Which symptoms of PTSD do the most damage?

In the case of post-traumatic stress disorder, not all symptoms are created equal.

In an effort to better treat PTSD, a study published March 1 in the journal Psychiatric Services is the first to examine which problems associated with PTSD actually correspond to lower quality of life, as indicated by the patient's willingness to die sooner or to risk life-threatening treatment to relieve their symptoms.

PTSD is more costly than any other anxiety disorder. As many as 300,000 veterans returning from Iraq and Afghanistan currently have PTSD, with costs for their care estimated at $4 to $6.2 billion over the next two years.

'To our knowledge, this is the first study to ask actual patients with PTSD about their health preferences,' said lead author Jason Doctor, associate professor of Pharmaceutical Economics and Policy at the USC School of Pharmacy. 'These findings identify targets for treatment that may improve quality of life among people with PTSD.'

The researchers found that, of four major symptoms associated with PTSD, not all were associated with a patient's immediate quality of life, even though those who sought treatment for PTSD expressed significant overall declines in mental health.

Distressing recollections of a traumatic event and avoidance of certain activities and thoughts - both commonly conceived of as dysfunctional behaviours - had little correlation to a patient's reported sense of well-being, according to the study.

However, symptoms tied to heightened arousal - such as trouble sleeping, irritability and vigilance - were associated with lower quality of life among PTSD patients. Anxiety and depression were also associated with lower quality of life.

'We conjecture that although avoidance is an important aspect of PTSD, its effect on quality of life may be limited because it is a coping strategy. Avoidance may be a dysfunction that improves, in the short term, subjective well-being,' explained Doctor, who is on the research faculty of the Schaeffer Centre for Health Policy and Economics at USC.

The researchers found that, on average, a patient with PTSD was willing to give up 13.6 years of his or her life to live unburdened by the symptoms of the disorder.

On average, those with PTSD were willing to accept a treatment with up to a 13 percent chance of immediate death in order to achieve total relief of PTSD symptoms.

Lori Zoellner of the University of Washington, Seattle, and Norah Feeny of Case Western Reserve University were co-authors of the study.

The researchers interviewed 184 persons seeking treatment for PTSD at two treatment sites in different regions of the United States. The research was funded by the National Institute of Mental Health.