Fuchkan Buljan, Nika
(2015)
Burden of Posttraumatic Stress Disorder (PTSD) – health, social, and economic impacts of exposure to the London bombings.
PhD thesis, London School of Economics and Political Science.
Abstract
Background: Posttraumatic Stress Disorder (PTSD) is a common disorder that causes a significant health, social and economic burden for the individuals who suffer from it and consequently, for society as a whole. However, little is known about the consequences of PTSD, and in particular there is a lack of empirical data in relation to its economic impact on individuals and health systems, or on the treatments that might be provided.
Aims: The aim of this research is to assess the health, social, and economic impacts of PTSD by focusing on the individuals exposed to the London bombings by: a) reviewing the current evidence and measures of the health, social and economic impact of PTSD; b) assessing the impact of the London bombings in terms of service use and the impact on health, social, and economic activity of those affected; c) conducting an economic evaluation of the ‘screen and treat’ programme implemented as a mental health response after the
London bombings; and d) assessing the broader implications and feasibility of screening for PTSD in primary care.
Method: Semi-structured interviews with 230 participants, screen and treat programme users and potential users conducted as a part of the evaluation of the NHS mental health response to the London bombings, analysis of the dataset on the outcomes collected as a part of the programme, and semistructured interviews on the benefits of and barriers to implementing screening for PTSD in the primary care sector. Analysis: A range of quantitative and qualitative methods are conducted including: estimation of the costs associated with exposure to the London bombings, analysis of cost and outcome variation between individuals exposed
to the bombings, economic evaluation of the screen and treat programme distinguishing three comparator groups, and directed qualitative content analysis of fourteen interviews on the benefits of and barriers to screening for PTSD in primary care. Results: The higher prevalence of London bombing-related problems for
individuals who were not treated, even as long as two and a half years after the 9 bombings, confirms the benefits of long-term screening after exposure to traumatic events. Participants who used the screen and treat programme reported significantly higher average direct and total costs. The treated group reported up to three times higher total costs in comparison to individuals who were screened and assessed only, with work-related costs making the highest contribution to the total cost, followed by the programme itself, and then other health care costs. Similar service use patterns were found between the treated, and the screened and assessed only groups. The main cost drivers identified in the analysis for the full sample of individuals exposed to the London bombings were being of female gender, being in a non-white British ethnicity group, experiencing injury, old age, and feeling one might be killed and/or injured. The treated group consisted of individuals who were more severely affected by the London bombings when compared to the group who were screened and assessed only.
Conclusions: The effects of trauma exposure and PTSD have a wideranging and long-term health-related and economic impact on exposed individuals. The findings suggest that the screen and treat programme was
successful in identifying participants with greater mental health needs and providing them with treatment. Providing the best evidence-based treatment early in the form of the ‘screen and treat’ approach does not seem to be costeffective. However, without having a proper waiting list comparison group the questions on effectiveness and cost-effectiveness of the ST programme are difficult to answer with certainty. This study has pointed out vulnerable groups such as minority ethnic groups and women who are likely to experience worse outcomes and generate higher direct and indirect costs. There is a need for timely, rigorously-implemented economic evaluations of mental health interventions for PTSD. There is a role for non-RCT study designs in economic evaluations of PTSD interventions. There is also a need for economic evaluation
of screening for PTSD intervention in primary care.
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