After Military Service, Veterans with Post-Traumatic Stress Disorder Die at Twice the Rate of Veterans Free of PTSD

NEW YORK CITY, September 7, 2005???A ground-breaking study conducted by Dr. Joseph Boscarino, a Senior Scientist at The New York Academy of Medicine and Associate Professor of Medicine at Mt. Sinai School of Medicine, found that U.S. Army Vietnam veterans with posttraumatic stress disorder (PTSD) had twice the rate of post-service deaths 30 years after military service, when compared to other veterans.

Dr. Boscarino???s study, published in the August 2005 issue of Annals of Epidemiology (Elsevier, New York, NY) is the first to confirm that PTSD can be deadly. Previous research indicated that veterans with PTSD???incurred during combat or other major life-threatening experiences???not only had more psychological problems, but also more physical disabilities, health problems, and medical conditions, such as heart disease.

???This is the first study to confirm that PTSD is associated with a higher risk of death from multiple causes, particularly from cardiovascular diseases, cancer, and from external causes, such as suicide or accidents,??? Dr. Boscarino stated. He added, ???The reasons are unclear, but may be related to biological, psychological, or behavioral factors associated with PTSD. We expected more deaths from cardiovascular disease, based on our past research, but the higher cancer mortality was a surprise. Clearly, further investigation is needed.???

Dr. Boscarino???s own combat experiences in Vietnam and his current work as an epidemiologist studying the health effects of 9/11 on New Yorkers offer a unique platform from which to study health issues that concern veterans. For years, he has examined the causes of health problems among a national random sample of about 15,000 male U.S. Army veterans. (His sample includes both veterans with and free of PTSD after military service. It is a national sample of all Army veterans from the Vietnam War era.)

In his 2005 study, Dr. Boscarino examined the causes of death among veterans 16 years after they completed a health survey in1985, which was approximately 30 years after their military service. The new study controlled for age, race, Army volunteer status, Army entry age, discharge status, illicit drug abuse, intelligence, and for cancer mortality, cigarette smoking. About half the men surveyed served in Vietnam (theater vets) and half in the United States, Europe, or Korea (era vets).

Dr. Boscarino???s most recent findings indicate that the postwar mortality for all-cause, cardiovascular, cancer, and for external causes (deaths from suicides, homicides, drug overdoses, accidents, etc.) was about twice as high among the PTSD-positive theater vets. Approximately 11 percent of theater vets and 3 percent of era vets in his study had PTSD. For era vets, PTSD was associated with all-cause mortality and also appeared to be associated with external-cause mortality as well. About 11 percent of the PTSD cases and about 5 percent of the non-PTSD cases were dead at follow-up.

Addressing the issue of whether having PTSD means that a veteran will die prematurely, Boscarino said, ???Not necessarily, but those veterans are at increased risk.??? Getting treatment, following a good diet, exercising, quitting smoking, and avoiding substance abuse will definitely improve the chances of survival.??? Boscarino cautions that the impact of PTSD on mortality is higher than actually revealed in the current study. Many PTSD-positive veterans were dead before the previous survey assessment in 1985, and those deaths were, in many cases, from suicide or related to drugs, alcohol, or accidents.

In terms of its relevance to veterans returning from Afghanistan and Iraq, the study makes the point that PTSD can be fatal unless those who suffer from it treat it both mentally and physically. Compared to thirty years ago, Dr. Boscarino concludes, ???Much more is known today about PTSD, its diagnosis and treatment than were known during the Vietnam War era. That is something that returning veterans and other victims today need to know and, more importantly, use for their benefit.???

The study is also relevant to other persons who suffer from PTSD, such as victims of Hurricane Katrina and other natural disasters. In fact, Dr. Boscarino???s findings do not just pertain to combat veterans. His study clearly proved that Vietnam era vets with PTSD, but with no Vietnam service, also died at twice the rate overall.

The New York Academy of Medicine, the country???s premier urban health policy and intervention center, focuses on enhancing the health of people living in cities through research, education, advocacy, and prevention.

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EDITORS: Interviews with Dr. Boscarino are available by appointment. Call Maria Dering at (212) 873-6715.

Available on Medline and in Annals of Epidemiology.

Posted on September 7, 2005

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