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Post-traumatic stress disorder (PTSD) is a mental health condition that can occur as a result of experiencing or witnessing a traumatic event. Events that trigger PTSD can include: combat exposure; physical or sexual assault (either as a child or an adult); accidents and natural disasters; or intentional destruction, such as terrorism. It's common to experience some stress-related reactions after a traumatic event, but reactions and behaviors that do not go away (or begin to disrupt daily life) may be signs of PTSD. And while PTSD can happen to anyone exposed to a traumatic event, it disproportionately impacts our nation's Veterans. It's currently estimated that approximately 400,000 Veterans enrolled in VA care carry a PTSD diagnosis. 1
Because PTSD has such a large impact on Veterans, research that focuses on addressing the detection and delivery of care for the condition is critical. Investigators working within VA's Health Services Research & Development Service (HSR&D) conduct studies that look at the quality, efficacy, and delivery of services to Veterans diagnosed with PTSD. These studies range from novel concepts such as alternative medicine, to furthering the understanding of why certain individuals are more or less susceptible to PTSD. Some of the recent investigations within VA HSR&D include:
Completed in 2010, this study, led by Dr. Jill Bormann of the VA San Diego Healthcare System, looked at whether an intervention of frequently repeating a mantram—a word or phrase with spiritual associations—would help manage symptom severity, psychological distress, and improve quality of life in combat Veterans with PTSD. The study took place over a four-year period and enrolled a total of 136 Veterans (66 in the mantram group, 70 in the control.) Results showed that mantram repetition therapy could be a beneficial complement to usual care in mitigating chronic PTSD symptoms in Veterans with military-related trauma, particularly those with fear of mental illness-related stigma. In this video, Dr. Bormann discusses mantram repetition and the work conducted in the study.
Military sexual trauma (MST) characterizes a range of experiences for which VA provides universal screening. For those with a positive MST screen, PTSD is one of the most frequently diagnosed mental health conditions. It is therefore critical that front-line clinicians have screening tools that are valid and effective in identifying PTSD and/or an underlying MST experience. In this video, Dr. Rachel Kimerling describes her work evaluating the screening tools and mechanisms VA uses to identify bothMST and PTSD in Veterans.
Concluded in 2012, this study sought to better understand risk and resilience factors in a group of approximately 2,500 Marines bound for deployment to Iraq and Afghanistan. Comprised of three interrelated projects, the study's primary goal was to identify individual, social, and deployment factors that may predict mental health responses (ranging from enduring resilience to chronic PTSD) to combat trauma. The study integrated and analyzed data from two other concurrent projects: one that collected data such as startle thresholds, reactivity, habituation, sensorimotor gating, heart rate variability; and another in which autonomic/cardiovascular physiology were assessed via sample collection of saliva, blood, and urine. Study results showed that there exists the potential to reduce future rates of chronic PTSD by providing answers about specific vulnerability factors that might be modified by improved training methods or early intervention, and by providing scientific information to support the rational application of secondary prevention and tertiary treatment strategies.
Funded through VA/HSR&D's Polytrauma and Blast-Related Injuries Quality Enhancement Research Initiative (PT/BRI-QUERI), this study sought to determine the prevalence of traumatic brain injury (TBI), PTSD, and pain (referred to as the "polytrauma triad") among Veterans from the OEF/OIF/OND wars, who received VA healthcare. Using VA data, investigators identified all OEF/OIF/OND Veterans who accessed VA care at least once from FY09 through FY11 (n=613,391). Because VA requires that all Veterans returning from Iraq and/or Afghanistan be screened for deployment-related TBI, as well as PTSD, investigators also identified a subset of Veterans who were diagnosed with TBI, PTSD, and/or common head, neck, or back pain. Findings show that large and increasing numbers of OEF/OIF/OND Veterans accessed the VA healthcare system over the three-year study period. Of these Veterans, about 10% (n=58,885) were diagnosed with TBI, 30% (n=179,723) with PTSD, and 40% (n=246,883) with pain. Approximately 6% (n=36,800) had all three diagnoses — or the polytrauma triad.
Overall, while the absolute number of OEF/OIF/OND Veterans increased by more than 40% from FY09 through FY11, the relative proportion of Veterans diagnosed with TBI, and the high rate of comorbid PTSD and pain in this population have remained stable.
Cifu D, Taylor B, Carne W, et al.TBI, PTSD, and Pain Diagnoses in OEF/OIF/OND Veterans. Journal of Rehabilitation Research & Development January 2014;50(9):1169-76.
This HSR&D study sought to determine whether beliefs about mental health treatment and/or social encouragement to seek treatment influence initiation of mental healthcare among Veterans with PTSD. Using VA data, investigators identified 7,645 Veterans recently diagnosed with PTSD (between 6/08 and 7/09) who were not receiving VA mental healthcare. Within two weeks of a diagnosis of PTSD by a VA clinician, Veterans were sent a survey that assessed: PTSD severity, mental health quality of life, anticipated access barriers, treatment-related beliefs, and whether VA healthcare users received encouragement from those in their social network to seek care. Findings show that whether Veterans initiate mental healthcare after a PTSD diagnosis depends not only on symptom severity and access to treatment, but also on encouragement by those in their social network, whether the Veteran perceives the need for treatment, how they view treatment for PTSD (e.g., positive beliefs about the efficacy of antidepressants), as well as their ability to follow treatment recommendations. Moreover, encouragement to get mental healthcare by individuals in their social network increased the odds of getting treatment, even after controlling for beliefs, particularly if encouragement was given by both family and friends/other Veterans.
Spoont M, Nelson D, Murdoch M, et al. Impact of beliefs and social facilitation on mental health care initiation among VA service users with PTSD. Psychiatric Services. May 2014;65(5):654-662.
