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The Impact of Repression, Hostility, and Post-Traumatic Stress Disorder on All-Cause Mortality: A Prospective 16-Year Follow-up Study

Boscarino, Joseph A. PhD, MPH*†; Figley, Charles R. PhD

The Journal of Nervous and Mental Disease: June 2009 - Volume 197 - Issue 6 - p 461-466
doi: 10.1097/NMD.0b013e3181a61f3e
Brief Report

A common assumption is that repression of traumatic memories is harmful to health. To assess this, we examined all-cause mortality among a national random sample of 4462 male US Army veterans evaluated in 1985 and followed up in 2000. Our hypothesis was that repression on the Welsh R scale would be associated with increased future mortality. We also expected to find a repression × post-traumatic stress disorder (PTSD) interaction effect. Multivariate Cox regression results for all veterans and for theater veterans (Vietnam service) and era veterans (no Vietnam service) separately, revealed that while PTSD was significant in all models, no main or interaction effect was found for repression. In addition, for era veterans, higher repression symptoms were protective for future mortality (HR = 0.95, p = 0.03). For hostility symptoms, although no interaction effect was found by PTSD, a positive main effect was detected for hostility, but only for theater veterans (HR = 1.04, p = 0.034). Disease-specific results were nonsignificant. Similar to a recent study, we also found that repression symptoms were negatively correlated with PTSD symptoms (r = −0.109, p < 0.001), suggesting repression might be protective. Our study found no evidence that repression had an adverse health impact on men exposed to psychological trauma.

*Center for Health Research, Geisinger Clinic, Danville, Pennsylvania; †Departments of Medicine and Pediatrics, Mount Sinai School of Medicine, New York, New York; and ‡Disaster Mental Health, School of Social Work, Tulane University, New Orleans, Louisiana.

Supported in part by grants from the National Institute of Mental Health (Training Grant MH-19105 and R01 Grant MH-66403 to Dr. Boscarino).

Send reprint requests to Joseph A. Boscarino, PhD, MPH, Senior Investigator-II, Center for Health Research, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA 17822. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.