nonsignificant 1.06 (95% CI 0.88-1.27) adjusted for age, smoking, alcohol consumption, and BMI at study entry.

Female veterans who attended a VA Puget Sound medical facility in 1996-1998 participated in a cross-sectional survey to determine any association between PTSD (screened for with the PTSD Checklist-Civilian Version) and medical conditions as reported on the veteran version of SF-36 (Dobie et al. 2004). Of the 1259 eligible veterans, 266 were positive for PTSD, and 8.9% of the latter had diabetes and 7.7% of those who were negative for PTSD had diabetes, for a nonsignificant OR of 1.51 (95% CI 0.90-2.52) adjusted for age.

Several small studies have examined the association between thyroid hormones and combat-related PTSD in veterans of various wars. Mason et al. (1994) conducted serum radioimmunoassays for total T4, free T4, total T3, free T3, T4-binding globulin, and TSH in 96 male Vietnam veterans who had PTSD and were patients at VA inpatient treatment groups. Veterans with PTSD were compared with 24 demographically similar community controls who did not have PTSD (11 with combat exposure). The PTSD group had moderately higher total T4, total T3, free T3, and T3:T4 ratios, but not free T4. There was also an increase in T4-binding globulin in the PTSD group but no difference between the groups in TSH. Similar TSH in the two groups suggests that there was no significant difference in thyroid metabolic disease between them.

A second study to investigate serum thyroid-hormone concentrations in 65 male Vietnam veterans with PTSD was conducted by Wang et al. (1995). PTSD symptom severity was rated with the Clinician-Administered PTSD Scale (CAPS). Increased CAPS scores correlated positively with free T3, total T3, and total T4, but not free T4 or T4-binding globulin.

When serum thyroid hormones were studied in 12 World War II veterans with PTSD and 18 without PTSD, similar correlations were seen between total and free T3 and PTSD severity (particularly hyperarousal symptoms), but significant differences were not found in total T4, free T4, T4-binding globulin, or TSH between the groups, although there was a slight trend toward higher TSH in the PTSD group (Wang and Mason 1999).

Obesity

Exposure to stressors may affect eating behavior and theoretically might predispose to obesity or eating problems (see Chapter 4 for a discussion of the effects of stress on obesity). No primary studies of obesity in veterans were identified.

A few secondary studies that examined small, selected samples, such as David et al. (2004), or used only self-report measures suggest that PTSD may be associated with an increased frequency of obesity and eating disorders. Dobie et al. (2004) screened female veterans who received care at a VA medical facility in 1996-1998 with a mail questionnaire that included the PTSD Checklist-Civilian Version and SF-36. A comparison of 940 veterans who were negative for PTSD and 266 who were positive for PTSD found that 60 and 66 of them, respectively, were also positive for an eating disorder (OR 5.00, 95% CI 3.37-7.38). Obesity (defined as a BMI over 30) was reported by 35.3% of those without PTSD and 47.0% of those with PTSD, respectively (OR 1.78, 95% CI 1.34-2.35).

Vieweg et al. (2006) examined 144 male Vietnam veterans with PTSD who were 50-59 years old and were patients at a VA medical center. Their mean BMI was 30.2, and 82.8% of them were overweight or obese, far exceeding the current general U.S. population rate of 64.5%.

Other studies, such as Stretch et al. (1995), which had substantial limitations, did not report such an association. Fielder et al. (2006) looked at the 12-month prevalence of bulimia



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