Skip to main content Accessibility help

Post-traumatic stress disorder and cardiometabolic disease: improving causal inference to inform practice

  • K. C. Koenen (a1) (a2), J. A. Sumner (a1) (a3), P. Gilsanz (a4), M. M. Glymour (a4) (a5), A. Ratanatharathorn (a1) (a6), E. B. Rimm (a7), A. L. Roberts (a4), A. Winning (a4) and L. D. Kubzansky (a4)...


Post-traumatic stress disorder (PTSD) has been declared ‘a life sentence’ based on evidence that the disorder leads to a host of physical health problems. Some of the strongest empirical research – in terms of methodology and findings – has shown that PTSD predicts higher risk of cardiometabolic diseases, specifically cardiovascular disease (CVD) and type 2 diabetes (T2D). Despite mounting evidence, PTSD is not currently acknowledged as a risk factor by cardiovascular or endocrinological medicine. This view is unlikely to change absent compelling evidence that PTSD causally contributes to cardiometabolic disease. This review suggests that with developments in methods for epidemiological research and the rapidly expanding knowledge of the behavioral and biological effects of PTSD the field is poised to provide more definitive answers to questions of causality. First, we discuss methods to improve causal inference using the observational data most often used in studies of PTSD and health, with particular reference to issues of temporality and confounding. Second, we consider recent work linking PTSD with specific behaviors and biological processes, and evaluate whether these may plausibly serve as mechanisms by which PTSD leads to cardiometabolic disease. Third, we evaluate how looking more comprehensively into the PTSD phenotype provides insight into whether specific aspects of PTSD phenomenology are particularly relevant to cardiometabolic disease. Finally, we discuss new areas of research that are feasible and could enhance understanding of the PTSD–cardiometabolic relationship, such as testing whether treatment of PTSD can halt or even reverse the cardiometabolic risk factors causally related to CVD and T2D.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Post-traumatic stress disorder and cardiometabolic disease: improving causal inference to inform practice
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Post-traumatic stress disorder and cardiometabolic disease: improving causal inference to inform practice
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Post-traumatic stress disorder and cardiometabolic disease: improving causal inference to inform practice
      Available formats


Corresponding author

*Address for correspondence: K. C. Koenen, Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 505, Boston, MA 02115, USA. (Email:


Hide All
Abboud, FM, Harwani, SC, Chapleau, MW (2012). Autonomic neural regulation of the immune system implications for hypertension and cardiovascular disease. Hypertension 59, 755762.
Abrams, D, Manstead, ASR (1981). A test of theories of social facilitation using a musical task. British Journal of Social Psychology 20, 271278.
Ahmadi, N, Hajsadeghi, F, Mirshkarlo, HB, Budoff, M, Yehuda, R, Ebrahimi, R (2011). Post-traumatic stress disorder, coronary atherosclerosis, and mortality. American Journal of Cardiology 108, 2933.
American Heart Association (2013). Stress and Blood Pressure (
Armour, C, Tsai, J, Durham, TA, Charak, R, Biehn, TL, Elhai, JD, Pietrzak, RH (2015). Dimensional structure of DSM-5 posttraumatic stress symptoms: support for a hybrid anhedonia and externalizing behaviors model. Journal of Psychiatric Research 61, 106113.
Baker, DG, Nievergelt, CM, O'Connor, DT (2012). Biomarkers of PTSD: neuropeptides and immune signaling. Neuropharmacology 62, 663673.
Bedi, US, Arora, R (2007). Cardiovascular manifestations of posttraumatic stress disorder. Journal of the National Medical Association 99, 642649.
Beristianos, MH, Yaffe, K, Cohen, B, Byers, AL (2016). PTSD and risk of incident cardiovascular disease in aging veterans. American Journal of Geriatric Psychiatry 24, 192200.
Blechert, J, Michael, T, Grossman, P, Lajtman, M, Wilhelm, FH (2007). Autonomic and respiratory characteristics of posttraumatic stress disorder and panic disorder. Psychosomatic Medicine 69, 935943.
Boscarino, JA (2006). Posttraumatic stress disorder and mortality among U.S. Army veterans 30 years after military service. Annals of Epidemiology 16, 248256.
