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:
Invisible Wounds of War: PTSD and Depression Over Time Terry Schell (with Grant Marshall, Terri Tanielian, Lisa Jaycox & Jeremy Miles)
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 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 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 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 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 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 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 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 10/2012 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 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 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 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 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 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 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 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
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