June 23, 2016

Yale Study: Clinicians Often Overlook Veterans’ Mental Health Disorders

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Nationally, at least one in five military veterans who experience trauma are at a heightened risk for depression, suicide or substance abuse but are often overlooked in clinical settings because they don’t fit the criteria for post-traumatic stress disorder (PTSD), according to a Yale University-led study.

The research, published June 1 in the World Psychiatry journal, examined sub-threshold PTSD, which occurs when someone experiences trauma-related symptoms that aren’t severe or long-lasting enough to warrant a PTSD diagnosis.

About 11 percent to 20 percent of veterans who served in Iraq have PTSD in a given year.

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About 11 percent to 20 percent of veterans who served in Iraq have PTSD in a given year, according to the VA.

The study, which included 1,484 veterans nationwide, found 8 percent were diagnosed with PTSD but more than 22 percent met criteria for sub-threshold PTSD. Also, in addition to 4.5 percent of veterans diagnosed with PTSD within the last month, 13 percent had sub-threshold symptoms, the study reported.

Veterans with sub-threshold PTSD had a 20 percent chance of suffering from major depression in their lifetimes, compared with about 4 percent of veterans without sub-threshold symptoms, the study found. And more than 12 percent of sub-threshold veterans reported having suicidal thoughts, compared with about 3 percent of those without the symptoms, the study found.

“The results were striking,” Robert Pietrzak, senior study author and Yale clinical psychologist, said in a statement. He also is director of the Translational Psychiatric Epidemiology Laboratory, Clinical Neurosciences Division of the U.S. Department of Veterans Affairs National Center for PTSD.

“We found three, four, five times higher rates of some disorders in veterans with sub-threshold PTSD,” he said.

Jerome Brodlie, head of the psychology department at Greenwich Hospital, said it is important to distinguish between those with PTSD and those with less severe symptoms. Brodlie is the emissary for the U.S. State Department regarding post-trauma for Southeast Asia and has worked with many veterans in that role.

Only 15 percent of people who experience trauma develop PTSD, which brings with it long-term disability, Brodlie said.

“The rest are all going to experience a reaction for a much shorter period of time until it wears off,” he said.

Pietrzak said the study’s findings show that clinicians should be vigilant in monitoring and potentially treating sub-threshold PTSD symptoms in those that have experienced any form of trauma, whether they are veterans or civilians.

“You have a very large group of people who may be in need of treatment but are often overlooked in clinical settings,” he said.

PTSD is marked by intrusive memories of a traumatic event, a pattern of avoiding people or things that spur those memories, increased negative thoughts and feelings, and symptoms of hyper-arousal such as increased anger, trouble sleeping and being easily startled, according to researchers. In order to get a PTSD diagnosis, all of those symptoms must be present, of a certain severity and duration, and cause significant functional impairment, according to Pietrzak.

About 11 percent to 20 percent of veterans who fought in operations Iraqi Freedom and Enduring Freedom suffer from PTSD in a given year, according to the U.S. Department of Veterans Affairs National Center for PTSD, and about 12 percent of Gulf War veterans have PTSD in a given year.

The Yale research team—which included lead author Natalie Mota, a former researcher in Pietrzak’s lab who currently is at the University of Winnipeg—suspected that many veterans who experience moderate PTSD symptoms could be at a heightened risk for other mental disorders and that sub-threshold PTSD is an “overlooked trigger” of various mental health problems.

Whether they meet the criteria for PTSD or not, all traumatized veterans deserve treatment, Brodlie said.

“All physicians, regardless of their specialty, should be questioning their patients regarding their experiences in war,” he said, adding that is not done often enough. “It’s such a complicated issue. Whether it’s short-term or long-term, in reality, doesn’t matter because you [should] get treatment until you no longer need treatment. We as a country have an obligation to take care of you as long as you need to be taken care of.”

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