Da-Chief
01-09-2007, 10:49
PTSD may cause heart disease
Studies encounter possible links in troops returning from combat
By Kelly Kennedy (mailto:kellykennedy@atpco.com?subject=Question from NavyTimes.com reader)
Staff writer
Two studies issued the first week of January highlight new evidence pointing to potential links between post-traumatic stress disorder and health problems.
One study funded by the Department of Veterans Affairs shows PTSD puts older men at risk for heart problems — even those with mild PTSD symptoms.
And the Army released a study showing a connection between health problems and PTSD in soldiers just returning from Iraq.
Researchers say they hope the studies will lead military and health care officials to pay closer attention when troops experience traumatic events such as combat.
“People often think of mental health problems as, ‘Oh, that’s too bad,’” said Laura Kubzansky, a public health professor who conducted the VA study. “But if mental and physical health are linked, it becomes more important — even though mental health should be important on its own. Distress is a signal something is wrong.”
Charles Hoge, chief of psychiatry and behavior services at Walter Reed Army Institute of Research, said the studies stress the need to provide mental health care at primary care facilities, such as where troops go for sick call. It also re-emphasizes the need to eliminate the stigma attached to mental health care in the military, he said.
“The most important thing is the need for continued awareness of mental health issues in primary health care facilities,” he said. “We need to continue to reduce barriers to care.”
The studies are nothing if not timely. Hoge’s research and post-deployment health assessments show the problem can be significant. Up to 35 percent of troops returning from Iraq and 27 percent from Afghanistan reported some sort of mental health concerns that could indicate PTSD or depression is present or looming.
The VA study came out of the Normative Aging Study, which involves a group of veterans in the Boston area who entered the study as healthy men in 1961. As they have aged, doctors studied correlations between their habits, experiences or environment, and health.
Kubzansky said researchers already knew there was a strong correlation between heart disease and anxiety and depression, and wondered if PTSD would be similar.
They found a greater risk of arterial damage and coronary heart disease in those with mild to moderate PTSD symptoms. For each increase in symptom levels, researchers found the risk of heart attacks rose 26 percent.
Because the symptoms of PTSD and anxiety and depression are similar, the researchers looked for indicators specific to PTSD. They used a combination of experiencing a traumatic event, plus re-experiencing the event, emotional numbing and hyperarousal, and then excluded people who suffer depression and anxiety, Kubzansky said.
“There’s a fair amount of debate about PTSD and how you diagnose it, which makes it difficult to tell if problems are caused by depression or anxiety, rather than PTSD itself,” she said. “But even if [the way we differentiated] is not perfect, with two different measures, it’s not going to be a fluke.”
Now, Kubzansky said, she wants to find out how, why and what needs to be done.
She would also like to look at other samples of veterans, such as those returning from Iraq and Afghanistan now, to determine whether PTSD contributes to hardening of the arteries and what measures might be taken early to prevent heart problems from starting in troops with PTSD.
In the Army study, Hoge said researchers also looked at a long-suspected correlation between PTSD and physical health.
“The connection has been well-described in literature, just not yet looked at in this particular war,” he said.
In the study, published in The American Journal of Psychiatry, Hoge and four other Army researchers looked at 2,863 soldiers one year after they had returned from Iraq. Of those, 17 percent had been diagnosed with PTSD.
These soldiers reported more sick call visits and more missed workdays, and exhibited more physical health symptoms as well as more severe physical symptoms — and that was after researchers omitted symptoms related to battle wounds.
About one-third of the soldiers with PTSD had high physical-symptom severity. They were 3½ times more likely to consider themselves in poor or fair health, twice as likely to visit sick call or miss two or more days of work in the past month, seven times more likely to have trouble falling asleep and 10 times more likely to have fainting spells.
Hoge said the study did not prove that PTSD caused the physical concerns. “It’s not a direct relationship,” he said. “What we’re saying is there is an association where those with PTSD are also more likely to have physical health concerns.”
After a series of such studies, Hoge said the Army continues to create programs to help troops deal with effects of serving in combat. For example, instead of saying they are “hyperaware” since returning from Iraq, soldiers have learned to say “tactical awareness” — just as they did in Iraq when they described how they constantly scanned the streets for danger.
Other programs include videos explaining symptoms to spouses, Web sites, PowerPoint presentations and PTSD awareness training for troops still in theater.
