Yu-Chu Shen

For years, microeconomist Yu-Chu Shen worked on calculating costs around different health insurance scenarios. At the Urban Institute’s Health Policy Center in Washington, D.C., she analyzed costs associated with expanding Medicaid. She began teaching at the Naval Postgraduate School in 2004, and her work soon took off in a new direction, transitioning from civilian to military health economics. She tackled the question: What are the economic effects of PTSD?

Shen found an enormous body of data to mine from existing Army records called Global Assessment Tools, a survey all incoming recruits fill out before deployment. She and her team analyzed responses from 63,186 U.S. Army recruits who enlisted between 2009 and 2012. They also looked at whether a soldier screened positive for depression and PTSD upon returning.

The conclusions, published in the Oct. 5 issue of BMC Psychology, represent a potential game-changer for how the military approaches PTSD – by screening for risk up front, maybe they can prevent the most at-risk soldiers from developing it to begin with.

“A set of validated, self-reported questions administered early in a soldier’s career can predict future mental health problems,” Shen writes. The idea is that by evaluating how new recruits score in categories like hope, optimism and confidence, military officials would be able to better place them in particular jobs that keep them healthy for the long term – which is good for the soldiers, and good for the Department of Defense.

Weekly: Tell me how you got started on the topic of PTSD.

Shen: I had a student who was an Army soldier. He was very good the first quarter, and then in the fourth quarter, he changed. He was very mellow, he talked slowly. He told me he was on a medication for PTSD. His wife is diagnosed with major depression. It takes a toll not just on the unit, but the family. He approached me, and he was interested in studying PTSD.

From an economist’s perspective, we know it’s very costly. When we think about a cost-benefit effect analysis, there are costs you can try to monetize, in terms of, how much is the psychological cost of war? If they can’t do their job, you have to find a replacement; a platoon is a platoon. It’s opportunity cost: If you’re a healthy solider, your productivity goes up.

The idea that the military might analyze information it’s already collecting and pre-screen for PTSD risk seems like it has potentially massive implications. Your study points out rates of PTSD among people who served in Iraq and Afghanistan are as high as 45 percent. What are the potential applications?

Some people might appreciate an early warning so they can understand, “This is who I am.”

I could see how it could backfire, if you tell someone who wants to join the military, “I don’t think you’d be good for combat, because your chance of PTSD is higher than the rest.”

There are a lot of non-combat jobs in all divisions. The way I think about it is that there’s got to be a way you can package this type of screening information with a final result of encouraging people to get the right fit. It’s not just for the military, but a lot of high-stress environments like fire and police departments.

Are there concerns about whether it’s appropriate to screen everybody for a potential psychological outcome?

There’s this vogue word, Big Data. It reminds me of the movie Minority Report. I don’t want to get into that type of world. It’s rather: Here’s something you can educate the person to be aware of – his strength is this, but not that – or through leadership and planning, what’s the best way to allocate resources and talent?

I think about my classes: There are weaker students and there are students that I never have to worry about. The weaker students, we give them more help. That’s how I would think about how to utilize this kind of information.

The work here seems to strive to be apolitical. Is that possible with your research?

People think of NPS as robots, climate research, hard science. The Graduate School of Business and Public Policy is all about studying human behavior. A lot of what I do is about understanding behaviors – risk factors for mental health problems that are very costly.

The student who had PTSD and got you started in this line of work – how is he doing?

His follow-up job was in the Pentagon. He’s like, “I just got staffed in a basement doing numbers.” He’s very good with numbers.