title: Posttraumatic stress disorder and mortality among U.S. Army veterans 30 years after military service.
abstract: OBJECTIVE
  Research suggests that posttraumatic stress disorder (PTSD) may be associated with later medical morbidity. To assess this, we examined all-cause and cause-specific mortality among a national random sample of U.S. Army veterans with and without PTSD after military service.
  
  
  METHODS
  We used Cox proportional hazards regressions to examine the causes of death among 15,288 male U.S. Army veterans 16 years after completion of a telephone survey, approximately 30 years after their military service. These men were included in a national random sample of veterans from the Vietnam War Era. Our analyses adjusted for race, Army volunteer status, Army entry age, Army discharge status, Army illicit drug abuse, intelligence, age, and, additionally -- for cancer mortality -- pack-years of cigarette smoking.
  
  
  RESULTS
  Our findings indicated that adjusted postwar mortality for all-cause, cardiovascular, cancer, and external causes of death (including motor vehicle accidents, accidental poisonings, suicides, homicides, injuries of undetermined intent) was associated with PTSD among Vietnam Theater veterans (N = 7,924), with hazards ratios (HRs) of 2.2 (p < 0.001), 1.7 (p = 0.034), 1.9 (p = 0.018), and 2.3 (p = 0.001), respectively. For Vietnam Era veterans with no Vietnam service (N = 7,364), PTSD was associated with all-cause mortality (HR = 2.0, p = 0.001). PTSD-positive era veterans also appeared to have an increase in external-cause mortality as well (HR = 2.2, p = 0.073).
  
  
  CONCLUSIONS
  Our study suggests that Vietnam veterans with PTSD may be at increased risk of death from multiple causes. The reasons for this increased mortality are unclear but may be related to biological, psychological, or behavioral factors associated with PTSD and warrant further investigation.
authors.affiliation: Division of Health and Science Policy, The New York Academy of Medicine, New York, NY 10029, USA. jboscarino@nyam.org
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Boscarino
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality; D012907:Smoking / Q000453:epidemiology / Q000401:mortality; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000401:mortality; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000401:mortality; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D014744:Vietnam; D014857:Warfare