Category Archives: PTSD

Invisible Wounds of War Report Available for Download

The Rand Corp. recently released a 499 page report titled “Invisible Wounds of War”.   This report was briefly summarized by numerous news articles and Internet reports, including my previous article. 

I’m happy to say that the entire report is available for free download online, or you can purchase a hard copy for $50 from the Rand Corporation through their online bookstore (link below).

Here is the link to the downloadable report which has details not reported elsewhere.  I strongly urge you to at least scan the entire report.   The subtitle is:

Psychological and Cognitive Injuries,

Their Consequences, and Services to Assist Recovery

 

 

TERRI TANIELIAN AND LISA H.  JAYCOX, EDITORS

 

 

Download here   (2.9 mb full report)

or here  (200KB summary).

You can find the Rand Bookstore with these links here  

Oldtimer

  

 

20% of Iraq, Afghanistan Soldiers Have Depression or PTSD

Veteranstoday.com

Half of Depression and PTSD affected troops untreated

A study published by the Rand Corporation shows that of the 300,000 troops affected by mental disorders of depression or PTSDless than half have been treated.   Yes, that is 150,000 untreated heroes on active dury or recently released to the streets without proper treatment according to this independent study.

Picture from Veterans Today site.  Find it Here

The sad news continues…  About one in five, about 20%, of our Iraq and Afghanistan active dury and veterans suffer from depression or PTSD.

The Rand study says that too many soldiers and Marines are still slipping through the cracks since the symptoms of depression and PTSD can appear months after an incident, and many mental problems that appear later may never be caught, the study said.

The RAND study interviewed 1,965 current and former service members and asked them how many had suffered from PTSD within the previous 30 days and suffered from depression within the previous two weeks.

  • “We have tried to generate this estimate across the entire deployed population,” said Terri Tanielian, one of the study’s authors. “We are looking at the scope of the problem now among the population back in the United States.”

The study shows that 19.5% of veterans had received a concussion or other traumatic brain injury during their combat tour.    The study found that some service members actively avoid a diagnosis of a mental health problem due to a fear of negative consequences of such a diagnosis.    The worry is that co-workers would have less confidence in them after a diagnosis and thus impact their career.

  • “When we asked folks what was limiting them from getting the help that they need, among the top barriers that were reported were really negative career repercussions,” Tanielian said.

Please read the rest of this article (paraphrased above) here:  Veterans Today.

You can get a different take at Medical News Today.  They report that 30% of our soldiers that are on their third or fourth tour have expressed emotional illnesses as gleaned from 2295 anonymous responses to the survey (11.9 % first tour soldiers, 18.5% second tour, 27.2% third tour).

And from the Associated Press at the Atlanta Journal Constitution website.

I encourage you to write the candidates at every government level and all of our current congressmen to encourage them to show their support by increasing the help for these wonderful men and women that have served our country.  Let’s serve them now!

Help our Heroes!

The ‘equal opportunity war’ bring equal opportunity trauma

Much of the information below was gleaned from a well written USA Today story entitled Mental toll of war hitting female servicemembers.   Early in the story the writer tells about Master Sgt. Cindy Rathbun who began losing hair in clumps within 3 weeks of arriving in Iraq.   She is now enrolled in the first group of a new Women’s Trauma Recovery Program which is a 60 to 90 day program for female warriors. 

Cindy is suffering from the stress and trauma of war, but also from sexual trauma from prior to her deployment by a military superior.

Some tidbits of information directly from the article cited:

More than 182,000 women have served in Iraq, Afghanistan and the surrounding region — about 11% of U.S. troops deployed, the Pentagon says.

That dwarfs the 7,500 who served mostly as nurses in Vietnam and the nearly 41,000 women deployed during the brief Gulf War.

Although some of those women suffered PTSD, few saw actual fighting or were subjected to the stress of multiple deployments.

In Iraq, “there are no lines, so anybody that deploys is in a war zone,” Rathbun says. “Females are combat veterans as well as guys.”

