While it has been 40 years since the Vietnam War ended, about 271,000 veterans who served in the war zone are estimated to have current full posttraumatic stress disorder (PTSD) plus subthreshold (meeting some diagnostic criteria) war-zone PTSD and more than one-third have current major depressive disorder, according to an article published online by JAMA Psychiatry.
The study by Charles R. Marmar, M.D., of the New York University Langone Medical Center, and colleagues builds on the National Vietnam Veterans Readjustment Study (NVVRS), which was implemented from 1984 through 1988 (about 10 years after the war ended). The authors’ National Vietnam Veterans Longitudinal Study (NVVLS) is the first follow-up to NVVRS. There were 1,839 veterans from the original study still living at the time of the NVVLS from July 2012 to May 2013 and 78.8 percent (n=1,450) of the veterans participated in at least one phase of the study.
The authors estimate a prevalence among male war zone veterans of 4.5 percent for a current PTSD diagnosis based on the Clinician-Administered PTSD Scale for DSM-5; 10.8 percent based on that assessment plus subthreshold PTSD; and 11.2 percent based on the PTSD Checklist for DSM-5 items for current war-zone PTSD. Among female veterans, the estimates were 6.1 percent, 8.7 percent and 6.6 percent, respectively.
The study also found coexisting major depression in 36.7 percent of veterans with current war-zone PTSD.
About 16 percent of war zone Vietnam veterans reported an increase of more than 20 points on a PTSD symptom scale while 7.6 percent reported a decrease of greater than 20 points on the symptom scale. “An important minority of Vietnam veterans are symptomatic after four decades, with more than twice as many deteriorating as improving,” the study notes.
The authors conclude: “Policy implications include the need for greater access to evidence-based mental health services; the importance of integrating mental health treatment into primary care in light of the nearly 20 percent mortality; attention to the stresses of aging, including retirement, chronic illness, declining social support and cognitive changes that create difficulties with the management of unwanted memories; and anticipating challenges that lie ahead for Iraq and Afghanistan veterans,” the study concludes.
Editorial: Measuring the Long-Term Impact of War Zone Military Service
In a related editorial, Charles W. Hoge, M.D., of the Walter Reed Army Institute of Research, Silver Spring, Md., writes: “This methodologically superb follow-up of the original NVVRS cohort offers a unique window into the psychiatric health of these veterans 40 years after the war’s end. No other study has achieved this quality of longitudinal information, and the sobering findings tell us as much about the Vietnam generation as about the lifelong impact of combat service in general, relevant to all generations.” (doi:10.1001/jamapsychiatry.2015.1066)
Funding: The National Vietnam Veterans Longitudinal Study was funded and contracted by the Department of Veterans Affairs.
Source: Jim Mandler – JAMA Network
Image Credit: The image is in the public domain
Original Research: Abstract for “Course of Posttraumatic Stress Disorder 40 Years After the Vietnam War: Findings From the National Vietnam Veterans Longitudinal Study” by Charles R. Marmar, MD; William Schlenger, PhD; Clare Henn-Haase, PsyD; Meng Qian, PhD; Emily Purchia, MPH; Meng Li, MA; Nida Corry, PhD; Christianna S. Williams, PhD; Chia-Lin Ho, PhD; Danny Horesh, PhD; Karen-Inge Karstoft, PhD; Arieh Shalev, MD; and Richard A. Kulka, PhD in JAMA Psychiatry. Published online July 22 2015 doi:10.1001/jamapsychiatry.2015.0803
Course of Posttraumatic Stress Disorder 40 Years After the Vietnam War: Findings From the National Vietnam Veterans Longitudinal Study
Importance The long-term course of readjustment problems in military personnel has not been evaluated in a nationally representative sample. The National Vietnam Veterans Longitudinal Study (NVVLS) is a congressionally mandated assessment of Vietnam veterans who underwent previous assessment in the National Vietnam Veterans Readjustment Study (NVVRS).
Objective To determine the prevalence, course, and comorbidities of war-zone posttraumatic stress disorder (PTSD) across a 25-year interval.
Design, Setting, and Participants The NVVLS survey consisted of a self-report health questionnaire (n = 1409), a computer-assisted telephone survey health interview (n = 1279), and a telephone clinical interview (n = 400) in a representative national sample of veterans who served in the Vietnam theater of operations (theater veterans) from July 3, 2012, through May 17, 2013. Of 2348 NVVRS participants, 1920 were alive at the outset of the NVVLS, and 81 died during recruitment; 1450 of the remaining 1839 (78.8%) participated in at least 1 NVVLS study phase. Data analysis was performed from May 18, 2013, through January 9, 2015, with further analyses continued through April 13, 2015.
Main Outcomes and Measures Study instruments included the Mississippi Scale for Combat-Related PTSD, PTSD Checklist for DSM-IV supplemented with PTSD Checklist for DSM-5 items (PCL-5+), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and Structured Clinical Interview for DSM-IV, Nonpatient Version.
Results Among male theater veterans, we estimated a prevalence (95% CI) of 4.5% (1.7%-7.3%) based on CAPS-5 criteria for a current PTSD diagnosis; 10.8% (6.5%-15.1%) based on CAPS-5 full plus subthreshold PTSD; and 11.2% (8.3%-14.2%) based on PCL-5+ criteria for current war-zone PTSD. Among female veterans, estimates were 6.1% (1.8%-10.3%), 8.7% (3.8%-13.6%), and 6.6% (3.5%-9.6%), respectively. The PCL-5+ prevalence (95% CI) of current non–war-zone PTSD was 4.6% (2.6%-6.6%) in male and 5.1% (2.3%-8.0%) in female theater veterans. Comorbid major depression occurred in 36.7% (95% CI, 6.2%-67.2%) of veterans with current war-zone PTSD. With regard to the course of PTSD, 16.0% of theater veterans reported an increase and 7.6% reported a decrease of greater than 20 points in Mississippi Scale for Combat-Related PTSD symptoms. The prevalence (95% CI) of current PCL-5+–derived PTSD in study respondents was 1.2% (0.0%-3.0%) for male and 3.9% (0.0%-8.1%) for female Vietnam veterans.
Conclusions and Relevance Approximately 271 000 Vietnam theater veterans have current full PTSD plus subthreshold war-zone PTSD, one-third of whom have current major depressive disorder, 40 or more years after the war. These findings underscore the need for mental health services for many decades for veterans with PTSD symptoms.
“Course of Posttraumatic Stress Disorder 40 Years After the Vietnam War: Findings From the National Vietnam Veterans Longitudinal Study” by Charles R. Marmar, MD; William Schlenger, PhD; Clare Henn-Haase, PsyD; Meng Qian, PhD; Emily Purchia, MPH; Meng Li, MA; Nida Corry, PhD; Christianna S. Williams, PhD; Chia-Lin Ho, PhD; Danny Horesh, PhD; Karen-Inge Karstoft, PhD; Arieh Shalev, MD; and Richard A. Kulka, PhD in JAMA Psychiatry. Published online July 22 2015 doi:10.1001/jamapsychiatry.2015.0803