Comorbid PTSD symptoms, depression significantly increase women’s risk for death

Women with high PTSD symptoms and co-occurring probable depression during midlife were at increased risk for death vs. women without these disorders, according to study results published in JAMA Network Open.

“Depression often co-occurs with PTSD and, like PTSD, it is far more prevalent in women than men,” Andrea L. Roberts, PhD, of the Harvard T.H. Chan School of Public Health, and colleagues wrote. “Depression has been independently associated with greater prevalence of health risk factors and risk of mortality. Evidence also suggests that PTSD with depression may constitute a particularly severe subtype of posttraumatic response, with unique biological outcomes important for physical health.”

Results of prior studies suggested that PTSD with depression may be linked to even greater risk for mortality vs. PTSD alone; however, findings remain sparse, since only three relatively short-term studies have examined this possibility, to the researchers’ knowledge.

Roberts and colleagues conducted the current prospective cohort study to evaluate the link between PTSD symptoms, with or without comorbid depressive symptoms, and risk for death. They analyzed data of 51,602 women with a mean age of 53.3 years who participated in the Nurses’ Health Study II, and they included those who responded to a 2008 questionnaire regarding PTSD and depressive symptoms.

Exposures included PTSD symptoms according to the short screening scale for DSM-4 PTSD, as well as depression symptoms according to the Center for Epidemiologic Studies Depression Scale-10. The researchers determined all-cause mortality via National Death Index, U.S. Postal Service or report of participant’s family.

Results showed PTSD and probable depression were comorbid. A total of 52.1% of women with high PTSD symptoms had probable depression, and 12% of those with no trauma exposure had probable depression. Those with high PTSD symptoms and probable depression were at nearly four times greater risk for death vs. those with no trauma exposure and no depression (HR = 3.8; 95% CI, 2.65-5.45). Women with these conditions were at more than three times increased risk (HR = 3.11; 95% CI, 2.16-4.47) after adjustment for health factors. Women with subclinical PTSD symptoms but no probable depression were at increased risk for death vs. those with no trauma exposure and no depression (HR = 1.43; 95% CI, 1.06-1.93). The researchers reported 109 deaths (1.4%) without available cause of death information among 7,565 women with PTSD symptoms and probable depression compared with 124 such deaths (0.6%) among 22,215 women without depression or PTSD symptoms. Women with PTSD symptoms and probable depression had higher rates of death from cardiovascular disease, diabetes, unintentional injury, suicide and other causes of death vs. women with no PTSD or depression.

“Our results suggest that future investigations of the associations among PTSD, depression and physical health outcomes should consider risk associated with co-occurrence of the disorders rather than modeling risk associated with [one] disorder adjusted for the other,” Roberts and colleagues wrote. “Our findings additionally highlight the need for better access to and dissemination of effective treatments for comorbid PTSD and depression.”