 To be sure, women are barred from ground jobs, technically assigned to support roles, but guess what?   Those support roles include guarding checkpoints, driving supply convoys and searching women in neighborhood patrols.   Dangerous duty just the same. 

Attacks come from IED’s, mortars, and suicide attacks on checkpoints as well as from enemy fighters.   The stress is there.  The fear is there.  The fatigue is there, the unknown is there, the worry about the home folks is there.  Death and destruction are evident every day.   More than 100 of our female warriors have died and almost 600 wounded.

 More from the article cited:

The ranks of psychologically wounded from this war are far larger. In 2006, nearly 3,800 women diagnosed with PTSD were treated by the VA. They accounted for 14% of a total 27,000 recent veterans treated for PTSD last year.

In June, the Defense Department’s Mental Health Task Force reported that the number of women suffering from combat trauma might be higher than reported. It cited “a potential barrier” for women needing mental-health treatment as “their need to show the emotional strength expected of military members.”

The report also said that after leaving the military, “many women no longer see themselves as veterans” and might not associate psychological symptoms with their time in the war zone.

Did you notice that?  Women represent 11% of the deployed but have 14% of the cases, even though the DoD thinks they are under reported.  Battle lines or not, they are being affected at a much higher rate than men, some possibly due to MST, Military Sexual Trauma that was being diagnosed and treated as PTSD.

Here is a link to Oldtimer’s PTSD Videos which includes a video on MST.

It is about time that this problem is being addressed early in the process for our returning heroes.   Our warriors are the best and deserve the best, black, white, male and female.    

Wear the uniform, deserve the best

Our programs should never be just about the men. 

It should be about our heroes.

Oldtimer

VA Research Factsheet on PTSD

The following is a factsheet from the VA’s Research Advances Series titled Posttraumatic Stress Disorder (PTSD),  published in September, 2007:

Soldier from VA BulletinSoldier from VA Bulletin VA’s Office of Research & Development supports a strong program of research directed to understanding, treating, and preventing Posttraumatic Stress Disorder (PTSD), which is an unrelenting biological reaction to the experience of a traumatic event. In the case of veterans, the trauma may occur from combat duty or other experiences where one’s safety or life is threatened. VA researchers have long been leaders in discovering new advances for treating and understanding PTSD.    The photo came with the article in 2007    I found a larger version here They title it “Prayer”.    I don’t know who the original photographer was.

Examples of VA research advances

Drug already used by millions may be effective in the treatment of PTSD – In an exciting new treatment development, VA researchers found that prazosin, an inexpensive generic drug already used by millions of Americans for high blood pressure and prostate problems, improved sleep and reduced trauma nightmares in a small number of veterans with PTSD.  Plans are under way for a large, multi-site trial to confirm the drug’s effectiveness.

Prolonged-exposure therapy effective in treatment of women veterans with PTSD– VA researchers found that prolonged-exposure therapy – in which therapists helped them recall their trauma memories under safe, controlled conditions-was effective in reducing PTSD symptoms in women veterans who have developed PTSD as the result of sexual trauma in the military, and that such reductions remained stable over time. Women who received prolonged-exposure therapy had greater reductions of PTSD symptoms than women who received only emotional support and counseling focused on current problems. This approach may be tested in, and applied to, other PTSD populations.

First ever clinical trial for the treatment of military service-related chronic PTSD– The largest study of its kind, involving 400 veterans from 20 VA medical centers nationwide, is being conducted to determine if risperidone, a medication already shown to be safe and effective in the treatment of PTSD, is also effective in veterans with chronic PTSD who continue to have symptoms despite receiving standard medications used for this disorder.

Facts About PTSD:

PTSD is a psychiatric disorder that can affect people who have experienced life-threatening events, such as combat, a terrorist attack, or a personal assault. Symptoms include flashbacks, nightmares, depression, and social withdrawal, as well as physical health changes. Treatment often includes anti-anxiety drugs or other medication, as well as exposure therapy, a form of cognitive-behavioral therapy in which patients recall their traumas in a safe setting and gradually learn to adjust their emotional response. VA Research has long been leaders in making new advances for treating and understanding PTSD.

http://www.research.va.gov
Research & Development
Veterans Affairs

Oldtimer’s Comment: There are 17 of these factsheets.  Below is a linked list of them.    You may find something of interest in one or more of them.   For example, PTSD is mentioned in several.

