The physical health consequences of PTSD and PTSD symptoms: A meta-analytic review

doi:10.1016/j.janxdis.2012.08.004

Journal of Anxiety Disorders

Volume 27, Issue 1, January 2013, Pages 33-46

https://doi.org/10.1016/j.janxdis.2012.08.004 Get rights and content

Abstract

The present meta-analysis systematically examined associations between physical health and posttraumatic stress disorder (PTSD)/PTSD symptoms (PTSS), as well as moderators of this relationship. Literature searches yielded 62 studies examining the impact of PTSD/PTSS on physical health-related quality of life (HR-QOL), general health symptoms, general medical conditions, musculoskeletal pain, cardio-respiratory (CR) symptoms, and gastrointestinal (GI) health. Sample-specific and methodological moderators were also examined. Results revealed significantly greater general health symptoms, general medical conditions, and poorer HR-QOL for PTSD and high PTSS individuals. PTSD/PTSS was also associated with greater frequency and severity of pain, CR, and GI complaints. Results of moderation analyses were mixed. However, consistent relationships emerged regarding PTSD assessment method, such that effect sizes were largest for self-reported PTSD/PTSS and all but one health outcome. Results highlight the need for prospective longitudinal examination of physical health shortly following trauma, and suggest variables to consider in the design of such studies.

Highlights

► We systematically examined the impact of PTSD and PTSD symptoms on physical health. ► The strongest relationship emerged between PTSD and general physical symptoms. ► Moderating variables of the PTSD-physical health relationship were identified.

Section snippets

Physical health outcomes influenced by PTSD

A multitude of individual psychological, behavioral, and biological factors (see Schnurr & Jankowski, 1999 and Pace & Heim, 2011 for reviews) as well as the interactions between these factors, serve as possible mechanisms through which PTSD may be associated with physical health. PTSD is characterized by a failure to physiologically adapt to stressors and reminders of stressors, such that the long-term activation of the stress pathways (i.e., sympathetic nervous system,

Sample moderators

Females report greater levels of PTSD than males (Tolin & Foa, 2006), and tend to report physical symptoms up to 50% more frequently than males independent of the presence of mental comorbidity (Kroenke & Spitzer, 1998). However, prior research has failed to find gender to be a significant moderator of the relationship between PTSD and physical health (Andreski et al., 1998, Kimerling et al., 2002, Ouimette et al., 2004, Wagner et al., 2000). Veteran status may also impact results; compared to

Selection of studies

Literature searches were conducted using PsycINFO, MEDLINE, and PILOTS databases.

Key search phrases included combinations of the following terms: PTSD, PTSS, physical health, somatic symptoms, cardiovascular, respiratory, cardio-respiratory, pulmonary, gastrointestinal, musculoskeletal pain, and HR-QOL. Additional studies were identified through the reference sections of relevant empirical and review articles. When necessary statistical information was omitted from an otherwise eligible

Weighted mean effect sizes

Sample and study characteristics of the 62 studies (118 independent effect sizes) are displayed in Table 1. Weighted effect sizes for each individual study are presented in Table 2, and Table 3 presents the overall weighted mean effect sizes for the 6 health outcomes. Examination of the Q statistics revealed that all health outcomes, with the exception of general medical conditions, were heterogeneous. Therefore, calculation of mean effect sizes was conducted with the random effects model for

Discussion

Results of the present meta-analysis support prior research by demonstrating that PTSD/PTSS were significantly related to each examined health outcome. These results expand prior research by providing an index of strength between PTSD/PTSS and physical health outcomes. More specifically, the largest effect size emerged for general health symptoms, followed by a moderate effect for medical conditions, and small effects for HR-QOL and GI health. CR health displayed the weakest effect.

