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Elevated Risk for Autoimmune Disorders in Iraq and Afghanistan Veterans with Posttraumatic Stress Disorder

  • Aoife O’Donovan
    Correspondence
    Address correspondence to Aoife O’Donovan, Ph.D., University of California San Francisco, San Francisco Veterans Affairs Medical Center, 4150 Clement Street (116H), San Francisco, CA 94121
    Affiliations
    Department of Psychiatry, University of California, San Francisco, California

    San Francisco Veterans Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, California
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  • Beth E. Cohen
    Affiliations
    Department of Psychiatry, University of California, San Francisco, California

    San Francisco Veterans Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, California
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  • Karen H. Seal
    Affiliations
    Department of Psychiatry, University of California, San Francisco, California

    San Francisco Veterans Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, California
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  • Dan Bertenthal
    Affiliations
    San Francisco Veterans Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, California
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  • Mary Margaretten
    Affiliations
    Department of Psychiatry, University of California, San Francisco, California
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  • Kristen Nishimi
    Affiliations
    Department of Psychiatry, University of California, San Francisco, California

    San Francisco Veterans Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, California
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  • Thomas C. Neylan
    Affiliations
    Department of Psychiatry, University of California, San Francisco, California

    San Francisco Veterans Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, California
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      Abstract

      Background

      Posttraumatic stress disorder (PTSD) is associated with endocrine and immune abnormalities that could increase risk for autoimmune disorders. However, little is known about the risk for autoimmune disorders among individuals with PTSD.

      Methods

      We conducted a retrospective cohort study of 666,269 Iraq and Afghanistan veterans under age 55 who were enrolled in the Department of Veterans Affairs health care system between October 7, 2001, and March 31, 2011. Generalized linear models were used to examine if PTSD, other psychiatric disorders, and military sexual trauma exposure increased risk for autoimmune disorders, including thyroiditis, inflammatory bowel disease, rheumatoid arthritis, multiple sclerosis, and lupus erythematosus, adjusting for age, gender, race, and primary care visits.

      Results

      PTSD was diagnosed in 203,766 veterans (30.6%), and psychiatric disorders other than PTSD were diagnosed in an additional 129,704 veterans (19.5%). Veterans diagnosed with PTSD had significantly higher adjusted relative risk (ARR) for diagnosis with any of the autoimmune disorders alone or in combination compared with veterans with no psychiatric diagnoses (ARR = 2.00; 95% confidence interval, 1.91–2.09) and compared with veterans diagnosed with psychiatric disorders other than PTSD (ARR = 1.51; 95% confidence interval, 1.43–1.59; p < .001). The magnitude of the PTSD-related increase in risk for autoimmune disorders was similar in women and men, and military sexual trauma exposure was independently associated with increased risk in both women and men.

      Conclusions

      Trauma exposure and PTSD may increase risk for autoimmune disorders. Altered immune function, lifestyle factors, or shared etiology may underlie this association.

      Keywords

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