New ‘Roadmap’ Seeks Better Tools for PTSD, TBI, Suicide Research

by U.S. Medicine

November 6, 2013

By Sandra Basu

FORT LAUDERDALE, FL — The newly released National Research Action Plan has created a “common roadmap” for federal agencies to tackle mental health research to include PTSD, TBI and suicide, DoD and VA officials said recently.

“It is a higher level of coordination from what we have been doing up to this point,” Col. Dallas Hack, MD, Combat Casualty Care Research Program director, explained during a teleconference held in conjunction with this year’s Military Health System Research Symposium.

The plan directs DoD, VA, HHS and the U.S. Department of Education to share resources and set common goals on managing PTSD, TBI and suicide. The plan, announced in August by President Barack Obama, resulted from an executive order he signed last year that addressed access to mental health services for veterans, troops and military families.

Terry Rauch, PhD, DoD health affairs director of medical research, explained that the plan sets “immediate milestones” the agencies need to accomplish in the next 12 months, as well as milestones to reach during the next two to five years and goals the agencies will work toward over the next five to 10 years.

“It’s a living document. It is not cast in concrete. I think we all expect it to be revised as we move our research agenda forward in this area, and we determine the results we are getting and the results we are not getting,” Rauch said.

Army Col. Dallas Hack, director of the U.S. Army’s Combat Casualty Care Research Program, right, and Dr. Terry Rauch, health affairs director of medical research, left, discuss veterans’ mental health and traumatic brain injury research and care issues during the Military Health System Research Symposium in Fort Lauderdale, FL. U.S. Army photo by Melissa Miller

Setting the Agenda

Specifically, the plan sets several priorities for the next 12 months, including to “increase the inventory of scarce research resources (e.g., tissue samples, blood and cerebrospinal fluid), facilitating access for scientific purposes.”

“To accomplish this, the agencies will leverage existing pathology archives to initiate development of a virtual tissue (brain) repository for PTSD, TBI and suicide research,” according to the plan.

Another priority is to adapt existing research initiatives “to maximize their impact.” The plan notes that a five-year study, Army Study To Assess Risk and Resilience in Servicemembers (Army STARRS), already is in process. While the study is due to run through 2014, the agencies “will explore the feasibility of a longitudinal follow-up of Army STARRS to find actionable factors that can be used to improve early detection and effective prevention and treatment of suicide, PTSD, TBI and comorbidities.”

“The follow-up study will include the ability to consent for the donation of postmortem brains and begin to establish necessary procedures for timely collection and preservation of tissue,” the plan explained.

Another priority is to “utilize tools for agencies to coordinate and share the research they support.”

“The agencies will identify a common database and explore the feasibility of utilizing it to share the research they support with other federal agencies and with researchers outside of the federal government, where appropriate,” according to the plan.

The development of two consortiums also is a major initiative, Hack pointed out. One of the consortiums will focus on biomarker discovery and development with the goal of identifying biomarkers for subacute and chronic PTSD. The other consortium will examine factors that influence the chronic effects of mTBI and common comorbidities in order to improve diagnostic and treatment options.

“This is probably the most complex scientific endeavor possible. Understanding the human brain and its response to psychological and physical trauma is more complicated than a wound shot,” Hack said.

Needed Research

Robert Ursano, MD

Robert Ursano, MD, director of the Uniformed Services University School of Medicine’s Center for the Study of Traumatic Stress, explained that the relationships among TBI, PTSD and suicidality “are complex.”

“It is the first time in history that the three have been grouped together so prominently as a target for investigation and care. That is a milestone itself,” he said. 

For her part, Katherine Helmick, MS, CRNP, CNRN, deputy director of the Defense and Veterans Brain Injury Center, pointed to the importance of ongoing TBI research, given that these injuries are likely to continue to occur even when troops are not deployed.

According to Armed Forces Health Surveillance Center data, 273,859 servicemembers had TBI diagnoses from 2000 through the first quarter of 2013, with the majority being mild TBIs.

Helmick said more than 80% of the total number of TBI injuries in the military occur in nondeployment settings.

“This is a very important statistic because it tells us that, even as deployments decrease, TBI will still be a health concern for our servicemembers in times when we are not in conflict,” she said.

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