Boscarino, JA (2008). A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: implications for surveillance and prevention. Psychosomatic Medicine 70, 668676.
Boscarino, JA, Chang, J (1999). Electrocardiogram abnormalities among men with stress-related psychiatric disorders: implications for coronary heart disease and clinical research. Annals of Behavioral Medicine 21, 227234.
Boyko, EJ, Jacobson, IG, Smith, B, Ryan, MAK, Hooper, TI, Amoroso, PJ, Gackstetter, GD, Barrett-Connor, E, Smith, TC, Team f. t. MCS (2010). Risk of diabetes in U.S. military service members in relation to combat deployment and mental health. Diabetes Care 33, 17711777.
Brouwers, CJ, Wolf, JM, von Känel, R (2016). Inflammatory markers in PTSD. In Comprehensive Guide to Post-Traumatic Stress Disorders (ed. Martin, C, Preedy, V and Patel, V), pp. 979993. Springer: New York.
Buckley, TC, Kaloupek, DG (2001). A meta-analytic examination of basal cardiovascular activity in posttraumatic stress disorder. Psychosomatic Medicine 63, 585594.
Chapman, C, Mills, K, Slade, T, McFarlane, AC, Bryant, R, Creamer, M, Silove, D, Teesson, M (2012). Remission from post-traumatic stress disorder in the general population. Psychological Medicine 42, 16951703.
Chen, M-H, Pan, T-L, Li, C-T, Lin, W-C, Chen, Y-S, Lee, Y-C, Tsai, S-J, Hsu, J-W, Huang, K-L, Tsai, C-F (2015). Risk of stroke among patients with post-traumatic stress disorder: nationwide longitudinal study. British Journal of Psychiatry 206, 302307.
Chwastiak, LA, Rosenheck, RA, Kazis, LE (2011). Association of psychiatric illness and obesity, physical inactivity, and smoking among a national sample of veterans. Psychosomatics 52, 230236.
Cloitre, M, Stovall-McClough, KC, Nooner, K, Zorbas, P, Cherry, S, Jackson, CL, Gan, W, Petkova, E (2010). Treatment for PTSD related to childhood abuse: a randomized controlled trial. American Journal of Psychiatry 167, 915924.
Cohen, JA, Deblinger, E, Mannarino, AP, Steer, RA (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry 43, 393402.
de Kloet, CS, Vermetten, E, Geuze, E, Kavelaars, A, Heijnen, CJ, Westenberg, HG (2006). Assessment of HPA-axis function in posttraumatic stress disorder: pharmacological and non-pharmacological challenge tests, a review. Journal of Psychiatric Research 40, 550567.
Dennis, PA, Watkins, LL, Calhoun, PS, Oddone, A, Sherwood, A, Dennis, MF, Rissling, MB, Beckham, JC (2014). Posttraumatic stress, heart rate variability, and the mediating role of behavioral health risks. Psychosomatic Medicine 76, 629637.
Dong, M, Giles, WH, Felitti, VJ, Dube, SR, Williams, JE, Chapman, DP, Anda, RF (2004). Insights into causal pathways for ischemic heart disease: adverse childhood experiences study. Circulation 110, 17611766.
Dube, SR, Felitti, VJ, Dong, M, Giles, WH, Anda, RF (2003). The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900. Preventive Medicine 37, 268277.
Dudley, KJ, Li, X, Kobor, MS, Kippin, TE, Bredy, TW (2011). Epigenetic mechanisms mediating vulnerability and resilience to psychiatric disorders. Neuroscience and Biobehavioral Reviews 35, 15441551.
Edmondson, D, Cohen, BE (2013). Posttraumatic stress disorder and cardiovascular disease. Progress in Cardiovascular Diseases 55, 548556.
Edmondson, D, Richardson, S, Falzon, L, Davidson, KW, Mills, MA, Neria, Y (2012). Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients: a meta-analytic review. PLOS ONE 7, e38915.
Ehlert, U (2013). Enduring psychobiological effects of childhood adversity. Psychoneuroendocrinology 38, 18501857.
El-Gabalawy, R, Mackenzie, CS, Pietrzak, RH, Sareen, J (2014). A longitudinal examination of anxiety disorders and physical health conditions in a nationally representative sample of U.S. older adults. Experimental Gerontology 60, 4656.
