A new study finds that the national economic burden of PTSD goes beyond direct health care expenditures and exceeds the costs of other common mental health conditions, such as anxiety and depression.
The researchers estimated the cost of PTSD at $232.2 billion for 2018, the latest year for which data was available at the time of the study. They called for increased awareness of PTSD, more effective therapies and the expansion of evidence-based strategies to “reduce the heavy clinical and economic burden” of this mental health condition.
The results appeared online in the Journal of Clinical Psychiatry April 25, 2022.
“The $232 billion annual economic burden of PTSD in the United States demonstrated in this study is staggering and fuels the urgency for public and private stakeholders to work together to discover new and better treatments, reduce stigma, improve access to existing treatments and expanding the evidence. program-based recovery and rehabilitation programs,” the researchers write.
Dr. Lori Davis, associate chief of staff for research at Tuscaloosa Veterans Affairs Medical Center in Alabama, led the study. She and her team used insurance claims data, academic publications, and government publications to estimate the costs of PTSD in US civilian and military populations. This latest cohort included active duty military and veterans.
Understanding the complex nature of post-traumatic stress disorder, commonly referred to as PTSD, is one of VA’s most pressing challenges. The agency says many veterans who fought in Vietnam, the Gulf War and the post-9/11 conflicts in Iraq and Afghanistan have had this mental health issue at some point in their lives.
The symptoms of PTSD are well documented: reliving trauma through flashbacks and nightmares; avoidance of reminders of a traumatic event; changes in thoughts and feelings, such as guilt and emotional numbness; insomnia; and hyperarousal.
In the study, investigators shed light on the extent to which PTSD affects not only veterans, but civilians as well. The research team found that civilians accounted for 82% of total PTSD costs, compared to 18% for the military population. This disparity is based on the fact that the number of civilians far exceeds that of active duty military personnel and veterans. Although PTSD is more common in the military, the number of civilians with PTSD still exceeds the number of veterans with the condition.
Davis and his colleagues noted that more studies of PTSD and its treatments are needed to address the increasing number of civilians with PTSD, calling it a “rapidly accumulating societal burden.” Better access to effective treatments is also needed, especially for people in economically vulnerable situations,” she noted.
“Much of the research and legislative response to PTSD has focused on combat-exposed populations due to the high prevalence of the disease among the military population,” the researchers write. “However, the military population constituted a small proportion of the overall American population with PTSD.
“With the increasing frequency of national and societal traumatic events around the world, including COVID-19, civil unrest and climate change, there are growing concerns about an increase in PTSD and the burden of civilian population. As such, the current cost estimate is likely an underestimate given these recent global traumas, the effects of which would not have been grasped and are likely to lead to growing negative repercussions.”
Although civilians accounted for more than three times the total costs of PTSD, the annual costs per civilian with PTSD ($18,640) were lower than those of the military population ($25,684). In the civilian population, direct health care costs and unemployment accounted for the economic burden, while disability and direct health care costs weighed heavily in the military population. Non-direct health costs such as disability benefits are higher in military populations, according to Davis. Expanding supported employment services for PTSD patients is overdue and could solve the growing disability and unemployment crisis among veterans, she says.
The researchers also found that women made up 66% and 74% of the total and civilian population with PTSD, respectively, contributing disproportionately to national costs. Research has shown that women exposed to trauma have higher levels of PTSD symptoms than men exposed to trauma. Additionally, traumas such as sexual assault and domestic violence tend to affect more women than men and represent important areas for prevention and treatment.
The study notes that the substantial economic burden of PTSD highlights the “urgent and unmet” need to treat and rehabilitate people with the disorder.
“Experts agree that there is a long-standing crisis in the development of pharmacological drugs for the treatment of PTSD, as no drugs have been approved by the FDA for PTSD since the only two marketed agents were approved there. 20 years ago,” the researchers write. “Furthermore, there is little evidence on the impact of available pharmacological and psychological treatments and the interaction between the two on patient-centered outcomes, such as quality of life, well-being, interpersonal relationships and professional functioning.A burden that is often overlooked in economic calculations is the cost of psychotherapy not covered by health plans, which represents a significant out-of-pocket [expense] for someone with PTSD, as demonstrated in the current study.
What does all of this mean for keeping the costs of PTSD in check in the future?
“It’s important to remember that we have effective treatments for PTSD,” says Dr. Paula Schnurr, executive director of VA’s National Center for PTSD. “A potential implication of the results of this study is that increasing treatment could reduce not only the burden of symptoms on individuals, but also the economic costs to society as a whole.”