Neal et al (Reference Neal, Green and Turner2004) recently found no association between post-traumatic stress and judgement of disability. Therefore, they concluded that the clinical importance of post-traumatic stress disorder (PTSD) and its symptoms may be questionable. However, in our opinion their conclusions need additional consideration.
First, their multivariate analysis of variance compared the degree of disability of persons with PTSD with that of people with other mental health problems. From their results they could only conclude that PTSD caused no additional disability compared with other mental health problems. Moreover, from a statistical point of view, the sample size is not sufficiently large, especially when one tries to find differences between groups given the significance level used (P=0.01). In addition, the authors do not give insight in the multicollinearity between the independent variables of the multiple regression analysis; the expected high intercorrelations may have influenced the results.
Second, is it not strange to question disability in people with PTSD, major depressive disorder or alcohol dependence, while disability in social or professional functioning or in other important areas is a requirement for all DSM-IV diagnoses? Also, the authors took subjective judgement of disability as their main outcome measure and not objective measures of disability, such as the number of days not at work.
Third, previous studies found contrasting results. Brown et al (Reference Brown, Schulberg and Madonia1996) and Lydiard (Reference Lydiard1991) report that major depressive disorder comorbid with anxiety disorders (i.e. PTSD) is more severe than major depressive disorder alone in terms of depressive symptoms, course of illness and treatment response. Finally, even if PTSD does not cause additional disability above major depression, the diagnosis is still relevant for the correct choice of treatment.
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