Patient journey before and after a formal post-traumatic stress disorder diagnosis in adults in the United States – a retrospective claims study

Figures & data

Figure 1. Study design. AA, atypical antipsychotic; PTSD, post-traumatic stress disorder; SNRI, serotonin-norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor.

Table 1. Patient characteristics.

	Overall N = 26,306	Patients treated with AAs N = 9,295	Patients not treated with AAs N = 17,011	Standardized differences^a
Demographic characteristics
Age, mean ± SD [median]	39.5 ± 13.6 [40.0]	38.4 ± 13.9 [39.0]	40.1 ± 13.4 [41.0]	0.12
Female, n (%)	19,273 (73.3)	6,757 (72.7)	12,516(73.6)	0.02
Health plan type, n (%)
Preferred provider organization	13,549 (51.5)	4,887 (52.6)	8,662 (50.9)	0.03
Home maintenance organization	3,877 (14.7)	1,255 (13.5)	2,622 (15.4)	0.05
Consumer driven health plan	3,237 (12.3)	1,165 (12.5)	2,072 (12.2)	0.01
High deductible health plan	2,083 (7.9)	710 (7.6)	1,373 (8.1)	0.02
Point of service, no capitation	1,563 (5.9)	541 (5.8)	1,022 (6.0)	0.01
Comprehensive	1,336 (5.1)	482 (5.2)	854 (5.0)	0.01
Unknown	397 (1.5)	146 (1.6)	251 (1.5)	0.01
Point of service, partially or fully capitated	154 (0.6)	59 (0.6)	95 (0.6)	0.01
Exclusive provider organization	110 (0.4)	50 (0.5)	60 (0.4)	0.03
Region of residence, n (%)
South	11,065 (42.1)	4,061 (43.7)	7,004 (41.2)	0.05
Midwest	6,227 (23.7)	2,167 (23.3)	4,060 (23.9)	0.01
West	4,768 (18.1)	1,575 (16.9)	3,193 (18.8)	0.05
Northeast	4,163 (15.8)	1,460 (15.7)	2,703 (15.9)	0.00
Unknown	83 (0.3)	32 (0.3)	51 (0.3)	0.01
Clinical characteristics
Frequent psychiatric comorbidities at diagnosis, n (%)
Depression	10,684 (40.6)	4,301 (46.3)	6,383 (37.5)	0.18
Anxiety disorders	7,913 (30.1)	3,043 (32.7)	4,870 (28.6)	0.09
Bipolar disorder	1,949 (7.4)	1,536 (16.5)	413 (2.4)	0.54
Substance use/abuse	1,954 (7.4)	1,153 (12.4)	801 (4.7)	0.28
Suicidal thoughts or actions	683 (2.6)	435 (4.7)	248 (1.5)	0.19
First PTSD-related pharmacological treatments received in the post-diagnosis period, n (%)
SSRI	17,729 (67.4)	4,316 (46.4)	13,413 (78.8)	0.71
AA	6,148 (23.4)	6,148 (66.1)	0 (0.0)	1.98
SNRI	5,934 (22.6)	1,994 (21.5)	3,940 (23.2)	0.04
Combination of SSRI, SNRI, and/or AA	3,407 (13.0)	3,065 (33.0)	342 (2.0)	0.89
Augmenting agents included in treatment regimen	19,630 (74.6)	7,779 (83.7)	11,851 (69.7)	0.34
Benzodiazepines	7,550 (28.7)	2,870 (30.9)	4,680 (27.5)	0.07
Anticonvulsants	7,056 (26.8)	3,475 (37.4)	3,581 (21.1)	0.37
Serotonin modulators	5,461 (20.8)	2,349 (25.3)	3,112 (18.3)	0.17
Antidepressants	5,917 (22.5)	2,416 (26.0)	3,501 (20.6)	0.13
Antianxiety agents	5,250 (20.0)	2,269 (24.4)	2,981 (17.5)	0.17
Antihypertensives	3,496 (13.3)	1,709 (18.4)	1,787 (10.5)	0.23
Number of PTSD-related treatments during the post-diagnosis period, mean ± SD [median]	1.8 ± 1.1 [1.0]	2.7 ± 1.3 [2.0]	1.3 ± 0.6 [1.0]	1.35
Number of augmenting agents during the post-diagnosis period, mean ± SD [median]	2.9 ± 2.5 [2.0]	4.1 ± 2.8 [4.0]	2.3 ± 2.0 [2.0]	0.77

AA, atypical antipsychotic; PTSD, post-traumatic stress disorder; SD, standard deviation; SNRI, serotonin-norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor.

^aStandardized differences between patients treated with AAs and patients not treated with AAs; values ≥0.10 are considered important differences.

Figure 2. PTSD-related symptoms and frequent psychiatric comorbidities pre- and post-PTSD diagnosis in the overall sample¹. AA, atypical antipsychotic; DX, diagnosis; PTSD, post-traumatic stress disorder. ¹Statistical comparisons were conducted for 0–6 vs 18–24 months post-diagnosis using Chi-square tests; all comparisons were statistically significant (p < 0.001).

Figure 3. Proportions of patients with selected PTSD comorbidities at 0–6 months and 18–24 months post-PTSD diagnosis in the overall sample and subgroups¹. AA, atypical antipsychotic; DX, diagnosis; PTSD, post-traumatic stress disorder. ¹ Statistical comparisons were conducted for 0–6 vs 18–24 months post-diagnosis using Chi-square tests, separately for the overall sample, the patients treated with AAs subgroup, and the patients not treated with AAs subgroup; all comparisons were statistically significant (p < 0.001).

Figure 4. Treatments received pre- and post-PTSD diagnosis¹. AA, atypical antipsychotic; PTSD, post-traumatic stress disorder; SNRI, serotonin-norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor. ¹ Statistical comparisons were conducted for 0–6 vs 18–24 months post-diagnosis using Wilcoxon’s signed rank tests, separately for the overall sample, the patients treated with AAs subgroup, and the patients not treated with AAs subgroup; all comparisons were statistically significant (p < 0.001).

Figure 5. HRU and healthcare costs pre- and post-PTSD diagnosis¹. AA, atypical antipsychotic; DX, diagnosis; USD, United States Dollar. ¹ Statistical comparisons were conducted for 0–6 vs 18–24 months post-diagnosis using Wilcoxon’s signed rank tests, separately for the overall sample, the patients treated with AAs subgroup, and the patients not treated with AAs subgroup; all comparisons were statistically significant (p < 0.001).

Data availability statement

The data that support the findings of this study are available from IBM. Restrictions apply to the availability of these data, which were used under license for this study. Requests for data should be made directly to IBM.