Not

References¹ (120)

D. *Amital et al.
Posttraumatic stress disorder, tenderness, and fibromyalgia syndrome: are they different entities?
Journal of Psychosomatic Research
(2006)
P. *Andreski et al.
Post-traumatic stress disorder and somatization symptoms: a prospective study
Psychiatry Research
(1998)
D.H. *Barrett et al.
Posttraumatic stress disorder and self-reported physical health status among U.S. military personnel serving during the Gulf War Period
Psychosomatics
(2002)
J.C. Beckham et al.
Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans
Journal of Psychosomatic Research
(1997)
Y. *Benyamini et al.
Combat stress reactions, posttraumatic stress disorder, cumulative life stress, and physical health among Israeli veterans twenty years after exposure to combat
Social Science & Medicine
(2005)
J.A. Boscarino
Posttraumatic stress disorder and mortality among U.S. army veterans 30 years after military service
Annals of Epidemiology
(2006)
P.S. *Ciechanowski et al.
Adult health status of women HMO members with posttraumatic stress disorder symptoms
General Hospital Psychiatry
(2004)
J.D. *Clapp et al.
Physical and psychosocial functioning following motor vehicle trauma: relationships with chronic pain, posttraumatic stress, and medication use
European Journal of Pain
(2010)
R.D. Goodwin et al.
Self-reported diabetes and posttraumatic stress disorder among adults in the community
Preventative Medicine
(2005)
R.L. Levy et al.
Psychosocial aspects of the functional gastrointestinal disorders
Gastroenterology
(2006)

D.B. *Maia et al.

Post-traumatic stress symptoms in an elite unit of Brazilian police officers: prevalence and impact on psychosocial functioning and on physical and mental health

Journal of Affective Disorders

(2007)

B.O. Olatunji et al.

Quality of life in the anxiety disorders: a meta-analytic review

Clinical Psychology Review

(2007)

B.I. O’Toole et al.

Trauma, PSTD, and physical health: an epidemiological study of Australian Vietnams veterans

Journal of Psychosomatic Research

(2008)

P. Ouimette et al.

Health and well being of substance use disorder patients with and without posttraumatic stress disorder

Addictive Behaviors

(2006)

T.W.W. Pace et al.

A short review on the psychoneuroimmunology of posttraumatic stress disorder: from risk factors to medical comorbidities

Brain, Behavior, and Immunity

(2011)

S.A. *Palyo et al.

Post-traumatic stress disorder symptoms, pain, and perceived life control: associations with psychosocial and physical functioning

Pain

(2005)

A. *Shalev et al.

Posttraumatic stress disorder: somatic comorbidity and effort tolerance

Psychosomatics

(1990)

American Psychiatric Association

Diagnostic and statistical manual of mental disorders: DSM-IV-TR

(2000)

American Psychological Association

DSM-5 development: posttraumatic stress disorder

(2010 August)

N. Afari et al.

PTSD, combat injury, and headache in veterans returning from Iraq/Afghanistan

Headache

(2009)

Z. Agha et al.

Are patients at veteran affairs medical centers sicker? A comparative analysis of health status and medical resource use

Archives of Internal Medicine

(2000)

G.J.G. Asmundson et al.

PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models

Canadian Journal of Psychiatry

(2002)

E. Avdibegovic et al.

Somatic diseases in patients with posttraumatic stress disorder

Medical Archives

(2010)

J.C. *Beckham et al.

Health status, somatization, and severity of posttraumatic stress disorders in Vietnam combat veterans with posttraumatic stress disorder

American Journal of Psychiatry

(1998)

J.C. *Beckham et al.

Ambulatory monitoring and physical health report in Vietnam veterans with and without chronic posttraumatic stress disorder

Journal of Traumatic Stress

(2003)

W. *Berger et al.

Partial and full PTSD in Brazilian ambulance workers: prevalence and impact on health and on quality of life

Journal of Traumatic Stress

(2007)

M. Borenstein et al.

Comprehensive meta-analysis, version 2

(2005)

J.A. *Boscarino

Diseases among men 20 years after exposure to severe stress: implications for clinical research and medical care

Psychosomatic Medicine

(1997)

J.A. Boscarino

Posttraumatic stress disorder and physical illness: results from clinical and epidemiologic studies

Annals of the New York Academy of Sciences

(2004)

J.A. Boscarino

A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: implications for surveillance and prevention

Psychosomatic Medicine

(2008)

R. Bradley et al.

A multidimensional meta-analysis of psychotherapy for PTSD

American Journal of Psychiatry

(2005)

N. Breslau et al.

Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma

Archives of General Psychiatry

(1998)

P.S. *Calhoun et al.

