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Women With PTSD and Depression Face Increased Early Mortality Risk

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Key Takeaways

  • PTSD and chronic responses to stress increase risk of disease.
  • Women have higher rates of exposure to stress.
  • Chronic stressors have a direct link to early death.

A recent study published in JAMA  conducted by the Harvard T. Chan School of Public Health found that, when post-traumatic stress disorder (PTSD) coexists with depressive symptoms in women, it drastically increases their risk of mortality from multiple causes, compared with women who experience neither of these conditions.

Women have traditionally been excluded from PTSD research, due to the usual focus on the mental health of veterans, which makes the results of this long-term study even more important. The results of this research also highlight the need for further investigation into the connection between mental and physical health.

What Did the Study Show?

The study compiled data based on 51,602 cisgender women between the ages of 43-64 and followed up with participants for nine years (2008-2017), covering those with reported high PTSD symptoms and depression.

The researchers found that those who reported both PTSD and depression had a tangible increased risk of death from Type 2 diabetes, cardiovascular disease, respiratory disease, and suicide compared with those without any reported trauma exposure or diagnosed depression.

Dr. Roseann Capanna-Hodge, interactive mental health expert and psychologist, says, "The research is clear that chronic stress can lead to physical health problems, including major medical issues such as stroke, heart attack, and autoimmune disease. The better we learn to cope with stress, the less likely we are to have physical and mental health issues."

Kara Dean-Assael, DSW, LMSW

Trauma affects us in many ways, and it starts with how we experience trauma, physically, in our bodies. When we experience life-threatening and incredibly scary events, our brain is triggered to set off our fight or flight response.

— Kara Dean-Assael, DSW, LMSW

Kara Dean-Assael, DSW, LMSW, director of the McSilver Institute’s Clinical Education and Innovation Department and clinical leader for the Community Technical Assistance Center of New York State (CTAC), references a 1998 study done by trauma researcher Vincent J Felitti that discusses the role of childhood exposure to household dysfunction and abuse. “Adverse childhood experiences and the accumulations of them have been correlated with a number of poor outcomes in health, such as cancer, cardiovascular disease and pulmonary disease," Dean-Assael says. "Such outcomes include co-occurring issues and other mental health challenges, that tend to disrupt healthy development across the life course and quite often contribute to health risks later in life.” 

The Effects of Stress 

While this study focused on middle-aged women, the effects of stress on the body can be found in younger individuals as well . Dean-Assael discusses allostatic load, which is used to describe the “wear and tear” that occurs from long-term attempts to adapt to stressors. “It has been shown to lead to early death and increase as people age."

Dean-Assael continues, "This can be detected in relatively young women with high-stress histories and particularly those with PTSD. This stress-related wear and tear can lead to a variety of health problems over time.” 

Types of Trauma

While no one is exempt from the physiological toll that trauma and stress can take, cisgender men and women are often exposed to different types of trauma, and are subsequently affected differently. Dean-Assael says, “It’s been found that women and men are exposed to different types of traumas. For example, men are often exposed to more accidents, witnessing injury and death, disaster, war or battles, and nonsexual assault. Meanwhile, women are often exposed to more abuse and sexual assault, as research has shown.”

Dean-Assael cites research published in the Journal of Aggression, Maltreatment & Trauma  and explains how our methods of socialization are a probable cause of both the diagnosis and treatment of mental health disorders. Data shows that more women are found to have been diagnosed, but we also know that men are less likely to discuss their symptoms or receive treatment.

Capanna-Hodge discusses the ways in which this socialization results in trauma affecting men and women differently. "Trauma affects men and women differently, as women are more likely to internalize their issues," she says. "When we internalize stressors and trauma, you will see higher rates of anxiety, depression, self-harm behaviors, and isolation. Women also have a higher rate of auto-immune diseases and their tendency to be 'silent sufferers' may be a contributing factor."

The Physiological Consequences of Increased Stress Hormones

The dangers of consistent stress are real, as elevated levels of hormones such as cortisol are shown to cause health problems over time. An important consideration when discussing the effects of trauma, especially long-term, is that stress can look different for everyone.

"Trauma can come in many forms and we often only think about trauma in its extreme forms. In reality, trauma can result from things like medical experiences, grief and loss, bullying, betrayal, and a multitude of experiences that are incredibly stressful. When we broaden our understanding of how trauma affects the brain and body, we can get the message out to people who may not be connecting their mental health or physical issues to events that are holding them back from healing." says Capanna-Hodge.

Heightened cortisol levels have been linked to chronic conditions such as cardiovascular disease and diabetes. Dean-Assael reminds us that the additional possible effects of stress, including rapid heartbeats and slowed digestion, can be hard on the body and potentially lead to issues down the road.

“Trauma affects us in many ways, and it starts with how we experience trauma in our bodies. When we experience horrifying events, our brain is triggered to set off our fight or flight response. This also triggers hormones in our bodies to protect our lives," says Dean-Assael.

Discrimination as a Health Factor

The women within the study were primarily white and middle-aged. While this is a gap in this particular study, there has been data connected to the stress that comes with navigating a marginalized identity and generational trauma.

Dean-Assael cites a 2015 study done by Maryam Jernigan and a 2016 article by Adriana Umaña-Taylor that discusses the ways in which trauma in direct relation to race has tangible physical symptoms, including insomnia, hypervigilance, depression, and anxiety.

"Research has shown that racism-related stress and trauma can manifest into physical ailments that may contribute to early death due to acute stress...Chronic stress harms people slowly, over time, and increases the risk of various diseases throughout the body," says Dean-Assael.

Those that live at marginalized intersections are exposed to higher levels of stress and trauma, making the risk of chronic disease and early death higher. However, this knowledge can impact the ways that both mental health professionals and physicians approach their work with women, people of color, and members of the LGBTQ+ community, encouraging both patients and physicians to look at the individual as a whole, considering all of the outcomes of negative mental health. 

What This Means For You

There is still stigma when it comes to taking care of your mental health, which is often treated as separate from your physical or overall wellbeing. This data supports the idea that mental health is health, and that caring for yourself in all aspects is monumentally important.

Prioritize your self-care and mental health in the same ways you'd protect your physical health, and take whatever steps necessary to do so, whether that means creating a solid support system, finding a therapist in your area, or changing your environment.

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Article Sources
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