Benefits of PTSD treatment going unmeasured, says Institute of Medicine Report

A report from the Institute of Medicine (IOM) finds that the U.S. Department of Defense (DOD) and U.S. Department of Veterans Affairs (VA) do not measure the effectiveness of treatment of post-traumatic stress disorder (PTSD), calling into question millions of dollars spent to improve service members' mental health. The report also found that neither agency has kept pace with growing demand for PTSD treatment.

"Both departments lack a coordinated, consistent, and well-developed evidence-based system of treatment for PTSD and need to do a better job tracking outcomes," said Sandro Galea, MD, DrPH, chair of the IOM committee, and chair of the Department of Epidemiology at Columbia University's Mailman School of Public Health. "Mental health is among the most important factors behind successful re-entry after military service, and we don't know if treatments are working."

The IOM issued this report on the heels of a scandal at the Department of Veterans Affairs that led to the resignation of VA Secretary Eric Shinseki on May 30. Federal investigators determined that service members were systematically denied timely care in a network of more than 1,700 healthcare facilities that suffers from inefficiency and bureaucracy.

PTSD is diagnosed by combination of symptoms, including hypervigilence and sleeplessness, and can be treated pharmacologically and psychologically with cognitive behavioral therapies involving multiple sessions with trained counselors.

An estimated 5 percent of service members have been diagnosed with PTSD; for veterans who served in Iraq and Afghanistan conflicts, the number rises to 8 percent. In 2012, more than half a million sought care for PTSD in the VA - 9.2 percent of all VA users. In 2012 the DOD and VA spent $294 million for PTSD care. If treatment demands continue to climb, the total cost for PTSD could exceed $500 million by 2017.

How common is PTSD?

An estimated 7.8 percent of Americans will experience PTSD at some point in their lives, with women (10.4%) twice as likely as men (5%) to develop PTSD. About 3.6 percent of U.S. adults aged 18 to 54 (5.2 million people) have PTSD during the course of a given year. This represents a small portion of those who have experienced at least one traumatic event; 60.7% of men and 51.2% of women reported at least one traumatic event. The traumatic events most often associated with PTSD for men are rape, combat exposure, childhood neglect, and childhood physical abuse. The most traumatic events for women are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse.

About 30 percent of the men and women who have spent time in war zones experience PTSD. An additional 20 to 25 percent have had partial PTSD at some point in their lives. More than half of all male Vietnam veterans and almost half of all female Vietnam veterans have experienced "clinically serious stress reaction symptoms." PTSD has also been detected among veterans of the Gulf War, with some estimates running as high as 8 percent.