An array of military-related presentations were given at this year’s American Psychiatric Association (APA) conference, addressing the rise of psychiatric issues in returning veterans and their families. These constitute a significant public health problem, according to Mary Helen Davis, MD, a member of the APA’s Committee on Mental Health of Veterans, Active Duty Military and Their Families. “Overall, approximately 20% of active duty and 42% of reserve troops have been identified as needing further mental health assessment and treatment post deployment,” Davis said.
There are a number of barriers that keep service members from seeking help, including a lack of trust in mental health professionals, said Robert J. Ursano, MD,1 professor of psychiatry at the Uniformed Services University in Bethesda, Maryland. Some are unable to get time off from work, and they are unable or not willing to spend money on care. In addition, soldiers may be particularly afraid of being perceived as weak and of hurting their career. He noted that these issues are not only prevalent in service members but also throughout the nation.
The common psychiatric responses to war and combat may include distress behaviors, mental health illness, and health risk behaviors, said Ursano. “In studies of soldiers 3 to 12 months after returning from war, posttraumatic stress disorder (PTSD) was present in 5.0% to 6.2% of those returning from Afghanistan and 12.2% to 12.9% of those returning from Iraq,” he said. However, only 23% to 40% of these soldiers sought mental health care. PTSD is also more likely to occur in service members who are younger and lower in rank, because they will have been exposed to combat
A retrospective study showed that 12% to 20% of veterans returning from the wars in Afghanistan and Iraq may have experienced a deployment-related mild traumatic brain injury (TBI).2 Another presentation at the APA conference showed that the rate of suicide was 8 times higher in patients with TBI than in those who did not experience TBI, according to Davis. She said these results were surprising. “Significant unmet needs exist in the realm of access to care and the availability of clinicians using evidence-based treatments to address the major mental health issues of veterans and their families,” she said.
The US Department of Veterans Affairs (VA) currently treats more than 5.5 million veterans, and 44.6% of these patients present with mental health issues according to Harold Kudler, MD,3 a member of the faculty in the department of psychiatry at Duke University in Durham, North Carolina. “Physicians in the community shouldn’t expect to treat veterans according to the war scenes they are used to seeing on television, said Kudler. “Of the veterans from these wars, 97% will walk into your office. So ask your patients whether they are veterans,” he said.
There will undoubtedly continue to be a need for community outreach to veterans in years to come. “Of those eligible for VA health care, about 40% seek it within the VA system, leaving the remainder to seek their care in the communities to which they are returning,” said Davis.
“The VA has instituted national training for clinicians in evidence-based practices, including cognitive processing therapy, prolonged exposure therapy and a program known as Seeking Safety, which manages veterans with PTSD and comorbid substance abuse. They have training programs in TBI and suicide prevention as well as psychopharmacology,” said Dr Davis.