Murdoch Maureen, Hodges James, Cowper Diane, Sayer Nina
Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minnesota 55417, USA.
Med Care. 2005 Feb;43(2):112-21. doi: 10.1097/00005650-200502000-00004.
Minnesota, Minneapolis, Minnesota. 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.
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.
We used a mailed survey linked to administrative data.
Subjects included 4918 representative, eligible men and women who filed PTSD disability claims between 1994 and 1998.
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.
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.
明尼苏达州，明尼阿波利斯市。创伤后应激障碍（PTSD）是一种慢性致残疾病，影响着超过60万美国退伍军人，是退伍军人寻求退伍军人事务部残疾福利的最常见精神疾病。获得此类福利可增加退伍军人获得退伍军人事务部医疗保健的机会，并降低他们陷入贫困的几率。
我们试图确定先前确定的PTSD残疾评定的地区差异是否可由适当的受试者特征（如PTSD症状学或功能障碍的差异）来解释，并估计退伍军人PTSD症状严重程度或功能障碍水平对其获得PTSD残疾福利几率的影响。
我们使用了与行政数据相关联的邮寄调查。
受试者包括1994年至1998年间提交PTSD残疾索赔的4918名具有代表性的合格男女。
共有3337名退伍军人返回了可用的调查问卷（68%）。调整前，各地区PTSD残疾索赔批准率在43%至75%之间。调整后，批准率在33%至72%之间（P<0.0001）。更严重的PTSD症状与获得PTSD残疾福利的几率更高相关（P<0.0001）。出乎意料的是，功能状态较差与获得福利的几率较低相关（P<0.0001）。平均而言，有和没有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功能障碍略大。
索赔批准率几乎两倍的地区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。未获得PTSD残疾福利的退伍军人至少与获得福利的退伍军人一样残疾。
