Preventing PTSD and Depression and Reducing Health Care Costs in the Military: A Call for Building Resilience Among Service Members

Abstract

The present study investigates the role of psychological resilience in protecting against the development of post-traumatic stress disorder (PTSD), depression, and comorbid PTSD and depression; and estimates the percent reductions in incidence of, and associated treatment cost savings for, each condition as a function of increasing resilience. A retrospective cohort of mental health care-seeking service members (n = 2,171) completed patient-reported outcome measures approximately every 10 weeks as part of the Psychological Health Pathways program. Patients with low resilience were at significantly greater odds for developing physical, behavioral, and mental health conditions, particularly sleep disorder (adjusted odds ratio [AOR] = 2.60, 95% confidence interval [CI] = 1.81-3.73), perceived stress (AOR = 2.86, 95% CI = 1.05-7.75), and depression (AOR = 2.89, 95% CI = 2.34-3.57) compared to patients with moderate/high resilience. Increasing resilience across services by 20% is estimated to reduce the odds of developing PTSD, depression, and comorbid PTSD and depression by 73%, 54%, and 93%, respectively; the incidence by 32%, 19%, and 61%, respectively; and save approximately $196, $288, and $597 million in annual treatment costs, respectively, or approximately $1.1 billion total (a 35% reduction in costs). Using resilience as a preventive model may reduce health care utilization and costs in an already overtaxed health care system.

Exploring resilience models in a sample of combat-exposed military service members and veterans: a comparison and commentary

“…Finally, the volunteer nature of the sample of primarily treatment-seeking participants is a limitation, in that results are probably not as generalizable to Afghanistan and Iraq-era veterans as a whole, or as generalizable they would be if random sampling was utilized. This sample is, however, similar to other existing studies of treatment-seeking military personnel (Vyas et al, 2016) and is representative of veterans likely to be presenting for treatment.…”

“…Johnson, Polousney, & Erbes, 2011; Nash et al, 2015; Polousny et al, 2017), low levels of self-reported resilience have also been reported (e.g. Vyas et al, 2016). These conflicting findings may be consistent with another line of research suggesting that resilience is not necessarily the most common outcome, particularly following certain stressors (e.g.…”

“…Among the various definitions, resilience often refers to traits or capacities, including self-reported responding and coping (Blackburn & Owen, 2016; Vyas et al, 2016), and encompassing both personal and societal values (Zimmerman et al, 2014). Resilience is also often viewed as an outcome, such as the absence of post-traumatic stress disorder (PTSD) or low levels of symptoms (Polousney et al, 2017).…”

Associations between changes in resilient coping and posttraumatic stress disorder symptoms

“…Resilience is a psychological factor that protects against the development of PTSD after trauma (Lee et al, 2016; Vyas et al, 2016). Resilience has been defined in many ways, but the common thread entails coping with stressful circumstances in a manner that results in adaptive outcomes (Masten, 2007).…”

Complexity of the Relationships of Pain, Posttraumatic Stress, and Depression in Combat‐Injured Populations: An Integrative Review to Inform Evidence‐Based Practice

“…The polytrauma clinical triad, defined by pain, posttraumatic stress disorder (PTSD), and TBI, is evident in over 40% of polytrauma OEF and OIF military service members and veterans (Lew et al., ). High rates of mental disorders, such as depression, coexist with this polytrauma clinical triad, further complicating the polytrauma rehabilitative services required to address biopsychosocial healthcare needs postinjury (Vyas et al., ). The concerning prevalence of depression seen in combat exposed uninjured veterans (28%), compared to other mental health conditions, emphasizes the importance of examining the interrelatedness of depression, PTSD, and pain after combat injury (Thomas et al., ).…”