Elhai, JD, Biehn, TL, Armour, C, Klopper, JJ, Frueh, BC, Palmieri, PA (2011). Evidence for a unique PTSD construct represented by PTSD's D1–D3 symptoms. Journal of Anxiety Disorders 25, 340345.
Eraly, SA, Nievergelt, CM, Maihofer, AX, Barkauskas, DA, Biswas, N, Agorastos, A, O'Connor, DT, Baker, DG (2014). Assessment of plasma C-reactive protein as a biomarker of posttraumatic stress disorder risk. JAMA Psychiatry 71, 423431.
Felitti, VJ, Anda, RF, Nordenberg, D, Williamson, DF, Spitz, AM, Edwards, V, Koss, MP, Marks, JS (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine 14, 245258.
Forbes, D, Lockwood, E, Elhai, JD, Creamer, M, O'Donnell, M, Bryant, R, McFarlane, A, Silove, D (2011). An examination of the structure of posttraumatic stress disorder in relation to the anxiety and depressive disorders. Journal of Affective Disorders 132, 165172.
Forbes, D, Parslow, R, Creamer, M, O'Donnell, M, Bryant, R, McFarlane, A, Silove, D, Shalev, A (2010). A longitudinal analysis of posttraumatic stress disorder symptoms and their relationship with fear and anxious–misery disorders: implications for DSM-V. Journal of Affective Disorders 127, 147152.
Fu, SS, McFall, M, Saxon, AJ, Beckham, JC, Carmody, TP, Baker, DG, Joseph, AM (2007). Post-traumatic stress disorder and smoking: a systematic review. Nicotine and Tobacco Research 9, 10711084.
Galatzer-Levy, IR, Ankri, Y, Freedman, S, Israeli-Shalev, Y, Roitman, P, Gilad, M, Shalev, AY (2013). Early PTSD symptom trajectories: persistence, recovery, and response to treatment: results from the Jerusalem Trauma Outreach and Prevention Study (J-TOPS). PLOS ONE 8, e70084.
Giacco, D, Matanov, A, Priebe, S (2013). Symptoms and subjective quality of life in post-traumatic stress disorder: a longitudinal study. PLOS ONE 8, e60991.
Gill, J, Vythilingam, M, Page, GG (2008). Low cortisol, high DHEA, and high levels of stimulated TNFα, and IL-6 in women with PTSD. Journal of Traumatic Stress 21, 530539.
Godfrey, KM, Lindamer, LA, Mostoufi, S, Afari, N (2013). Posttraumatic stress disorder and health: a preliminary study of group differences in health and health behaviors. Annals of General Psychiatry 12, 30.
Goldstein, BI, Carnethon, MR, Matthews, KA, McIntyre, RS, Miller, GE, Raghuveer, G, Stoney, CM, Wasiak, H, McCrindle, BW (2015). Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease: a scientific statement from the American Heart Association. Circulation 132, 965986.
Gooding, HC, Milliren, CE, Austin, SB, Sheridan, MA, McLaughlin, KA (2016). Child abuse, resting blood pressure, and blood pressure reactivity to psychosocial stress. Journal of Pediatric Psychology 41, 514.
Gradus, JL, Farkas, DK, Svensson, E, Ehrenstein, V, Lash, TL, Milstein, A, Adler, N, Sørensen, HT (2015). Associations between stress disorders and cardiovascular disease events in the Danish population. BMJ Open 5, e009334.
Grant, DM, Beck, JG, Marques, L, Palyo, SA, Clapp, JD (2008). The structure of distress following trauma: posttraumatic stress disorder, major depressive disorder, and generalized anxiety disorder. Journal of Abnormal Psychology 117, 662672.
Greenland, S (2000). An introduction to instrumental variables for epidemiologists. International Journal of Epidemiology 29, 722729.
Hall, KS, Hoerster, KD, Yancy, WS Jr. (2015). Post-traumatic stress disorder, physical activity, and eating behaviors. Epidemiologic Reviews 37, 103115.
