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For veterans, depression is deadlier than PTSD.

Current depressive symptoms in veterans with a prior history of depression might be more of a concern as a risk factor for all-cause mortality than would a history of posttraumatic stress disorder, according to a study of more than 35,000 veterans.

"The data presented here highlight the importance of depression as a predictor of health outcomes and mortality among veterans ... [and] suggest that depression should not be ignored in studies evaluating the health consequences of PTSD," reported lead investigator Leslie S. Kinder, Ph.D., of the Veterans Affairs Puget Sound Health Care System, Seattle, and her colleagues.

Major depressive disorder and PTSD might be more common among U.S. veterans than in the general population, Dr. Kinder and her associates said. They pointed out that previous studies of primarily male soldiers and marines 3-4 months after returning from Iraq have found that 15% reported symptoms of depression and 20% reported PTSD. In the current study, the risk of death was evaluated from all causes during a 2-year follow-up period of 35,715 veterans in primary care who had completed a questionnaire for a separate study. This cohort of men with a mean age of 64 years included those with a history of depression alone (6,876), PTSD alone (748), and both depression and PTSD (3,762).

Compared with veterans without any history of depression or PTSD, a history of depression alone appeared to increase the risk of death significantly by 17% after the researchers controlled for age, demographics, and health behavior factors, as well as comorbid illnesses (cancer, lung disease, heart failure, diabetes, myocardial infarction, pneumonia, and stroke).

No significant associations could be found between having a history of PTSD alone or a history of both depression and PTSD when the investigators accounted for comorbid illnesses, current depressive symptoms, and/or the intensity of mental health treatment that the veterans received (Psychosom. Med. 2008;70:20-6).

A history of depression was no longer significantly associated with an increased risk of death from all causes when the investigators adjusted the analysis for current depressive symptoms. This suggested to Dr. Kinder and her colleagues that "current depressive symptoms may explain the association between history of depression and mortality."

The investigators noted that they did not have measurements for PTSD symptoms in the patients, which theoretically could provide results similar to those found for current depressive symptoms if only those with current or severe PTSD symptoms were at a greater risk of dying.

The study also asked about PTSD, in some cases, decades after veterans were in active duty, which may miss accidents and suicides that occurred in the first few years after combat exposure, according to the investigators. Accidents and suicides comprise the majority of deaths associated with PTSD.

"In addition, we were unable to verify whether depression and PTSD preceded the onset of medical problems or resulted from those medical problems, an important issue to evaluate in future studies," the investigators wrote.


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Title Annotation:Adult Psychiatry
Author:Evans, Jeff
Publication:Clinical Psychiatry News
Date:Mar 1, 2008
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