intermediate increase at interrogation. The findings do not represent an endocrine disease entity and are similar to other changes in the endocrine system that may occur after acute stress.

Posttraumatic Stress Disorder and Endocrine Diseases

Several secondary studies of veterans have examined the association between PTSD and endocrine diseases, such as diabetes or thyroid conditions, but the populations have generally been small and the conclusions based on self-reports of PTSD or medical conditions. In an analysis of VES data collected in 1985-1986 on a random sample of 2490 Vietnam-theater veterans, Boscarino (1997) found that 9.0% of 332 veterans with lifetime PTSD and high combat exposure also had an endocrine-nutritional-metabolic disease compared with 4.0% of 1067 veterans without PTSD and low or no combat exposure. Comparison of the two groups for endocrine-nutritional-metabolic disease yielded a nonsignificant OR of 1.58 (95% CI 0.92-2.73, p = 0.100) adjusted for numerous military, demographic, and socioeconomic variables.

Boscarino (2004) further assessed the prevalence of autoimmune diseases in the VES cohort of 2490 Vietnam-theater veterans. The author assessed 178 veterans with any of 9 autoimmune diseases for the presence of PTSD: 54 veterans were characterized as having PTSD within the last 30 days on the basis of a DIS and meeting the full Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) criteria and 124 veterans were characterized as having comorbid PTSD (PTSD concurrent with psychopathology on the basis of the main Minnesota Multiphasic Personality Inventory scales and considered by the author to be a more severe type of PTSD). Of the 178 veterans with an autoimmune disease and PTSD, six had type 1 diabetes mellitus, four had hypothyroidism, and two had Graves disease (the most common form of hyperthyroidism). The OR for veterans with PTSD compared with veterans without PTSD was 2.9 (95% CI 0.9-8.9, p = 0.066) for diabetes, 8.5 (95% CI 1.9-37.9, p = 0.005) for hypothyroidism, and 3.2 (95% CI 0.6-16.5, p = 0.157) for Graves disease. The ORs were adjusted for age, education, race, intelligence, income, geographic region, Army volunteer status, number of times married, and history of antisocial personality, alcohol abuse, drug abuse, and cigarette-smoking. The study had the advantage of using laboratory tests to confirm the presence of disease, but the number of cases was small.

The Veterans Health Study assessed the prevalence of PTSD, depression, and several medical conditions in a sample of 2425 male ambulatory-care patients at a VA medical facility in the Boston area (Spiro et al. 2006). PTSD was screened for based on responses to the PTSD Checklist for Civilians, reported exposure to traumatic events was assessed with the Laufer Combat Exposure Scale, and health status was based on the self-administered 36-item Medical Outcomes Study Short-Form (SF-36), an instrument to measure physical and mental health, physical and social functioning, and general well-being. Data were collected in 1993-1995; the response rate was 57.2%. The screening criteria for PTSD were met by 20.2% of the patients; when they were compared with those who did not meet the criteria for either PTSD or depression, the OR for type 2 diabetes was a nonsignificant 0.81 (95% CI 0.59-1.11). For thyroid disease, the risk associated with having PTSD was again nonsignificant (OR 1.27, 95% CI 0.58-2.79). ORs were adjusted for age and depression.

Schnurr et al. (2000) failed to find an association in veterans between combat-related PTSD and physician-diagnosed medical conditions. Of 605 combat veterans of World War II and the Korean War assessed for PTSD with the Mississippi Scale for Combat-Related PTSD in 1990, only six were positive for PTSD. Endocrine disease was found in 92 (15%) of the veterans on medical examination. The hazard ratio for having both PTSD and an endocrine disorder was a



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