MONTREAL - The physical burden of psychological trauma remains largely underrecognized from both a public health and clinical perspective, a panel of experts explained at the annual meeting of the International Society for Traumatic Stress Studies. And the interplay of mental and physical health should be a central consideration in prevention and treatment programs, they said.
"I think we are just beginning to peel apart the onion" of the extent to which physical illness and mental illness are comorbid, said Dr. Sandro Galea, a physician and epidemiologist affiliated with the school of public health at Columbia University, New York. Mental illness "is a key component in the onset, progression, and severity of a full range of physical illnesses, which, if factored in properly, would illustrate a dramatically greater burden of mental illness than we have currently accepted," he said.
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Dr. Sandro Galea
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In several ongoing studies across a wide variety of populations, Dr. Galea and his colleagues have documented "an extraordinary relationship" between posttraumatic stress disorder (PTSD) and health disorders such as vascular problems, respiratory and lung problems (including chronic obstructive pulmonary disease, tuberculosis, and emphysema), and other major illnesses such as arthritis, cancer, and diabetes, he reported.
"With few exceptions, it is pretty consistent across the board" that there is a clear association of physical health, functioning, and disability according to the presence or absence of current or lifetime PTSD, he said.
For example, recent evidence from the Detroit Neighborhood Health Study shows evidence of epigenetic and immune system dysfunction among individuals with depression and/or PTSD, compared with unaffected individuals (Proc. Natl. Acad. Sci. 2010;10720:9470-5).
"As providers, we need to be aware of this association and should think about screening for trauma in many of our patients, particularly those with chronic illness," said Dr. Beth E. Cohen of the University of California, San Francisco, and an internal medicine specialist at the San Francisco VA Medical Center. "There’s a lot of data showing [that] people do not actually get diagnosed and treated for things like PTSD for years or even decades after they start to experience these symptoms. If we were able to treat people more aggressively up front, perhaps we could prevent a lot of this."
As coinvestigator on the Heart and Soul Study, Dr. Cohen and her colleagues have documented an increased rate of cardiovascular (CVD) events among heart disease patients with a history of psychological trauma vs. those without (Arch. Gen. Psychiatry 2010;67:750-8). Over a mean of 6 years’ follow-up, there was a 44% rate of CVD events in subjects in the highest quartile of psychological trauma, compared with 36% among those in the lowest quartile, she said.
"Psychological trauma was common in this cohort of patients with heart disease," she said. In addition, greater lifetime trauma was prospectively associated with an increased risk of cardiac events, independent of psychiatric comorbidities, health behaviors, and conventional cardiac risk factors, she explained.
"Cumulative psychological trauma is a very real risk factor for cardiac disease, and patients do not have to either develop a psychiatric disorder or engage in a negative health behavior for this cardiac risk to emerge."
Both Dr. Cohen and Dr. Galea noted the importance of communication between providers of mental and medical health care.
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