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Untreated Vets: A “Gathering Storm” of PTSD/Depression

(PSYCHIATRIC TIMES) - Reports of 1 in 5 military service members returning from Iraq or Afghanistan with posttraumatic stress disorder (PTSD) and/or depression and rising suicide rates have led researchers and military leaders to warn civilian psychiatric care providers of a “gathering storm”1 headed their way.

A RAND Corporation study released in April found that 300,000 individuals—18.5% of US service members who have returned from Afghanistan and Iraq—report current symptoms of PTSD and/or depression.2

Since October 2001, about 1.6 million US troops have been deployed to Iraq and Afghanistan. Of those with PTSD/depression, most will not be treated within the Department of Defense (DoD) or the Department of Veterans Affairs (VA) systems, Thomas Insel, MD, director of NIMH, told the press at the annual meeting of the American Psychiatric Association (APA).

“In both the RAND report and what we are hearing from the VA is the prediction that most of those people, about 70%, will not seek treatment from the DoD or VA, so we are talking about a gathering storm for the civilian sector, for the public mental health system,” he said.

Psychologist Lisa Jaycox, PhD, a senior behavioral scientist with RAND, told Psychiatric Times that there is a need to track the whole population, including those who are not receiving care from the DoD or VA, because psychiatrists and psychologists are likely to encounter these individuals in their practices in coming years.

Jaycox, along with Terri Tanielian, codirector of RAND’s Center for Military Health Policy Research, led a group of 25 RAND researchers who conducted a large-scale survey to assess psychological and cognitive injuries of returning service members. This group also analyzed treatment services and barriers and determined individual and societal costs related to PTSD and traumatic brain injury (TBI).

RAND’s nongovernmental telephone survey involved 1965 service members and veterans from 24 communities across the United States. Post-stratification weighting was used so that results accurately reflected the entire deployed population.

“This is the first study that tries to look at the size of the problem now, across everybody who has been deployed,” Jaycox said. “We had all 4 branches of the military, and with Reservists and National Guard as well as active duty, and we were able to look at all those people who are back in the US . . . whether it is just 1 month back or back as much as 5 years.”

Researchers also identified the subgroups most at risk. “Army soldiers and Marines were more likely to report PTSD and depression than individuals from the Navy and Air Force; people who are not on active duty (Reservists and those who have separated or retired) were more likely to have problems than [those on] active duty. Women, enlisted personnel, and Hispanics were more likely to report more problems than their counterparts,” Jaycox added.

But the single best predictor of PTSD and depression, she said, was the number of combat trauma exposures (eg, friend seriously wounded or killed) while deployed. The number of exposures generally increases with multiple deployments.

Colonel Elspeth C. Ritchie, MD, MPH, consultant to the US Army Surgeon General confirmed, during an APA meeting lecture, that “the rates of anxiety and depression are rising with multiple deployments, ranging from 12% with first deployment to 27% with third deployment.”

“This [increase] is concerning to us,” she said, “because the backbone of the Army is our noncommissioned officers, and about a quarter of them have at least significant symptoms of PTSD.”

“Ask patients if they are soldiers,” she advised psychiatrists. “Don’t assume that every soldier is young and male. There are old ladies like me in the military.”

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