Prospective study of externalizing and internalizing subtypes of posttraumatic stress disorder and their relationship to mortality among Vietnam veterans.
Posttraumatic stress disorder (PTSD) can be a complex disorder, and some studies have found that samples of individuals with PTSD contain subtypes that may relate to health outcomes. The goals were to replicate previously identified PTSD subtypes and examine how subtype membership relates to mortality. Data from the Vietnam Experience Study and a clinical sample of Vietnam veterans were combined (n = 5248) to address these research questions. Consistent with previous studies, 3 PTSD subtypes emerged: externalizers (n = 317), internalizers (n = 579), and low pathology (n = 280). Posttraumatic stress disorder diagnosis was associated with increased risk of all-cause and behavioral-cause (eg, homicide, suicide) mortality. Both externalizing and internalizing subtypes had higher mortality and were more likely to die from cardiovascular causes than those without PTSD. Externalizers were more likely to die from substance-related causes than those without PTSD. The value of considering possible PTSD subtypes is significant in that it may contribute to identifying more specific targets for treatment and rehabilitation in veterans with PTSD.
Flood
Amanda M
AM
Durham Veterans Affairs Medical Center, Durham, NC 27705, USA.
Boyle
Stephen H
SH
Calhoun
Patrick S
PS
Dennis
Michelle F
MF
Barefoot
John C
JC
Moore
Scott D
SD
Beckham
Jean C
JC
D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D003130:Combat Disorders / Q000145:classification / Q000175:diagnosis* / Q000401:mortality* / Q000523:psychology; D006708:Homicide / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007389:Internal-External Control; D008950:MMPI / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011594:Psychometrics; D013313:Stress Disorders, Post-Traumatic / Q000145:classification / Q000175:diagnosis* / Q000401:mortality* / Q000523:psychology; D019966:Substance-Related Disorders / Q000401:mortality; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D016019:Survival Analysis; D014481:United States; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D047829:Vietnam Conflict
Adv Mind Body Med. 2004 Spring;20(1):18-29
15068106
Psychol Assess. 2003 Jun;15(2):205-15
12847781
Ann N Y Acad Sci. 2004 Dec;1032:141-53
15677401
Ann Epidemiol. 2006 Apr;16(4):248-56
16099672
Am J Epidemiol. 1998 Dec 1;148(11):1077-84
9850130
JAMA. 1987 Feb 13;257(6):790-5
3027422
J Abnorm Psychol. 1994 Feb;103(1):103-16
8040472
Int J Psychophysiol. 2003 May;48(2):147-78
12763572
J Psychoactive Drugs. 1999 Apr-Jun;31(2):103-10
10437991
Psychosom Med. 1997 Nov-Dec;59(6):605-14
9407579
J Abnorm Psychol. 2004 Nov;113(4):636-45
15535795
J Trauma Stress. 1995 Jan;8(1):75-90
7712061
Behav Ther. 2007 Mar;38(1):58-71
17292695
Compr Psychiatry. 2006 Nov-Dec;47(6):503-14
17067875
Psychol Bull. 1978 Nov;85(6):1275-1301
366649
J Abnorm Psychol. 1998 May;107(2):216-27
9604551
Ann Behav Med. 2002 Summer;24(3):219-28
12173679