Relationships between health behaviours, posttraumatic stress disorder, and comorbid general anxiety and depression

Researchers consistently find a relationship between posttraumatic stress disorder (PTSD) and physical health problems, including (but not limited to) chronic pain, obesity, diabetes, and heart attacks. One possible explanation for this relationship is that people with PTSD take part in more unhealthy behaviours (e.g., illicit drug use, excessive drinking) and less healthy behaviours (e.g., regular physical activity, healthy eating) as ways of coping with their PTSD symptoms, which in turn predisposes them to physical health problems. For instance, people with PTSD might use alcohol to dampen heightened emotions or delay going to bed at night because they dread the possibility of nightmares. Although research generally supports the idea that people with PTSD engage in more unhealthy behaviours and less healthy behaviours, these findings are not always consistent. For instance, some studies have found that people with PTSD symptoms have unhealthy eating habits and are less likely to engage in regular physical activity than those without, but other studies have found no relationship between PTSD symptoms and these health behaviours. One explanation for these mixed associations is that they may, in part, be related to other co-occurring mental health symptoms such as those related to generalized anxiety and depression.

To explore this possibility, we invited 256 individuals who had experienced a traumatic event to complete an online survey asking about their health behaviour patterns such as the amount of time they spent sitting, the amount of weekly physical activity they participated in, what their sleep and eating habits were like, and whether they used alcohol, substances, or smoked cigarettes. This survey also asked questions about their experience with symptoms of PTSD, depression, and generalized anxiety. We then used a statistical approach called multilevel modelling that allowed us to test the associations between these health behaviours and PTSD, and determine whether these associations are better explained by co-occurring symptoms of generalized anxiety or depression.

We found that symptoms of PTSD, generalized anxiety and depression symptoms were all associated with a different pattern of health behaviour participation. Specifically, sedentary behaviour and poor sleep quality were associated with symptoms of PTSD, whereas low physical activity, poor sleep quality, and unhealthy eating habits were associated with symptoms of depression. Lastly, increased alcohol and substance use were uniquely associated with symptoms of generalized anxiety. Our findings suggest that some previously reported relationships between health behaviours and PTSD symptoms may be better explained by co-occurring symptoms of generalized anxiety and depression. Given the multifaceted nature of PTSD, our findings highlight the need for researchers and clinicians alike to conceptualize the relationships between health behaviours and specific psychological symptoms in a comprehensive manner when assessing clinical presentations of PTSD and developing recommendations for intervention.

Read the full paper: Mason, J. E., LeBouthillier, D. M., & Asmundson, G. J. G. (in press). Relationships between health behaviors, posttraumatic stress disorder, and comorbid general anxiety and depressionCognitive Behaviour Therapy. doi:10.1080/16506073.2018.1498119

Julia Mason
Daniel LeBouthillier
Gordon Asmundson


Photo by: Living Fitness

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