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The study estimated the total excess economic burden of PTSD in the United States at $232.2 billion in 2018, which corresponds to $19,630 in excess annual costs per person with PTSD. Of that total, $189.5 billion (81.6%) was attributed to the civilian population and $42.7 billion (18.4%) to the military population. The estimates were based on 2018 prevalence data and included direct health care, direct nonhealth care, and indirect costs from a societal perspective.

The total burden was higher in the civilian population, while the per-person burden was higher in the military population. The study estimated $189.5 billion in total excess costs in civilians versus $42.7 billion in the military population, but excess costs per individual with PTSD were lower in civilians ($18,640) than in the military population ($25,684). The authors noted that the civilian population accounted for most people with PTSD in the US, which drove the larger total cost.

The largest cost components were unemployment, caregiving, productivity loss at work, disability, and direct health care. The study estimated unemployment costs at $46.2 billion, caregiving at $36.7 billion, productivity loss at work at $34.8 billion, disability benefits at $32.3 billion, and direct health care costs at $76.1 billion. In the military population specifically, disability was the single largest contributor to excess economic burden.

Direct health care costs represented only part of the total burden. The study estimated $76.1 billion in excess direct health care costs, compared with substantial additional costs from direct nonhealth care and indirect categories such as disability benefits ($32.3 billion), unemployment ($46.2 billion), productivity loss at work ($34.8 billion), caregiving ($36.7 billion), homelessness ($869.1 million), substance use disorder ($2.3 billion), psychotherapy not covered under health plans ($156.2 million among uninsured civilians), and premature mortality ($2.6 billion). These findings show that the burden of PTSD extends well beyond medical spending alone.

The study used US prevalence estimates of 2.6% for civilian men and 6.0% for civilian women, and 6.7% for men and 11.7% for women in the military population. Using these rates and 2018 population estimates, the authors estimated that 2,607,131 male and 7,558,833 female adults had PTSD in the civilian population, and 1,368,925 male and 293,256 female adults had PTSD in the military population. Female adults accounted for 66.4% of the overall PTSD population in the analysis.

Yes. The study estimated that female adults accounted for 66.4% of the overall PTSD population, and women represented 74% of the civilian PTSD population discussed in the paper's interpretation. The authors concluded that the civilian population, specifically women, has been underrecognized in the literature as a disproportionally affected group.

Among civilian and military populations, the average excess direct health care cost was estimated to range from $12,167 to $13,016 per person with PTSD. Across all individuals with PTSD, total excess direct health care costs were estimated at $76.1 billion, including $66.0 billion in the civilian population and $10.1 billion in the military population.

PTSD was associated with large employment-related costs. The study estimated unemployment costs at $46.2 billion overall, including $42.7 billion in the civilian population and $3.5 billion in the military population. It also estimated $34.8 billion in productivity loss at work, based on 9.7 excess days of absenteeism and 33.1 excess days of presenteeism per year among adults with PTSD.

The study estimated $36.7 billion in excess caregiving costs due to PTSD, including $33.3 billion in the civilian population and $3.4 billion in the military population. Caregivers were estimated to spend an additional 3.4 hours per week on PTSD-related care in the civilian population and 2.1 additional hours per week in the military population.

PTSD was associated with substantially higher rates of substance use disorder in both civilian and military populations. In civilians, the proportion with alcohol use disorder was estimated to be 2.2 times higher and the proportion with drug use disorder 2.4 times higher than in adults without PTSD; in the military population, those ratios were 5.8 and 7.3, respectively. The resulting excess costs of substance use disorder due to PTSD were estimated at $2.3 billion overall, including $1.6 billion in civilians and $722.4 million in the military population.

Yes, but only for psychotherapy services not covered under health plans among uninsured civilians. The study estimated an 11.6% excess rate of psychotherapy use due to PTSD in uninsured civilian adults, corresponding to about 124,000 additional uninsured individuals seeking psychotherapy. Assuming 10 visits per year at $133 per 1-hour visit, the excess psychotherapy cost was estimated at $156.2 million.

The authors used a prevalence-based approach and estimated the excess burden of PTSD in 2018 from a societal perspective by comparing average costs for adults with PTSD versus adults without PTSD, or versus the general population when a non-PTSD comparison was unavailable. Direct health care costs for civilians came from IBM MarketScan Commercial, Medicare Supplemental, and Multi-State Medicaid databases, while military health care costs and direct nonhealth care and indirect costs were estimated from published literature, US Census data, and governmental sources. Cost components were weighted to reflect the 2018 US population and were calculated to be mutually exclusive.

The authors noted several limitations. PTSD case identification relied in part on documented diagnoses and ICD codes, which may miss undiagnosed cases and may misclassify some patients. Estimates for direct nonhealth care and indirect costs were limited by available literature, and making cost components mutually exclusive may have underestimated the true burden of some components. The PTSD prevalence estimates were based on a narrow definition that may have underestimated total burden, while some costs may have been overestimated if they reflected the trauma itself rather than PTSD. The study also combined multiple data sources with different methods, designs, and populations because no single data source captured all PTSD-related costs.

The study concluded that PTSD imposes a substantial economic burden that exceeds costs for anxiety and depressive disorders on a per-individual basis. The authors also stated that, because PTSD is relatively prevalent, its per-person costs translated into higher total excess costs than bipolar disorder or schizophrenia in their comparison framework. They further noted that PTSD incurred higher costs per individual than coronary heart disease and non-serious psychiatric mental illnesses, including anxiety and depressive disorders.