Association of Comorbid Substance Use Disorders and PTSD on Later Symptom Severity, Functioning, and Economic Outcomes among Veterans Applying for Department of Veterans Affairs PTSD Disability Benefits: A Retrospective Cohort Study

Resumen

Background: Posttraumatic stress disorder (PTSD) that is comorbid with substance use disorders (SUDs) has been associated with poorer mental health outcomes compared to when SUD is not present. Objectives: To identify the prevalence of SUDs in Veterans who have applied for PTSD disability benefits and, within this subgroup, examine the effect of a SUD diagnosis on PTSD symptom severity, functioning, and economic outcomes approximately 2 years later. Method: Retrospective, gender-stratified cohort study of 4,918 representatively sampled Veterans who applied for Department of Veterans’ Affairs (VA) PTSD disability benefits between 1994 and 1998. We used medical administrative data to determine if a SUD diagnosis was present when Veterans’ disability claims were adjudicated. PTSD symptom severity; work, role, and social functioning; physical functioning; working for pay; and low income were assessed by mailed survey approximately 2 years later. Results: 3,337 (68%) Veterans returned surveys. Among respondents, men were more likely than women to have any SUD diagnosis at the time of their claims’ adjudication (25.6% v. 17.6%, p < 0.001). Regardless of gender, Veterans with a SUD diagnosis had clinically meaningful and statistically significantly severer PTSD symptoms and poorer functioning approximately 2 years after their claim was adjudicated than did Veterans without SUD (ps < 0.001). Work, role, and social functioning was also statistically significantly worse for men and women with a SUD diagnosis (ps < 0.001). In terms of economic outcomes, men and women with a SUD diagnosis at the time their claim was adjudicated were 50-60% less likely to report working for pay two years later and 40%-100% more likely to report low income compared to respondents without a SUD diagnosis (ps < 0.001). Conclusions: Although a substantial fraction of respondents were diagnosed with a SUD at the time their claim was adjudicated, the proportion of men with a SUD was similar to that reported for other clinical samples with PTSD; it was actually lower among the women compared to other clinical samples. A SUD diagnosis was a poor prognostic factor for the Veterans in this sample, associated with severer PTSD, poorer functioning, and poorer economic outcomes.

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Cómo citar (APA 7)

Boudreaux, M. H., & Murdoch, M. (2019). Association of Comorbid Substance Use Disorders and PTSD on Later Symptom Severity, Functioning, and Economic Outcomes among Veterans Applying for Department of Veterans Affairs PTSD Disability Benefits: A Retrospective Cohort Study. https://doi.org/10.31234/osf.io/eavj6