DISEASES AMONG MEN 20 YEARS AFTER EXPOSURE TO SEVERE STRESS - IMPLICATIONS FOR CLINICAL RESEARCH AND MEDICAL-CARE

Objective: Epidemiologic studies have linked exposure to severe enviro nmental stress, such as natural disasters and combat operations, to th e onset of specific psychiatric disorders. Some research also suggests that these exposures may be associated with the onset of chronic dise ases as well. However, these chronic disease outcome studies often hav e been obscured by bias and confounding. Method: The medical histories of 1399 male Vietnam veterans approximately 20 years after combat exp osure (mean years = 17) were analyzed by lifetime posttraumatic stress disorder (PTSD) status (Lifetime PTSD = 332 cases). These men were in cluded in a national, random in-person study of United States Army vet erans of the Vietnam War (study completion rate = 65%). Results: After controlling for preservice, in-service, and postservice factors (incl uding intelligence, race, region of birth, enlistment status, voluntee r status, Army marital status, Army medical profile, hypochondriasis, age, smoking history, substance abuse, education, and income), associa tions were found for reported circulatory [odds ratio (OR) = 1.62, p = .007], digestive (OR = 1.47, p = .036), musculoskeletal (OR = 1.78, p = .008), endocrine-nutritional-metabolic (OR = 1.58, p = .10), nervou s system (OR = 2.47, p < .001), respiratory (OR = 1.54, p = .042), and nonsexually transmitted infectious diseases (OR = 2.14, p < .004) aft er military service. Conclusion: Although this study has some limitati ons, it suggests that there is a direct Link between severe stress exp osures and a broad spectrum of human diseases. In the future, medical researchers and clinicians should focus more on the medical consequenc es of exposure to severe environmental stress and seek to better integ rate psychobiologic models of disease pathogenesis.