Behavioral Healthcare

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With mental health issues rising in returning soldiers, organizations should install programs specific to war-related mental health conditions to offset possible billions in healthcare and productivity costs, according to a RAND Corporation study entitled "Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences and Services to Assist Recovery." Soldiers returning from serving in Iraq and Afghanistan are reporting significant cases of mental health problems, such as post traumatic stress disorder (PTSD), major depression and traumatic brain injury (TBI).

The study surveyed 1,965 returned service members from 24 communities across the United States. Fourteen percent had screened positive for PTSD and another 14 percent for major depression. Nineteen percent experienced a possible TBI while deployed and 7 percent reported both TBI and PTSD or major depression. Half of the respondents had a friend that was seriously wounded or killed in the war. Forty five percent reported seeing dead or seriously injured non-combatants and over 10 percent reported being injured themselves and required hospitalization.

The study found rates of PTSD and major depression were more prevalent among Army soldiers, Marines and those who are no longer serving (i.e., reservists and discharged). Women, Hispanics and enlisted personnel were more likely to report symptoms of PTSD or major depression. The best indicator researchers found for predicting PTSD or major depression was exposure to combat trauma while deployed.

One area the study focused on was the cost of returning service members with an "invisible wound." Using a microsimulation model to project a two-year estimation of costs within the first two years after returning, the study found:

• Per-case basis, two-year associated cost for PTSD range from $5,904 to $10,298.
• Per-case basis, two-year associated cost for major depression range from $15,461 to $25,757.
• Per-case basis, two-year associated cost for co-morbid PTSD and major depression range from $12,427 to $16,884.

A microsimulation model was used to project a one-year estimate of the cost to treat those diagnosed with TBI:

• Per-case basis for mild cases range from $27,259 to $32,759.
• Per-case basis for moderate to severe cases range from $268,902 to $408,519.

"We estimate that PTSD-related and major depression-related costs could range from $4 to $6.2 billion over two years. Applying the costs per case for TBI to the total number of diagnosed TBI cases identified as of June 2007 (2,726), we estimate that total costs incurred within the first year after diagnosis could range from $591 million to $910 million," the researchers said.

"Our findings also indicate that lost productivity is a key cost driver for major depression and PTSD. Approximately 55 to 95 percent of total costs can be attributed to reduced productivity; for mild TBI, productivity losses may account for 47 to 57 percent of total costs. Because severe TBI can lead to death, mortality is the largest component of costs for moderate to severe TBI, accounting for 70 to 80 percent of total costs," the researchers added.

Researchers estimated once evidence-based treatments are used to care for PTSD and major depression, an increase in productivity will save $1.7 billion in two-years or $1,063 per returning service member.

Address: RAND Corporations, Corporate Headquarters, 1776 Main Street, Santa Monica, CA 90401; (310) 393-0411, http://www.rand.org.

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Source: Employee Assistance Program Management Letter, July 2008