New analysis reveals hidden economic burden of PTSD in the UK

The annual UK cost of the mental health disorder PTSD is likely to top £40 billion, but the figures are based on 2020-1 prevalence rates-the most recently available-and don't include many indirect costs, such as family support services, finds a cost analysis published in the open access journal BMJ Open.

The societal and financial impacts of this increasingly common condition have been "gravely" undervalued, conclude the researchers. 

Post-traumatic stress disorder, more commonly referred to as PTSD, usually develops after witnessing or experiencing a traumatic event or being subjected to a more systematic pattern of trauma or abuse, explain the researchers. 

Those experiencing physical violence, life-threatening injury, sexual abuse, active military combat, first responders and aid workers in humanitarian disasters may all be at risk.

Yet, despite an anticipated rise in cases of 77,000 a year, primarily due to the COVID-19 pandemic, PTSD continues to be misunderstood, stigmatised, and often misdiagnosed, say the researchers. Evaluating its economic toll is therefore crucial to inform policymakers about the importance of PTSD and the provision of care, they add.

They calculated an overall lifetime prevalence of around 4% for 2020-21-equivalent to 6,665,000 people who are expected to develop PTSD at some point in their life-from available military and civilian data. 

And they searched databases for all types of quantitative studies evaluating the economic and societal costs associated with PTSD, published in English between 1990 and 2023.

Five studies involving millions of people were eligible for the analysis. From these they extracted and pooled direct cost components: hospital stays; drug treatment; family doctor (GP) and specialist (psychiatrist) time; treatment for alcohol and/or substance misuse; costs of counsellors and psychologists.

Similarly, they extracted and pooled indirect cost components: homelessness; disability living allowance; unemployment allowance; lost productivity at work (absenteeism and presenteeism); domiciliary care; social worker costs (mental health); and premature death.

At 2020-1 prices, they estimated the annual average direct excess costs for a patient with PTSD in the UK to be around £1,118, and the annual average indirect costs to be around £13,663, adding up to a total of £14,781, but ranging from around £11,373 to £16,797. 

Based on the prevalence figures for 2020-1, this comes to more than £40 billion a year, they calculate.

The researchers acknowledge that PTSD is often present with other mental health conditions, and disentangling the costs due to PTSD alone is difficult. The severity of the condition (and therefore associated treatment costs) also varies.

"Certain costs are hard to measure, such as stigma and discrimination, for which we have provided only a qualitative analysis. These in turn may lead to indirect costs, such as reduced income and higher dependence on social security assistance," they write. 

But they say: "Recognising the hidden costs of PTSD (eg, in criminal justice, family support services and education) for which we were unable to provide estimates, suggests the actual economic burden is higher than estimated here," adding: "we are gravely underquantifying the cost of this increasingly prevalent condition."

They suggest: "The UK would do well to consider the need for the collection of high-quality cost data to more accurately assess the different costs associated with this condition. These include the involvement of individuals affected by PTSD in criminal activities, the stigma and discrimination they face, leading to social exclusion, the impact on personal relationships, and the effect on education, potentially limiting future opportunities."

And they conclude that their findings underscore: "the need for increased awareness of PTSD, the development of more effective therapies, and the expansion of evidence-based interventions to alleviate the substantial disease and economic burden of PTSD in the UK."