Abstract:
Abstract
Background:
This study examined the associatio
n between the type, and cumulative number of lifetime potentially
traumatic events (PTEs), and chronic physical conditions, i
n a South African sample. PTE exposures have been associated
with an increased risk for a wide range of chronic physical c
onditions, but it is unclear whe
ther psychiatric disorders
mediate this association. Given the established differences
in trauma occurrence, and the epidemiology of posttraumatic
stress disorder (PTSD) in South Africa relative to other countries, examining associations between PTEs and chronic
physical conditions, particula
rly while accounting for psychia
tric comorbidity is important.
Methods:
Data were drawn from the South African Stress and Health Study, a cross-sectional population-representative
study of psychological and physical health of South African adults. Twenty-seven PTEs, based on the World Health
Organization Composite International Diagnostic Interview Version 3.0, DSM-IV PTSD module were grouped into seven
PTE types (war events, physical violence, sexual violence, accidents, unexpected death of a loved one, network events,
and witnessing PTEs). Five clusters of physical conditions (cardiovascular, arthritis, respiratory, chronic pain, and other
health conditions) were examined. Logistic regressions assessed the odds of reporting a physical condition in relation
to type and cumulative number of PTEs. Cochran-Armitage test for trend was used to examine dose-response effect
of cumulative PTEs on physical conditions.
Results:
After adjusting for sociodemographic variables and psychiatric disorders, respondents with any PTE had
increased odds of all assessed physical conditions, ranging between 1.48 (95 % CI: 1.06
–
2.07) for arthritis and 2.07
(95 % CI: 1.57
–
2.73) for respiratory conditions, compared to those without PTE exposure. Sexual violence, physical
violence, unexpected death of a loved one, and network PTEs significantly increased the odds of all or nearly all the
physical conditions assessed. There was a dose-response relationship between number of PTEs and increased odds
of all physical conditions.
Conclusions:
Results from this study, the first in an African general population, are consistent with other
population-based studies; PTEs confer a broad-spectrum risk for chronic physical conditions, independent
of psychiatric disorders. These risks increase with eac
h cumulative PTE exposure. Clinically, comprehensive
evaluations for risk of mental and physical health mor
bidities should be considered among PTE survivors.