Self-reported health and physician diagnosed illnesses in women with posttraumatic stress disorder and major depressive disorder

Journal of Traumatic Stress

(2009)

R. *Campbell et al.

The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: a mediational model of posttraumatic stress disorder and physical health outcomes

Journal of Consulting and Clinical Psychology

(2008)

Y. *Capsi et al.

Trauma exposure and posttraumatic reactions in a community sample of Bedouin members of the Israel defense forces

Depression and Anxiety

(2008)

G.A. *Clum et al.

Associations among symptoms of depression and posttraumatic stress disorder and self-reported health in sexually assaulted women

The Journal of Nervous and Mental Disease

(2000)

J. Cohen

Statistical power analysis for the behavioral sciences

(1988)

J. Cohen

A power primer

Psychological Bulletin

(1992)

E.A. Dedert et al.

Posttraumatic stress disorder, cardiovascular, and metabolic disease: a review of the evidence

Annals of Behavioral Medicine

(2010)

E.Y. *Deykin et al.

Posttraumatic stress disorder and the use of health services

Psychosomatic Medicine

(2001)

R.M. DiMatteo et al.

Patient adherence and medical treatment outcomes: a meta-analysis

Medical Care

(2002)

A.J.E. *Dirkzwager et al.

Disaster-related posttraumatic stress disorder and physical health

Psychosomatic Medicine

(2007)

A.L. Dougall et al.

Psychoneuroimmunology and trauma

E.M. *Eadie et al.

Posttraumatic stress symptoms as a mediator between sexual assault and adverse health outcomes in undergraduate women

Journal of Traumatic Stress

(2008)

C.C. *Engel et al.

Relationship of physical symptoms to posttraumatic stress disorder among veterans seeking care for Gulf War-related health concerns

Psychosomatic Medicine

(2000)

A. Eytan et al.

Posttraumatic stress disorder and the use of general health services in Postwar Kosovo

Journal of Traumatic Stress

(2006)

A.M. *Flood et al.

Substance use behaviors as a mediator between posttraumatic stress disorder and physical health in trauma-exposed college students

Journal of Behavioral Medicine

(2009)

M.J. Friedman et al.

The relationship between trauma, post-traumatic stress disorder, and physical health

T.E. Galovski et al.

Does Cognitive–Behavioral Therapy for PTSD Improve Perceived Health and Sleep Impairment?

Journal of Traumatic Stress

(2009)

K.L. *Gillock et al.

Posttraumatic stress disorder in primary care: prevalence and relationships with physical symptoms and medical utilization

General Hospital Psychiatry

(2005)

Cited by (460)

