Murdoch Maureen, Sayer Nina A, Spoont Michele R, Rosenheck Robert, Noorbaloochi Siamak, Griffin Joan M, Arbisi Paul A, Hagel Emily M
Center for Chronic Disease Outcomes Research, Section of General Internal Medicine, Minneapolis Department of Veterans Affairs Medical Center, Department of Internal Medicine, University of Minnesota School of Medicine, USA.
Arch Gen Psychiatry. 2011 Oct;68(10):1072-80. doi: 10.1001/archgenpsychiatry.2011.105.
Most studies examining the clinical impact of disability benefits have compared aid recipients with people who never applied for benefits. Such practices may bias findings against recipients because disability applicants tend to be much sicker than never-applicants. Furthermore, these studies ignore the outcomes of denied claimants.
To examine long-term outcomes associated with receiving or not receiving Department of Veterans Affairs (VA) disability benefits for posttraumatic stress disorder (PTSD), the most common mental disorder for which veterans seek such benefits.
Comparison of outcomes between successful and unsuccessful applicants for VA disability payments. Because we could not randomize the receipt of benefits, we used exact matching by propensity scores to control for potential baseline differences. We examined clinical outcomes approximately 10 years later.
Stratified, nationally representative cohort of 3337 veterans who applied for VA PTSD disability benefits between January 1, 1994, and December 31, 1998.
Assessment on validated survey measures of PTSD; work, role, social, and physical functioning; employment; and poverty. We compared outcomes with earlier scores. Homelessness and mortality were assessed using administrative data.
Of still-living cohort members, 85.1% returned usable surveys. Symptoms of PTSD were elevated in both groups. After adjustment, awardees had more severe PTSD symptoms than denied claimants but were nonetheless more likely to have had a meaningful symptom reduction since their last assessment (-6.1 vs -4.4; SE, 0.1; P = .01). Both groups had meaningful improvements of similar magnitude in work, role, and social functioning (-0.15 vs -0.19; SE, 0.01; P = .94), but functioning remained poor nonetheless. Comparing awardees with denied claimants after adjustment, 13.2% vs 19.0% were employed (P = .11); 15.2% vs 44.8% reported poverty (P < .001); 12.0% vs 20.0% had been homeless (P = .02); and 10.4% vs 9.7% had died (P = .66).
Regardless of claim outcome, veterans who apply for PTSD disability benefits are highly impaired. However, receiving PTSD benefits was associated with clinically meaningful reductions in PTSD symptoms and less poverty and homelessness.
大多数研究残疾福利临床影响的研究，都是将福利领取者与从未申请过福利的人进行比较。这种做法可能会使研究结果对领取者产生偏差，因为残疾申请者往往比从未申请者病情严重得多。此外，这些研究忽略了被拒申请者的结局。
研究因创伤后应激障碍（PTSD）获得或未获得退伍军人事务部（VA）残疾福利的长期结局，PTSD是退伍军人寻求此类福利的最常见精神障碍。
比较VA残疾抚恤金成功申请者和未成功申请者的结局。由于我们无法随机分配福利的领取情况，因此我们使用倾向得分精确匹配来控制潜在的基线差异。我们在大约10年后检查了临床结局。
1994年1月1日至1998年12月31日期间申请VA PTSD残疾福利的3337名退伍军人组成的分层、具有全国代表性的队列。
通过经过验证的PTSD调查量表进行评估；工作、角色、社交和身体功能；就业；以及贫困状况。我们将结局与早期得分进行了比较。使用行政数据评估无家可归和死亡率。
在仍在世的队列成员中，85.1%返回了可用的调查问卷。两组的PTSD症状均有所升高。调整后，获奖者的PTSD症状比被拒申请者更严重，但自上次评估以来仍更有可能出现有意义的症状减轻（-6.1对-4.4；标准误，0.1；P = 0.01）。两组在工作、角色和社交功能方面都有类似程度的有意义改善（-0.15对-0.19；标准误，0.01；P = 0.94），但功能仍然较差。调整后比较获奖者和被拒申请者，就业比例分别为13.2%对19.0%（P = 0.11）；报告贫困的比例分别为15.2%对44.8%（P < 0.001）；无家可归的比例分别为12.0%对20.0%（P = 0.02）；死亡比例分别为10.4%对9.7%（P = 0.66）。
无论申请结果如何，申请PTSD残疾福利的退伍军人都有严重的功能障碍。然而，获得PTSD福利与PTSD症状在临床上有意义的减轻以及较少的贫困和无家可归情况相关。
