Rates of post-traumatic stress disorder (PTSD) diagnoses have increased dramatically for Veterans in the United States. In fact, nearly 400,000 received a diagnosis between 2002–2015.
PTSD is associated with comorbid mental health conditions, decreased functioning and quality of life, unemployment, greater health care costs, and difficulty reintegrating into civilian society. And although antidepressant therapies and trauma-focused psychotherapies may improve PTSD symptoms for some, relief can be elusive for others.
Because PTSD can be a chronic and debilitating condition, combining new treatments with existing treatments may be a valuable strategy. One promising new approach is utilizing service and/or emotional support dogs.
Multiple studies have shown that dogs have beneficial effects on one’s mental health, quality of life, and well-being, especially trained service dogs who can improve PTSD symptoms and social functioning in Veterans. While service dogs are able to perform various tasks specific to assisting a Veteran with PTSD, the sole function of an emotional support dog is to provide comfort (a distinction that disqualifies them from accessing public buildings under the Americans with Disabilities Act).
Studies have yet to assess the therapeutic and economic benefits of service dogs versus emotional support dogs for veterans with PTSD.
New Evidence:
In January 2023, evaluators from the Partnered Evidence-based Policy Resource Center (PEPReC) published a novel paper titled “Therapeutic and Economic Benefits of Service Dogs Versus Emotional Support Dogs for Veterans With PTSD” in Psychiatric Services, a journal of the American Psychiatric Association. Authors studied whether providing a service dog versus an emotional support dog to Veterans diagnosed with PTSD improved overall functioning and quality of life over time. Additionally, they assessed PTSD symptoms, suicidal behavior and ideation, depression, sleep quality, anger, and economic outcomes
Methods:
Authors conducted a randomized clinical trial recruiting 181 Veterans diagnosed with PTSD from three Department of Veterans Affairs (VA) medical centers. The Veterans randomly received either a trained service dog or emotional support dog and were followed for 18 months.
Throughout the study, participants were assessed, either by phone or in person, for several therapeutic outcome measures, including health-related quality of life. They received questionnaires at screening, baseline, before pairing, and at a variety of points post-pairing.
Authors used a linear mixed repeated-measures model to determine changes over time between the service dog and emotional support dog groups. They also used panel models to examine whether treatment assignment was associated with VA health care utilization and costs, with analyses controlled for follow-up time. Work productivity and sensitivity analyses were also conducted.
Findings:
The authors found that both groups appeared to benefit from having a service or emotional support dog, but there were no significant differences in improved functioning or quality of life between the two. Service dogs did not appear to be superior to emotional support dogs in terms of costs, health care utilization, employment, or productivity outcomes. Though, those in the service dog group had a greater reduction in PTSD symptoms, better anti-depressant adherence, and tended to have a reduction in suicidal behavior and ideation compared with those paired with an emotional support dog.
Conclusion:
This study had several limitations. For example, participants were unable to be blind to dog type and there was no control group (i.e., Veterans with no dog) included because that would have created ethical and analytical challenges. The study results may not be generalizable to other populations (e.g., non-Veterans) either.
This study suggests that pairing Veterans with PTSD with service or emotional support dogs can complement existing evidence-based treatments, increase levels of treatment engagement, and reduce PTSD symptoms. Future work should examine the mechanisms by which a service or emotional support dog has an impact on patient functioning, such as by directly reducing PTSD symptoms or by improving treatment engagement or adherence.
PEPReC, within the Veterans Health Administration and funded in large part by the Quality Enhancement Research Initiative (QUERI), is a team of health economists, health services and public health researchers, statistical programmers, and policy analysts who engage policymakers to improve Veterans’ lives through evidence-driven innovations using advanced quantitative methods.
