Changes in Post-traumatic Stress Disorder Service Connection Among Veterans Under Age 55: An 18-Year Ecological Cohort Study.
Changes in Post-traumatic Stress Disorder Service Connection Among Veterans Under Age 55: An 18-Year Ecological Cohort Study.
复制标题
55 岁以下退伍军人中创伤后应激障碍服务联系的变化：一项 18 年生态队列研究。
DOI：
10.1093/milmed/usz052
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发表时间：
2019
影响因子：
1.2
通讯作者：
Arbisi,Paul
中科院分区：
文献类型：
--
作者：
Murdoch,Maureen;Kehle-Forbes,Shannon;Spoont,Michele;Sayer,NinaA;Noorbaloochi,Siamak;Arbisi,Paul
创伤后应激障碍（PTSD）服务连接的强制性，基于年龄的重新评估大大增加了退伍军人福利管理局的工作量，仅在2017财政年度就完成了168，013项PTSD残疾评估，占近43%。这些重新评估对退伍军人的残疾福利的影响还没有被描述。Materials and MethodsThe study is a 18-year，ecological，ambispective cohort of 620 men and 970 women receiving Department of Veterans Affairs PTSD disability benefits.退伍军人在性别范围内进行代表性抽样;所有人都有资格因年龄而至少进行一次创伤后应激障碍残疾重新评估。结果包括PTSD服务连接中断，减少，恢复或恢复的百分比。我们还检查了那些中断或减少创伤后应激障碍服务连接的人的总残疾评级。亚组分析研究了中断PTSD服务连接的潜在预测因素，包括服务时代，种族/民族，创伤暴露类型和PTSD或严重精神疾病的图表诊断。我们机构的内部审查委员会审查并批准了study.ResultsOver 18年，32（5.2%）男性和180（18.6%）女性有他们的PTSD服务连接中断，其中，恢复率为50%的男性和34.3%的女性。6名男性（1%）和23名女性（2.4%）的PTSD残疾评级降低; 50.0%的男性和57.1%的女性恢复了评级。总体而言，失去PTSD服务联系的退伍军人倾向于保持或增加他们的总残疾评级。对男性来说，中断PTSD服务的预测因素是越战后的服务，没有退伍军人健康管理局的PTSD诊断图;对女性来说，预测因素是非裔美国人或黑人种族，西班牙裔，没有战斗或军事性侵犯史，没有PTSD的诊断图，以及持续的严重精神疾病。然而，与其他失去PTSD服务联系的女性相比，非洲裔美国人和西班牙裔女性，没有战斗或军事性侵犯历史的女性以及患有持续严重疾病的女性的平均总残疾等级较高。对于男性和女性谁失去了他们的PTSD服务连接，那些没有PTSD图表诊断有较低的平均总残疾评级比他们的people. Conclusionsespecially对于男性，中断或减少PTSD服务连接在这个队列是罕见的，往往逆转。无论性别如何，大多数中断PTSD服务连接的退伍军人在他们的整体，总残疾评级中没有减少。成本效益分析可以帮助确定是否强制性的，基于年龄的重新评估创伤后应激障碍服务连接的成本效益。
IntroductionMandatory, age-based re-evaluations for post-traumatic stress disorder (PTSD) service connection contribute substantially to the Veterans Benefits Administration’s work load, accounting for almost 43% of the 168,013 assessments for PTSD disability done in Fiscal Year 2017 alone. The impact of these re-evaluations on Veterans’ disability benefits has not been described.Materials and MethodsThe study is an 18-year, ecological, ambispective cohort of 620 men and 970 women receiving Department of Veterans Affairs PTSD disability benefits. Veterans were representatively sampled within gender; all were eligible for PTSD disability re-evaluations at least once because of age. Outcomes included the percentage whose PTSD service connection was discontinued, reduced, re-instated, or restored. We also examined total disability ratings among those with discontinued or reduced PTSD service connection. Subgroup analyses examined potential predictors of discontinued PTSD service connection, including service era, race/ethnicity, trauma exposure type, and chart diagnoses of PTSD or serious mental illness. Our institution’s Internal Review Board reviewed and approved the study.ResultsOver the 18 years, 32 (5.2%) men and 180 (18.6%) women had their PTSD service connection discontinued; among them, the reinstatement rate was 50% for men and 34.3% for women. Six men (1%) and 23 (2.4%) women had their PTSD disability ratings reduced; ratings were restored for 50.0% of men and 57.1% of women. Overall, Veterans who lost their PTSD service connection tended to maintain or increase their total disability rating. Predictors of discontinued PTSD service connection for men were service after the Vietnam Conflict and not having a Veterans Health Administration chart diagnosis of PTSD; for women, predictors were African American or black race, Hispanic ethnicity, no combat or military sexual assault history, no chart diagnosis of PTSD, and persistent serious mental illness. However, compared to other women who lost their PTSD service connection, African American and Hispanic women, women with no combat or military sexual assault history, and women with persistent serious illness had higher mean total disability ratings. For both men and women who lost their PTSD service connection, those without a PTSD chart diagnosis had lower mean total disability ratings than did their counterparts.ConclusionsParticularly for men, discontinuing or reducing PTSD service connection in this cohort was rare and often reversed. Regardless of gender, most Veterans with discontinued PTSD service connection did not experience reductions in their overall, total disability rating. Cost-benefit analyses could help determine if mandated, age-based re-evaluations of PTSD service connection are cost-effective.