Harpaz-Rotem, I, Tsai, J, Pietrzak, RH, Hoff, R (2014). The dimensional structure of posttraumatic stress symptomatology in 323 903 US veterans. Journal of Psychiatric Research 49, 3136.
Jordan, HT, Miller-Archie, SA, Cone, JE, Morabia, A, Stellman, SD (2011). Heart disease among adults exposed to the September 11, 2001 World Trade Center disaster: results from the World Trade Center Health Registry. Preventive Medicine 53, 370376.
Kagan, BL, Leskin, G, Haas, B, Wilkins, J, Foy, D (1999). Elevated lipid levels in Vietnam veterans with chronic posttraumatic stress disorder. Biological Psychiatry 45, 374377.
Karlovic, D, Buljan, D, Martinac, M, Marcinko, D (2004). Serum lipid concentrations in Croatian veterans with post-traumatic stress disorder, post-traumatic stress disorder comorbid with major depressive disorder, or major depressive disorder. Journal of Korean Medical Science 19, 431436.
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593602.
Kibler, JL (2009). Posttraumatic stress and cardiovascular disease risk. Journal of Trauma and Dissociation 10, 135150.
Klungel, OH, Martens, EP, Psaty, BM, Grobbee, DE, Sullivan, SD, Stricker, BHC, Leufkens, HGM, de Boer, A (2004). Methods to assess intended effects of drug treatment in observational studies are reviewed. Journal of Clinical Epidemiology 57, 12231231.
Koenen, KC, Hitsman, B, Lyons, MJ, Stroud, L, Niaura, R, McCaffery, J, Goldberg, J, Eisen, SA, True, W, Tsuang, M (2006). Posttraumatic stress disorder and late-onset smoking in the Vietnam era twin registry. Journal of Consulting and Clinical Psychology 74, 186.
Koenen, KC, Moffitt, TE, Poulton, R, Martin, J, Caspi, A (2007). Early childhood factors associated with the development of post-traumatic stress disorder: results from a longitudinal birth cohort. Psychological Medicine 37, 181192.
Koenen, KC, Stellman, SD, Sommer, JF, Stellman, JM (2008). Persisting posttraumatic stress disorder symptoms and their relationship to functioning in Vietnam veterans: a 14-year follow-up. Journal of Traumatic Stress 21, 4957.
Kronish, IM, Lin, JJ, Cohen, BE, Voils, CI, Edmondson, D (2014). Posttraumatic stress disorder and medication nonadherence in patients with uncontrolled hypertension. JAMA Internal Medicine 174, 468470.
Kubzansky, LD, Bordelois, P, Jun, HJ, Roberts, AL, Cerda, M, Bluestone, N, Koenen, KC (2014). The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women. JAMA Psychiatry 71, 4451.
Kubzansky, LD, Koenen, KC, Jones, C, Eaton, WW (2009). A prospective study of posttraumatic stress disorder symptoms and coronary heart disease in women. Health Psychology 28, 125130.
Kubzansky, LD, Koenen, KC, Spiro, A III, Vokonas, PS, Sparrow, D (2007). Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study. Archives of General Psychiatry 64, 109116.
LeardMann, CA, Smith, TC, Smith, B, Wells, TS, Ryan, MA (2009). Baseline self reported functional health and vulnerability to post-traumatic stress disorder after combat deployment: prospective US military cohort study. BMJ 338, b1273.
Lefkowitz, RJ, Rockman, HA, Koch, WJ (2000). Catecholamines, cardiac β-adrenergic receptors, and heart failure. Circulation 101, 16341637.
Leskin, GA, Woodward, SH, Young, HE, Sheikh, JI (2002). Effects of comorbid diagnoses on sleep disturbance in PTSD. Journal of Psychiatric Research 36, 449452.
Levine, AB, Levine, LM, Levine, TB (2014). Posttraumatic stress disorder and cardiometabolic disease. Cardiology 127, 119.
Lloyd-Jones, DM, Hong, Y, Labarthe, D, Mozaffarian, D, Appel, LJ, Van Horn, L, Greenlund, K, Daniels, S, Nichol, G, Tomaselli, GF (2010). Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic impact goal through 2020 and beyond. Circulation 121, 586613.
