MILITARY-RELATED PTSD, CURRENT DISABILITY POLICIES, AND MALINGERING/FRUEH ET AL. RESPOND

Frueh et al.1 argued that longstanding Department of Veterans Affairs (VA) disability policies for posttraumatic stress disorder (PTSD) reward illness behavior, diminish engagement in treatment, and perversely promote chronic disability. In particular, they fail to cite studies showing that: (1) rat...

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Bibliographic Details
Published in:American journal of public health (1971) 2008-05, Vol.98 (5), p.773
Main Authors: Marx, Brian P, Miller, Mark W, Sloan, Denise M, Litz, Brett T, Kaloupek, Danny G, Keane, Terence M, Frueh, B Christopher, Buckley, Todd C, Grubaugh, Anouk L, Elhai, Jon D
Format: Article
Language:English
Subjects:
Accountability
Behavior
Clinical outcomes
Comorbidity
Compensation
Disability
Editors
Health care
Health hazards
Health services
Iraq War-2003
Mental disorders
Mental health
Mental health care
Post traumatic stress disorder
Psychological tests
Psychology
Public health
Veterans
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Summary:Frueh et al.1 argued that longstanding Department of Veterans Affairs (VA) disability policies for posttraumatic stress disorder (PTSD) reward illness behavior, diminish engagement in treatment, and perversely promote chronic disability. In particular, they fail to cite studies showing that: (1) rates of mental health service use increase among veterans who receive VA disability benefits for military-related PTSD,2 (2) medical and mental health service use increases after filing a disability claim compared with the preapplication period,3 (3) engagement with mental health services is sustained after claim determination for veterans whose disability-related claims are approved,3,4 and (4) treatment outcomes are comparable between outpatient veterans who seek or receive disability compensation relative to those who do not.5,6 Selective coverage also is reflected in the Frueh et al. presentation of issues concerning malingering. The highly influential study by Dohrenwend et al. cited by Frueh et al. also presented minimal evidence of attempts to inflate disability claims.7 Furthermore, their suggestion that 53% of treatment-seeking (especially compensationseeking) veterans exaggerate symptoms or malinger on psychological tests is based on a small sample drawn from a clinical setting.8 The evidence is further limited by reliance on a measure of malingering that has not been validated in relation to assessment of PTSD outside a forensic setting. Brian P. Marx, PhD Mark W. Miller, PhD Denise M. Sloan, PhD Brett T. Litz, PhD Danny G. Kaloupek, PhD Terence M. Keane, PhD About the Authors The authors are with the National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, MA, and Boston University School of Medicine, Boston.
ISSN:0090-0036