Cognitive Behavioral Therapy for Trauma and Self-Care to Treat Posttraumatic Stress Symptoms and Support HIV Care Engagement Among Men With HIV Who Have Sex With Men: A Case Series
2024, Cognitive and Behavioral Practice
There is a strong need for clinical interventions that improve engagement in HIV care among men who have sex with men (MSM) with HIV who have histories of trauma. Cognitive behavioral therapy (CBT) has substantial support for treating posttraumatic stress among people with HIV and among HIV-negative MSM. In this population, posttraumatic responses can include both general avoidance of distress related to the trauma but also specific avoidance of HIV-related stimuli that can reduce engagement in HIV care. The present paper introduces an application of Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC), which integrates CBT strategies to address posttraumatic stress symptoms with the Life-Steps framework, an evidence-based, single-session problem-solving intervention that increases adherence to antiretroviral therapies. Other CBT components include psychoeducation and the reduction of specific trauma symptoms, including avoidance and negative self-beliefs that can act as barriers to care engagement. The intervention is presented via four individual case studies. These cases demonstrate the ways in which CBT-TSC can be used to support mental health and self-care among MSM with HIV who have histories of trauma and are facing barriers to full participation in HIV care.
Trauma Shaping the Psychopathological Correlates of Patients with Long-COVID: A 6-Months Longitudinal Study with Repeated Measures Mixed Models
2023, Psychiatry Research
This research aimed at investigating how the experience of trauma can influence the psychological correlates of long-COVID over time in a clinical sample of patients hospitalized because of COVID-19. Through a longitudinal research design, 70 post-acute patients with COVID-19 were followed-up after hospital discharge in 3-time points up to 6 months and completed the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) and the Symptoms Checklist-90-Revised (SCL-90 R). Repeated measures mixed models with random intercept were used to evaluate the effect of trauma (yes/no) over time (T1, T2, T3) on the SCL-90-R scales. Results showed that patients with trauma display significantly worse psychological outcomes in all the SCL-90-R dimensions [all p_adj < .05 for the principal effects of trauma(y)], especially in symptoms of depression [time 2 vs time 1*trauma(y): b = -3.86, 95%CI (-7.18, -0.53), p_adj = .035; time 3 vs time 1*trauma(y): b = -4.77, 95%CI (-8.10, -1.45), p_adj = .011], anxiety [time 3 vs time 1*trauma(y): b = -4.54, 95%CI (-7.72, -1.37), p_adj = .011], and obsessive-compulsive difficulties [time 3 vs time 1*trauma(y): b = -4.03, 95%CI (-7.20, -0.86), p_adj = .027]. These findings shed light on the long-term psychological consequences of COVID-19 among hospitalized patients and highlight the key role of trauma, suggesting its assessment to tailor psychological interventions.
Screening for mental distress symptoms among Ukrainian refugees in an initial reception center in Baden-Württemberg
2023, Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen
Millionen Menschen befinden sich auf der Flucht vor dem Krieg in der Ukraine. Stressoren im Zusammenhang mit einer Flucht können die mentale Gesundheit massiv beeinträchtigen. Ziel der vorliegenden Studie war, ukrainische Geflüchtete in einem Ankunftszentrum in Baden-Württemberg niederschwellig auf psychische Belastungssymptome zu screenen.
Ukrainische Geflüchtete wurden im Ankunftszentrum in Heidelberg bei der Konsultation medizinischer Versorgungsangebote mithilfe von vier Screening-Fragebögen (PC-PTSD-5, PHQ-9, GAD-7, Stress-Thermometer), die in ukrainischer oder russischer Sprache zur Verfügung standen, zu psychischen Belastungssymptomen befragt, und es wurden Daten zu Soziodemographie und Fluchthintergrund erhoben.
Von N = 36 Befragten berichteten mehr als 90%, Krieg erlebt zu haben, 55,6% der Befragten erreichten den Cut-off-Wert für eine posttraumatische Belastungsstörung. Ein Viertel der Befragten erreichte den Cut-off-Wert für eine Depression, mehr als 30% für eine generalisierte Angststörung. Die Mehrzahl der Befragten hatte Verwandte in umkämpften Städten, bei über 36% waren nahe Angehörige aktuell im Kriegseinsatz. Im Gruppenvergleich ergab sich kein signifikanter Zusammenhang der Symptombelastung mit der familiären Hintergrundsituation
Kongruent mit bestehender Literatur zeigten sich bei vielen der Teilnehmenden Hinweise auf eine psychische Belastung. Potenziell belastete Personen können durch Screening-Fragebögen niederschwellig ermittelt werden. Nachgehend sollte bedarfsgerecht ein Versorgungsangebot für psychisch belastete Geflüchtete geschaffen werden, um so die Integration zu erleichtern.
Aufgrund der bekannt hohen Prävalenzen von psychischer Belastung sollten Geflüchtete niederschwellig auf psychische Belastungssymptome gescreent werden, um betroffene Personen zu identifizieren. Die psychosoziale Situation sollte bei der medizinischen Versorgung frühzeitig mit einbezogen werden.
Millions of people are fleeing the war in Ukraine. Stressors associated with flight can have a massive impact on mental health. The aim of the present study was to perform a low-threshold screening for mental distress symptoms among Ukrainian refugees in an initial reception center in Baden-Württemberg.
At the initial reception center in Heidelberg Ukrainian refugees were interviewed about psychological distress during consultations with medical care providers, using four screening questionnaires (PC-PTSD-5, PHQ-9, GAD-7, stress thermometer) in Ukrainian or Russian language, and further sociodemographic data and data about the refugees’ background were collected.
More than 90% of the N = 36 respondents reported that they had experienced war, 55.6% reached the cut-off score for post-traumatic stress disorder. One fourth of the participants reached cut-off scores for depression and more than 30% for generalized anxiety disorder. The majority of respondents had relatives living in embattled cities, and in over 36% close relatives were currently deployed in war. In the group comparison there was no significant correlation of symptom burden with the family background situation.
In line with the existing literature, many of the participants showed signs of mental distress. Potentially affected persons can be identified using low-threshold screening questionnaires. Adequate care for mentally stressed refugees according to their needs should be established to facilitate integration.
Due to the known high prevalence of mental distress, refugees should be screened for mental distress symptoms at a low-threshold level to identify affected individuals. The psychosocial situation of Ukrainian refugees should be considered at an early stage in medical care.
Resting heart rate associations with violence exposure and posttraumatic stress symptoms: sex differences in children
2024, Biology of Sex Differences
Impact of COVID-19 on posttraumatic stress disorder in ICU survivors: a prospective observational comparative cohort study
2024, Critical Care
The impact of isolation on comorbidity of PTSD symptoms and depression: evidence from PTRP-5-6 in China
2024, BMC Public Health

