Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT, 06520, USA.
VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA.
Psychiatr Q. 2019 Jun;90(2):275-291. doi: 10.1007/s11126-019-09632-5.
Over 30% of veterans treated for psychiatric disorders in the Veterans Health Administration (VHA) are diagnosed with Post-Traumatic Stress Disorder (PTSD), with most receiving treatment for war-zone stress they experienced decades previously. We examined psychiatric multimorbidity among these patients and consider its implications for treatment and research. Using national VHA data from Fiscal Year 2012 on all veterans diagnosed with PTSD, we compared those with PTSD only to those with one, two, and three or more concurrent (non-substance use) psychiatric disorders. Comparisons of these four groups on sociodemographic characteristics, medical and substance use co-morbidities, health service use, and psychotropic prescription fills were conducted using bi-variate and ordinal logistic regression methods. Of 638,451 veterans diagnosed with PTSD in FY2012, only 29.8% had PTSD alone; 36.7% had one concurrent psychiatric diagnosis, 21.3% had two, and 12.2% had three or more. Anxiety disorder and major depressive disorder were the most common concurrent diagnoses. Veterans with higher levels of multimorbidity were younger, had greater likelihood of recent homelessness, substance use disorder, and diverse medical diagnoses, along with increased mental health and medical service use and greater psychotropic medication use. Psychiatric multimorbidity is highly prevalent among VHA patients diagnosed with PTSD, and may represent an underappreciated and poorly understood clinical complication that poses unique challenges to effective treatment. Clinical attention and both epidemiological and interventional research on multimorbidity in PTSD patients are needed in order to better understand and treat this common but understudied phenomenon.
超过 30%在退伍军人健康管理局 (VHA) 接受精神疾病治疗的退伍军人被诊断患有创伤后应激障碍 (PTSD)，其中大多数人接受的是几十年前在战区经历的压力的治疗。我们研究了这些患者中的精神共病，并考虑了其对治疗和研究的影响。使用 2012 财年全国 VHA 退伍军人 PTSD 诊断数据，我们将仅患有 PTSD 的退伍军人与患有一种、两种和三种或更多同时存在的（非物质使用）精神疾病的退伍军人进行了比较。使用双变量和有序逻辑回归方法比较了这四组退伍军人的社会人口统计学特征、医疗和物质使用共病、卫生服务使用情况和精神药物处方填写情况。在 2012 财年，被诊断患有 PTSD 的 638451 名退伍军人中，只有 29.8%的退伍军人仅患有 PTSD；36.7%的退伍军人同时患有一种精神疾病诊断，21.3%的退伍军人同时患有两种，12.2%的退伍军人同时患有三种或更多。焦虑症和重度抑郁症是最常见的同时存在的诊断。患有共病程度较高的退伍军人年龄较小，最近无家可归、物质使用障碍和多种医疗诊断的可能性较大，心理健康和医疗服务使用增加，精神药物使用也增加。精神共病在 VHA 诊断为 PTSD 的患者中非常普遍，可能代表一种被低估和理解不足的临床并发症，对有效治疗构成独特挑战。需要对 PTSD 患者的共病进行临床关注以及流行病学和干预研究，以便更好地理解和治疗这种常见但研究不足的现象。