Logue, MW, Amstadter, AB, Baker, DG, Duncan, L, Koenen, KC, Liberzon, I, Miller, MW, Morey, RA, Nievergelt, CM, Ressler, KJ (2015). The Psychiatric Genomics Consortium Posttraumatic Stress Disorder Workgroup: posttraumatic stress disorder enters the age of large-scale genomic collaboration. Neuropsychopharmacology 40, 22872297.
Lohr, JB, Palmer, BW, Eidt, CA, Aailaboyina, S, Mausbach, BT, Wolkowitz, OM, Thorp, SR, Jeste, DV (2015). Is post-traumatic stress disorder associated with premature senescence? A review of the literature. American Journal of Geriatric Psychiatry 23, 709725.
Lowe, SR, Walsh, K, Uddin, M, Galea, S, Koenen, KC (2014). Bidirectional relationships between trauma exposure and posttraumatic stress: a longitudinal study of Detroit residents. Journal of Abnormal Psychology 123, 533544.
Maia, DB, Marmar, CR, Mendlowicz, MV, Metzler, T, Nobrega, A, Peres, MC, Coutinho, ES, Volchan, E, Figueira, I (2008). Abnormal serum lipid profile in Brazilian police officers with post-traumatic stress disorder. Journal of Affective Disorders 107, 259263.
Matthews, KA, Schott, LL, Bromberger, JT, Cyranowski, JM, Everson-Rose, SA, Sowers, M (2010). Are there bi-directional associations between depressive symptoms and C-reactive protein in mid-life women? Brain, Behavior, and Immunity 24, 96101.
Morina, N, Wicherts, JM, Lobbrecht, J, Priebe, S (2014). Remission from post-traumatic stress disorder in adults: a systematic review and meta-analysis of long term outcome studies. Clinical Psychology Review 34, 249255.
Mustapic, M, Maihofer, AX, Mahata, M, Chen, Y, Baker, DG, O'Connor, DT, Nievergelt, CM (2014). The catecholamine biosynthetic enzyme dopamine β-hydroxylase (DBH): first genome-wide search positions trait-determining variants acting additively in the proximal promoter. Human Molecular Genetics 23, 63756384.
Pace, TW, Wingenfeld, K, Schmidt, I, Meinlschmidt, G, Hellhammer, DH, Heim, CM (2012). Increased peripheral NF-κB pathway activity in women with childhood abuse-related posttraumatic stress disorder. Brain, Behavior, and Immunity 26, 1317.
Pan, A, Keum, N, Okereke, OI, Sun, Q, Kivimaki, M, Rubin, RR, Hu, FB (2012). Bidirectional association between depression and metabolic syndrome: a systematic review and meta-analysis of epidemiological studies. Diabetes Care 35, 11711180.
Pan, A, Lucas, M, Sun, Q, van Dam, RM, Franco, OH, Manson, JE, Willett, WC, Ascherio, A, Hu, FB (2010). Bidirectional association between depression and type 2 diabetes mellitus in women. Archives of Internal Medicine 170, 18841891.
Parker, AM, Sricharoenchai, T, Raparla, S, Schneck, KW, Bienvenu, OJ, Needham, DM (2015). Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Critical Care Medicine 43, 11211129.
Passos, IC, Vasconcelos-Moreno, MP, Costa, LG, Kunz, M, Brietzke, E, Quevedo, J, Salum, G, Magalhaes, PV, Kapczinski, F, Kauer-Sant'Anna, M (2015). Inflammatory markers in post-traumatic stress disorder: a systematic review, meta-analysis, and meta-regression. Lancet Psychiatry 2, 10021012.
Perkonigg, A, Owashi, T, Stein, MB, Kirschbaum, C, Wittchen, HU (2009). Posttraumatic stress disorder and obesity: evidence for a risk association. American Journal of Preventive Medicine 36, 18.
Pitman, RK, Rasmusson, AM, Koenen, KC, Shin, LM, Orr, SP, Gilbertson, MW, Milad, MR, Liberzon, I (2012). Biological studies of post-traumatic stress disorder. Nature Reviews Neuroscience 13, 769787.
Plantinga, L, Bremner, JD, Miller, AH, Jones, DP, Veledar, E, Goldberg, J, Vaccarino, V (2013). Association between posttraumatic stress disorder and inflammation: a twin study. Brain, Behavior, and Immunity 30, 125132.
