Estimating the Disease Burden of Combat-Related Posttraumatic Stress Disorder in United States Veterans and Military Service Members

Abstract

Posttraumatic stress disorder (PTSD) is chronic, disabling, but treatable and potentially preventable anxiety disorder characterized by re-experiencing, avoidance, and hyperarousal symptoms following a traumatic event. The World Health Organization (WHO) characterized disease burden in the general population and listed PTSD among the top 20 most “burdensome” diseases. The WHO Global Burden of Disease study estimated a disability weights for PTSD of 0.11 (0 = perfect health; 1 = dead), but other studies have estimated weights up to 0.66, a figure closer to estimates for severe major depression. Limited research exists on the disease burden of PTSD, and to date, no literature estimated the disease burden of combat-related PTSD in the US military and Veterans Affairs (VA) healthcare systems. Extant PTSD literature is arguably sufficient in scope and content needed to calculate reasonable estimates of disease burden of PTSD in these populations. We review five key components to estimating the disease burden of PTSD in the US military and VA: disorder prevalence; course of illness; disability weights; impact on the healthcare system; and prevention and treatment efficacy. Current PTSD prevalence estimates vary, but range from 4.2 to 24.5% in servicemembers returning from Operation Iraqi and Enduring Freedom, depending on the subpopulation and assessment method. PTSD often develops months to years after traumatic exposure, and 40% of Vietnam veterans with PTSD reported symptom chronicity over 20 years. PTSD is associated with low quality of life, high rates of medical service utilization, interpersonal conflict, co-morbidity, and work impairment compared to persons without PTSD. PTSD is a chronic, disabling, but treatable and perhaps preventable condition. Disease burden estimates of PTSD could be used to better determine the need for and utility of therapeutic interventions designed to alleviate symptoms of PTSD and associated impairment.