Change of diagnosis of post-traumatic stress disorder related to compensation-seeking

To explore the change in the diagnosis of posttraumatic stress disorder (PTSD) related to the implementation of the new national regulation on compensation-seeking by war veterans in Croatia. The study included 225 compensation-seeking war veterans who were psychiatrically assessed and diagnosed on three different occasions. The first diagnosis was made by a local psychiatrist when a veteran sought psychiatric help for the first time. The second psychiatric diagnosis was established during the veteran's psychiatric treatment, and the third one was made by an independent expert team in charge of the psychiatric assessment for compensation purposes. The expert examination included structured diagnostic procedure and analysis of military service data. The diagnoses established on three different points were compared. There were significant differences between the diagnoses of mental disorders made at three different occasions in compensation-seeking war veterans. Six different diagnostic categories of mental disorders were confirmed. The diagnosis changed in 134 (59.5%) out of 225 veterans, mainly in the categories of PTSD and personality changes due to catastrophic experience, during their psychiatric treatment in the 2000-2002 period, when the new regulation for compensation was implemented. PTSD diagnosis remained unchanged at all three psychiatric assessments in only 7.5% of the veterans, whereas the diagnosis of a mental disorder remained unchanged in 37 (16.4%) veterans. Experts' confirmation of PTSD or PTSD comorbid with other mental disorders positively correlated with the number of hospitalizations. Inconsistencies in the diagnosis of PTSD could be related to the different diagnostic criteria and the course of illness. Psychiatric examination for compensation purposes should be independent and integrate all relevant data for making a complete assessment. Compensation-seeking policy, represented by new regulations, could be a source of bias in diagnostic outcome.