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Invisible Wounds of War: PTSD and Depression Over Time Terry Schell (with Grant Marshall, Terri Tanielian, Lisa Jaycox & Jeremy Miles)

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Presentation on theme: "Invisible Wounds of War: PTSD and Depression Over Time Terry Schell (with Grant Marshall, Terri Tanielian, Lisa Jaycox & Jeremy Miles)"— Presentation transcript:

1 Invisible Wounds of War: PTSD and Depression Over Time Terry Schell (with Grant Marshall, Terri Tanielian, Lisa Jaycox & Jeremy Miles)

2 2 10/2012 Sampling Methods  Data collection was sponsored by California Community Foundation; NIH has funded secondary analyses of these data (R01MH087657)  Was conducted independent of the DoD and VA  Respondents were sampled using Random Digit Dialing within 24 geographic regions  Residences were screened for individuals who had deployed for OEF/OIF  Respondents were given incentives to participate  Baseline data collection occurred in Late 2007 and early 2008

3 3 10/2012 Analytic Weights  Final baseline sample of 2120 service members previously deployed to OEF/OIF  The Invisible Wounds of War RAND report was based on a preliminary data set from this study that had approximately 200 fewer respondents  The analytic sample is weighted to be representative of the total previously-deployed force on branch of service, and within each branch on age, gender, marital status, rank, separation status, and reserve component.

4 4 10/2012 Follow-up Sample  Surveys conducted about 18 months after first wave  Follow up sample N = 1010  Re-interviewed 88% of those who could be contacted at the baseline number, but the majority of participants had moved in the interval  Unweighted follow-up sample is highly representative of the baseline sample  Attrition weights create a close match to the weighted baseline sample on almost all variables, including rates of PTSD, Depression, TBI, and trauma exposure  31% of respondents deployed in between the two surveys

5 5 10/2012 Approximately 1 in 6 Had a Current Probable Diagnosis at Wave 1 No mental health condition 83.5% 1 st Wave Depression Only 3.7 % PTSD Only 4.0 % Both 8.8 % 16.5%

6 6 10/2012 Who Develops Post-Deployment Mental Health Problems?  The mental health outcomes were very well predicted by the available variables  Multivariate regression models found several subgroups at high risk:  Army, Separated, Enlisted, Hispanic Ethnicity, Female, Trauma Exposed  Very similar partial relative risk ratios observed when predicting PTSD and Depression outcomes  Several factors often assumed to be important were not significant in the multivariate models:  number of deployments, length of deployments, total deployment time, time since deployment

7 7 10/2012 Trauma Exposure Was Common During Deployment The study assessed deployment trauma with a 0-11 scale counting the different types of traumatic events that occurred during any prior deployment, e.g.,: Friend was seriously wounded or killed50% Witnessing serious accident44% Seeing dead/injured non-combatants44% Smelling decomposing bodies36% Injured not requiring hospitalization23% Being physically moved by an explosion22% Having a bump or blow to the head17% Injured requiring hospitalization10% Killing a civilian5%

8 8 10/2012 Trauma Exposure is the Primary Risk Factor  The range of covariate-adjusted, relative risk between the highest and lowest trauma exposure categories is very large.  25-fold increase in risk for PTSD,  23-fold increase in risk for Depression  Prevalence among individuals reporting none of the 11 deployment traumas were at or below the rates found in the general US population.  RRR’s for deployment trauma are virtually unchanged in bivariate and multivariate models

9 9 10/2012 Prevalence of Mental Health Problems by Prior Deployment Trauma Exposure Trauma Category Probable PTSD Probably MDD Either No Reported Trauma (N= 537)1%3%4% Medium Trauma (N=1115)8% 13% High Trauma (N= 468)38%33%40% Medium Trauma = experienced 1 - 4 trauma types High Trauma = experienced 5 - 11 trauma types

10 10 10/2012 Trauma Exposure Shows a Regular Dose- Response Relationship with MH Symptoms Model: SX = b(covariates) + b 1 f 1 + b 2 f 2 + …+b n f n where Q is estimated at.30. Model: SX = b(covariates) + b 1 f 1 + b 2 f 2 + … + b n f n where Q is estimated at.30. Q Q Q

11 11 10/2012 Implications of Deployment Trauma  The substantial majority of PTSD and Major Depression cases in this population can be attributed to deployment trauma  The was no significant evidence that general deployment stressors (time deployed, number of cycles) play a significant role in the etiology of either disorder controlling for trauma  Initial exposure to a given deployment trauma type poses the greatest incremental risk for mental health symptoms

12 12 10/2012 How Do Military Mental Health Problems Change Over Time?  Most longitudinal civilian studies show gradual improvement of PTSD symptoms following trauma  Studies of Vietnam era veterans have shown relatively stable rates over time, with minimal aggregate improvement  In contrast, two published longitudinal studies on service members deployed to OEF/OIF have shown increases in symptoms over time

13 13 10/2012 Approximately 1 in 5 Had a Current Mental Health Condition at Wave 2 No mental health condition 83.5% No mental health condition 80% 1 st Wave 2 nd Wave Depression Only 3.7 % 5.6 % PTSD Only 4.0 % 5.5 % Both 8.8 % 8.9 % 16.5% 20.0%

14 14 10/2012 Probable Diagnoses Are Relatively Stable Over Time Probable Diagnoses T1T2Either T1 or T2 Any PTSD 12.8%14.4%19.0% Any MDD 12.5%14.5%19.8% Either PTSD or MDD 16.5%20.0%24.8%  Of those with some probable diagnosis at T1, 71% continued with some diagnosis at T2  Of those without any probable diagnosis at T1, 10% developed a new diagnoses  About 41% of T2 cases are “new”

15 15 10/2012 Mental Health Problems Increase Over Time  The odds of having a probable mental health problem increased over time, Odds Ratio = 1.25 [1.03, 1.50 ] per year  The increase was not significantly associated with:  Whether individual deployed between surveys  Length of time they were home since last deployment  This pattern is slightly different than found in other studies  Civilian traumatized samples usually show declines in symptoms over time  The rate of increase is considerably smaller than was found when comparing PDHA and PDHRA data

16 16 10/2012 Service Members Prefer Talk Therapies  About half of those with a probably diagnosis sought help in the last year  About half of those who sought help received some sort of treatment  Service members were about 3x more likely to seek care from a mental health specialist (MHS) than from a primary care physician (PCP), 14% vs 5% of the sample.  Visit length and frequency is consistent with the view that MHS are delivering talk therapies and PCPs pharmacotherapy  Among those who sought help, care received from mental health specialist was rated as more helpful than either care from PCPs or pharmacotherapy.

17 17 10/2012 Overall Conclusions  Cross sectional studies are likely to underestimate the number of individuals who will have mental health problems subsequent to combat exposure  Mental health problems, including Depression, appear to be trauma-related and service-connected rather than a product of pre-existing problems  The peak demand for mental health services in this population may be several years in the future  Meeting this demand may require a substantial expansion of our capacity to deliver evidence-based talk therapies

18 18 10/2012


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