Effectiveness and cost of the inpatient treatment of posttraumatic stress disorder: comparison of three models of treatment

Am J Psychiatry. 1997 Jun;154(6):758-65. doi: 10.1176/ajp.154.6.758.


Objective: This study compared the outcomes and costs of three models of Department of Veterans Affairs (VA) inpatient treatment for posttraumatic stress disorder (PTSD): 1) long-stay specialized inpatient PTSD units, 2) short-stay specialized evaluation and brief-treatment PTSD units, and 3) nonspecialized general psychiatric units.

Method: Data were drawn from 785 Vietnam veterans undergoing treatment at 10 programs across the country. The veterans were followed up at 4-month intervals for 1 year after discharge. Successful data collection averaged 66.1% across the three follow-up intervals.

Results: All models demonstrated improvement at the time of discharge, but during follow-up symptoms and social functioning rebounded toward admission levels, especially among participants who had been treated in long-stay PTSD units. Veterans in the short-stay PTSD units and in the general psychiatric units showed significantly more improvement during follow-up than veterans in the long-stay PTSD units. Greatest satisfaction with their programs was reported by veterans in the short-stay PTSD units. Finally, the long-stay PTSD units proved to be 82.4% and 53.5% more expensive over 1 year than the short-stay PTSD units and general psychiatric units, respectively.

Conclusions: The paucity of evidence of sustained improvement from costly long-stay specialized inpatient PTSD programs and the indication of high satisfaction and sustained improvement in the far less costly short-stay specialized evaluation and brief-treatment PTSD programs suggest that systematic restructuring of VA inpatient PTSD treatment could result in delivery of effective services to larger numbers of veterans.

MeSH terms

  • Attitude to Health
  • Delivery of Health Care / economics
  • Follow-Up Studies
  • Health Care Costs
  • Hospitalization / economics*
  • Hospitals, Veterans / economics
  • Humans
  • Length of Stay
  • Male
  • Mental Disorders / psychology
  • Mental Disorders / therapy
  • Middle Aged
  • Psychiatric Department, Hospital / economics
  • Psychiatric Status Rating Scales
  • Severity of Illness Index
  • Social Environment
  • Stress Disorders, Post-Traumatic / economics
  • Stress Disorders, Post-Traumatic / psychology
  • Stress Disorders, Post-Traumatic / therapy*
  • Treatment Outcome