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The impact of Purple Heart commendation and PTSD on mortality rates in older veterans
Author(s) -
Kimbrell Tim,
Pyne Jeffrey M.,
Kunik Mark E.,
Magruder Kathy M.,
Petersen Nancy J.,
Yu HongJen,
Hudson Teresa J.,
Schulz Paul E.,
Qureshi Salah U.
Publication year - 2011
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.20850
Subject(s) - hazard ratio , medicine , confidence interval , veterans affairs , psychiatry , mortality rate
Background: To determine whether having received a Purple Heart (PH) or having been diagnosed with posttraumatic stress disorder (PTSD) affected mortality in older veterans. Methods: We compared mortality rates of older veterans with a PH but without PTSD (PH+/PTSD−) to veterans with a PH and PTSD (PH+/PTSD+), veterans without a PH but with PTSD (PH−/PTSD+), and a comparison group without a PH or PTSD (PH−/PTSD−). Administrative data from the Veterans Integrated Service Network 16 were collected between 10/01/97 and 09/30/99 for veterans who were 65 years or older. Proportional hazards regression was used to compare the survival times for the four groups (n = 10,255) from entry into the study until death or study termination (9/30/2008). The Charleson co‐morbidity index was used to control for potential co‐morbid illness burden differences between the groups. Results: Older veterans with a PH (PH+/PTSD− and PH+/PTSD+) had significantly lower mortality rates than PH−/PTSD− veterans (hazard ratio [HR] = 0.6, 95% confidence interval [CI] 0.5 to 0.6, P<.0001; and HR = 0.5, 95% CI 0.4 to 0.7, P<.0001). The PH−/PTSD+ group had a higher mortality rate than the PH−/PTSD− group (HR = 1.1, 95% CI 1.0 to 1.2, P<.01). Conclusions: Veterans who had PH citations and survived into their seventh decade had half the mortality rate of veterans without PH citations with or without PTSD. Veterans with PTSD but without a PH had a significantly higher mortality rate compared to (PH−/PTSD−). Veterans who suffer combat injury without developing PTSD may provide a useful study population for determining the factors that confer resilience. Depression and Anxiety, 2011. © 2011 Wiley Periodicals, Inc.