Pole, N, Neylan, TC, Otte, C, Henn-Hasse, C, Metzler, TJ, Marmar, CR (2009). Prospective prediction of posttraumatic stress disorder symptoms using fear potentiated auditory startle responses. Biological Psychiatry 65, 235240.
Prins, BP, Abbasi, A, Wong, A, Vaez, A, Nolte, I, Franceschini, N, Stuart, PE, Guterriez Achury, J, Mistry, V, Bradfield, JP, Valdes, AM, Bras, J, Shatunov, A, Lu, C, Han, B, Raychaudhuri, S, Bevan, S, Mayes, MD, Tsoi, LC, Evangelou, E, Nair, RP, Grant, SF, Polychronakos, C, Radstake, TR, van Heel, DA, Dunstan, ML, Wood, NW, Al-Chalabi, A, Dehghan, A, Hakonarson, H, Markus, HS, Elder, JT, Knight, J, Arking, DE, Spector, TD, Koeleman, BP, van Duijn, CM, Martin, J, Morris, AP, Weersma, RK, Wijmenga, C, Munroe, PB, Perry, JR, Pouget, JG, Jamshidi, Y, Snieder, H, Alizadeh, BZ (2016). Investigating the causal relationship of C-reactive protein with 32 complex somatic and psychiatric outcomes: a large-scale cross-consortium Mendelian randomization study. PLoS Medicine 13, e1001976.
Roberts, AL, Agnew-Blais, JC, Spiegelman, D, Kubzansky, LD, Mason, SM, Galea, S, Hu, FB, Rich-Edwards, JW, Koenen, KC (2015). Posttraumatic stress disorder and incidence of type 2 diabetes mellitus in a sample of women: a 22-year longitudinal study. JAMA Psychiatry 72, 203210.
Robins, JM, Hernán, MA, Brumback, B (2000). Marginal structural models and causal inference in epidemiology. Epidemiology 11, 550560.
Roy, SS, Foraker, RE, Girton, RA, Mansfield, AJ (2015). Posttraumatic stress disorder and incident heart failure among a community-based sample of US veterans. American Journal of Public Health 105, 757763.
Rusiecki, JA, Chen, L, Srikantan, V, Zhang, L, Yan, L, Polin, ML, Baccarelli, A (2012). DNA methylation in repetitive elements and post-traumatic stress disorder: a case–control study of US military service members. Epigenomics 4, 2940.
Sadeh, N, Miller, MW, Wolf, EJ, Harknes, KL (2015). Negative emotionality and disconstraint influence PTSD symptom course via exposure to new major adverse life events. Journal of Anxiety Disorders 31, 2027.
Santiago, PN, Ursano, RJ, Gray, CL, Pynoos, RS, Spiegel, D, Lewis-Fernandez, R, Friedman, MJ, Fullerton, CS (2013). A systematic review of PTSD prevalence and trajectories in DSM-5 defined trauma exposed populations: intentional and non-intentional traumatic events. PLOS ONE 8, e59236.
Schaefer, JD, Caspi, A, Belsky, DW, Harrington, H, Houts, R, Israel, S, Levine, ME, Sugden, K, Williams, B, Poulton, R, Moffit, TE (2015). Early-life intelligence predicts midlife biological age. Journals of Gerontology Series B: Psychological Sciences and Social Sciences. Published online 26 May 2015. doi: 10.1093/geronb/gbv035.
Scherrer, JF, Chrusciel, T, Zeringue, A, Garfield, LD, Hauptman, PJ, Lustman, PJ, Freedland, KE, Carney, RM, Bucholz, KK, Owen, R (2010). Anxiety disorders increase risk for incident myocardial infarction in depressed and nondepressed Veterans Administration patients. American Heart Journal 159, 772779.
Schnurr, PP, Spiro, AI (1999). Combat disorder, posttraumatic stress disorder symptoms, and health behaviors as predictors of self-reported physical health in older veterans. Journal of Nervous and Mental Disease 187, 353359.
Schnurr, PP, Spiro, AI, Vielhauer, MJ, Findler, MN, Hamblen, JL (2002). Trauma in the lives of older men: findings from the Normative Aging Study. Journal of Clinical Geropsychology 8, 175187.
