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The findings of new research suggest that post-traumatic stress disorder (PTSD) may be a risk factor for the formation of colonic polyps, which can lead to colorectal cancer. The research found a link between PTSD and increased incidence of gastrointestinal investigations, including colonoscopy and polypectomy – the surgical removal of colonic polyps – in Australian veterans.

Undertaken by Gallipoli Medical Research Foundation (GMRF), the study analysed more than 138,000 case records of male veterans over the age of 50 who accessed health services funded by the Department of Veterans’ Affairs. The analysis showed that veterans with PTSD were approximately 76%-81% more likely to undergo colonoscopy than veterans without PTSD, with similar percentages for polypectomies.

“The relationship between PTSD and polypectomy is intriguing and clearly requires more work to properly determine the exact nature of the relationship between PTSD, polyp formation and colorectal cancer,” said Professor Darrell Crawford, Director of Research at GMRF.

Raising awareness of the connection between PTSD and gastrointestinal symptoms

This research raises the awareness of the association between PTSD and gastrointestinal symptoms for clinicians and patients. A recommendation of the study is more physician and patient-centered education about the physical symptoms of PTSD, and adherence to evidence-based clinical guidelines for gastrointestinal screening, such as those developed by Cancer Council Australia.

This is likely to improve both clinician and patient confidence in when colonoscopy should be performed, and reduce unnecessary procedures for patients with PTSD, as well as for the broader community.

“This study draws attention to the relationship between PTSD and gut symptoms and the need for clinicians to appreciate this connection. It does suggest that more clinician education is needed in relation to the management of the physical comorbidities of PTSD – particularly as it applies to the gut, but probably to other body systems as well,” said Professor Crawford.

Future research needed

Further research is planned to investigate similar patterns in contemporary Australian Defence Force (ADF) personnel, including younger age categories and female ADF personnel, with more comprehensive data to be collected.

“Further work in other cohorts both within and external to Defence is important to see if our observations can be replicated in these populations,” said Professor Crawford.

Collaboration with key organisations to conduct research

This study was carried out by Professor Crawford and Dr Rebecca Mellor of GMRF, in collaboration with Professor Luke Connelly and Patrick Duenow of the University of Queensland Centre for the Business and Economics of Health.

“Studies of this magnitude require cooperation across many different organisations, and I am truly grateful for the assistance of the Department of Veterans Affairs in the conduct of this study and for the support of RSL Queensland in helping us to gain further insights into the complexities of PTSD,” said Professor Crawford.

The article ‘Post-traumatic stress disorder is associated with a higher rate of polypectomy independent of an increased frequency of colonoscopy in Australian veterans: a retrospective review’ was published in the Internal Medicine Journal, on 12 June 2022.

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