion

The experience of a psychological trauma can put someone at risk of poorer health outcomes. This is particularly the case when trauma leads to PTSD, which is in turn related to a variety of other health risks that can exacerbate overall poor health. The research reviewed above suggests that treating PTSD may help improve some aspects of physical health, or at least potentially make it easier to manage physical health conditions. Increased collaboration with mental health and medical care providers is recommended in order to better address this relationship between PTSD and health problems.

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References

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