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Therapeutic and Economic Benefits of Service Dogs Versus Emotional Support Dogs for Veterans With PTSD
Joan T Richerson1, Todd H Wagner1, Thad Abrams1
1U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang).
Objective:
This work aimed to assess the therapeutic and economic benefits of service dogs versus emotional support dogs for veterans with posttraumatic stress disorder (PTSD).
Methods:
Veterans with PTSD (N=227) participating in a multicenter trial were randomly assigned to receive a service or emotional support dog; 181 veterans received a dog and were followed up for 18 months. Primary outcomes included overall functioning (assessed with World Health Organization Disability Assessment Scale II [WHODAS 2.0]) and quality of life (Veterans RAND 12-Item Health Survey [VR-12]). Secondary outcomes included PTSD symptoms (PTSD Checklist for DSM-5), suicidal ideation, depression, sleep quality, health care costs and utilization, medication adherence, employment, and productivity.
Results:
Participants paired with a dog had a mean±SD age of 50.6±13.6 years (range 22-79), and most were male (80%), White (66%), and non-Hispanic (91%). Adjusted linear mixed repeated-measures models indicated no difference between the two groups on WHODAS 2.0 or VR-12 scores. Participants with service dogs had a 3.7-point greater reduction in PTSD symptoms versus participants with emotional support dogs (p=0.036). No reduced health care utilization or cost was associated with receiving a service dog. Veterans with service dogs had an increase of 10 percentage points in antidepressant adherence compared with those with emotional support dogs (p<0.01).
Conclusions:
Both groups appeared to benefit from having a service or emotional support dog. No significant differences in improved functioning or quality of life were observed between the groups. Those in the service dog group had a greater reduction in PTSD symptoms and better antidepressant adherence, improvements that should be explored further.
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