Burden of Medical Illness in Women With Depression and Posttraumatic Stress Disorder | Depressive Disorders | JAMA Internal Medicine | JAMA Network
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Original Investigation
June 28, 2004

Burden of Medical Illness in Women With Depression and Posttraumatic Stress Disorder

Author Affiliations

From Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Menlo Park, Calif (Dr Frayne); Department of Medicine, Boston University School of Medicine (Drs Frayne and Seaver), Boston University School of Public Health (Drs Frayne, Christiansen, Spiro, Parker, and Skinner and Ms Loveland), Veterans Affairs Boston Healthcare System (Dr Seaver), and Massachusetts Veterans Epidemiology Research & Information Center (Dr Spiro), Boston, Mass; and Center for Health Quality, Outcomes and Economic Research, Veterans Affairs Medical Center, Bedford Mass (Drs Christiansen, Spiro, Parker, and Skinner and Ms Loveland). The authors have no relevant financial interest in this article. Dr Skinner is deceased.

Arch Intern Med. 2004;164(12):1306-1312. doi:10.1001/archinte.164.12.1306

Background  Depression and posttraumatic stress disorder (PTSD) are important women's health issues. Depression is known to be associated with poor physical health; however, associations between physical health and PTSD, a common comorbidity of depression, have received less attention.

Objectives  To examine number of medical symptoms and physical health status in women with PTSD across age strata and benchmark them against those of women with depression alone or with neither depression nor PTSD.

Methods  A random sample of Veterans Health Administration enrollees received a mailed survey in 1999-2000 (response rate, 63%). The 30 865 women respondents were categorized according to whether a health care provider had ever told them that they had PTSD, depression (without PTSD), or neither. Outcomes were self-reported medical conditions and physical health status measured with the Veterans SF-36 instrument, a version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) modified for use in veteran populations.

Results  Across age strata, women with PTSD (n = 4348) had more medical conditions and worse physical health status (physical functioning, role limitations due to physical problems, bodily pain, and energy/vitality scales from the Veterans SF-36) than women with depression alone (n = 7580) or neither (n = 18 937). In age-adjusted analyses, the Physical Component Summary score was on average 3.4 points lower in women with depression alone and 6.3 points lower in women with PTSD than in women with neither (P<.001).

Conclusions  Posttraumatic stress disorder is associated with a greater burden of medical illness than is seen with depression alone. The presence of PTSD may account for an important component of the excess medical morbidity and functional status limitations seen in women with depression.