title: Elevated risk for autoimmune disorders in iraq and afghanistan veterans with posttraumatic stress disorder.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) is associated with endocrine and immune abnormalities that could increase risk for autoimmune disorders. However, little is known about the risk for autoimmune disorders among individuals with PTSD.
  
  
  METHODS
  We conducted a retrospective cohort study of 666,269 Iraq and Afghanistan veterans under age 55 who were enrolled in the Department of Veterans Affairs health care system between October 7, 2001, and March 31, 2011. Generalized linear models were used to examine if PTSD, other psychiatric disorders, and military sexual trauma exposure increased risk for autoimmune disorders, including thyroiditis, inflammatory bowel disease, rheumatoid arthritis, multiple sclerosis, and lupus erythematosus, adjusting for age, gender, race, and primary care visits.
  
  
  RESULTS
  PTSD was diagnosed in 203,766 veterans (30.6%), and psychiatric disorders other than PTSD were diagnosed in an additional 129,704 veterans (19.5%). Veterans diagnosed with PTSD had significantly higher adjusted relative risk (ARR) for diagnosis with any of the autoimmune disorders alone or in combination compared with veterans with no psychiatric diagnoses (ARR = 2.00; 95% confidence interval, 1.91-2.09) and compared with veterans diagnosed with psychiatric disorders other than PTSD (ARR = 1.51; 95% confidence interval, 1.43-1.59; p < .001). The magnitude of the PTSD-related increase in risk for autoimmune disorders was similar in women and men, and military sexual trauma exposure was independently associated with increased risk in both women and men.
  