Factsheets

  • Alzheimer’s Disease (193 KB, PDF)
  • Depression (192 KB, PDF)
  • Diabetes (168 KB, PDF)
  • Hearing Loss (194 KB, PDF)
  • Heart Disease and Stroke (223 KB, PDF)
  • Hepatitis C (198 KB, PDF)
  • HIV / AIDS (205 KB, PDF)
  • Iraq / Afghanistan (232 KB, )
  • Low Vision (248 KB, PDF)
  • Mental Health (191 KB, PDF)
  • Obesity (214 KB, PDF)
  • Osteoarthritis (175 KB, PDF)
  • Parkinson’s Disease (179 KB, PDF)
  • Personalized Medicine (208 KB, PDF)
  • Post-Traumatic Stress Disorder (PTSD) (189 KB, PDF)
  • Prosthetics / Amputations (209 KB, PDF)
  • Spinal Cord Injury (205 KB, PDF)
  • Substance Abuse (175 KB, PDF)
  • Womens’ Health (201 KB, PDF)
  • Oldtimer

    VA overrates its success stories

    VA overrates its success stories

    This problem was first brought to light by an article written by Chris Adams that appeared in the Ledger Enquirer in an article printed May 11, 2007.  

    The McClatchy Newspapers study shows that the VA has “habitually exaggerated” its success stories in ways that would assure Congress that the agency is doing a good job of caring for our soldier heroes.   The indented areas below are details taken from the article linked above.  Large portions of the original article are omitted and others paraphrased.  You should take the time to read the original article in its entirety to get all the details.  

    The agency has touted how quickly veterans get in for appointments, but its own inspector general found that scheduling records have been manipulated repeatedly.

    For example, on Oct. 2, 2003, a veteran was referred to an ophthalmology clinic. On May 3, 2004, a scheduler created an appointment, saying the “desired date” was June 21. The appointment was scheduled for June 23, the inspector general said.

    Actual waiting time: 264 days. Reported waiting time: two days. Some schedulers even kept “informal waiting lists” to consult when they were ready to make formal appointments.

    The VA boasted that its customer service ratings are 10 points higher than those of private-sector hospitals, but the survey it cited shows a far smaller gap.

    The article details how that the gap narrows to 3 points (still favorable but not nearly 10 points higher) when adjusted to the same conditions.  

    Regarding the key issue of PTSD treatment, the VA said this about the PTSD treatment teams: “There are over 200 of them,” Dr. Michael Kussman told a congressional subcommittee. He indicated that they were in all of the agency’s roughly 155 hospitals.

    When McClatchy asked for more detail, the VA said that about 40 hospitals didn’t have the specialized units known as “PTSD clinical teams.” Committees in the House of Representatives and the Senate and experts within the VA have encouraged the agency to put those teams into every hospital.  

    Dr. Jonathan Perlin, then the top VA health official, said in a radio interview that RAND “compared VA care to 12 other health-care organizations, some of the best in the country,” and found VA superior. Studies such as RAND’s showed the agency’s care to be “the best that you can get in the country,” he said.

    Kussman wrote in a statement to McClatchy earlier this year that RAND “recently” reported that veterans “receive better health care than any other patients in America.”

    The VA’s public affairs department wrote in a magazine that the study “was conducted by the RAND Corporation, an independent think tank,” as well as researchers from two universities.

    Those are pretty lofty statements, but as it turns out, the RAND study was neither fully independent nor all that recent. A VA grant helped pay for it. Two of its main authors had received VA career-development awards, and four of its nine listed authors were affiliated with the agency, according to the study’s documentation.

    It was published in 2004 but used data from 1997 to 1999, when the system treated far fewer patients than it does now.  In additon, the “12 other health care organization” were not organizations at all but 12 health care regions under many mixed organizational entities.

