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

Cogn Behav Ther. 2019 May;48(3):184-199. doi: 10.1080/16506073.2018.1498119. Epub 2018 Aug 7.


Poor health outcomes associated with posttraumatic stress disorder (PTSD) may reflect engagement in unhealthy behaviors that increase morbidity risk and disengagement in healthy behaviors that decrease morbidity risk. Although research supports this pattern, findings are not definitive, particularly for healthy behaviors. Many studies have not controlled for effects of concurrent generalized anxiety and depression, which might explain conflicting findings. To address this limitation, we used an online cross-sectional research design and multivariate multilevel modelling to evaluate associations between a multitude of health behaviors (i.e. sedentary behavior, sleep quality, physical activity, eating habits, alcohol use and substance use) and PTSD, while adjusting for comorbid generalized anxiety and depression, in a sample of trauma-exposed individuals (N = 246). Our results indicate that PTSD and comorbid generalized anxiety and depression symptoms were differentially associated with specific health constructs. Specifically, sedentary behavior and poor sleep quality were associated with PTSD, whereas low physical activity, poor sleep quality, and unhealthy eating habits were associated with depression. Both increased alcohol and substance use were associated with generalized anxiety. Results from our study highlight the need to conceptualize associations between health behaviors and specific psychological symptoms in a comprehensive manner as part of clinical presentations of PTSD.

Keywords: Posttraumatic stress disorder; depression; generalized anxiety; healthy behaviors; unhealthy behaviors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anxiety / epidemiology*
  • Canada / epidemiology
  • Comorbidity
  • Cross-Sectional Studies
  • Depression / epidemiology*
  • Depressive Disorder / epidemiology
  • Female
  • Health Behavior*
  • Humans
  • Male
  • Middle Aged
  • Stress Disorders, Post-Traumatic / epidemiology*
  • Stress Disorders, Post-Traumatic / psychology*
  • Substance-Related Disorders / epidemiology*
  • Young Adult