Presented by: Renée El-Gabalawy, M.A., PhD Candidate

Dr. Natalie Husarewycz

Dr. Jitender Sareen

Dr. Sarvesh Logsetty

Limited research on the association between trauma and mental illness

Growing body of research on the association between physical health conditions and mental disorders including PTSD

Preliminary research on the association of trauma and physical health conditions

1. Is there a cumulative linear effect of experiencing multiple traumatic events on the association to physical health conditions?

2. Is it the nature of the trauma experienced or the mental disorder that increases the susceptibility of physical health problems?

National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Wave 2 in 2004-2005 (n=34 653), response rate: 70.2%

Age ≥20 years

U.S. adult, non-institutionalized population

Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version used to establish mental disorder diagnoses

Trauma Groups (Lifetime) Physical Health Conditions (Past-Year)

Injurious Cardiovascular Disease

Psychological Arteriosclerosis/Hypertension

Combat Gastrointestinal Disease

Witness Diabetes

Natural disaster/terrorism Arthritis

Obesity

Injurious Accident Sexual assault Physical attack Physical abuse as child Physical abuse by partner Kidnapping/held hostage Injured in terrorist attack

Psychological Neglect Stalking Threat with weapon

Natural Disaster/Terrorism Natural disaster (e.g. fire,

hurricane) Experience terrorism

Combat Active military combat Peacekeeper/relief worker in

war zone Unarmed civilian in

war/revolution/military group Refugee

Witness Witness physical abuse Witness terrorism Witness trauma (e.g. see

someone injured/killed, see a dead body)

Trauma of someone close (e.g. illness/accident/injury, death)

Traumatic Experience n (weighted %)

Injurious Trauma 10,741 (30.68)

Psychological Trauma 6,316 (17.32)

Combat Trauma 2,441 (7.53)

Witness Trauma 24,282 (71.57)

Natural Disaster/ Terrorism

5,518 (16.10)

Logistic regressions: Number of traumatic experiences assessed physical

health conditions

Logistic regressions: Type of trauma assessed physical health conditions

Model 1: adjusted for sociodemographic variables

Model 2: adjusted for sociodemographics and Axis I and II disorders

Model 3: adjusted for sociodemographics, Axis I and II disorders, all other trauma groups

Trauma Type Significant Associations

Injurious All conditions (AOR 1.17-1.61)

Psychological All conditions (AOR 1.16-1.41)

Combat CVD and GI (AOR 1.27-1.30)

Negatively with obesity (AOR 0.87)

Witnessing All conditions (AOR 1.25-1.53)

Natural disaster/ terrorism

All conditions except obesity (AOR 1.15-1.42)

Adjusted for sociodemographics and any mood, anxiety, substance use and personality disorders

Adjusted for sociodemographics, Axis I and II disorders and all other trauma groups

Trauma Type Significant Associations

Injurious All conditions (AOR 1.13-1.47)

Psychological CVD, GI disease, diabetes, arthritis

(AOR 1.15-1.22)

Combat Negatively with obesity (AOR 0.84)

Witnessing All conditions (AOR 1.22-1.89)

Natural disaster/ terrorism

CVD, GI disease, arthritis (AOR 1.12-1.28)

Modest association between several types of trauma and physical health conditions, even when controlling for Axis I and II disorders (including PTSD)

The impact of traumatic events on physical health may be independent of Axis I and II disorders

There appears to be a cumulative effect of traumas on the odds of having all assessed physical health conditions

Self-reported physical health conditions and traumatic events

Cross-sectional sample

Certain populations (under 18, institutionalized) were not included in the sample, so results may not generalize to these groups

Physiological reactivity associated with stress response and PTSD

Some evidence that survivors of trauma even without PTSD have increased autonomic reactivity

Likely trauma itself is associated with biological changes

Why is combat trauma NOT significantly associated with increased odds of physical conditions? Haley’s (1998) “healthy warrior effect”

suggests that chronically ill soldiers are selectively withheld from deployment

Screening and treatment for individuals who do not fulfill criteria for a mental disorder but who have experienced trauma

Clinicians should consider screening for trauma in those presenting with multiple somatic complaints

Vanier Canada Graduate Scholarship (El-Gabalawy)

Manitoba Graduate Scholarship (El-Gabalawy)

Canadian Institutes of Health Research (Sareen)

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