Associations between Post Traumatic Stress Disorder, Combat Exposure, and COVID-19 Post Acute Sequalae among War Veterans Público
Hess, Thomas (Spring 2024)
Abstract
Objectives: In this analysis, we sought to determine whether PTSD could increase the risk of Post Acute Sequelae of COVID-19 (PASC) outcomes and whether combat exposure and number of deployments had a modifying effect on this association for individuals who served in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND).
Design: This was a secondary analysis of electronic health record data contained in the Corporate Data Warehouse (CDW) and DaVINCI databases in the VA national health delivery system.
Methods: Veterans diagnosed with COVID-19 were included in the analyses. Demographic and clinical data were compared using the Chi-squared test for categorical data and Mann-Whitney-Wilcoxon for continuous data. The logistic regression analysis was conducted using a Poisson distribution. Models were adjusted for covariates based on previous research and subject matter recommendations.
Results: More than 116,000 OEF/OIF/OND Veterans with COVID-19 were analyzed; most were men, white and an average age of 44 years. Additionally, more than 50% had a diagnosis of PTSD prior to their COVID-19 diagnosis and 4% were diagnosed with PASC. Veterans with PTSD were more than three times as likely to have PASC outcomes compared to those without PTSD (incidence rate (IR) of 3.58 (95% Confidence Interval (CI) 3.54, 3.61, p-value < 0.01). When number of deployments was considered as an effect modifier, Veterans with PTSD who were deployed 2 times or more were 62% more likely to have PASC compared to those with PTSD who deployed 1 time (IR 1.62, 95% CI 1.34, 1.95, p < 0.001).
Conclusion: This research shows the importance of conducting observational epidemiological research on populations with increased rates of PTSD such as Veterans. Interventions targeting Veterans who have PTSD and/or were exposed to a higher number of deployments should have special considerations regarding their PASC risk.
Table of Contents
1. Introduction
1.1 Overview
1.2 Combat Related PTSD
1.3 PTSD and PASC
1.4 Preventing PASC
2. Methods
2.1 Specific Aims
2.2 Data Sources
2.3 Study design and model specification
2.4 Bias Considerations
3. Results
4. Discussion
5. List of Abbreviations
6. References
7. Tables
8. Figures
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