Depression, posttraumatic stress disorder, and mortality.
OBJECTIVE
To determine whether a history of depression and/or posttraumatic stress disorder (PTSD) is associated with all-cause mortality in primary care patients over an average of 2 years.


METHODS
Patients from seven Department of Veterans Affairs medical centers completed mailed questionnaires. Depression and PTSD status were determined from patient self-report of a prior diagnosis and/or electronic administrative data. Date of death was ascertained from Veterans Health Information Systems and Technology Architecture and the Department of Veterans Affairs' Beneficiary Identification and Records Locator System.


RESULTS
Among 35,715 primary care patients, those with a history of depression without a history of PTSD (n = 6876) were at increased risk of death over an average of 2 years compared with patients with neither depression nor PTSD after adjustment for demographic variables, health behaviors, and medical comorbidity (hazard ratio (HR) = 1.17; 95% Confidence Interval (CI) = 1.06-1.28). However, patients with a history of PTSD without a history of depression (n = 748) were not at increased risk of death compared with patients with neither depression nor PTSD (HR = 0.84; 95% CI = 0.63-1.13). Patients with a history of both (n = 3762) were at increased risk of death after adjustment for demographic factors, although not after additional adjustment for health behaviors and medical comorbidity (HR = 0.90; 95% CI = 0.78-1.04).


CONCLUSIONS
In a large sample of veterans, a prior diagnosis of depression, but not PTSD, was associated with an increased risk of death over an average of 2 years after adjusting for age, demographic variables, health behaviors, and medical comorbidity.
Kinder
Leslie S
LS
Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA. lskinder@stanfordalumni.org
Bradley
Katharine A
KA
Katon
Wayne J
WJ
Ludman
Evette
E
McDonell
Mary B
MB
Bryson
Chris L
CL
D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000401:mortality*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology