Posttraumatic stress disorder, substance use disorders, and medical comorbidity among returning U.S. veterans

Authors

  • Deborah Nazarian,

    Corresponding author
    1. VA Advanced Fellowship Program in Mental Illness Research and Treatment, VA Palo Alto Health Care System, Palo Alto, California, USA
    2. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
    • Deborah Nazarian, VA Palo Alto Health Care System, 3801 Miranda Ave. (151Y), Palo Alto, CA 94304
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  • Rachel Kimerling,

    1. National Center for Posttraumatic Stress Disorder, VA Palo Alto Health Care System, Menlo Park, California, USA
    2. Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, California, USA
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  • Susan M. Frayne

    1. Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, California, USA
    2. Division of General Medical Disciplines and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California, USA
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  • Writing of this manuscript was supported by the VA Advanced Fellowship Program in Mental Illness Research and Treatment, VA Office of Academic Affiliations. This material is based upon work supported by Department of Veterans Affairs Health Services Research & Development grants SDR 07-331, SHP 08-161, and IAE 05-291. We thank Jenny Hyun, Ph.D., and Ruth Cronkite, Ph.D., for statistical consultation and Jessica Turchik, Ph.D., Annabel Prins, Ph.D., and Judith Boczkowski Chapman, Ph.D., ABPP, for providing comments on earlier versions of the manuscript.

    The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Abstract

Evidence suggests that posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are associated with poorer physical health among U.S. veterans who served in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). No research of which we are aware has examined the independent and interactive effects of PTSD and SUD on medical comorbidity among OEF/OIF veterans. This cross-sectional study examined medical record data of female and male OEF/OIF veterans with ≥ 2 Veterans Affairs primary care visits (N = 73,720). Gender-stratified logistic regression analyses, adjusted for sociodemographic factors, were used to examine the association of PTSD, SUD, and their interaction on the odds of medical diagnoses. PTSD was associated with increased odds of medical diagnoses in 9 of the 11 medical categories among both women and men, range of odds ratios (ORs) ranged from 1.07 to 2.29. Substance use disorders were associated with increased odds of 2 of the 11 medical categories among women and 3 of the 11 medical categories among men; ORs ranged from 1.20 to 1.74. No significant interactions between PTSD and SUD were detected for women or men. Overall, findings suggest that PTSD had a stronger association with medical comorbidity (in total and across various medical condition categories) than SUD among female and male OEF/OIF veterans.

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