Lifetime posttraumatic stress disorder as a predictor of mortality: a systematic review and meta-analysis

Abstract

Background Posttraumatic Stress Disorder (PTSD) could potentially increase the risk of mortality, and there is a need for a meta-analysis to quantify this association. This study aims to determine the extent to which PTSD is a predictor of mortality. Methods EMBASE, MEDLINE, and PsycINFO were searched systematically on 12th February 2020, with updated searches conducted in July 2021, and December 2022 (PROSPERO CRD42019142971). Studies involving community-dwelling participants with a diagnosis of PTSD or PTSD symptoms, and a comparator group of individuals without PTSD, and which assessed mortality risk, were included. A random-effects meta-analysis was conducted on studies reporting Odds Ratio (OR), Hazard Ratio (HR), and Risk Ratio (RR), and subgroup analysis was also performed by age, sex, type of trauma experienced, PTSD diagnosis, and cause of death. Results A total of 30 eligible studies of mostly good methodological quality were identified, with a total of more than 2.1 million participants with PTSD. The majority of studies involved male-dominated, veteran populations. PTSD was associated with a 47% (95% CI: 1.06–2.04) greater risk of mortality across six studies that reported OR/RR, and a 32% increased risk across 18 studies which reported time to death (HR: 1.32, 95% CI: 1.10–1.59). There was very high study heterogeneity (I2 > 94%) and this was not explained by the prespecified subgroup analysis. Conclusion PTSD is associated with increased mortality risk, however further research is required amongst civilians, involving women, and in individuals from underdeveloped countries.

Пос Ттравматичний Стресовий Розлад, Метаболічний Синдром І Вег Етативна Нервова Система

“…Зокрема, в учасників бойових дій, поширеність ПТСР становить від 12% до 30% порівняно з ризиком 7,8% серед загального населення США [17]. У пацієнтів із ПТСР спостерігається підвищений рівень смертності, який у 2-3 рази перевищує аналогічний у загальній популяції [18]. ПТСР корелює з незадовільним фізичним здоров'ям, приєднанням і прогресуваням ССЗ [19].…”

The lipidome of posttraumatic stress disorder

“…Lipids are emerging as an important contributor of health of the brain but the relationship between PTSD severity and lipid metabolites is unknown. While prior studies have found alterations in neuroendocrine, immune, and aging processes in PTSD 4–13 , our understanding of the role of metabolite disturbances in PTSD is limited.…”

“…In contrast, greater rapid eye movement sleep is found in women with PTSD compared to healthy controls, a difference not seen in men 3 . PTSD is also known to affect physical health and has been associated with greater inflammation, metabolic syndrome, gastrointestinal illness, and even early mortality 4–13 . It is possible that disturbed sleep may play a role in these health impacts since sleep duration correlates with metabolic risk in PTSD 14 .…”

Biological Embedding of Early-Life Adversity and a Scoping Review of the Evidence for Intergenerational Epigenetic Transmission of Stress and Trauma in Humans

“…While activation of these systems is beneficial under normal circumstances, excessive or prolonged stimulation is maladaptive, resulting in adverse biological effects on the body and brain. Indeed, it is now clear that stress is an important risk factor for a range of diseases [ 3 , 4 ].…”