Faculty Articles

Association of Posttraumatic Stress Disorder With Somatic Symptoms, Health Care Visits, and Absenteeism Among Iraq War Veterans

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American Journal of Psychiatry





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Objective: Studies of soldiers from prior wars conducted many years after combat have shown associations between combat-related posttraumatic stress disorder (PTSD) and physical health problems. The current Iraq war has posed a considerable PTSD risk, but the association with physical health has not been well studied. Method: The authors studied 2,863 soldiers using standardized self-administered screening instruments 1 year after their return from combat duty in Iraq. Results: Among all participants, 16.6% met screening criteria for PTSD. PTSD was significantly associated with lower ratings of general health, more sick call visits, more missed workdays, more physical symptoms, and high somatic symptom severity. These results remained significant after control for being wounded or injured. Conclusions: The high prevalence of PTSD and its strong association with physical health problems among Iraq war veterans have important implications for delivery of medical services. The medical burden of PTSD includes physical health problems; combat veterans with serious somatic concerns should be evaluated for PTSD.

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Research has established a strong relationship between combat-related posttraumatic stress disorder (PTSD) and physical health measures (1–16). This association was observed in veterans from the 1991 Gulf War who experienced increased rates of physical symptoms in all domains in the years after returning from deployment (1, 4–7, 12, 16). Compared to military personnel who were not stationed in the war zone, 1991 Gulf War veterans showed significantly higher rates of somatic symptoms, more psychological distress, worse general health status, and greater health-related physical and psychosocial functional impairment (1). The major limitations of these studies were that they were conducted many years after the veterans returned from combat, were based largely on clinical populations, and did not control for wartime injuries.

Research conducted on veterans from the current war in Iraq has already established the presence of a high prevalence of PTSD (12%–13%) during the first 3–4 months after their return home (17). One study conducted among seriously injured hospitalized veterans showed that PTSD was strongly correlated with the level of injury (18). However, to date the relationship between PTSD and physical health has not been explored among healthy noninjured veterans. This study evaluated the association of PTSD with physical health measures among Iraq war veterans 1 year after their return from deployment with control for combat injury.



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