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Veterans with PTSD at higher risk for death by suicide, accident, hepatitis

Compared with the general U.S. population, veterans with PTSD appeared at higher risk for death by suicide, accidental injury and viral hepatitis, according to data published in American Journal of Preventive Medicine.

“Although literature strongly supports the assertion that patients with PTSD have increased overall mortality, the exact causes of that excess mortality have been more elusive. Understanding these causes may help elucidate potential targets for prevention,” Jenna A. Forehand, MD, MPH, of the Veterans Affairs Medical Center in White River Junction, Vermont, and colleagues wrote.

In a retrospective cohort study, the investigators examined the leading causes of death among veterans within the first year of PTSD treatment initiation at any VA Medical Center between 2008 and 2013. They also calculated age- and sex-adjusted standardized mortality ratios (SMRs) for the top 10 causes of death to compare mortality among veterans with PTSD with that of the U.S. population.

Of 491,040 veterans (mean age, 48.5 years; 90.7% men) who began treatment over the 5-year period, 60.3% were diagnosed with comorbid depression, 39% with nicotine dependence, 22.6% with alcohol dependence and 3.2% with opioid dependence in the year after index PTSD diagnosis.

In the year after starting PTSD treatment, 5,215 (1.1%) veterans died. Compared with the U.S. general population, Forehand and colleagues found that all-cause mortality was significantly higher among veterans (SMR = 1.05; 95% CI, 1.02-1.08).

The results showed that veterans with PTSD were twice as likely to die by suicide (SMR = 2.52; 95% CI, 2.24-2.82), unintentional injury (SMR = 1.99; 95% CI, 1.83-2.16) and viral hepatitis (SMR = 2.26; 95% CI, 1.68-2.93) as people in the general U.S. population. In addition, those with PTSD had a significant increase in mortality for diabetes mellitus (SMR =1.29; 95% CI, 1.11-1.49) and chronic liver disease (SMR = 1.34; 95% CI, 1.11-1.59).

"Future studies should develop preventive interventions that target PTSD and comorbid depression, pain disorder and substance use to lessen the risk of suicide, accidental poisoning and viral hepatitis in veterans with PTSD,” Forehand said in a press release. “Similarly, lifestyle modifications may reduce the risk [for] diabetes and chronic liver disease in this patient population. Veterans seeking treatment for PTSD should receive comprehensive education on the benefits of diet and exercise and the risks of chronic stress and substance use.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.