CDMRP Investigator Vignette

Title: Psychosocial Outcomes in OEF/OIF Veterans with PTSD

Investigator: Raymond C. Rosen, PhD; New England Research Institutes, Inc.

Our research is directed at Soldiers with symptoms of post-traumatic stress disorder, and our study is unique in that we're trying to follow these men and women over time, find out how many of them receive treatment, how adequate the treatment is, and what happens to them over the course of time.

We're integrating across different databases and different sources of data and then we're examining a lot of different ideas and hypotheses about why some Veterans recover much more effectively from trauma, from battlefield trauma, whereas others continue to have many more difficulties over time.

Fifty-one percent of our sample are women; 49% of our sample are men, which was quite an accomplishment to recruit almost identical numbers of men and women for the study. The average age is in the mid-30s for both the men and women. The ethnic minorities are about the same across the different groups and the majority of both are from the Army as opposed to Marines or other Service branches.

The second important point is that the majority of these individuals have by design post-traumatic stress disorder in the medical record, and this was confirmed in an independent telephone interview doing a diagnostic interview with those individuals.

We had some individuals however who had the diagnosis in their medical record within the past 12 months but do not have PTSD currently as judged by this independent interview. And then we had a third group by design who have no diagnosis of PTSD in the medical record or in the research interview.

This table over here shows you the pattern of results for these three groups of individuals and the key point is those who had PTSD in the medical record and by the research diagnosis had very poor results on all of the other tests and measures that we gave them. Fifty-eight percent of them qualified for major depressive syndrome; 52% had panic disorder. Particularly noteworthy, almost 16% of them were judged to be high suicide risks with 27% of them already having made one suicide attempt. So this is a very serious pattern of behavioral health disorders.

Those who had the PTSD in the medical record but not on the research evaluation were in the same direction but had better scores than the first group. These are still very serious behavioral health indicators but not as severe as the first group.

And those two groups, the groups who have it in one place but not the other, are very interesting groups to study-to ask why they don't have the diagnosis in the medical record or why they don't have it in the interview.

And then interestingly, the third group who had no PTSD in either the medical record or by the research interview, their scores are much lower-only 2.5% had moderate or severe suicide risk. Ten percent, still high-had made one previous attempt. And you can see the scores for depression, panic anxiety, alcohol abuse, and all of the other disorders were much, much lower in the third group.

I think the most important take-home message is that individuals with symptoms of post-traumatic stress disorder, whether they're in the medical record, or if we see the diagnosis in an independent diagnostic evaluation by one of our researchers is a very serious warning sign.

These results show that these individuals are at high risk for depression, anxiety, suicide, substance abuse, family disorders; across the board the behavioral health indicators were much worse in these individuals. Individuals who have a PTSD diagnosis in one place and not the other are still at increased risk although it's not as severe as those who have PTSD across the board.

Why there are some of these differences is the particular focus of our work now and we're looking further into this.

I know the Department of Defense are very aware of and very focused on this issue, how to prevent post-traumatic stress and my hope is that in the next decade we'll see more and more progress in this area. And I believe the Military Services, the different Service branches, will have much better facilities for coping with those Soldiers who do show signs of stress.

So from that perspective I'm quite optimistic.