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Posttraumatic Stress Disorder and Gastrointestinal Disorders in the Danish Population

Gradus, Jaimie L.; Farkas, Dóra Körmendiné; Svensson, Elisabeth; Ehrenstein, Vera; Lash, Timothy L.; Toft Sørensen, Henrik

doi: 10.1097/EDE.0000000000000622
Mental Health
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SDC

Background: Evidence for the association between posttraumatic stress disorder (PTSD) and gastrointestinal (GI) disorders is mixed, owing in part to methodologic differences across studies. Furthermore, studies which have combined GI disorders or symptoms for examination as one overall category may potentially obscure associations between PTSD and individual GI diagnoses.

Methods: This nationwide cohort study examined the incidence of all major nonmalignant GI disorders in patients with a prior PTSD diagnosis (n = 4,076), compared with the general population incidence from 1995 to 2013, using Danish medical registry data. We examined differences by sex, age, marital status, psychiatric and somatic comorbidity, and follow-up time. Risks, standardized incidence rates (SIRs), and confidence intervals (95% CIs) were calculated.

Results: Risk of any GI disorder among PTSD patients was 25% (95% CI: 21%, 29%); the SIR for any GI disorder was 1.8 (95% CI: 1.7, 2.0). Risk and SIRs varied by disorder (e.g., no association with diverticula of the intestines [SIR: 1.1, 95% CI: 0.83, 1.5]; stronger association with peptic ulcer, site unspecified [SIR: 3.3, 95% CI: 1.8, 5.5]). Stratified analyses revealed that some associations were stronger for persons ages 16–39 or unmarried at PTSD diagnosis, persons with comorbid psychiatric diagnoses, and in the year following PTSD diagnosis.

Conclusions: This study documents associations between clinician-diagnosed PTSD and all major nonmalignant GI disorders in an unselected nationwide cohort with long follow-up. Differences in associations across GI disorders and important modifiers may account for previous conflicting research findings.

From the aNational Center for PTSD, VA Boston Healthcare System, Boston, MA; bDepartments of Psychiatry and Epidemiology, Boston University, Boston, MA; cDepartment of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; and dDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.

Submitted 7 January 2016; accepted 11 January 2017.

This study was supported by the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck Foundation and the Novo Nordisk Foundation and by a National Institute of Mental Health grant: “Constructing a Danish Reaction to Severe Stress Cohort” (1R21MH094551-01A1), Jaimie Gradus, Principal Investigator.

The authors report no conflicts of interest.

For access to data, contact the Department of Clinical Epidemiology at Aarhus University Hospital. The analytic code used for the analyses contained herein is presented in eAppendix 3 (http://links.lww.com/EDE/B163).

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (www.epidem.com).

Correspondence: Jaimie L. Gradus, 150 S. Huntington Ave (116B-3), Boston, MA 02130. E-mail: Jaimie.gradus@va.gov.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.