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The impact of Purple Heart commendation and PTSD on mortality rates in older veterans

Authors

  • Tim Kimbrell M.D.,

    Corresponding author
    1. Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
    2. Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
    3. VA South Central Mental Illness Research, Education and Clinical Center, Little Rock, Arkansas
    • 116A/NLR, 2N112 Bldg 170, Eugene Towbin VA Medical Center, 2200 Fort Roots Drive, North Little Rock, AR 72114
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  • Jeffrey M. Pyne M.D.,

    1. Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
    2. Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
    3. VA South Central Mental Illness Research, Education and Clinical Center, Little Rock, Arkansas
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  • Mark E. Kunik M.D. M.P.H.,

    1. VA South Central Mental Illness Research, Education and Clinical Center, Little Rock, Arkansas
    2. Houston Center for Quality of Care & Utilization Studies, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
    3. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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  • Kathy M. Magruder M.P.H. Ph.D.,

    1. Ralph H. Johnson VA Medical Center; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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  • Nancy J. Petersen Ph.D.,

    1. VA South Central Mental Illness Research, Education and Clinical Center, Little Rock, Arkansas
    2. Houston Center for Quality of Care & Utilization Studies, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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  • Hong-Jen Yu M.S.,

    1. VA South Central Mental Illness Research, Education and Clinical Center, Little Rock, Arkansas
    2. Houston Center for Quality of Care & Utilization Studies, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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  • Teresa J. Hudson Pharm.D.,

    1. Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
    2. Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
    3. VA South Central Mental Illness Research, Education and Clinical Center, Little Rock, Arkansas
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  • Paul E. Schulz M.D.,

    1. Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
    2. Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas
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  • Salah U. Qureshi M.D.

    1. VA South Central Mental Illness Research, Education and Clinical Center, Little Rock, Arkansas
    2. Houston Center for Quality of Care & Utilization Studies, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
    3. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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Abstract

Background: To determine whether having received a Purple Heart (PH) or having been diagnosed with posttraumatic stress disorder (PTSD) affected mortality in older veterans. Methods: We compared mortality rates of older veterans with a PH but without PTSD (PH+/PTSD−) to veterans with a PH and PTSD (PH+/PTSD+), veterans without a PH but with PTSD (PH−/PTSD+), and a comparison group without a PH or PTSD (PH−/PTSD−). Administrative data from the Veterans Integrated Service Network 16 were collected between 10/01/97 and 09/30/99 for veterans who were 65 years or older. Proportional hazards regression was used to compare the survival times for the four groups (n = 10,255) from entry into the study until death or study termination (9/30/2008). The Charleson co-morbidity index was used to control for potential co-morbid illness burden differences between the groups. Results: Older veterans with a PH (PH+/PTSD− and PH+/PTSD+) had significantly lower mortality rates than PH−/PTSD− veterans (hazard ratio [HR] = 0.6, 95% confidence interval [CI] 0.5 to 0.6, P<.0001; and HR = 0.5, 95% CI 0.4 to 0.7, P<.0001). The PH−/PTSD+ group had a higher mortality rate than the PH−/PTSD− group (HR = 1.1, 95% CI 1.0 to 1.2, P<.01). Conclusions: Veterans who had PH citations and survived into their seventh decade had half the mortality rate of veterans without PH citations with or without PTSD. Veterans with PTSD but without a PH had a significantly higher mortality rate compared to (PH−/PTSD−). Veterans who suffer combat injury without developing PTSD may provide a useful study population for determining the factors that confer resilience. Depression and Anxiety, 2011. © 2011 Wiley Periodicals, Inc.

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