Causes of Excess Mortality in Veterans Treated for Posttraumatic Stress Disorder

Abstract: Introduction: Published research indicates that posttraumatic stress disorder (PTSD) is associated with increased mortality. However, causes of death among treatment-seeking PTSD patients remain poorly characterized. The study objective was to describe causes of death among PTSD patients to inform preventive interventions for this treatment population. Methods: A retrospective cohort study was conducted of all veterans who initiated PTSD treatment at any Department of Veterans Affairs Medical Center from fiscal year 2008–2013. The primary outcome was mortality within the first year after treatment initiation. In 2018, the collected data was analyzed to determine leading causes of death. For the top 10 causes, standardized mortality ratios (SMRs) were calculated from age- and sex-matched mortality tables of the U.S. general population. Results: 491,040 veterans were identified who initiated PTSD treatment. Mean age was 48.5 years (+/− 16.0 years), 90.7% were male, and 63.5% were of white race. In the year following treatment initiation, 1.1% (5,215/491,040) died. All-cause mortality was significantly higher for veterans with PTSD compared to the U.S. population (SMR 1.05, 95% CI: 1.02–1.08, p<0.001). Veterans with PTSD had a significant increase in mortality from suicide (SMR 2.52, CI: 2.24–2.82, p<0.001), accidental injury (SMR 1.99, CI: 1.83–2.16, p<0.001) and viral hepatitis (SMR 2.26, CI: 1.68–2.93, p<0.001) compared to the U.S. population. Of those dying from accidental injury, more than half died of poisoning (52.3%, 325/622). Conclusions:  Veterans with PTSD have an elevated risk of death from suicide, accidental injury and viral hepatitis. Preventive interventions should target these important causes of death.

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