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Post-traumatic stress disorder (PTSD) stands out as a major mental illness; however, little is known about effective policies for mitigating the problem. The importance and complexity of PTSD raise critical questions: What are the trends in the population of PTSD patients among military personnel and veterans in the postwar era? What policies can help mitigate PTSD? To address these questions, we developed a system dynamics simulation model of the population of military personnel and veterans affected by PTSD. The model includes both military personnel and veterans in a "system of systems." This is a novel aspect of our model, since many policies implemented at the military level will potentially influence (and may have side effects on) veterans and the Department of Veterans Affairs. The model is first validated by replicating the historical data on PTSD prevalence among military personnel and veterans from 2000 to 2014 (datasets from the Department of Defense, the Institute of Medicine, the Department of Veterans Affairs, and other sources). The model is then used for health policy analysis. Our results show that, in an optimistic scenario based on the status quo of deployment to intense/combat zones, estimated PTSD prevalence among veterans will be at least 10% during the next decade. The model postulates that during wars, resiliency-related policies are the most effective for decreasing PTSD. In a postwar period, current health policy interventions (e.g., screening and treatment) have marginal effects on mitigating the problem of PTSD, that is, the current screening and treatment policies must be revolutionized to have any noticeable effect. Furthermore, the simulation results show that it takes a long time, on the order of 40 years, to mitigate the psychiatric consequences of a war. Policy and financial implications of the findings are discussed.

We developed and simulated a systems model of the population of military personnel and veterans affected by post-traumatic stress disorder (PTSD). Simulation results fit the historical data on PTSD prevalence in 2000-2014, and forecast the trends for the next decade under several scenarios of US involvement in future wars. Using the model, we tested the effects on PTSD prevalence and healthcare costs of four PTSD policies aimed at improving: 1) resiliency, 2) screening, 3) treatment, and 4) a combination of the three. Results showed that in a postwar period, there is no silver bullet for overcoming the problems of PTSD, and screening and treatment policies must be revolutionized to have any noticeable effect. One critical characteristic of this system is the long time that it takes, about 40 years, to vanquish the psychiatric consequences of a war. In a very optimistic scenario, estimated PTSD prevalence among veterans in 2025 will be at least 10%. ; Department of Defense

Post-traumatic stress disorder (PTSD) stands out as a major mental illness; however, little is known about effective policies for mitigating the problem. The importance and complexity of PTSD raise critical questions: What are the trends in the population of PTSD patients among military personnel and veterans in the postwar era? What policies can help mitigate PTSD? To address these questions, we developed a system dynamics simulation model of the population of military personnel and veterans affected by PTSD. The model includes both military personnel and veterans in a "system of systems." This is a novel aspect of our model, since many policies implemented at the military level will potentially influence (and may have side effects on) veterans and the Department of Veterans Affairs. The model is first validated by replicating the historical data on PTSD prevalence among military personnel and veterans from 2000 to 2014 (datasets from the Department of Defense, the Institute of Medicine, the Department of Veterans Affairs, and other sources). The model is then used for health policy analysis. Our results show that, in an optimistic scenario based on the status quo of deployment to intense/combat zones, estimated PTSD prevalence among veterans will be at least 10% during the next decade. The model postulates that during wars, resiliency-related policies are the most effective for decreasing PTSD. In a postwar period, current health policy interventions (e.g., screening and treatment) have marginal effects on mitigating the problem of PTSD, that is, the current screening and treatment policies must be revolutionized to have any noticeable effect. Furthermore, the simulation results show that it takes a long time, on the order of 40 years, to mitigate the psychiatric consequences of a war. Policy and financial implications of the findings are discussed. ; United States. Dept. of Defense. Office of the Assistant Secretary of Defense for Health Affairs (W81XWH-12-0016)

Systems modelling of health issues enriches analysis of health care policies by exploring interdependencies among system components. Considering a wide range of stakeholder behavior is a requisite for developing a useful model. Our paper shows how to systematically identify stakeholder behavior, formulate them in a model and test their impact on health outcomes. Stakeholder behavior are explained in the context of a simulation‐based analysis of infant mortality in Ohio. Using group model building techniques, we identify three levels of stakeholder behavior—individual, organizational and policy behaviors—and discuss how these behaviors are reflected in the model formulation and drive the key health outcomes. Specifically, we show how individual and policy behaviors are formulated to examine their influence on the impact of progesterone therapy—one of the interventions identified in the group model building session—on infant mortality. We conclude with recommendations for incorporating diverse stakeholder perspectives in systems modelling of health issues. © 2018 John Wiley & Sons, Ltd.