Halle P's List: Economic Impacts on PTSD and Vietnam

• PTSD) – an anxiety  disorder that often occurs simultaneously with other anxiety disorders,  depression, and chronic pain.
•   The  direct and indirect costs of mental health conditions have been most  extensively studied in the United States.²  In 1990,  the total economic cost of mental illness in the US was estimated to  be $147.8 billion, with the breakdown of costs by disorder being as  follows: anxiety disorders --  $46.6 billion; schizophrenic disorders  -- $32.5 billion; affective disorders -- $30.4 billion; and, othe
• r disorders  - $38.4 billion.  The indirect costs of mental illness ($79 billion)  were estimated to be higher than the direct costs ($69 billion), with  the bulk of the indirect costs being attributable to loss of productivity  in usual activities.³ 
• Health care costs per person are almost  five times as high for depressed or anxious patients than for non-distressed  patients.⁵).
• is attributable to absenteeism from work or reduction  in work productivity. 
• higher rates of disability and lost  work days, increased usage of mental health services, poorer self-ratings  of emotional health, and increased likelihood of suicide attempts⁶   Therefore, depressive affect, whether of diagnostic severity or merely  of sub-threshold intensity, has substantial negative economic effects.  
•    The  total cost of anxiety disorders in the US in 1990 was $46.6 billion.⁷   The bulk of these costs appear to relate to increased health care utilization.   PTSD and panic disorder are two prominent anxiety disorders. 
• PTSD is frequently comorbid with other mental health  and physical conditions.  For example, it has been reported that  40-50%, or more, of PTSD patients have comorbid depression.⁹   Thus, PTSD patients with comorbid depression will be at risk for the  negative economic consequences of depression as well.  The negative  impact of PTSD upon employment has been relatively well established.   A rec
• ent review of the labor force participation research for individuals  who have suffered traumatic exposure (i.e., to combat, childhood abuse,  concentration camp experiences, and refugee status),) found a consistent  pattern whereby exposure to traumatic stress is associated with reduced  labor market outcomes.¹

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• . Rather than massive recriminations, a collective amnesia took hold. The majority of Americans, it appeared, neither wanted to talk or think about their nation's longest and most debilitating war--the only war the United States ever lost.
• At first, rather than giving returning veterans of the war welcoming parades, Americans seemed to shun, if not denigrate, the 2 million-plus Americans who went to Vietnam, the 1.6 million who served in combat, the 300,000 physically wounded, the many more who bore psychological scars, the 2,387 listed as "missing in action," and the more than 58,000 who died. Virtually nothing was done to aid veterans and their loved ones who needed assistance in adjusting. Then a torrent of fiction, films, and television programs depicted Vietnam vets as drug-crazed psychotic killers, as vicious executioners in Vietnam and equally vicious menaces at home. Not until after the 1982 dedication of the Vietnam Veterans Memorial in Washington, D.C., did American culture acknowledge their sacrifice and suffering, and concede that most had been good soldiers in a bad war.
• Yet this altered view of the Vietnam veterans as victims as much as victimizers, if not as brave heroes, was not accompanied by new public policies. Although most veterans did succeed in making the transition to ordinary civilian life, many did not. More Vietnam veterans committed suicide after the war than had died in it. Even more--perhaps three-quarters of a million--became part of the lost army of the homeless. And the nearly 700,000 draftees, many of them poor, badly educated, and nonwhite, who had received less than honorable discharges, depriving them of educational and medical benefits, found it especially difficult to get and keep jobs, to maintain family relationships, and to stay out of jail. Although a majority of Americans came to view dysfunctional veterans as needing support and medical attention rather than moral condemnation, the Veterans Administration, reluctant to admit the special difficulties faced by these veterans and their need for additional benefits, first denied the harm done by chemicals like Agent Orange and by the posttraumatic stress disorder (PTSD) afflicting as many as 700,000, and then stalled on providing treatment.

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