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War Vets Suffer Intensified Mental Distress Over Time, Study Finds

November 14, 2007 at 6:20 PM EDT

JIM LEHRER: Now, the latest on post-traumatic stress disorder among veterans. Jeffrey Brown has our update.

JEFFREY BROWN: A new report out today underscores the degree to which veterans returning from Iraq show symptoms of poor mental health. The study, published in the Journal of the American Medical Association, looked at screenings done of military personnel over the course of six months after they return from the combat zone.

It found that one-in-five active-duty soldiers needed mental health care. For reservists, the numbers were even higher: Two out of five needed treatment.

For more, we turn to our health correspondent, Susan Dentzer. The Health Unit is a partnership with the Robert Wood Johnson Foundation.

Susan, so this was an attempt to study soldiers at different times over the period when they first come back?

SUSAN DENTZER, NewsHour Health Correspondent: Yes. In effect, Jeff, the military’s attempts to tease out what’s going on with mental health issues in combat veterans has evolved over the course of the Iraq war. Shortly after the start of the war, the military added a mental health screening component to a normal health screening that is done one month after people return from combat.

JEFFREY BROWN: So very soon after?

SUSAN DENTZER: Very soon after they return. Just last year, the Army went in and added an additional screening test that is done three to six months after people return.

And the effort was really to determine whether there are other issues that surface after people have been back for a while. And the answer that the study basically says is, yes, there are, that, in effect, what happened was that the rate at which people not only reported symptoms of depression or post-traumatic stress disorder — and clinicians actually verified that those symptoms probably were real and needed to be investigated — and actually were referred to treatment, that all of that happened at about a two to three times higher rate in the second screening that was done three to six months after returning from deployment versus what happened in the first screening.

JEFFREY BROWN: Is it known why, why the numbers were so much higher later than at that initial one-month screening?

SUSAN DENTZER: The study doesn’t answer that, and we don’t really know, but one can speculate. For example, one can speculate that rather young, mostly male soldiers when they return are so happy to be back that, for the first month, they’re really focusing on being home, rejoining the family, and everything else, and that really it’s only over a matter of time that things begin to surface.

Another, though, very important intervention that the Army has introduced is something called Battlemind. And you can actually, as a civilian, access this by going to and see a training tool that actually helps soldiers and others understand combat stress issues before they deploy, while they’re in the field, and after they deploy.

And we also — the researchers, I should say, also surmise that maybe this itself is actually teasing out a little bit more of a response from people. Soldiers are actually doing what the Army doctors hope they’ll do, which is recognizing that they have some symptoms that might be PTSD or depression, and actually being mobilized to report those and follow up with clinicians about them. And they view that as a very important, constructive development.

Higher numbers for reservists

JEFFREY BROWN: Now, were the numbers in themselves surprising, one in five and two in five for reservists? And was there some thinking about why the number for reservists was so much higher?

SUSAN DENTZER: Well, the reservist numbers did raise eyebrows. But actually -- and, again, we don't know the bottom line. We really don't know why this turns up to be higher numbers in reservists. But, again, the researchers speculate that what's going on here is not so much that they're experiencing more distress or combat stress, but that actually it has everything to do, they think, with health coverage issues, which is to say...

JEFFREY BROWN: What happens when they get home.

SUSAN DENTZER: When you come home as a reservist, you've got six months of care under the military system. You have up to two years of care under the VA system. But after that, depending on what your normal civilian health insurance coverage is, you're on your own.

So what they speculate may be going on here is that people are realizing that they have a finite period of time when these issues might be able to be addressed in either the military or the VA system, so they are reporting it and basically being referred in higher numbers to clinicians.

And the reason, part of the reason they think that is that the same group of people, the reservists, also have higher physical health symptoms. It's not just mental health symptoms. So that suggests that this coverage issue is really what's driving these higher numbers.

Early intervention

JEFFREY BROWN: So the key question now is, what is to be done? Now, the study suggested one thing that should happen is that the Army should intervene earlier.

SUSAN DENTZER: Right. And, of course, clinicians, including the lead author on this study, Dr. Milliken from Walter Reed Army Medical Center, feels very strongly that that should happen. He told me he had spent last summer down at Fort Benning treating people who are inpatients in the psychiatric unit for PTSD, whom he felt very strongly probably had been exhibiting symptoms much earlier and could have been effectively intervened with much earlier, so that you forestall this big slide that lands you up in the hospital.

So he believes that the evidence really isn't in yet, in terms of clear medical studies showing that that really works. But now, as a consequence of $150 million of new appropriations that have been given to the VA and DOD to study interventions, we'll know in the future whether early intervention really does make a difference.

Focusing on treatment

JEFFREY BROWN: And the real question hanging out there from this and other studies is what we know about treatment, what is effective and what is not.

SUSAN DENTZER: Exactly, and that's an evolving story, as well. Just last month, the Institute of Medicine, an arm of the National Academy of Sciences, put out a report saying, with one exception, which is something called exposure therapy, which is when you actually have people re-enact or re-live their traumatic experience as way of desensitizing them to the response from that experience, with that exception, that is the only form of intervention in PTSD that has been demonstrated in scientifically rigorous studies to be effective.

Everything else, we really don't have the evidence to know if it works. So to the degree veterans and others are being prescribed anti-depressants or being given other forms of psychotherapy, we really don't know if any of that works.

So, again, as a consequence of this money that's now been appropriated for studies at VA and DOD, in the next few years we'll be subjecting more of those to rigorous scrutiny and understanding what really will help a veteran with these conditions.

JEFFREY BROWN: And just to be clear, briefly, they're not telling people not to get treatment. They're just saying they're still not quite sure what works?

SUSAN DENTZER: What works, exactly. And the important point, finally, to make on this study is this is really focusing on early symptoms. The military is really trying to understand here what happens at the very early stages. None of these people were actually diagnosed with PTSD or with clinical depressions, but it's really a sign that the military is stepping up to the plate and trying to capture these things at the earliest possible stages to the best that it can.

JEFFREY BROWN: All right, Susan Dentzer, thanks a lot.

SUSAN DENTZER: Thanks, Jeff.