By Sandra Basu
WASHINGTON – Thousands of Vietnam-era veterans continue to suffer from post-traumatic stress disorder (PTSD), 41 years after the war ended, a recent congressionally mandated study shows.
In addition, researchers found that Vietnam veterans who had been identified as having PTSD symptoms in a related study performed in the mid-1980s had twice the risk of dying over the next 25 years than similar veterans without PTSD.
In preliminary findings presented recently at the American Psychological Association meeting in Washington, the National Vietnam Veterans Longitudinal Study (NVVLS) estimated the current prevalence of PTSD in combat Vietnam veterans at 11.2%. That translates to approximately 283,000 male and 400 female Vietnam veterans living today.
“That is really important for both DoD and VA —that for at least a subset of people who get PTSD they have it mostly for the rest of their lives,” William Schlenger, PhD of Abt Associates, co-principal investigator for the study, told U.S. Medicine in an interview.
The NVVLS is a follow-up to the National Vietnam Veterans Readjustment Study (NVVRS), which was completed 25 years ago and funded by VA. That first study was mandated by Congress to increase understanding of PTSD and other mental health effects of the Vietnam War to better equip VA to care for the veterans of that era.
Until Vietnam, “there had never been a war that we were in that we would have been looking for PTSD, so there was no way of knowing how many people would have PTSD and how long they would have it and how it would affect their lives,” said Schlenger, who also was an NVVRS investigator.
The NVVRS was conducted from 1984-1988 and was hailed as a landmark study providing critical information about the prevalence of PTSD. Among that study’s findings was that, of the 30% of the male Vietnam combat veterans who developed PTSD, half said they still suffered from it when the study was conducted in the late 1980s.
In the more recent assessment, investigators found that 16% of the veterans who participated in the first study in the mid-1980s had died before the more recent study began. In fact, the researchers found that male Vietnam veterans identified with war zone PTSD in the first study were nearly twice as likely to die in the decades between the two studies than those who had not reported post-traumatic stress. That association held up across demographic factors.
“The takeaway is, if you had PTSD in 1987 at the baseline, you were about twice as likely to be dead when we looked for you in 2012,” Schlenger emphasized.
While PTSD symptoms for most Vietnam War veterans remained stable over the course of the 25 years since the first NVVRS study, investigators found that not to be the case for all survey respondents. The report noted that 13% reported substantial increases in PTSD symptoms while 4.6% reported decreased symptoms.
Of the 1,839 of the 2,348 NVVRS participants who were alive when the more recent study was conducted, 79% participated in at least one of the study’s phases. Participants answered questions via a paper survey for Phase 1 and took part in a telephone interview in Phase 2. In addition, a clinical assessment was done for a subset of the participants in the third phase of the study. Data collection for the study began in 2012 and ended on May 17, 2013.
Schlenger pointed out that the new data is an important asset to VA and other care providers, helping to reveal what happened to Vietnam veterans and “why did it happen.”
“We will be able to answer a lot of questions that we haven’t been able to so far just because we have these two studies,” he said.
Other findings of the more recent study included that there were high rates of Vietnam veterans with stable, high or increasing PTSD symptoms who had been using VA services for physical health problems.
Vietnam veterans reported developing multiple chronic health conditions over the course of the past 25 years, according to Schlenger, who noted that “for warzone veterans, PTSD is associated with increased risk for multiple chronic health conditions, including cardiovascular diseases, nervous system disorders, and musculoskeletal disorders.”
Study findings also showed higher rates of recent VA outpatient service utilization for physical health concerns among male and female Vietnam veterans with PTSD compared to those without PTSD.
Co-investigator Nida Corry, PhD, also of Abt Associates, suggested that is one reason why integrated care is so critical for veterans.
“That really reinforces the rationale for integrated care and for behavioral health and mental health providers to be cognizant of other chronic health issues their patients may be dealing with and for healthcare provider and healthcare teams to consider screening for some of these behavioral health issues,” Corry emphasized.
Funded by VA, the study was led by Abt Associates in partnership with New York University’s Langone Medical Center Department of Psychiatry. The researchers cited the 25-year gap between the two studies as one of the study’s limitations, noting that the long interval makes it difficult to study mental illness progression.
Tom Berger, PhD, executive director of the Veterans Health Council for Vietnam Veterans of America (VVA) said it would have been better if VA had moved forward with the second study sooner after the completion of the first, suggesting the data could have been helpful in dealing with returning veterans from the first Gulf War and the more recent conflicts in Afghanistan and Iraq.
“In our opinion they waited too long, but they did it. We welcome that they did it, but it was a hassle to get them to do it a second time,” Berger told U.S. Medicine.