Suicide, accidents, and hepatitis: The leading causes of death for Veterans in their first year of PTSD treatment

June 24, 2019

Ann Arbor, June 24, 2019 - According to a new study in the American Journal of Preventive Medicine, published by Elsevier, United States Veterans seeking treatment for posttraumatic stress disorder (PTSD) are at increased risk of death compared with the general population. Veterans with PTSD are twice as likely to die from suicide, accidental injury, and viral hepatitis than the general population. Veterans with PTSD are also more likely to die from diabetes and chronic liver disease than the general population.

"Our findings suggest that treatment-seeking Veterans with PTSD, including young Veterans and women, are dying from largely preventable causes compared with the general population. PTSD is therefore a major public health concern and a priority for preventive health care," explained lead investigator Jenna A. Forehand, MD, MPH, Veterans Affairs Medical Center, White River Junction, VT, US.

This is the first study to investigate specific causes of death by age group among all-era, treatment-seeking Veterans with PTSD and compare death rates to the US general population. Veterans with PTSD had a significant increase in all-cause mortality in the year following initiation of treatment; 1.1 percent of them died, which is a 5 percent higher incidence than in the general population. Veterans with PTSD had a twofold increase in death from suicide, accidental injury, and viral hepatitis compared with the US population. Death from diabetes and chronic liver disease was also significantly higher for Veterans with PTSD. During the first year of VA PTSD treatment, younger Veterans with PTSD were more likely to die from suicide and accidental injury, whereas middle-aged and older Veterans were more likely to die from heart disease and malignant neoplasms. Among individuals dying from accidental injury, more than half died of poisoning, which could include some misclassified suicides.

This retrospective cohort study identified the leading causes of death among 491,040 Veterans who initiated PTSD treatment at any Department of Veterans Affairs Medical Center from 2008 to 2013; 5,215 of them died within the first year of care. The mean age was 48.5 years, 90.7 percent were male, 63.5 percent were of white race, and 34.9 percent served in the wars in Iraq and Afghanistan.

Causes of death during the first year of treatment were grouped according to age (18-34, 35-64, and 65 or older). To statistically compare the observed mortality among Veterans in PTSD treatment with the general population, standardized mortality ratios were calculated from age- and sex-matched mortality tables of the 2014 US population.

Because of advances in medicine and technology, Veterans who served in recent conflicts are more likely to survive combat injuries than previous generations. As a result, the prevalence of PTSD, pain disorders, and opioid use has increased among survivors. As Veterans with PTSD and comorbid pain may be at increased risk of opioid use disorder, the investigators posit that opioids may play a role in accidental injury, suicide, and hepatitis-related deaths, especially in young Veterans with PTSD. Understanding the complex nature of PTSD and its associated mortality risks is important for developing targeted interventions in this age group.

"Future studies should develop preventive interventions that target PTSD and comorbid depression, pain disorder, and substance use to lessen the risk of suicide, accidental poisoning, and viral hepatitis in Veterans with PTSD. Similarly, lifestyle modifications may reduce the risk of diabetes and chronic liver disease in this patient population. Veterans seeking treatment for PTSD should receive comprehensive education on the benefits of diet and exercise and the risks of chronic stress and substance use," commented Dr. Forehand.


Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to