Depression, Posttraumatic Stress Disorder, and Mortality

Objective: To determine whether a history of depression and/or posttraumatic stress disorder (PTSD) is associated with all-cause mortality in primary care patients over an average of 2 years. Methods: Patients from seven Department of Veterans Affairs medical centers completed mailed questionnaires. Depression and PTSD status were determined from patient self-report of a prior diagnosis and/or electronic administrative data. Date of death was ascertained from Veterans Health Information Systems and Technology Architecture and the Department of Veterans Affairs ’ Beneficiary Identification and Records Locator System. Results: Among 35,715 primary care patients, those with a history of depression without a history of PTSD (n 6876) were at increased risk of death over an average of 2 years compared with patients with neither depression nor PTSD after adjustment for demographic variables, health behaviors, and medical comorbidity (hazard ratio (HR) 1.17; 95 % Confidence Interval (CI) 1.06–1.28). However, patients with a history of PTSD without a history of depression (n 748) were not at increased risk of death compared with patients with neither depression nor PTSD (HR 0.84; 95 % CI 0.63–1.13). Patients with a history of both (n 3762) were at increased risk of death after adjustment for demographic factors, although not after additional adjustment for health behaviors and medical comorbidity (HR 0.90; 95 % CI 0.78–1.04). Conclusions: In a large sample of veterans, a prior diagnosis of depression, but not PTSD, was associated with an increased risk of death over an average of 2 years after adjusting for age, demographic variables, health behaviors, and medical comorbidity.Key words: depression, posttraumatic stress disorder, mortality, veterans. PTSD posttraumatic stress disorder; VA Department of Veter