Study Examines Relationship between Compensation Status and Treatment Outcomes for Veterans with PTSD
BACKGROUND:
PTSD is the most commonly diagnosed psychiatric disorder among Veterans, and is also the most common psychiatric disorder for which Veterans seek and receive compensation. The number of Veterans seeking and receiving PTSD-related compensation has jumped from just over 10,000 Veterans in 1999 to more than 437,000 at the end of FY2010. This study examined the relationship of compensation status, treatment expectations, military cohort, length of stay, and treatment outcomes in 776 Veterans (72% pre-OEF/OIF/OND; 27% OEF/OIF/OND) enrolled in five different VA residential PTSD programs between 2005 and 2010. Veterans completed a baseline assessment during program intake that included questions on: compensation status (21% of Veterans were identified as having stable PTSD compensation, 49% as seeking increased compensation, and 30% as seeking initial compensation); treatment expectations (e.g., Will treatment make symptoms better or worse?); and symptom severity (PTSD and depression). Just prior to program discharge, Veterans completed another survey that included questions on symptom severity (725 Veterans completed both surveys).
FINDINGS:
- PTSD compensation status may have little influence on treatment outcomes for Veterans engaged in VA residential PTSD programs.
- Veterans who already had pensions and were seeking increased compensation for PTSD, endorsed marginally lower treatment expectations as compared to Veterans with stable compensation for PTSD; however, these differences did not result in significant differences in symptom changes during the course of treatment. Veterans seeking initial compensation for PTSD did not report lower treatment expectations or poorer treatment outcomes.
- Positive treatment expectations were associated with longer lengths of stay and greater improvement in symptoms.
- Compared to non-OEF/OIF/OND Veterans, OEF/OIF/OND Veterans reported lower treatment expectations and higher PTSD and depressive symptoms at intake, yet experienced similar treatment gains at discharge. It is unclear whether their decreased treatment expectations reflect less motivation to get better (due to secondary gain issues) or less socialization to treatment and, therefore, less belief in treatment efficacy.
LIMITATIONS:
- Given that the majority of Veterans in the study were either compensated and/or seeking compensation, investigators were unable to compare these groups to a non-compensated/not seeking compensation group.
- This study focused on Veterans receiving specialized PTSD care within residential treatment settings; thus, the results may not generalize to Veterans seeking outpatient care for PTSD.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (TEL 03-135). Dr. Rosen is part of VA/HSR&D's Mental Health Quality Enhancement Research Initiative (MH-QUERI) and HSR&D's Center for Health Care Evaluation, Palo Alto, CA. Drs. Tiet, Garvert, and Rosen are part of VA's National Center for PTSD, VA Palo Alto Health Care System.
Belsher B, Tiet Q, Garvert D, and Rosen C. Compensation and Treatment: Disability Benefits and Outcomes of Veterans Receiving Residential PTSD Treatment. Journal of Traumatic Stress October 2012;25(5):494-502.
