title: Is Post-Traumatic Stress Disorder Associated with Premature Senescence? A Review of the Literature.
abstract: OBJECTIVE
  Post-traumatic stress disorder (PTSD) has major public health significance. Evidence that PTSD may be associated with premature senescence (early or accelerated aging) would have major implications for quality of life and healthcare policy. We conducted a comprehensive review of published empirical studies relevant to early aging in PTSD.
  
  
  METHODS
  Our search included the PubMed, PsycINFO, and PILOTS databases for empirical reports published since the year 2000 relevant to early senescence and PTSD, including: 1) biomarkers of senescence (leukocyte telomere length [LTL] and pro-inflammatory markers), 2) prevalence of senescence-associated medical conditions, and 3) mortality rates.
  
  
  RESULTS
  All six studies examining LTL indicated reduced LTL in PTSD (pooled Cohen's d = 0.76). We also found consistent evidence of increased pro-inflammatory markers in PTSD (mean Cohen's ds), including C-reactive protein = 0.18, Interleukin-1 beta = 0.44, Interleukin-6 = 0.78, and tumor necrosis factor alpha = 0.81. The majority of reviewed studies also indicated increased medical comorbidity among several targeted conditions known to be associated with normal aging, including cardiovascular disease, type 2 diabetes mellitus, gastrointestinal ulcer disease, and dementia. We also found seven of 10 studies indicated PTSD to be associated with earlier mortality (average hazard ratio: 1.29).
  
  
  CONCLUSIONS
  In short, evidence from multiple lines of investigation suggests that PTSD may be associated with a phenotype of accelerated senescence. Further research is critical to understand the nature of this association. There may be a need to re-conceptualize PTSD beyond the boundaries of mental illness, and instead as a full systemic disorder.
authors.affiliation: VA Center of Excellence for Stress and Mental Health, San Diego, CA; Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA. Electronic address: jlohr@ucsd.edu.
authors.forename: James B
authors.initials: JB
authors.lastname: Lohr
authors.affiliation: VA Center of Excellence for Stress and Mental Health, San Diego, CA; Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA.
authors.forename: Barton W
authors.initials: BW
authors.lastname: Palmer
authors.affiliation: VA Center of Excellence for Stress and Mental Health, San Diego, CA; Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Eidt
authors.affiliation: VA Center of Excellence for Stress and Mental Health, San Diego, CA; Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA.
authors.forename: Smitha
authors.initials: S
authors.lastname: Aailaboyina
authors.affiliation: Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA.
authors.forename: Brent T
authors.initials: BT
authors.lastname: Mausbach
authors.affiliation: Department of Psychiatry, University of California, San Francisco, CA.
authors.forename: Owen M
authors.initials: OM
authors.lastname: Wolkowitz
authors.affiliation: VA Center of Excellence for Stress and Mental Health, San Diego, CA; Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Thorp
authors.affiliation: Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA.
authors.forename: Dilip V
authors.initials: DV
authors.lastname: Jeste
mesh_terms: D019588:Aging, Premature / Q000209:etiology*; D015415:Biomarkers; D015897:Comorbidity; D006801:Humans; D061213:Mortality, Premature; D011788:Quality of Life; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*
chemical_list: D015415:Biomarkers
keywords: PTSD; aging; dementia; mortality; telomere