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Medical Care Needs of Returning Veterans with PTSD: Their Other Burden

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ABSTRACT

BACKGROUND

There has been considerable focus on the burden of mental illness (including post-traumatic stress disorder, PTSD) in returning Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, but little attention to the burden of medical illness in those with PTSD.

OBJECTIVES

(1) Determine whether the burden of medical illness is higher in women and men OEF/OIF veterans with PTSD than in those with No Mental Health Conditions (MHC). (2) Identify conditions common in those with PTSD.

DESIGN

Cross-sectional study using existing databases (Fiscal Year 2006–2007).

SETTING

Veterans Health Administration (VHA) patients nationally.

PATIENTS

All 90,558 OEF/OIF veterans using VHA outpatient care nationally, categorized into strata: PTSD, Stress-Related Disorders, Other MHCs, and No MHC.

MEASUREMENTS

(1) Count of medical conditions; (2) specific medical conditions (from ICD9 codes, using Agency for Health Research and Quality’s Clinical Classifications software framework).

MAIN RESULTS

The median number of medical conditions for women was 7.0 versus 4.5 for those with PTSD versus No MHC (p < 0.001), and for men was 5.0 versus 4.0 (p < 0.001). For PTSD patients, the most frequent conditions among women were lumbosacral spine disorders, headache, and lower extremity joint disorders, and among men were lumbosacral spine disorders, lower extremity joint disorders, and hearing problems. These high frequency conditions were more common in those with PTSD than in those with No MHC.

CONCLUSIONS

Burden of medical illness is greater in women and men OEF/OIF veteran VHA users with PTSD than in those with No MHC. Health delivery systems serving them should align clinical program development with their medical care needs.

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Acknowledgements

The authors are very grateful to Kristian Gima, BA (National Center for PTSD, VA Palo Alto Health Care System), for his technical contributions, to Ann Thrailkill, RNP, MSN, CNS (Women’s Health Center of Excellence, VA Palo Alto Health Care System), Mark W. Smith PhD (Health Economics Resource Center, VA Palo Alto Health Care System), Jenny Hyun MPH, PhD (National Center for PTSD, VA Palo Alto Health Care System), and Amy Street, PhD (National Center for PTSD, VA Boston Healthcare System) for their contributions to study development, and to Rudolf Moos, PhD (Center for Health Care Evaluation, VA Palo Alto Health Care System, and Department of Psychiatry, Stanford University) for his helpful comments on an earlier version of the manuscript. None of the individuals listed in the Acknowledgements section received compensation from this study.

Conflicts of Interest

None disclosed.

Disclaimer

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Prior Presentation

One aspect of the data (information regarding the relationship between PTSD and obesity) was presented in poster format at a national meeting: Phibbs CS, Frayne S, Kimerling R, Pavao J, Berg E, Laungani K, Gima K. "Obesity and PTSD in OIF-OEF Veterans." Poster presentation at AcademyHealth National Meeting, Washington DC, June 2008.

Financial Support

This material is based upon work supported by Department of Veterans Affairs Health Services Research and Development grants SDR 07-331, SHP 08-161, and IAE 05-291. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Role of the Funding Sources

The funding sources had no role in any of the following: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Access to Data

Dr. Frayne and Mr. Berg had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Author information

Authors and Affiliations

  1. Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA

    Susan M. Frayne MD, MPH, Victor Y. Chiu BA, Eric A. Berg MS, Kaajal J. Laungani BA, Ruth C. Cronkite PhD & Rachel Kimerling PhD

  2. Division of General Internal Medicine, Stanford University, Stanford, CA, USA

    Susan M. Frayne MD, MPH, Samina Iqbal MD & Eric A. Berg MS

  3. Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA

    Susan M. Frayne MD, MPH & Ruth C. Cronkite PhD

  4. Center of Excellence in Women’s Health , VA Palo Alto Health Care System, 3801 Miranda Ave (111-A), Palo Alto, CA, 94304, USA

    Susan M. Frayne MD, MPH, Samina Iqbal MD & Rachel Kimerling PhD

  5. Department of Sociology, Stanford University, Stanford, CA, USA

    Ruth C. Cronkite PhD

  6. National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA

    Joanne Pavao MPH & Rachel Kimerling PhD

Authors
  1. Susan M. Frayne MD, MPH
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  2. Victor Y. Chiu BA
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  3. Samina Iqbal MD
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  4. Eric A. Berg MS
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  5. Kaajal J. Laungani BA
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  6. Ruth C. Cronkite PhD
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  7. Joanne Pavao MPH
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  8. Rachel Kimerling PhD
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Corresponding author

Correspondence to Susan M. Frayne MD, MPH.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Appendix 1

Mental Health Condition Specifications (PDF 54.4 KB)

Appendix 2

Gender-stratified Frequency of all 222 Medical Conditions, by PTSD Status, in OEF/OIF Veterans Health Administration Patients; Frequency Rank for Women and Men with PTSD (with 1 indicating most frequent); and Age-Adjusted Odds Ratio (PTSD vs No MHC)* (PDF 484 KB)

Appendix 3

Cumulative Medical Condition Count by PTSD Status by Gender, Sensitivity Analysis 1-4, truncated at 25 conditions. (PDF 295 KB)

Appendix 4

Definition of VA Outpatient Face-to-Face Visits (Technical specifications: clinic “stop” codes used to define face-to-face visits.) (PDF 118 KB)

Appendix 5

Definition of Primary Care Clinic Stops. (Technical specifications: Clinic stop codes used to define primary care encounters.) (PDF 13.2 KB)

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Frayne, S.M., Chiu, V.Y., Iqbal, S. et al. Medical Care Needs of Returning Veterans with PTSD: Their Other Burden. J GEN INTERN MED 26, 33–39 (2011). https://doi.org/10.1007/s11606-010-1497-4

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  • DOI: https://doi.org/10.1007/s11606-010-1497-4

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