title: 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.
authors.affiliation: Naval Center for Combat & Operational Stress Control, Bureau of Medicine and Surgery, U.S. Navy, 34960 Bob Wilson Drive, Suite 400, San Diego, CA 92134-6400.
authors.forename: Kartavya J
authors.initials: KJ
authors.lastname: Vyas
authors.affiliation: Naval Center for Combat & Operational Stress Control, Bureau of Medicine and Surgery, U.S. Navy, 34960 Bob Wilson Drive, Suite 400, San Diego, CA 92134-6400.
authors.forename: Susan F
authors.initials: SF
authors.lastname: Fesperman
authors.affiliation: Naval Center for Combat & Operational Stress Control, Bureau of Medicine and Surgery, U.S. Navy, 34960 Bob Wilson Drive, Suite 400, San Diego, CA 92134-6400.
authors.forename: Bonnie J
authors.initials: BJ
authors.lastname: Nebeker
authors.affiliation: Naval Center for Combat & Operational Stress Control, Bureau of Medicine and Surgery, U.S. Navy, 34960 Bob Wilson Drive, Suite 400, San Diego, CA 92134-6400.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Gerard
authors.affiliation: Naval Center for Combat & Operational Stress Control, Bureau of Medicine and Surgery, U.S. Navy, 34960 Bob Wilson Drive, Suite 400, San Diego, CA 92134-6400.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Boyd
authors.affiliation: Naval Center for Combat & Operational Stress Control, Bureau of Medicine and Surgery, U.S. Navy, 34960 Bob Wilson Drive, Suite 400, San Diego, CA 92134-6400.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Delaney
authors.affiliation: Naval Center for Combat & Operational Stress Control, Bureau of Medicine and Surgery, U.S. Navy, 34960 Bob Wilson Drive, Suite 400, San Diego, CA 92134-6400.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Webb-Murphy
authors.affiliation: Naval Center for Combat & Operational Stress Control, Bureau of Medicine and Surgery, U.S. Navy, 34960 Bob Wilson Drive, Suite 400, San Diego, CA 92134-6400.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Johnston
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003863:Depression / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D017048:Health Care Costs / Q000592:standards*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards; D008889:Military Personnel / Q000523:psychology*; D011613:Psychotherapy / Q000379:methods / Q000592:standards; D055500:Resilience, Psychological; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000517:prevention & control* / Q000523:psychology; D013315:Stress, Psychological / Q000628:therapy; D011795:Surveys and Questionnaires