    Once again, we see some deliberate misleading statements from the VA, often directly to Congress.  Yet they seem to get away with it.  

    Oldtimer

    PTSD Payments Vary State to State

    PTSD Payments Vary State to State

    I’m indebted to the blog at Healing Combat Trauma for alerting me to this information in which they refererence an article published in Military.com with the above title.   You should read the information at Healing Combat Trauma as it is told better there than I can do it.   Below is a summary of information.

    It seems that the McClatchy Newspapers chain did extensive research through the freedom of information act and discovered that there is wide variation in the way disability ratings are given depending on where the veteran lives.   A veteran returning from Iraq that lives in Ohio or Montana for example, is typically given a much lower disability rating on average than one that returns to New Mexico.

    The study involved some 3 million disability claims records.  Consider these quotes from the Military.com article:

    “The VA workers who decide PTSD cases determine whether a veteran’s ability to function at work is limited a little, a lot or somewhere in between. They examine the frequency of panic attacks and the level of memory loss. The process is subjective, and veterans are placed on a scale that gives them scores – or “ratings” – of zero, 10, 30, 50, 70 or 100.

    “McClatchy’s analysis found that some regional offices are far more likely to give veterans scores of 50 or 70 while others are far more likely to stick with scores of 10 or 30.

    “Consider the New Mexico and Montana offices, where there are big differences up and down the scale.

    “In Montana, more than three-quarters of veterans have ratings of zero, 10 or 30. In New Mexico, a majority of the veterans have ratings of 50 or 70.

    “On top of that, 6 percent of New Mexico veterans had the highest rating possible – 100, worth $2,527 a month – compared with just 1 percent of Montana veterans.”

    The initial ratings pretty much stick with a veteran for the rest of their life, and the disparity in how the disability is rated may make a difference of hundreds of thousands over the remaining lifetime of the veteran.   Apparently some offices make a point of being generous in their ratings and some apparently are downright stingy, not giving a proper rating. 

    “Of recent vets processed in Roanoke, Va., 27 percent have high ratings for post-traumatic stress disorder. In Albuquerque, N.M., the number is 56 percent.”

    You need to read the Healing Combat Trauma article for some excellent commentary and also the military.com article for some extra details.   The research suggests that something is wrong with the VA’s rating system when one city rates twice as many of their veterans higher than in another city.   The VA does not treat our heroes fairly if they happen to live in the wrong part of our great country.

    Oldtimer

    Surge Seen in Number of Homeless Veterans

    Surge Seen in Number of Homeless Veterans

     Oldtimer’s Comment:  I’ve seen a number of these types of articles.   Although the estimates vary depending on the subject area from 400 to about 1500, the word on the street is that the returning soldiers from Iraq and Afghanistan are showing up in shelters much faster than in previous wars.  The problem stems from higher rates of PTSD and TBI (traumatic brain injury) which still take too long to diagnose, and which are resulting from the combined effect of IED’s and higher survival rates.    The VA has long under diagnosed these problems and only recently, after much heat, begun to actively pursue it. 

    Photo by Jeff Swensen for The New York Times
    Frederick Johnson, a veteran of the Iraq war, lives in temporary housing provided by the V.A. after spending a year on the streets.

    By ERIK ECKHOLM

    WASHINGTON, Nov. 7 – More than 400 veterans of the Iraq and Afghanistan wars have turned up homeless, and the Veterans Affairs Department and aid groups say they are bracing for a new surge in homeless veterans in the years ahead.

     

    Photo by Brendan Smialowski for The New York Times
    Joe Williams lives in a homeless shelter in Washington.

    Experts who work with veterans say it often takes several years after leaving military service for veterans’ accumulating problems to push them into the streets. But some aid workers say the Iraq and Afghanistan veterans appear to be turning up sooner than the Vietnam veterans did.

    “We’re beginning to see, across the country, the first trickle of this generation of warriors in homeless shelters,” said Phil Landis, chairman of Veterans Village of San Diego, a residence and counseling center. “But we anticipate that it’s going to be a tsunami.”

