The association of posttraumatic stress disorder, depression, and head injury with mid-life cognitive function in civilian women

May 24, 2022

Authors: Rebecca B Lawn, Shaili C Jha, Jiaxuan Liu, Laura Sampson, Audrey R Murchland, Jennifer A Sumner, Andrea L Roberts, Seth G Disner, Francine Grodstein, Jae H Kang, Laura D Kubzansky, Lori B Chibnik, Karestan C Koenen

Journal: Depression and Anxiety

DOI: 10.1002/da.23233

Year Published: 2022


Despite evidence linking posttraumatic stress disorder (PTSD), depression, and head injury, separately, with worse cognitive performance, investigations of their combined effects on cognition are limited in civilian women.


The Cogstate Brief Battery assessment was administered in 10,681 women from the Nurses’ Health Study II cohort, mean age 64.9 years (SD = 4.6). Psychological trauma, PTSD, depression, and head injury were assessed using online questionnaires. In this cross-sectional analysis, we used linear regression models to estimate mean differences in cognition by PTSD/depression status and stratified by history of head injury.


History of head injury was prevalent (36%), and significantly more prevalent among women with PTSD and depression (57% of women with PTSD and depression, 21% of women with no psychological trauma or depression). Compared to having no psychological trauma or depression, having combined PTSD and depression was associated with worse performance on psychomotor speed/attention (β = -.15, p = .001) and learning/working memory (β = -.15, p < .001). The joint association of PTSD and depression on worse cognitive function was strongest among women with past head injury, particularly among those with multiple head injuries.


Head injury, like PTSD and depression, was highly prevalent in this sample of civilian women. In combination, these factors were associated with poorer performance on cognitive tasks, a possible marker of future cognitive health. Head injury should be further explored in future studies of PTSD, depression and cognition in women.

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