Associations between Lifetime Traumatic Events and Subsequent Chronic Physical Conditions: A Cross-National, Cross-Sectional Study

Abstract

BackgroundAssociations between lifetime traumatic event (LTE) exposures and subsequent physical ill-health are well established but it has remained unclear whether these are explained by PTSD or other mental disorders. This study examined this question and investigated whether associations varied by type and number of LTEs, across physical condition outcomes, or across countries.MethodsCross-sectional, face-to-face household surveys of adults (18+) were conducted in 14 countries (n = 38, 051). The Composite International Diagnostic Interview assessed lifetime LTEs and DSM-IV mental disorders. Chronic physical conditions were ascertained by self-report of physician's diagnosis and year of diagnosis or onset. Survival analyses estimated associations between the number and type of LTEs with the subsequent onset of 11 physical conditions, with and without adjustment for mental disorders.FindingsA dose-response association was found between increasing number of LTEs and odds of any physical condition onset (OR 1.5 [95% CI: 1.4–1.5] for 1 LTE; 2.1 [2.0–2.3] for 5+ LTEs), independent of all mental disorders. Associations did not vary greatly by type of LTE (except for combat and other war experience), nor across countries. A history of 1 LTE was associated with 7/11 of the physical conditions (ORs 1.3 [1.2–1.5] to 1.7 [1.4–2.0]) and a history of 5+ LTEs was associated with 9/11 physical conditions (ORs 1.8 [1.3–2.4] to 3.6 [2.0–6.5]), the exceptions being cancer and stroke.ConclusionsTraumatic events are associated with adverse downstream effects on physical health, independent of PTSD and other mental disorders. Although the associations are modest they have public health implications due to the high prevalence of traumatic events and the range of common physical conditions affected. The effects of traumatic stress are a concern for all medical professionals and researchers, not just mental health specialists.

Effect of psychosocial stressors on patients with Crohn’s disease: threatening life experiences and family relations

“…These groups were similar in age (39.20 14.54 years for paper, 36.32 12.17 years for internet, P = 0.188) and disease activity P-HBI [median (IQR): 4 (2-8) and 5 (3)(4)(5)(6)(7)(8)(9), respectively, P = 0.058]. In the final cohort, the mean age was 38.38 years, the majority of patients were women, and over half were married or living with a partner (Table 1).…”

“…These experiences impact on physical and mental health [2,3]. In a large study of various populations and controlling for mental illness, it has been shown that stressful life events have a significant relationship with a variety of physical illnesses [4]. Although there is no evidence that stress is a primary cause of IBD, several studies have shown that patients with IBD experience increased stress and threatening life experiences before disease exacerbations.…”

Brazilian cross-cultural adaptation and validation of the List of Threatening Events Questionnaire (LTE-Q)

“…19 In fact, the assessment of environmental stressful events has been used in several household national surveys to validate predictors of mental health disorders such as posttraumatic stress, depression, and anxiety disorders, as well as addictive disorders. 32,33 In this study, we also validated the LTE-Q using the latent class analysis method, allowing the estimation of the latent construct adversity with binge drinking and cocaine use. (4) Brazilian validation of the LTE-Q…”

Trauma and Posttraumatic Stress Disorder

“…At least 1 prior study found a dose-response association between the number of separate traumatic events and self-reported chronic conditions that was independent of PTSD and other mental disorders. 17 Additional research is needed to determine whether these results would extend to objective CVD outcomes in women.…”