Article1997

Effectiveness and cost of the inpatient treatment of posttraumatic stress disorder: comparison of three models of treatment

107 citations0/0 files storedAmerican Journal of Psychiatry

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Posttraumatic Stress Disorder Research Psychotherapy Techniques and Applications Personality Disorders and Psychopathology

Abstract

OBJECTIVE: This study compared the outcomes and costs of three models of Department of Veterans Affairs (VA) inpatient treatment for posttraumatic stress disorder (PTSD): 1) long-stay specialized inpatient PTSD units, 2) short-stay specialized evaluation and brief-treatment PTSD units, and 3) nonspecialized general psychiatric units. METHOD: Data were drawn from 785 Vietnam veterans undergoing treatment at 10 programs across the country. The veterans were followed up at 4-month intervals for 1 year after discharge. Successful data collection averaged 66.1% across the three follow-up intervals. RESULTS: All models demonstrated improvement at the time of discharge, but during follow-up symptoms and social functioning rebounded toward admission levels, especially among participants who had been treated in long-stay PTSD units. Veterans in the short-stay PTSD units and in the general psychiatric units showed significantly more improvement during follow-up than veterans in the long-stay PTSD units. Greatest satisfaction with their programs was reported by veterans in the short-stay PTSD units. Finally, the long-stay PTSD units proved to be 82.4% and 53.5% more expensive over 1 year than the short-stay PTSD units and general psychiatric units, respectively. CONCLUSIONS: The paucity of evidence of sustained improvement from costly long-stay specialized inpatient PTSD programs and the indication of high satisfaction and sustained improvement in the far less costly short-stay specialized evaluation and brief-treatment PTSD programs suggest that systematic restructuring of VA inpatient PTSD treatment could result in delivery of effective services to larger numbers of veterans.

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References

1983The Brief Symptom Inventory: an introductory report 1990Trauma and the Vietnam War generation: report of findings from the National Vietnam Veterans Readjustment Study 1988Mississippi Scale for Combat-Related Posttraumatic Stress Disorder: Three studies in reliability and validity.1996Outcome of intensive inpatient treatment for combat-related posttraumatic stress disorder 1995Multisite Experimental Cost Study of Intensive Psychiatric Community Care

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