ONLINE RESOURCE MATERIAL
MANUSCRIPT INFORMATION
Title: The Association of PTSD with Physical and Mental Health Functioning and Disability (VA Cooperative Study #569:
The Course and Consequences of Posttraumatic Stress Disorder in Vietnam-era Veteran Twins)
Journal: Quality of Life Research
Authors: Jack Goldberg, PhD; Kathryn M. Magruder, PhD; Christopher W. Forsberg, MS; Lewis E. Kazis, ScD; T.
Bedirhan Üstün, MD; Matthew J. Friedman, MD, PhD; Brett T. Litz, PhD; Viola Vaccarino, MD, PhD; Patrick J. Heagerty,
PhD; Theresa C. Gleason, PhD; Grant D. Huang, MPH, PhD; Nicholas L. Smith, PhD
Departmental and Institutional Affiliations: Seattle Epidemiologic Research and Information Center, VA Puget Sound
Health Care System, Seattle, WA (Drs Goldberg and Smith, Mr Forsberg); Department of Epidemiology, University of
Washington, Seattle, WA (Drs Goldberg and Smith); Mental Health Service, Ralph H. Johnson VA Medical Center,
Charleston, SC; and Department of Psychiatry, Medical University of South Carolina (Dr Magruder); Center for Health
Quality, Outcomes and Economic Research (CHQOER), Bedford VAMC, Bedford, MA; and Department of Health Policy
and Management, Boston University School of Public Health, Boston, MA (Dr Kazis); Coordinator, Classifications and
Terminology Team, World Health Organization, Geneva, Switzerland (Dr Üstün); National Center for Posttraumatic Stress
Disorder, Department of Veterans Affairs, White River Junction, VT; and Departments of Psychiatry and Pharmacology &
Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH (Dr Friedman); Massachusetts Epidemiology Research
and Information Center, VA Boston Healthcare System, Boston, MA; and Boston University School of Medicine, Boston,
MA (Dr Litz); Departments of Epidemiology, Emory University, Atlanta, GA (Dr Vaccarino); Department of Biostatistics,
University of Washington, Seattle, WA (Dr Heagerty); Cooperative Studies Program, VA Office of Research and
Development, Washington, DC (Drs Gleason and Huang)
Address for Correspondence: Jack Goldberg, PhD, Seattle Epidemiologic Research and Information Center (S-152-E),
VA Puget Sound Health Care System, 1600 South Columbian Way, Seattle, WA 98108; telephone: 206-277-1984; fax:
206-764-2563; email: jack.goldberg@va.gov
ONLINE RESOURCE EXPLANATORY NOTES
Non-response and population weighting
We used a two-stage weighting process that adjusted for both non-response and the current population characteristics of
the living Vietnam-era Veteran population. Our non-response weights were based on factors available from the military
records for VET Registry members who were eligible for this study. The non-response weights were generated based on:
race, current age, branch of service, marital status at enlistment, education at enlistment, rank at enlistment, enlistment
year, and the enlistment Armed Forces Qualify Test score. After weighting for non-response we then developed second
stage weights using the 2010 living Vietnam-era Veteran population as estimated by the National Survey of Veterans
(NSV). We restricted the NSV sample so that it mirrored the construction criteria used to build the VET Registry cohort:
males who served during the Vietnam era (1964-1975), born from 1939 through1957, enlisted in 1965 through 1975, and
discharged prior to 1986. We developed these second stage population weights using age, branch of service, discharge
year, enlistment year, current marital status, education, and total family income.
We used a model-based approach to perform a direct adjustment for both our non-response and population
weights. Briefly, this method fits a multivariable logistic regression model where the dependent variable (yi) is defined as a
binary outcome for responder and the reference population (1 if in sample of interest, 0 if reference population) and the
socio-demographic and military service variables are the independent variables (xi). Results from the fitted model are then
used to generate inverse probabilities weights. The non-response and current population weights are multiplied together
to generate the final weights used in all analyses.
