Study Shows Very High Rate of PTSD Among Veterans

Almost 40 percent of Iraq and Afghanistan veterans receiving health care from VA hospitals have one or more mental disorders.

A new study, published in the July 16 online edition of the American Journal of Public Health, reported this and other shocking news about the mental health of our veterans of the Middle East wars.

The study’s principal author, Dr. Karen H. Seal, an assistant professor of medicine and psychiatry at the University of California, San Francisco, had even more distressing news. She said:

When the definition is expanded to include diagnoses of mental health disorders or psychosocial behavioral problems such as homelessness, or both, 43 percent of these veterans received these diagnoses.

If previous history with Vietnam-era veterans is any guide, the burden of mental illness will follow these veterans for many years to come. The research reported on in this post seems to back this idea up.

The findings of the study and its implications are detailed under the following headings:

• How the study was conducted?
• What were the findings of the study?
• The incidence of mental illness among veterans is accelerating
• It can take years for Anxiety Disorders such as PTSD to develop
• What are the implications of the study?

How the study was conducted?

The health records of 289,328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from April 1, 2002 to April 1, 2008 were studied by researchers at the San Francisco Veterans Administration (VA) Medical Center and the University of California, San Francisco. This number accounts for about 40 percent of returning veterans.

Mark Kaplan, a professor of community health at the School of Community Health at Portland State University in Oregon, noted that the study only covers veterans who have received care at the VA, but there are many more with serious mental health problems that are either seeking care privately or not at all. He said,

This study adds to what we know about this population, however, that’s the veterans who seek care at the VA system. But if you look at the total population of veterans from all wars, there are one-third of all veterans who have these problems.

What were the findings of the study?

Well over a third of the returning veterans, 37 percent, received a diagnosis of having a mental disorder. Of these, the largest groups of diagnoses were:

• 22 percent: Post Traumatic Stress Disorder (PTSD)
• 17 percent: depression
• 7 percent: alcohol use disorder
• 3 percent: drug use disorder

Many veterans had several mental health problems. In fact, 29 percent of veterans with mental health issues were diagnosed with two different conditions, and 33 percent were diagnosed with three or more. Women were at higher risk for depression than were men, but men had over twice the risk for drug use disorders.

Active duty veterans younger than 25 years had higher rates of PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older than 40 years. Greater combat exposure was associated with higher risk for PTSD.

Veterans older than 40 with the National Guard or the Reserves were more likely to develop PTSD and substance abuse disorders than those under 25. Dr. Seal said a possible reason is that older reservists go to war from established civilian lives, with families and full-time jobs, making combat trauma potentially more difficult to absorb. She continued:

It’s the disparity between their lives at home, which they are settled in, and suddenly, without much training, being dropped into this situation.

The incidence of mental illness among veterans is accelerating

Dr. Seal states that, “What’s really striking is the dramatic acceleration in mental health diagnoses, particularly PTSD, after the beginning of the conflict in Iraq,”

The increase in mental illness diagnoses accelerated after the invasion of Iraq in 2003, the researchers found, increasing 4 to 7 times. Among the group of veterans who enrolled in veterans health services during the first three months of 2004, 15 percent received mental health diagnoses after one year. But after four years, the number had nearly doubled, to 27.5 percent.

Dr. Seal attributed the rising number of diagnoses to several factors: repeat deployments; the perilous and confusing nature of war in Iraq and Afghanistan, where there are no defined front lines; growing public awareness of PTSD; unsteady public support for the wars; and reduced troop morale. She said that “waning public support and lower morale among troops may predispose returning veterans to mental health problems, as occurred during the Vietnam era.”

It can take years for Anxiety Disorders such as PTSD to develop

Dr. Seal said often it takes more than a year for symptoms of PTSD to appear and diagnosis to be made. She said,

The longer we can work with a veteran in the system, the more likely there will be more diagnoses over time. It sometimes takes time, given the stigma associated with mental illness, before we are able to break through the barriers and have patients tell us what is happening.

This finding supports the recent move to extend VA benefits to five years of free health care, which allows VA doctors the time to detect and treat more mental illness in returning combat veterans, the researchers said.

Kaplan noted that it is not uncommon for problems such as PTSD to arise years, even decades, after service. “We don’t know the full emotional toll of the wars in Iraq and Afghanistan,” he said.

What are the implications of the study?

Dr. Seal believes that more resources are needed to deal with the problem of mental illness among returning veterans. She states that:

After the start of the Iraq War, there is a growing burden of mental illness, particularly post-traumatic stress disorder (PTSD), that will require increased allocation of resources for better detection and early intervention to prevent chronic mental illness, which threatens individual veterans, their families and communities.

Simon A. Rego, associate director of psychology training at Montefiore Medical Center in New York City, says,

An important and often overlooked finding here was that a lack of social support — being separated, divorced, widowed, etc.– may pose a serious risk for new post-deployment mental health problems.

Rego emphasizes that this underscores the need for social support services for returning veterans who are unmarried and/or without social support. He continues:

All too often we focus on treating the symptoms but fail to address the individual’s social context. Based on the data here, a failure to do so could lead to increased risk in developing new mental health problems.

What do you think?

I live in the city that is host to Fort Benning, one of the largest army installations in the world. There is a continual flow of new recruits coming in for training, combat-ready soldiers being deployed to Iraq and Afghanistan, and veterans returning from the wars. The health and well-being of these troops is a matter of no small concern to not only the Army, but to the entire community.

The results of the study reported on in this article are distressing to me for two reasons: I am shocked how many veterans are returning home, burdened by a load of mental woe and illness that will follow them the rest of their lives; and I cannot help but think of the millions of veterans of former wars whose mental disorders went undiagnosed, and whose lives were lived out in pain and frustration.

• Do you think that the dramatic rise in diagnoses of mental illness in veterans is due to better diagnostic techniques, or the increasing difficulties of the wars?
• Congress has increased the length of time a veteran can be treated by the VA to 5 years. Do you think it should be longer still given the long gestation of PTSD?

©2009 Michael L Nichols. All rights reserved.

Resources Used in This Post
Chong, Jia-Rui. (2009, July 16). Percentage of veterans with mental health problems jumps dramatically. Retrieved July 21, 2009 from Los Angeles Times web site: http://latimesblogs.latimes.com/booster_shots/2009/07/veterans-mental-health-veterans-affairs-study-.html
Dao, James. (2009, July 16). Vets’ Mental Health Diagnoses Rising. Retrieved July 21, 2009 from The New York Times web site: http://www.nytimes.com/2009/07/17/health/views/17vets.html?_r=1&ref=health
Grohol, John. (2009, July 18). Veterans’ Mental Health Concerns Rising. Retrieved July 21, 2009 from PsychCentral web site: http://psychcentral.com/news/2009/07/18/veterans-mental-health-concerns-rising/7199.html
Reinberg]]Reinberg, Steven. (2009, July 16). Many Veterans Need Mental Health Care. Retrieved July 21, 2009 from HealthScout web site: http://www.healthscout.com/news/1/629099/main.html
Seal, Karen; Metzler, Thomas; Gima, Kristian; Bertenthal, Daniel; Maguen, Shira; Marmar, Charles. (2009, July 16). Trends and Risk Factors for Mental Health Diagnoses Among Iraq and Afghanistan Veterans Using Department of Veterans Affairs Health Care, 2002-2008. Retrieved July 21, 2009 from American Journal of Public Health web site: http://www.ajph.org/cgi/content/abstract/AJPH.2008.150284v1