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Association With Self-reported Health Problems and Functional Impairment

Dorcas J. Dobie, MD; Daniel R. Kivlahan, PhD; Charles Maynard, PhD; Kristen R. Bush, MPH; Tania M. Davis, PhD; Katharine A. Bradley, MD, MPH

Arch Intern Med. 2004;164:394-400.

Background  The purpose of this report is to identify self-reported health problems and functional impairment associated with screening positive for posttraumatic stress disorder (PTSD) in women seen for care at a Department of Veterans Affairs (VA) medical center.

Methods  A survey was mailed to all women (N = 1935) who received care at the VA Puget Sound Health Care System between October 1996 and January 1998. The survey inquired about health history and habits. It included the PTSD Checklist–Civilian Version (PCL-C) and validated screening measures for other psychiatric disorders. The veteran's version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36-V) was included to assess health-related quality of life.

Results  Of the 1259 eligible women who completed the survey, 266 women (21%) screened positive for current PTSD (PCL-C score 50). In age-adjusted bivariate analyses, women who screened positive for PTSD reported more psychiatric problems, substance abuse, and lifetime exposure to domestic violence. They were significantly more likely to endorse physical health problems including obesity, smoking, irritable bowel syndrome, fibromyalgia, chronic pelvic pain, polycystic ovary disease, asthma, cervical cancer, and stroke. In fully adjusted multivariate models, a PCL-C score of 50 or greater was independently associated with scoring in the lowest quartile on SF-36-V subscales and composite scales.

Conclusions  Symptoms of PTSD are common in women treated at VA facilities. In addition, PTSD is associated with self-reported mental and physical health problems and poor health-related quality of life in these patients. These findings have implications for the design of VA primary care services for the growing population of female veterans.

From the Departments of Psychiatry and Behavioral Sciences (Drs Dobie, Kivlahan, and Davis) and Medicine (Dr Bradley), University of Washington School of Medicine, Seattle; and the Mental Illness Research Education and Clinical Center (Dr Dobie), Center of Excellence in Substance Abuse Treatment and Education (Drs Kivlahan and Davis and Ms Bush), and Health Services Research & Development (Drs Maynard and Bradley), VA Puget Sound Health Care System, Seattle. The authors have no relevant financial interest in this article.

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