Scott, KM, McGee, MA, Wells, JE, Oakley Browne, MA (2008). Obesity and mental disorders in the adult general population. Journal of Psychosomatic Research 64, 97105.
Seckl, JR (2007). Glucocorticoids, developmental ‘programming’ and the risk of affective dysfunction. Progress in Brain Research 167, 1734.
Seckl, JR, Meaney, MJ (2006). Glucocorticoid “programming” and PTSD risk. Annals of New York Academy of Science 1071, 351378.
Shah, AJ, Lampert, R, Goldberg, J, Veledar, E, Bremner, JD, Vaccarino, V (2013). Posttraumatic stress disorder and impaired autonomic modulation in male twins. Biological Psychiatry 73, 11031110.
Sledjeski, EM, Speisman, B, Dierker, LC (2008). Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R). Journal of Behavioral Medicine 31, 341349.
Smith, AK, Conneely, KN, Kilaru, V, Mercer, KB, Weiss, TE, Bradley, B, Tang, Y, Gillespie, CF, Cubells, JF, Ressler, KJ (2011). Differential immune system DNA methylation and cytokine regulation in post-traumatic stress disorder. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics 156B, 700708.
Smith, GD, Ebrahim, S (2003). ‘Mendelian randomization’: can genetic epidemiology contribute to understanding environmental determinants of disease? International Journal of Epidemiology 32, 122.
Spitzer, C, Barnow, S, Völzke, H, Wallaschofski, H, John, U, Freyberger, HJ, Löwe, B, Grabe, HJ (2010). Association of posttraumatic stress disorder with low-grade elevation of C-reactive protein: evidence from the general population. Journal of Psychiatric Research 44, 1521.
Su, S, Jimenez, MP, Roberts, CT, Loucks, EB (2015). The role of adverse childhood experiences in cardiovascular disease risk: a review with emphasis on plausible mechanisms. Current Cardiology Reports 17, 88.
Suglia, SF, Clark, CJ, Boynton-Jarrett, R, Kressin, NR, Koenen, KC (2014). Child maltreatment and hypertension in young adulthood. BMC Public Health 14, 1149.
Sumner, JA, Kubzansky, LD, Elkind, MS, Roberts, AL, Agnew-Blais, J, Chen, Q, Cerdá, M, Rexrode, KM, Rich-Edwards, JW, Spiegelman, D (2015). Trauma exposure and posttraumatic stress disorder symptoms predict onset of cardiovascular events in women. Circulation 132, 251259.
Tchetgen Tchetgen, EJ (2014). Identification and estimation of survivor average causal effects. Statistics in Medicine 33, 36013628.
Tchetgen Tchetgen, EJ, Glymour, MM, Shpitser, I, Weuve, J (2012). Rejoinder: to weight or not to weight?: On the relation between inverse-probability weighting and principal stratification for truncation by death. Epidemiology 23, 132137.
Thayer, JF, Brosschot, JF (2005). Psychosomatics and psychopathology: looking up and down from the brain. Psychoneuroendocrinology 30, 10501058.
Tsigos, C, Chrousos, GP (2002). Hypothalamic–pituitary–adrenal axis, neuroendocrine factors and stress. Journal of Psychosomatic Research 53, 865871.
Vaccarino, V, Goldberg, J, Magruder, KM, Forsberg, CW, Friedman, MJ, Litz, BT, Heagerty, PJ, Huang, GD, Gleason, TC, Smith, NL (2014). Posttraumatic stress disorder and incidence of type-2 diabetes: a prospective twin study. Journal of Psychiatric Research 56, 158164.
