High Posttraumatic Stress Disorder Burden and Depression Association With Higher Risk for Mortality

sad man on black background
Evidence has found associations between PTSD and an increased risk of chronic disease. While this association has been investigated with military personnel, the association between PTSK and all-cause mortality has not been thoroughly investigated in civilians.

Women at midlife who had a high posttraumatic stress disorder (PTSD) burden with comorbid depression were at an increased risk for mortality. These findings, from a prospective cohort study, were published in JAMA Network Open.

Researchers from the Harvard T. H. Chan School of Public Health analyzed data from the Nurses’ Health Study II, which was an on-going biennial study of women recruited in 1989. In 2008. Participants (N=51,602) were surveyed about whether or not they had experienced 15 potentially traumatic events and were assessed by the Short Screening Scale for Diagnostic and Statistical Manual of Mental Disorders for symptoms of PTSD and by the Center for Epidemiologic Studies Depression Scale-10 for symptoms of depression. Mortality rates were obtained through the National Death Index, cancer registries, and the United States Postal Service.

The women were aged mean 53.3 (range, 43-64) years, 97.2% were White, 8890 had PTSD symptoms alone, and 2093 had PTSD symptoms with probable depression.

Among women with PTSD, those with depression were more likely to be divorced (24.8% vs 8.1%), obese (33.4% vs 22.3%), and smoke (11.2% vs 4.4%).

Mortality risk was increased among women who smoked (hazard ratio [HR], 2.81; 95% CI, 2.18-3.61), had low physical activity (HR, 1.49; 95% CI, 1.09-2.04), and were divorced (HR, 1.30; 95% CI, 1.02-1.65).

Compared with women who did not have PTSD or depression, women with a high PTSD symptom burden and depression were at an increased risk for mortality (HR, 3.80; 95% CI, 2.65-5.45; P <.001), as were women with moderate PTSD burden and depression (HR, 2.03; 95% CI, 1.35-3.03; P <.001), and subclinical PTSD symptoms and depression (HR, 2.85; 95% CI, 1.99-4.07; P <.001).

After adjusting for health factors which potentially contributed to an increased mortality risk, the association between mortality and high PTSD burden with depression (HR, 3.11; 95% CI, 2.16-4.47; P <.001), subclinical PTSD with depression (HR, 1.43; 95% CI, 1.06-1.93; P =.02), and depression alone (HR, 2.39; 95% CI, 1.44-3.95; P <.001) remained significant.

Women with PTSD and depression were more likely to die from cardiovascular disease (0.22% vs 0.05%), suicide (0.12% vs <0.01%), accidental injury (0.09% vs 0.03%), diabetes (0.05% vs 0%), or other causes of death (0.19% vs 0.08%).

This study was limited by its lack of diversity. It remains unclear whether the connection between PTSD and depression with mortality risk may be generalizable to a more diverse population or among men.

These data indicated that women with PTSD and comorbid depression symptoms may benefit from targeted therapeutics for improving general health and healthy behaviors in order to potentially reduce mortality risk.


Roberts AL, Kubzansky LD, Chibnik LB, et al. Association of posttraumatic stress and depressive symptoms with mortality in women. JAMA Netw Open. Published online December 4, 2020. doi:10.1001/jamanetworkopen.2020.27935