Regional variation and other correlates of department of veterans affairs disability awards for patients with posttraumatic stress disorder
Regional variation and other correlates of department of veterans affairs disability awards for patients with posttraumatic stress disorder
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DOI：
10.1097/00005650-200502000-00004
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发表时间：
2005-02-01
期刊：
影响因子：
3
通讯作者：
Sayer, N
中科院分区：
文献类型：
--
作者：
Murdoch, M;Hodges, J;Sayer, N
背景：创伤后应激障碍 (PTSD) 是一种慢性致残疾病，影响超过 600,000 名美国退伍军人，也是退伍军人寻求退伍军人事务部残疾福利的最常见的精神疾病。获得此类福利可以提高退伍军人获得退伍军人事务部医疗保健的机会，并减少他们陷入贫困的机会。目标：我们试图确定先前确定的 PTSD 残疾奖励的地区差异是否可以通过适当的受试者特征（例如 PTSD 症状或功能障碍的差异）来解释，并估计退伍军人的 PTSD 症状严重程度或功能障碍水平对其获得 PTSD 残疾福利的几率的影响。研究设计：我们使用了与管理数据相关的邮寄调查。包括 4918 名在 1994 年至 1998 年间提出 PTSD 残疾索赔的代表性合格男性和女性。结果：共有 3337 名退伍军人返回了可用的调查（68%）。调整前，各地区 PTSD 伤残索赔的批准率在 43% 至 75% 之间。调整后，比率范围为 33% 至 72% (P < 0.0001)。较严重的 PTSD 症状与获得 PTSD 残疾福利的几率较高相关（P < 0.0001）。出乎意料的是，较差的功能状态与较低的获益几率相关（P < 0.0001）。平均而言，获得和没有获得 PTSD 残疾福利的退伍军人之间的临床差异很小，但表明没有福利的退伍军人的功能障碍略大。结论：索赔批准率几乎两倍的区域差异不能用退伍军人的 PTSD 症状严重程度、功能障碍水平或其他受试者水平特征来解释。没有获得创伤后应激障碍（PTSD）残疾福利的退伍军人至少与那些获得福利的退伍军人一样残疾。
Background: Posttraumatic stress disorder (PTSD) is a chronic disabling condition affecting more than 600,000 United States veterans and is the most common psychiatric condition for which veterans seek Veterans Affairs disability benefits. Receipt of such benefits enhances veterans' access to Veteran Affairs health care and reduces their chance of poverty.Objectives: We sought to determine whether previously identified regional variations in PTSD disability awards are explained by appropriate subject characteristics (eg, differences in PTSD symptomatology or dysfunction) and to estimate the impact of veterans' PTSD symptom severity or level of dysfunction on their odds of obtaining PTSD disability benefits.Research Design: We used a mailed survey linked to administrative data.Subjects: Subjects included 4918 representative, eligible men and women who filed PTSD disability claims between 1994 and 1998.Results: A total of 3337 veterans returned useable surveys (68%). Before adjustment, PTSD disability claims approval rates ranged from 43% to 75% across regions. After adjustment, rates ranged from 33% to 72% (P < 0.0001). Severer PTSD symptoms were associated with greater odds of having PTSD disability benefits (P < 0.0001). Unexpectedly, poorer functional status was associated with lower odds of having benefits (P < 0.0001). On average, clinical differences between veterans who did and did not have PTSD disability benefits were small but suggested slightly greater dysfunction among those without benefits.Conclusions: An almost twofold regional difference in claims approval rates was not explained by veterans' PTSD symptom severity, level of dysfunction, or other subject-level characteristics. Veterans who did not obtain PTSD disability benefits were at least as disabled as those who did receive benefits.