Online Resource Table S1. The Association of Current PTSD with Health Functioning Measured by the VR-36 and Disability
Measured by the WHODAS 2.0 Subscales
Served in the Vietnam Theater
PTSD Diagnosis
No
PTSD
VR-36 and WHODAS 2.0
Subscales
VR-36
Subthreshold
PTSDa
Did not Serve in the Vietnam Theater
PTSD Diagnosis
Full PTSDa
No
PTSD
Subthreshold
PTSDa
mean
Effect
Size
mean
mean
Effect
Size
Physical Functioning
75.4
60.3b
0.58
57.7b
0.68
78.9
64.5b
0.58
48.4bc
1.23
Role Physical
76.1
60.9b
0.52
47.0bc
1.00
79.7
63.9b
0.56
41.1bc
1.36
Bodily Pain
64.7
51.4b
0.53
44.0b
0.84
68.4
51.5b
0.68
40.9bc
1.11
General Health
64.9
50.7b
0.59
44.3b
0.86
68.6
50.1b
0.78
38.0bc
1.29
Vitality
60.1
44.0b
0.69
37.7b
0.95
62.7
46.9b
0.69
33.3bc
1.28
Social Functioning
81.5
60.9b
0.74
45.4bc
1.30
84.4
58.4b
1.00
44.9bc
1.52
85.8
69.7b
0.62
51.1bc
1.34
88.8
71.2b
0.76
52.9bc
1.55
78.0
63.7b
0.69
47.4bc
1.48
79.8
64.5b
0.80
52.3bc
1.45
Cognition
11.4
23.5b
0.65
36.4bc
1.34
9.0
21.7b
0.79
33. 7bc
1.52
Mobility
16.1
30.4b
0.61
39.7b
1.00
13.0
28.0b
0.68
43.2bc
1.37
Self-Care
5.0
10.4b
0.39
20.0bc
1.08
4.0
13.6b
0.74
20.8b
1.29
Getting Along
16.5
26.2b
0.42
46.2bc
1.29
13.0
30.3b
0.87
41.3bc
1.43
Life Activities
17.2
30.8b
0.55
47.9bc
1.23
14.0
31.8b
0.77
43.0bc
1.25
Work Activities
9.9
22.3b
0.65
49.4bc
2.09
9.3
19.2b
0.57
32.4bc
1.35
Participation
15.0
30.4b
0.73
44.5bc
1.40
13.3
31.8b
0.94
45.8bc
1.65
Role Emotional
Mental Health
mean
Effect Size
mean
mean
Effect
Size
Full PTSDa
WHODAS 2.0
a
Full and subthreshold PTSD diagnoses are explained in the footnotes to Table 1.
Indicates the functional scale means are significantly different at p < .05 compared to No PTSD; all tests account for clustering by
twin pairs. Weighted for non-response and to the characteristics of the living male US population of Vietnam-era Veterans.
c
Full PTSD are significantly different at p < .05 compared with subthreshold PTSD; all tests account for clustering by twin pairs.
b
Online Resource Figure S1: The Effect Size of the Change in Functioning as Measured by VR-36 Physical Component
Score (PCS), Mental Component Score (MCS), and WHODAS 2.0 Summary Disability Score for PTSDa and Subthreshold
PTSDa Compare with No PTSD by Combat Exposure in Theater Veterans
1.6
No
Subthreshold
PTSD
1.4
1.4
1.3
1.2
1.3
1.2
1.2
1.1
1.0
Effect Size b, c
1.0
0.9
0.9
0.8
0.8
0.7
0.6
0.6
0.6
0.4 0.4
0.4
0.5
0.5
0.4
0.3
0.7
0.4
0.3
0.3
0.2
0.0
a
0.0
No
Low Medium High
Combat Combat Combat Combat
No
Low Medium High
Combat Combat Combat Combat
No
Low Medium High
Combat Combat Combat Combat
PCS
MCS
WHO-DAS
Full and subthreshold PTSD diagnoses are explained in the footnotes to Table 1.
b
c
Adjustment for demographic, military service, lifestyle, clinical, and psychiatric factors is explained in the footnotes to Figure 1.
Weighted for non-response and to the characteristics of the living male US population of Vietnam-era Veterans.