    With more women serving in combat zones, the current wars are already resulting in a higher share of homeless women as well. They have an added risk factor: roughly 40 percent of the hundreds of homeless female veterans of recent wars have said they were sexually assaulted by American soldiers while in the military, officials said.

    “Sexual abuse is a risk factor for homelessness,” Pete Dougherty, the V.A.’s director of homeless programs, said.

    Special traits of the current wars may contribute to homelessness, including high rates of post-traumatic stress disorder, or PTSD, and traumatic brain injury, which can cause unstable behavior and substance abuse, and the long and repeated tours of duty, which can make the reintegration into families and work all the harder.

    Frederick Johnson, 37, an Army reservist, slept in abandoned houses shortly after returning to Chester, Pa., from a year in Iraq, where he experienced daily mortar attacks and saw mangled bodies of soldiers and children. He started using crack cocaine and drinking, burning through $6,000 in savings.

    “I cut myself off from my family and went from being a pleasant guy to wanting to rip your head off if you looked at me wrong,” Mr. Johnson said.

    (…)  Read more about Fredrick at the link above

    Poverty and high housing costs also contribute. The National Alliance to End Homelessness in Washington will release a report on Thursday saying that among one million veterans who served after the Sept. 11 attacks, 72,000 are paying more than half their incomes for rent, leaving them highly vulnerable.

    Mr. Dougherty of the V.A. said outreach officers, who visit shelters, soup kitchens and parks, had located about 1,500 returnees from Iraq or Afghanistan who seemed at high risk, though many had jobs. More than 400 have entered agency-supported residential programs around the country. No one knows how many others have not made contact with aid agencies.

    More than 11 percent of the newly homeless veterans are women, Mr. Dougherty said, compared with 4 percent enrolled in such programs over all.

    Veterans have long accounted for a high share of the nation’s homeless. Although they make up 11 percent of the adult population, they make up 26 percent of the homeless on any given day, the National Alliance report calculated.

    Oldtimer’s comment:   My studies show that homeless male veterans make up 43% of the homeless male population, far in excess of what would be expected.

    According to the V.A., some 196,000 veterans of all ages were homeless on any given night in 2006. That represents a decline from about 250,000 a decade back, Mr. Dougherty said, as housing and medical programs grew and older veterans died.

    Oldtimer’s comment:  Oops!  That is a deliberately misleading statement.   A GAO report states that the drop from 250,000 a decade ago was due to a major change in how homeless veterans are counted.   While it is true that our older veterans are dieing off, many more veterans are joining the ranks of the homeless and make up for it.  There has been no real decline, and actually there has been a steady increase in the percentage of homeless veterans vs the overall population of veterans.

    The most troubling face of homelessness has been the chronic cases, those who live in the streets or shelters for more than year. Some 44,000 to 64,000 veterans fit that category, according to the National Alliance study.

    On Wednesday, the Bush administration announced what it described as “remarkable progress” for the chronic homeless. Alphonso R. Jackson, the secretary of housing and urban development, said a new policy of bringing the long-term homeless directly into housing, backed by supporting services, had put more than 20,000, or about 12 percent, into permanent or transitional homes.

    Oldtimer’s comment:  I’m not sure where these numbers come from.  It appears the HUD secretary is talking about all chronic homeless, not just veterans.   20,000 is 12% of 166,000, which is about right for the chronic homeless for the entire homeless population. To get a feel for progress among veterans, see the following two paragraphs.

    Veterans have been among the beneficiaries, but Mary Cunningham, director of the research institute of the National Alliance and chief author of their report, said the share of supported housing marked for veterans was low.

    A collaborative program of the Department of Housing and Urban Development and the V.A. has developed 1,780 such units. The National Alliance said the number needed to grow by 25,000.

    Mr. Dougherty described the large and growing efforts the V.A. was making to prevent homelessness including offering two years of free medical care and identifying psychological and substance abuse problems early.

    Oldtimer’s Comment:  ‘Bout Time!

    (…)