Veterans Receiving PTSD Disability Benefits May Experience Fewer Symptoms, Less Poverty and Homelessness over Long Term
BACKGROUND:
PTSD is the most common mental disorder for which Veterans seek VA disability benefits. As of 2009, nearly 400,000 Veterans were receiving PTSD compensation. However, there is a paucity of high-quality research that examines clinical outcomes in aid recipients – or those who are denied disability benefits. This study sought to examine long-term outcomes associated with receiving and not receiving VA disability benefits for PTSD. Investigators identified 3,337 Veterans (1,655 men and 1,682 women) who had applied for VA PTSD disability benefits between 1994 and 1998. Using subsequent survey and administrative data from two time periods (1998-2000 and 2004-2006), investigators then examined clinical outcomes, including: PTSD symptoms; work, role, social, and physical functioning; employment; and poverty. Homelessness and mortality also were assessed.
FINDINGS:
- Compared to Veterans not receiving VA PTSD disability benefits, Veterans receiving benefits continued to report more severe PTSD symptoms 10 years after applying for benefits, but were more likely to have had a clinically meaningful reduction in PTSD symptoms. Beneficiaries also had reduced odds of poverty (15% vs. 45%) and homelessness (12% vs. 20%) compared to denied claimants.
- Employment was low in both groups (14% vs. 19%), and mortality was similar (10.3% vs. 9.5%).
- On average, Veterans who had been awarded PTSD benefits and Veterans who had been denied them both experienced meaningful improvements of similar magnitude in work, role, and social functioning; however, overall functioning remained poor nonetheless.
IMPLICATIONS:
- Findings counter common concerns that PTSD disability benefits impede recovery by incentivizing Veterans to remain ill, and suggest that such benefits may be helpful.
- Building on these findings, investigators are conducting a third wave of data collection from these Veterans designed to identify novel strategies and interventions Veterans used to “recover” from PTSD, that might be helpful to other Veterans disabled by PTSD.
LIMITATIONS:
- Because Veterans could not be ethically randomized to receive or not receive disability benefits, findings may be more related to baseline differences in the two groups than to any specific effect of disability benefits. Unmeasured variables also could have accounted for beneficiaries’ improved PTSD symptoms.
- The generalizability of findings to Veterans of more recent conflicts, to other disabling conditions, and to other types of disability aid (i.e., Social Security) is unknown.
- The time frames for initial disability determination were prior to OEF/OIF and the follow-up period ended more than 5 years ago. Much has changed in disability determination methods and VA’s approach to PTSD treatment in the past 15 years, so the study’s conclusions may no longer apply.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 01-188). Drs. Murdoch, Sayer and Spoont are all part of HSR&D’s Center for Chronic Disease Outcomes Research, Minneapolis, MN. Dr. Sayer also is Director of the VA/HSR&D’s Polytrauma & Blast-Related Injuries Quality Enhancement Research Initiative (PT/BRI-QUERI).
Murdoch M, Sayer N, Spoont M, et al. Long-Term Outcomes of Disability Benefits in U.S. Veterans with Post-Traumatic Stress Disorder. Archives of General Psychiatry Oct 2011;68(10):1072-80.
