Handbook of Disease Burdens and Quality of Life Measures pp 1527-1548 | Cite as
Estimating the Disease Burden of Combat-Related Posttraumatic Stress Disorder in United States Veterans and Military Service Members
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.
KeywordsVeteran Affair Disease Burden Health Utility Standard Gamble Preference Weight
List of Abbreviations:
disability adjusted life year
department of defense
diagnostic and statistics manual
global burden of disease
Institute of Medicine
- MOS SF
36 medical outcome survey short form-36
medical record review
National Research Council
operation enduring freedom
operation Iraqi freedom
primary care- posttraumatic stress disorder (screen)
posttraumatic stress disorder check list
post-deployment health assessment
post-deployment health re-assessment
posttraumatic stress disorder
short form-6 dimensional health state classification
substance used disorder
veterans health administration
World Health Organization
year of life with disability
years of life lost
- Adler AB, Wright KM, Bliese PD, Eckford R, Hoge CW. (2008). J Trauma. 21: 301–308.Google Scholar
- Adler AB, Castro CA, McGurk D. (2007). US Army Medical Research Unit-Europe Research Report 2007–001. USAMRU-E, Heidelberg, Germany.Google Scholar
- American Psychiatric Association. (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. American Psychiatric Association, Washington, DC.Google Scholar
- American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd ed, (text revision). American Psychiatric Association, Washington, DC.Google Scholar
- American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th ed, (text revision). American Psychiatric Association, Washington, DC.Google Scholar
- Army Medical Surveillance Activity. (2004). Defense Medical Epidemiology Database (DMED 3.7) [computer software]. Available at: http://amsa.army.mil/AMSA/amsa_home.htm.
- Bennett KJ, Torrance GW. (1996). Measuring health state preferences and utilities: rating scale, time trade-off, and standard gamble techniques. In B. Spiker (ed.), Quality of Life and Pharacoeconomics in Clinical Trials, 2nd ed. Lippincott-Raven Publishers, Philadelphia, PA.Google Scholar
- Berzon RA, Mauskoph JA, Simeon GP. (1996). Choosing a health profile (descriptive) and/or a patient-preference (utility) measure for a clinical trial. In B. Spiker (ed), Quality of Life and Pharacoeconomics in Clinical Trials, 2nd ed. Lippincott-Raven Publishers, Philadelphia, PA.Google Scholar
- Freed MC, Engel CC. (2006). Behavioral Health Track at the U.S. Army Center for Health Promotion and Preventive Medicine-hosted Force Health Protection Conference, Albuquerque, NM.Google Scholar
- Freed MC, Yeager D, Liu X, Gore KL, Engel CC, Magruder KM. (2007). Behavioral Health Track at the U.S. Army Center for Health Promotion and Preventive Medicine-hosted Force Health Protection Conference, Louisville, KY.Google Scholar
- Gold MR, Siegel JE, Russell LB, Weinstein MC. (1996). Cost-Effectiveness in Health and Medicine. Oxford University Press, New York.Google Scholar
- Gore KG, Engel CC, Freed MF, Liu XL, Armstrong DW. (2008). Gen Hosp Psychiatry. 30: 391–397.Google Scholar
- Gore KG, Freed MC, Messer SC, Engel CC. (2006). Behavioral Health Track at the U.S. Army Center for Health Promotion and Preventive Medicine-hosted Force Health Protection Conference, Albuquerque, NM.Google Scholar
- Institute of Medicine (IOM), National Research Council (NRC), Committee on Veterans Compensation for Posttraumatic Stress Disorder. (2007). PTSD Compensation and Military Service. National Academies Press, Washington, DC. Available at: http://www.nap.edu/catalog/11870.html.
- Institute of Medicine (IOM), Subcommittee on Posttraumatic Stress Disorder of the Committee of Gulf War and Health. (2006). Posttraumatic Stress Disorder: Diagnosis and Assessment. National Academies Press, Washington, DC. Available at: www.nap.edu/catalog/11674.html.
- Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, Weiss DS. (1990). Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study. Brunner/Mazel, New York.Google Scholar
- Murray CJL, Lopez AD (eds). (1996). The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 Projected to 2020. Harvard School of Public Health, Cambridge, MA.Google Scholar
- Veterans Health Administration (VHA), Department of Defense (DoD). (2004). VA/DoD0 Clinical Practice Guideline for the Management of Post-Traumatic Stress. Veterans Health Administration, Department of Defense, Washington, DC.Google Scholar