Persistent Serious Mental Illness Among Former Applicants for VA PTSD Disability Benefits and Long‐Term Outcomes: Symptoms, Functioning, and Employment

Millions of U.S. veterans have returned from military service with posttraumatic stress disorder (PTSD), for which a substantial number receive U.S. Department of Veterans Affairs (VA) disability benefits. Although PTSD is treatable, comorbid serious mental illness (defined here as schizophrenia, schizoaffective disorder, and bipolar spectrum disorders) could complicate these veterans’ recovery. Using VA administrative data, we examined the burden of persistent serious mental illness in a nationally representative cohort of 1,067 men and 1,513 women who applied for VA PTSD disability benefits between 1994 and 1998 and served during or after the Vietnam conflict. Self‐reported outcomes were restricted to the 713 men and 1,015 women who returned surveys at each of 3 collection points. More than 10.0% of men and 20.0% of women had persistent serious mental illness; of these, more than 80.0% also had persistent PTSD. On repeated measures modeling, those with persistent serious mental illness consistently reported more severe PTSD symptoms and poorer functioning in comparison to other participants (ps < .001); their employment rate did not exceed 21.0%. Interactions between persistent serious mental illness and PTSD were significant only for employment (p = .002). Persistent serious mental illness in this population was almost 2 to 19 times higher than in the general U.S. population. The implications of these findings are discussed. Resumen Spanish s by the Asociación Chilena de Estrés Traumático (ACET) Millones de veteranos en EE. UU. han regresado del servicio militar con trastorno por estrés postraumático (TEPT), para el cual un número sustancial recibe beneficios por discapacidad del Departamento de Asuntos de Veteranos (VA). Aunque el TEPT es tratable, la enfermedad mental grave comórbida podría complicar la recuperación de estos veteranos. Utilizando datos administrativos del VA, examinamos la carga de la enfermedad mental grave persistente en un cohorte nacionalmente representativo de 1.067 hombres y de 1.513 mujeres que solicitaron los beneficios de discapacidad por TEPT de la VA entre 1994 y 1998 y que prestaron servicios durante o después del conflicto de Vietnam. Los resultados auto‐reportados se limitaron a los 713 hombres y 1.015 mujeres que devolvieron encuestas en cada uno de los 3 puntos de recolección. Más del 10% de los hombres y el 20% de las mujeres tenían una enfermedad mental grave y persistente; de éstos, más del 80% también tenían TEPT p