“We’re always looking at the impact of war in terms of mental health,” Hoge said.
Studies encounter possible links in troops returning from combat
By Kelly Kennedy (mailto:kellykennedy@atpco.com?subject=Question from NavyTimes.com reader)
Staff writer
Two studies issued the first week of January highlight new evidence pointing to potential links between post-traumatic stress disorder and health problems.
One study funded by the Department of Veterans Affairs shows PTSD puts older men at risk for heart problems — even those with mild PTSD symptoms.
And the Army released a study showing a connection between health problems and PTSD in soldiers just returning from Iraq.
Researchers say they hope the studies will lead military and health care officials to pay closer attention when troops experience traumatic events such as combat.
“People often think of mental health problems as, ‘Oh, that’s too bad,’” said Laura Kubzansky, a public health professor who conducted the VA study. “But if mental and physical health are linked, it becomes more important — even though mental health should be important on its own. Distress is a signal something is wrong.”
Charles Hoge, chief of psychiatry and behavior services at Walter Reed Army Institute of Research, said the studies stress the need to provide mental health care at primary care facilities, such as where troops go for sick call. It also re-emphasizes the need to eliminate the stigma attached to mental health care in the military, he said.
“The most important thing is the need for continued awareness of mental health issues in primary health care facilities,” he said. “We need to continue to reduce barriers to care.”
The studies are nothing if not timely. Hoge’s research and post-deployment health assessments show the problem can be significant. Up to 35 percent of troops returning from Iraq and 27 percent from Afghanistan reported some sort of mental health concerns that could indicate PTSD or depression is present or looming.
The VA study came out of the Normative Aging Study, which involves a group of veterans in the Boston area who entered the study as healthy men in 1961. As they have aged, doctors studied correlations between their habits, experiences or environment, and health.
Kubzansky said researchers already knew there was a strong correlation between heart disease and anxiety and depression, and wondered if PTSD would be similar.
They found a greater risk of arterial damage and coronary heart disease in those with mild to moderate PTSD symptoms. For each increase in symptom levels, researchers found the risk of heart attacks rose 26 percent.
Because the symptoms of PTSD and anxiety and depression are similar, the researchers looked for indicators specific to PTSD. They used a combination of experiencing a traumatic event, plus re-experiencing the event, emotional numbing and hyperarousal, and then excluded people who suffer depression and anxiety, Kubzansky said.
“There’s a fair amount of debate about PTSD and how you diagnose it, which makes it difficult to tell if problems are caused by depression or anxiety, rather than PTSD itself,” she said. “But even if [the way we differentiated] is not perfect, with two different measures, it’s not going to be a fluke.”
Now, Kubzansky said, she wants to find out how, why and what needs to be done.
She would also like to look at other samples of veterans, such as those returning from Iraq and Afghanistan now, to determine whether PTSD contributes to hardening of the arteries and what measures might be taken early to prevent heart problems from starting in troops with PTSD.
In the Army study, Hoge said researchers also looked at a long-suspected correlation between PTSD and physical health.
“The connection has been well-described in literature, just not yet looked at in this particular war,” he said.
In the study, published in The American Journal of Psychiatry, Hoge and four other Army researchers looked at 2,863 soldiers one year after they had returned from Iraq. Of those, 17 percent had been diagnosed with PTSD.
These soldiers reported more sick call visits and more missed workdays, and exhibited more physical health symptoms as well as more severe physical symptoms — and that was after researchers omitted symptoms related to battle wounds.
About one-third of the soldiers with PTSD had high physical-symptom severity. They were 3½ times more likely to consider themselves in poor or fair health, twice as likely to visit sick call or miss two or more days of work in the past month, seven times more likely to have trouble falling asleep and 10 times more likely to have fainting spells.
Hoge said the study did not prove that PTSD caused the physical concerns. “It’s not a direct relationship,” he said. “What we’re saying is there is an association where those with PTSD are also more likely to have physical health concerns.”
After a series of such studies, Hoge said the Army continues to create programs to help troops deal with effects of serving in combat. For example, instead of saying they are “hyperaware” since returning from Iraq, soldiers have learned to say “tactical awareness” — just as they did in Iraq when they described how they constantly scanned the streets for danger.
Other programs include videos explaining symptoms to spouses, Web sites, PowerPoint presentations and PTSD awareness training for troops still in theater.
“We’re always looking at the impact of war in terms of mental health,” Hoge said.