Cancer is a broad group of diseases involving abnormal cell growth such that cells divide and grow forming malignant tumours. These may spread through the lymphatic system or blood stream. Not all tumours are malignant – some remain benign and do not invade other organs. Lifestyle, genetic factors and environmental pollutants increase a persons’ risk of developing cancer. Cancer can affect people of all ages. The most common cancers include lung cancer (22% of all cancers), bowel cancer (12%), breast cancer (8-23%) and prostate cancer (7%). Cancer may be measured by incidence or mortality rates. Incidence is the number of new cases in a specific population. Mortality refers to the rate of deaths due to cancer in a specific population.

What is the evidence for PTSD in cancer patients?

Moderate to high quality evidence finds more severe PTSD symptoms in cancer patients were associated with more depression, anxiety, distress, and post-traumatic growth. They were also associated with less social support and quality of life. There were no significant associations with age, gender, or time since cancer diagnosis.

August 2021

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Chronic fatigue syndrome is a widely accepted medical condition characterised by extreme fatigue. The fatigue lasts for at least six months, worsens with physical or mental activity, and does not improve with rest. The fatigue cannot be explained by an underlying medical condition. The causes of chronic fatigue syndrome are still being investigated, but may include viral infection and/or exposure to psychological stress.

What is the evidence for chronic fatigue syndrome in people with PTSD?

Moderate to low quality evidence finds a medium-sized effect of increased rates of chronic fatigue syndrome in people with previous exposure to trauma.

August 2021

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Pain is common in trauma patients, with greater frequency and severity of pain found when compared to people without PTSD. Fibromyalgia is also commonly reported, which is a centralised pain syndrome characterised by the presence of chronic widespread pain in association with fatigue, sleep disturbances, and cognitive dysfunction.

What is the evidence for chronic pain in people with PTSD?

Moderate to high quality evidence finds a small association between increased PTSD symptoms and increased chronic widespread pain. Lower quality evidence found a bidirectional associations between pain and PTSD symptoms within six months post-trauma. There were unidirectional patterns found after six months, either from pain to PTSD symptoms or from PTSD symptoms to pain. Moderate to low quality evidence finds medium-sized increases in fibromyalgia and chronic widespread pain in people previously exposed to any trauma, regardless of a PTSD diagnosis.

August 2021

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Dementia is characterised by significant cognitive impairment. Symptoms include memory, executive functioning, language, and movement impairments, and an inability to identify objects, people, sound or smell. Other symptoms may include behavioural disturbances, anxiety, apathy, delirium, and mood and sleep disturbances. Mental disorders are associated with a high prevalence of psychiatric comorbidities, and aging may increase the risk of developing comorbidities such as dementia.

What is the evidence for dementia?

Moderate to low quality evidence finds a small increased risk of dementia in older veterans with PTSD compared to older veterans without the disorder.

August 2021

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Diabetes is a state of impaired insulin function, either as a result of reduced insulin production (type 1 diabetes) or reduced insulin responsiveness (type 2 diabetes). Insulin regulates blood glucose levels, and reduced insulin function effectively increases blood glucose levels (hyperglycaemia). This is a dangerous state in the long term, and can ultimately damage the retina, kidneys, nerves, and blood vessels. It is also an established risk factor for cardiovascular diseases including coronary heart disease, major stroke subtypes, and deaths attributable to other vascular causes. Therefore, diabetes is an important comorbidity in people with mental health problems and its prevention and treatment require attention in these populations.

What is the evidence for diabetes in people with PTSD?

Moderate quality evidence finds around 10% of people with PTSD have type 2 diabetes, which represents a small increased risk when compared to people without PTSD. People with PTSD most at risk were older people, war veterans, and non-Hispanic white people.

No reviews were identified that assessed type 1 diabetes in people with PTSD.

August 2021

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People with mental disorders often show increased rates of co-occurring physical conditions such as heart disease. An increased risk of heart disease in people with PTSD may be a consequence of the disorder itself, as it is associated with dysfunction of the immunological system and excess inflammation. This in turn is associated with significant cardiovascular health problems. Unhealthy lifestyle factors such as smoking and poor diet may also contribute to any increased risk of heart disease.

