Although one in four veterans returning from Iraq and Afghanistan who visit
a Veterans Affairs (VA) medical center receives a diagnosis involving mental
health, better diagnostic tools are still needed to evaluate these troops, a
prominent researcher told the House Appropriations Subcommittee on Defense in
Washington, D.C., in January.
"Thirteen percent of the 100,000 first visits were diagnosed with
PTSD," said Charles Marmar, M.D., vice chair and professor of psychiatry
at the University of California, San Francisco, and associate chief of staff
for mental health at the San Francisco VA Medical Center. "Those
diagnoses were made by clinicians in face-to-face diagnostic interviews,
usually in primary care."
Marmar noted that on this occasion, he was not speaking on behalf of the
Department of Veterans Affairs since his remarks had not been cleared by the
Marmar was the main psychiatric witness before the committee. He reported
on a study (in press with Archives of Internal Medicine) of more than
100,000 veterans of warfare in Iraq and Afghanistan. The committee room was so
crowded that Capitol police turned away latecomers.
Rates of PTSD in this group were roughly similar to those of veterans of
the Vietnam War, but there was one "striking" difference, he said.
The present wars have seen a marked rise in traumatic brain injuries, largely
due to roadside bomb explosions and motor vehicle accidents, along with
"Unfortunately, these closed head injuries are the same kind of
events in the same settings that are likely to lead to terror and horror,
which trigger posttraumatic stress," he said. "So the two occur
together, creating a kind of double jeopardy."
Furthermore, the military and medical systems for veterans may be missing
many head-injury cases, said Marmar. Troops with major wounds are routinely
screened for closed head injury, but those who have minor wounds, or have
briefly lost consciousness but recovered, are not. One of the lessons provided
by the experience of Vietnam veterans was the need for "early and
aggressive identification and treatment of PTSD" among the current
generation of troops. More extensive clinical interviews based on current
research and still-undeveloped biological markers would increase the
reliability of diagnoses.
Elsewhere in the Capitol, the House Committee on Veterans' Affairs began
its work after an intraparty fight among the new Democratic majority. Former
ranking member Lane Evans (D-Ill.), who stepped down for health reasons, had
thrown his support behind Michael Michaud (D-Maine) as the new chair, but
Michaud lost out to Robert Filner (D-Calif.). As a result, Filner dismissed
several of Evans's former staff members, including those who worked on
subcommittees overseeing veterans' benefits and health care, according to a
former staffer. Some veterans groups felt that the changes would mean the loss
of extensive institutional memory about veterans' health issues, especially
mental health. Filner's new staff director, retired Army Lt. Col. Malcolm
Shorter, has experience working in Congress but not on veterans' issues.
Michaud will chair the subcommittee on veterans' health, however. Two of
the former staff members moved to jobs on the Senate side of the Capitol, and
some veterans groups said that leadership on veterans' health issues may go
with them. ▪