View all citing articles on Scopus

¹: * indicates studies included in meta-analysis.

View full text

ReviewThe physical health consequences of PTSD and PTSD symptoms: A meta-analytic review

Abstract

Highlights

Section snippets

Physical health outcomes influenced by PTSD

Sample moderators

Selection of studies

Weighted mean effect sizes

Discussion

Journal of Psychosomatic Research

Psychiatry Research

Psychosomatics

Journal of Psychosomatic Research

Social Science & Medicine

Annals of Epidemiology

General Hospital Psychiatry

European Journal of Pain

Preventative Medicine

Gastroenterology

Journal of Affective Disorders

Clinical Psychology Review

Journal of Psychosomatic Research

Addictive Behaviors

Brain, Behavior, and Immunity

Pain

Psychosomatics

Diagnostic and statistical manual of mental disorders: DSM-IV-TR

DSM-5 development: posttraumatic stress disorder

PTSD, combat injury, and headache in veterans returning from Iraq/Afghanistan

Headache

Are patients at veteran affairs medical centers sicker? A comparative analysis of health status and medical resource use

Archives of Internal Medicine

PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models

Canadian Journal of Psychiatry

Somatic diseases in patients with posttraumatic stress disorder

Medical Archives

Health status, somatization, and severity of posttraumatic stress disorders in Vietnam combat veterans with posttraumatic stress disorder

American Journal of Psychiatry

Ambulatory monitoring and physical health report in Vietnam veterans with and without chronic posttraumatic stress disorder

Journal of Traumatic Stress

Partial and full PTSD in Brazilian ambulance workers: prevalence and impact on health and on quality of life

Journal of Traumatic Stress

Comprehensive meta-analysis, version 2

Diseases among men 20 years after exposure to severe stress: implications for clinical research and medical care

Psychosomatic Medicine

Posttraumatic stress disorder and physical illness: results from clinical and epidemiologic studies

Annals of the New York Academy of Sciences

A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: implications for surveillance and prevention

Psychosomatic Medicine

A multidimensional meta-analysis of psychotherapy for PTSD

American Journal of Psychiatry

Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma

Archives of General Psychiatry

Self-reported health and physician diagnosed illnesses in women with posttraumatic stress disorder and major depressive disorder

Journal of Traumatic Stress

The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: a mediational model of posttraumatic stress disorder and physical health outcomes

Journal of Consulting and Clinical Psychology

Trauma exposure and posttraumatic reactions in a community sample of Bedouin members of the Israel defense forces

Depression and Anxiety

Associations among symptoms of depression and posttraumatic stress disorder and self-reported health in sexually assaulted women

The Journal of Nervous and Mental Disease

Statistical power analysis for the behavioral sciences

A power primer

Psychological Bulletin

Posttraumatic stress disorder, cardiovascular, and metabolic disease: a review of the evidence

Annals of Behavioral Medicine

Posttraumatic stress disorder and the use of health services

Psychosomatic Medicine

Patient adherence and medical treatment outcomes: a meta-analysis

Medical Care

Disaster-related posttraumatic stress disorder and physical health

Psychosomatic Medicine

Psychoneuroimmunology and trauma

Posttraumatic stress symptoms as a mediator between sexual assault and adverse health outcomes in undergraduate women

Journal of Traumatic Stress

Relationship of physical symptoms to posttraumatic stress disorder among veterans seeking care for Gulf War-related health concerns

Psychosomatic Medicine

Posttraumatic stress disorder and the use of general health services in Postwar Kosovo

Journal of Traumatic Stress

Substance use behaviors as a mediator between posttraumatic stress disorder and physical health in trauma-exposed college students

Review
The physical health consequences of PTSD and PTSD symptoms: A meta-analytic review