What is the evidence for heart disease?

High quality evidence finds a small increased risk of coronary heart disease in people with PTSD than in people without the disorder.

Moderate quality evidence finds large effects of lower high-frequency and RMSSD (root mean square of the successive differences) heart rate variability in people with PTSD. These effects were largest in clinical populations. There was also a small increased risk of lower resting respiratory sinus arrhythmia. There was no change in low-frequency heart rate variability. The results remained regardless of medication status, year of publication, study quality score, study methodology, or participant age or sex.

Moderate to high quality evidence finds a small association between increased PTSD symptoms and increased cardio-respiratory symptoms in general.

August 2021

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Irritable bowel syndrome is a common gastrointestinal disorder. It is characterised by chronic abdominal pain and a change in the frequency or form of stool. Its pathophysiology remains poorly understood but is thought to involve dysregulation of the hypothalamic–pituitary–adrenal axis, neuroendocrine alterations, and emotional hypersensitivity. Mechanisms that might underlie any association between post-traumatic stress syndrome and irritable bowel syndrome include hyperarousal, an exaggerated response to stress, and hypervigilance to bodily sensations.

What is the evidence for irritable bowel syndrome?

Moderate quality evidence finds a medium-sized effect of increased rates of irritable bowel syndrome in people with PTSD. There were also increased rates of irritable bowel syndrome in people exposed to trauma who do not have the disorder compared to people who were not exposed to trauma.

August 2021

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People with mental disorders often have increased rates of physical disorders, including metabolic syndrome. This syndrome is a risk factor for diabetes and cardiovascular diseases and is defined as a clustering of at least three abnormalities. These include obesity, high blood pressure, high blood triglycerides, low levels of high-density lipoprotein (HDL) cholesterol, and insulin resistance. Any increased risk of metabolic syndrome may be the result of unhealthy lifestyle factors, genetics, and factors associated with medications.

What is the evidence for metabolic syndrome?

High quality evidence finds a small to medium-sized increased risk of metabolic syndrome and its components in people with PTSD compared to general population rates. This effect was found regardless of age, gender, geographic region, setting or population (war veterans or other).

August 2021

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People with mental disorders often have increased rates of physical disorders, including obesity. This may be due to genetic factors, lifestyle choices, and metabolic effects of psychotropic medications. Obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. A crude population measure of obesity is the body mass index (BMI), which is a person’s weight divided by the square of his or her height. A person with a BMI of 30 or more is generally considered obese. Being obese is a major risk factor for diabetes, cardiovascular diseases, and cancer.

What is the evidence for obesity in people with PTSD?

Moderate to low quality evidence found around half of middle-aged people with PTSD are obese. Higher quality evidence finds this represents a medium-sized increase in risk of obesity when compared to people without PTSD. Moderate to high quality evidence also found large effects of increased rates of obesity in people with PTSD aged between 20 and 30 years and aged over 60 years when compared to age-matched controls.

August 2021

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People with mental disorders may show increased rates of co-occurring conditions such as sleep apnea. The most common form of sleep apnea is obstructive sleep apnea (OSA). OSA is seen in around 5-10% of the general population and occurs when the muscles of the upper airway relax in such a way that they block the airway during sleep. As a result, OSA is associated with daytime sleepiness, cognitive dysfunction, and the development of hypertension, cardiovascular disease, and abnormalities in glucose metabolism. OSA also has adverse effects on quality of life and can lead to anxiety and depression symptoms.

What is the evidence for sleep apnea?

Moderate quality evidence finds around half of people with PTSD have obstructive sleep apnea. Rates are highest in veterans, in older people, and in people diagnosed using the apnea-hypopnea index with a cut-off of five rather than ten events per hour of sleep.

A common treatment for obstructive sleep apnea is continuous positive airway pressure. Moderate quality evidence found large improvements in PTSD symptoms and reduced nightmares after treatment.

August 2021

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