BACKGROUND: Female veterans are at risk for stress-related physical disorders given unique environmental stress factors, high rates of trauma exposure and a heightened physiologic stress response. There is a need to identify modifiable risk factors which may help minimize the emergence and impact of veteran illness. RESEARCH QUESTION: The present study investigated the contributions of posttraumatic stress symptoms, maladaptive repetitive thought (MRT), depression, childhood trauma and health behaviors (sleep, alcohol use and smoking) to physical disease as operationalized by immune-mediated inflammatory disease occurrence and related functional disability. METHOD: Female Reserve or National Guard veterans (N = 643) enrolled in a parent study conducted through the Iowa City Veteran's Affairs Hospital completed a one-time computer-assisted telephone interview. The current study examined self-report measures of posttraumatic stress symptoms, MRT, depression, childhood trauma, smoking, alcohol use, sleep, inflammatory disease incidence and physical functioning. RESULTS: Proposed models of primary hypotheses were tested using structural equation modeling. Results indicated that both physical disease and functional decline were greater in veterans reporting a history of trauma. Physical disease was associated with greater depression and childhood trauma but lower levels of alcohol use after accounting for covariates. Unexpectedly, greater MRT was associated with less physical disease, although it was only related to disease when depression was included as a covariate. Reduced sleep was linked with greater disease but only when depression was not included in the model, and depression was found to fully mediate the relationship between sleep and physical disease. Smoking and the interaction between posttraumatic stress symptoms and MRT were generally unrelated to physical disease in this sample. CONCLUSIONS: Results of this study are consistent with the hypothesis that physical disorders and related functional decline are greater in trauma-exposed individuals and that depression, childhood trauma, repetitive thought and alcohol use have independent associations with physical disease. This study offers support for further research and interventions which address these relationships to protect female veteran health.

There is evidence of a prospective association between wellbeing and health outcomes including disease risk and longevity. The aim of this thesis was firstly to further explore whether wellbeing is a risk factor for specific chronic physical diseases, and secondly, to identify potential mediators and moderators of the association between wellbeing and disease risk or longevity. Chapter 1 provides an overview of research into associations between wellbeing and physical health. In addition, we outline theoretical models of how the experience of high wellbeing might impact physical health. In chapters 2 and 3, we build on research into wellbeing and chronic physical disease risk. In these chapters, we tested whether the association between wellbeing and disease risk was similar across different types of disease, and, whether different theoretical domains of wellbeing varied in their association with disease risk. We found particularly strong associations - that were not explained by demographic or health behaviour differences - between higher wellbeing and lower risk of arthritis, diabetes or chronic lung disease. In chapter 4, we further explore the association between wellbeing and arthritis risk using mediation analysis. Specifically, we tested whether this association was mediated by inflammatory biomarkers. We found that the biomarker C-reactive protein accounted for a small proportion of the association between wellbeing and a reduced risk of arthritis. The focus of the next two chapters was on potential moderators of the association between wellbeing and mortality risk. In chapter 5, we examined whether the association between higher wellbeing and lower mortality risk varied across individualist and collectivist cultures. We found a significant interaction between individualism and wellbeing such that the association between wellbeing and risk of mortality from cardiovascular disease was stronger in more individualistic countries. In chapter 6, we examined how positive affect (a subdomain of wellbeing), interacted with another psychosocial factor, namely subjective stress. Here, we tested Pressman and Cohen's (2005) stress buffering hypothesis that positive affect may be most strongly related with health under stressful conditions. In support of this hypothesis, we found that the association between positive affect and all-cause mortality risk was stronger in people reporting higher stress. In the final chapter, we summarise our findings, discuss the limitations of our approach and make recommendations for future research.