  
  CONCLUSIONS
  Trauma exposure and PTSD may increase risk for autoimmune disorders. Altered immune function, lifestyle factors, or shared etiology may underlie this association.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, California; San Francisco Veterans Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, California. Electronic address: aoife.odonovan@ucsf.edu.
authors.forename: Aoife
authors.initials: A
authors.lastname: O'Donovan
authors.affiliation: Department of Psychiatry, University of California, San Francisco, California; San Francisco Veterans Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, California.
authors.forename: Beth E
authors.initials: BE
authors.lastname: Cohen
authors.affiliation: Department of Psychiatry, University of California, San Francisco, California; San Francisco Veterans Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, California.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Seal
authors.affiliation: San Francisco Veterans Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, California.
authors.forename: Dan
authors.initials: D
authors.lastname: Bertenthal
authors.affiliation: Department of Psychiatry, University of California, San Francisco, California.
authors.forename: Mary
authors.initials: M
authors.lastname: Margaretten
authors.affiliation: Department of Psychiatry, University of California, San Francisco, California; San Francisco Veterans Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, California.
authors.forename: Kristen
authors.initials: K
authors.lastname: Nishimi
authors.affiliation: Department of Psychiatry, University of California, San Francisco, California; San Francisco Veterans Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, California.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D001327:Autoimmune Diseases / Q000453:epidemiology* / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012742:Sex Offenses / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000453:epidemiology*; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Autoimmune disorders; Glucocorticoids; Immune system; Inflammation; Military sexual trauma; Posttraumatic stress disorder; Traumatic stress; Veterans
references.citation: Brain Behav Immun. 2011 Jan;25(1):6-13
references.pmid: 20934505
references.citation: J Endocrinol Invest. 1993 May;16(5):384-91
references.pmid: 8320432
references.citation: Alcohol Clin Exp Res. 1998 Dec;22(9):1927-42
references.pmid: 9884135
references.citation: Autoimmun Rev. 2003 May;2(3):119-25
references.pmid: 12848952
references.citation: Arch Gen Psychiatry. 2007 Jan;64(1):109-16
references.pmid: 17199060
references.citation: Arthritis Res Ther. 2003;5(6):251-65
references.pmid: 14680500
references.citation: Biol Psychiatry. 2014 Feb 15;75(4):300-6
references.pmid: 24199668
references.citation: Clin Immunol Immunopathol. 1997 Sep;84(3):223-43
references.pmid: 9281381
references.citation: Psychosom Med. 2008 Jul;70(6):668-76
references.pmid: 18596248
references.citation: Arch Intern Med. 2007 Mar 12;167(5):476-82
references.pmid: 17353495
references.citation: J Neuroimmunol. 2006 Jun;175(1-2):39-51
references.pmid: 16631261
references.citation: Am J Public Health. 2009 Sep;99(9):1651-8
references.pmid: 19608954
references.citation: Arthritis Res Ther. 2009;11(3):229
references.pmid: 19519924
references.citation: J Nerv Ment Dis. 1999 Nov;187(11):680-4
references.pmid: 10579596
references.citation: Ann N Y Acad Sci. 1994 Nov 30;746:378-80
references.pmid: 7825891
references.citation: J Trauma Stress. 2010 Feb;23(1):5-16
references.pmid: 20146392
references.citation: Am J Pathol. 2008 Sep;173(3):600-9
references.pmid: 18688037
references.citation: Ann N Y Acad Sci. 2009 Feb;1153:209-19
references.pmid: 19236344
references.citation: Ann Neurol. 2007 Jun;61(6):504-13
references.pmid: 17492755
references.citation: Expert Rev Clin Immunol. 2012 Mar;8(3):269-84
references.pmid: 22390491
references.citation: BMC Psychiatry. 2013 Jan 29;13:40
references.pmid: 23360282
references.citation: Am J Med Genet B Neuropsychiatr Genet. 2013 Apr;162B(3):262-72
references.pmid: 23505260
references.citation: J Rehabil Res Dev. 2006 Jul-Aug;43(4):475-84
references.pmid: 17123187
references.citation: Arch Gen Psychiatry. 2010 Jun;67(6):608-13
references.pmid: 20530010
references.citation: Ann N Y Acad Sci. 2004 Dec;1032:141-53
references.pmid: 15677401
references.citation: Exp Gerontol. 2006 Mar;41(3):246-51
references.pmid: 16427234
references.citation: Biol Psychiatry. 2011 Sep 1;70(5):465-71
references.pmid: 21489410
references.citation: Lupus. 2006;15(5):308-18
references.pmid: 16761508
references.citation: Proc Natl Acad Sci U S A. 2010 May 18;107(20):9470-5
references.pmid: 20439746
references.citation: PLoS One. 2011;6(5):e19687
references.pmid: 21602933
references.citation: Brain Behav Immun. 2012 Jan;26(1):13-7
references.pmid: 21801830
references.citation: Autoimmun Rev. 2010 Aug;9(10):646-51
references.pmid: 20435169
references.citation: JAMA. 2009 Aug 5;302(5):489-92
references.pmid: 19654382
references.citation: Mult Scler. 2009 Nov;15(11):1339-46
references.pmid: 19797452
references.citation: Womens Health Issues. 2012 Jan-Feb;22(1):e61-6
references.pmid: 21907590
references.citation: Clin Gastroenterol Hepatol. 2007 Dec;5(12):1424-9
references.pmid: 17904915
references.citation: Autoimmun Rev. 2011 Jul;10(9):569-73
references.pmid: 21575746
references.citation: BMC Med. 2009 Mar 30;7:12
references.pmid: 19331649
references.citation: Psychosom Med. 2009 Feb;71(2):243-50
references.pmid: 19188532
references.citation: Dis Markers. 2011;30(2-3):123-32
references.pmid: 21508516
references.citation: Hepatogastroenterology. 2005 Mar-Apr;52(62):509-15
references.pmid: 15816468
references.citation: Psychosom Med. 2010 Jun;72(5):481-6
references.pmid: 20410244
references.citation: Psychoneuroendocrinology. 2005 May;30(4):373-81
references.pmid: 15694117
references.citation: Am J Physiol Regul Integr Comp Physiol. 2006 Nov;291(5):R1527-32
references.pmid: 16809486
references.citation: Curr Treat Options Neurol. 2005 Sep;7(5):413-7
references.pmid: 16079045
references.citation: Arch Gen Psychiatry. 2005 Jun;62(6):593-602
references.pmid: 15939837
references.citation: JAMA Psychiatry. 2013 Aug;70(8):812-20
references.pmid: 23760347
references.citation: Am J Psychiatry. 2005 May;162(5):998-1000
references.pmid: 15863805
references.citation: Brain Behav Immun. 2011 Mar;25(3):524-31
references.pmid: 21145962
references.citation: J Anxiety Disord. 2013 Jun;27(5):520-6
references.pmid: 23954726
references.citation: Depress Anxiety. 2011 Dec 21;28(12):1081-5
references.pmid: 22065550
references.citation: J Psychiatr Res. 2013 Jan;47(1):64-71
references.pmid: 23107307
references.citation: Am J Public Health. 2003 Oct;93(10):1734-9
references.pmid: 14534230
references.citation: Biol Psychiatry. 2009 Oct 1;66(7):708-11
references.pmid: 19393990
references.citation: J Psychiatr Res. 2007 Nov;41(9):744-52
references.pmid: 16901505
references.citation: Nat Rev Neurosci. 2008 Jan;9(1):46-56
references.pmid: 18073775
references.citation: Depress Anxiety. 2009;26(5):447-55
references.pmid: 19319993
references.citation: Psychosom Med. 2009 Nov;71(9):1012-7
references.pmid: 19834051
references.citation: Immunol Res. 2014 May;58(2-3):193-210
references.pmid: 24798553
references.citation: Clin Dev Immunol. 2012;2012:604892
references.pmid: 22690240
references.citation: Nat Rev Rheumatol. 2011 May;7(5):307-10
references.pmid: 21283144
references.citation: Arthritis Rheum. 2004 Oct;50(10):3085-92
references.pmid: 15476204
references.citation: Nature. 2011 Feb 24;470(7335):492-7
references.pmid: 21350482
references.citation: Trends Mol Med. 2010 May;16(5):238-46
references.pmid: 20444648