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2019 HSR&D/QUERI National Conference Abstract

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4145 — Examining Post-Traumatic Stress Disorder in Veterans dying with Serious Medical Illness

Lead/Presenter: Kathleen Bickel,  COIN - Seattle/Denver
All Authors: Bickel KE (Rocky Mountain Regional Medical Center, University of Colorado School of Medicine), Langner P (Seattle/Denver COIN, Rocky Mountain Regional Medical Center), Levy C (Seattle/Denver COIN, Rocky Mountain Regional Medical Center, University of Colorado School of Medicine)

Objectives:
The Vietnam Veteran cohort is aging, with a 26% estimated lifetime risk of post-traumatic stress disorder (PTSD). However, little is known about the impact that PTSD has at the end of life, especially in the setting of serious medical illness, such as end-stage cancer, heart or lung disease. Our aim is to describe end-of-life healthcare utilization for our cohort, currently in process.

Methods:
Descriptive data of 562,129 Veterans, dying between 2010 and 2015 with serious medical illnesses, based on International Statistical Classification of Diseases (ICD-9) codes from the Central Data Warehouse, stratified by PTSD. Serious medical illness examples include poor prognosis cancer, congestive heart failure (CHF), and chronic pulmonary disease (COPD). PTSD was defined as PTSD via ICD-9 code within 2 years of death, VA problem list, or service connection for PTSD.

Results:
Of the cohort, 56,901 (10.12%) had a PTSD diagnosis. Seventy-seven percent (43,772/56,901) were classified based on ICD-9 codes. The remaining 23.07% (13,129/56,901) were identified by service connection or problem list. Vietnam Veterans were 34.95% (196,447/562,129) of the cohort, 18.45% (36,243/196,447) with PTSD. Veterans with PTSD were more likely younger at death (age 71.7 vs age 78.77, p < 0.001), non-white (19.9% vs 14.0%, p < 0.001), and have a history of homelessness (14.7% vs 5.6%, p < 0.001). They were also more likely to have any level of service connection (86.6% vs 33.7%), and to be dying with COPD (27.2% vs 23.4%), poor prognosis cancer (15.0% vs 11.4%), or chronic liver disease (6.1% vs 2.8%). Vietnam Veterans made up 63.7% (36,243/56,901) of the cohort with PTSD, but only 31.7% (160,204/505,228) of the cohort without it. Those without PTSD were more likely to be dying with CHF (19.5% vs 16.2%), coronary artery disease (22.3% vs 19.7%), or dementia (15.4% vs 12.5%).

Implications:
Additional utilization data are still pending, but these findings suggest that Veterans with PTSD die younger and are more likely to be dying with cancer, lung or liver disease, potentially tied to their coping strategies.

Impacts:
Understanding the effects of PTSD at end of life are important not only for Vietnam Veterans, but for all Veterans struggling with PTSD.