Vaccarino, V, Goldberg, J, Rooks, C, Shah, AJ, Veledar, E, Faber, TL, Votaw, JR, Forsberg, CW, Bremner, JD (2013). Post-traumatic stress disorder and incidence of coronary heart disease: a twin study. Journal of the American College of Cardiology 62, 970978.
van der Velden, PG, Kleber, RJ, Koenen, KC (2008). Smoking predicts posttraumatic stress symptoms among rescue workers: a prospective study of ambulance personnel involved in the Enschede Fireworks Disaster. Drug and Alcohol Dependence 94, 267271.
van Zuiden, M, Geuze, E, Willemen, HL, Vermetten, E, Maas, M, Amarouchi, K, Kavelaars, A, Heijnen, CJ (2012). Glucocorticoid receptor pathway components predict posttraumatic stress disorder symptom development: a prospective study. Biological Psychiatry 71, 309316.
van Zuiden, M, Geuze, E, Willemen, HL, Vermetten, E, Maas, M, Heijnen, CJ, Kavelaars, A (2011). Pre-existing high glucocorticoid receptor number predicting development of posttraumatic stress symptoms after military deployment. American Journal of Psychiatry 168, 8996.
Vandenbroucke, JP, Broadbent, A, Pearce, N (2016). Causality and causal inference in epidemiology: the need for a pluralistic approach. International Journal of Epidemiology. Published online 22 January 2016. doi: 10.1093/ije/dyv341.
Vin-Raviv, N, Hillyer, GC, Hershman, DL, Galea, S, Leoce, N, Bovbjerg, DH, Kushi, LH, Kroenke, C, Lamerato, L, Ambrosone, CB, Valdimorsdottir, H, Jandorf, L, Mandelblat, JS, Tsai, WY, Neugut, AI (2013). Racial disparities in posttraumatic stress after diagnosis of localized breast cancer: the BQUAL study. Journal of the National Cancer Institute 105, 563572.
von Känel, R, Abbas, CC, Schmid, J-P, Saner, H, Haeberli, A, Stutz, M, Begré, S (2010). Momentary stress moderates procoagulant reactivity to a trauma-specific interview in patients with posttraumatic stress disorder caused by myocardial infarction. Journal of Psychiatric Research 44, 956963.
Von Känel, R, Hepp, U, Buddeberg, C, Keel, M, Mica, L, Aschbacher, K, Schnyder, U (2006). Altered blood coagulation in patients with posttraumatic stress disorder. Psychosomatic Medicine 68, 598604.
von Känel, R, Hepp, U, Traber, R, Kraemer, B, Mica, L, Keel, M, Mausbach, BT, Schnyder, U (2008). Measures of endothelial dysfunction in plasma of patients with posttraumatic stress disorder. Psychiatry Research 158, 363373.
Weathers, F, Blake, D, Schnurr, P, Kaloupek, D, Marx, B, Keane, T (2013). The Life Events Checklist for DSM-5 (LEC-5). National Center for PTSD: Washington, DC (
Weisskopf, MG, Kioumourtzoglou, MA, Roberts, AL (2015). Air pollution and autism spectrum disorders: causal or confounded? Current Environmental Health Reports 2, 430439.
Wentworth, BA, Stein, MB, Redwine, LS, Xue, Y, Taub, PR, Clopton, P, Nayak, KR, Maisel, AS (2013). Post-traumatic stress disorder: a fast track to premature cardiovascular disease? Cardiology in Review 21, 1622.
Winning, A, Glymour, MM, McCormick, MC, Gilsanz, P, Kubzansky, LD (2015). Psychological distress across the life course and cardiometabolic risk: findings from the 1958 British Birth Cohort Study. Journal of the American College of Cardiology 66, 15771586.
Wolf, EJ, Bovin, MJ, Green, JD, Mitchell, KS, Stoop, TB, Barretto, KM, Jackson, CE, Lee, LO, Fang, SC, Trachtenberg, F, Rosen, RC, Keane, TM, Marx, BP (2016). Longitudinal associations between post-traumatic stress disorder and metabolic syndrome severity. Psychological Medicine 46, 22152226.
Yehuda, R (2006). Advances in understanding neuroendocrine alterations in PTSD and their therapeutic implications. Annals of the New York Academy of Science 1071, 137166.
Yehuda, R, Flory, J, Pratchett, L, Buxbaum, J, Ising, M, Holsboer, F (2010). Putative biological mechanisms for the association between early life adversity and the subsequent development of PTSD. Psychopharmacology 212, 405417.
Zoellner, LA, Pruitt, LD, Farach, FJ, Jun, JJ (2014). Understanding heterogeneity in PTSD: fear, dysphoria, and distress. Depression and Anxiety 31, 97106.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed