Assessing the Non-mental Health Burden of Untreated or Ineffectively Treated Post-Traumatic Stress Disorder (PTSD) among Civilian Population: A Targeted Literature Review
Background: While the psychological impact of posttraumatic stress disorder (PTSD) is well known, its consequences on physical health and social functioning are not well documented. We synthesized the current evidence on non-mental health consequences of untreated or ineffectively treated PTSD in the U.S. civilian population.
Methods: A comprehensive search in PubMed, EMBASE™ and PsycInfo® for relevant publications since 2010 including keywords related to PTSD and non-mental health outcomes (e.g. metabolic disorders, heart disease) yielded 8,704 studies, which were screened by one reviewer and independently quality checked by another reviewer. Data were assessed for quality using pre-determined criteria, and results were narratively synthesized.
Results: Forty studies were included (total 482,338 participants). PTSD increased risks of cardiovascular (Absolute Hazard Ratio [AHR]:1.18-3.55), neurological (AHR:0.67-2.10), and respiratory conditions (Absolute Odds Ratio [AOR]:1.94-3.59 for World Trade Center Cough Syndrome). Metabolic disorders showed varied risks (AHR:1.04-2.58 for obesity/diabetes). Cancer risk (AOR:2.87), and mortality (HR:1.27-2.13) were elevated. All-cause mortality (HR:3.80) and disruptive life events (AOR:2.1-10.7 for early retirement/job loss) were higher among people with PTSD vs those without. The observed heterogeneity in the outcomes could be due to the differences in study designs, populations, and diagnostic criteria.
Conclusion: Findings highlight substantial impact of PTSD on non-mental health and emphasize the importance of routine screening, prevention, and integrated treatment approaches. However, more recent data on the economic impact of PTSD particularly post-COVID 19 are lacking. Future research should focus on understanding the economic burden and the longitudinal trends tracking overall costs of PTSD among the U.S. civilian population.
