Psychobiologic predictors of disease mortality after psychological trauma - Implications for research and clinical surveillance

Research has suggested that exposure to traumatic events can result in adverse health outcomes. However, the reasons for this are unclear. We examined psychobiologic factors associated with disease mortality among a community-based sample of 4462 male veterans 30 years after military service, including posttraumatic stress disorder (PTSD), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, and cortisol/dehydroepiandrosteronesulfate (cortisol/DHEA-s) ratio. In the study, 56% (n=2490) were theater veterans who served in Vietnam and 44% (n=1972) era veterans who served elsewhere. During baseline in 1985, 10.2% of theater and 3.4% of era veterans had current PTSD. At follow-up in 2000, 13.6% of men with current baseline PTSD were deceased, compared with 5% without PTSD. Analyses suggested that having PTSD, a high ESR, a high WBC count, and a high cortisol/DHEA-s ratio at baseline were associated with all-cause disease mortality at follow-up. With the exception of cortisol/DHEA-s ratio, these factors also predicted cardiovascular mortality. Depression was not consistently associated with mortality, once other factors were controlled. Noteworthy was that having PTSD had an impact on mortality nearly comparable to common indicators of disease in medicine, such as an ESR > 65 mm/h and a WBC count > 11,000 mm(3). This study suggests that the morbidity associated with PTSD may be comparable to laboratory measures of disease pathology in common use and warrants further investigation and surveillance among at risk populations.