New Study Is Criticized for Using Narrow Criteria for Condition

A painstaking reanalysis of data collected in the 1980s from Vietnam War veterans confirms that post-traumatic stress disorder is a real and common psychiatric consequence of war, but it comes to the controversial conclusion that significantly fewer veterans were affected than experts have thought.

The report's suggestion that one in five Vietnam veterans had the syndrome at some point in the first dozen years after the war -- as opposed to previous estimates as high as one in three -- drew praise from some experts as a valuable reassessment of an issue made timely by fresh waves of disturbed veterans coming back from Iraq.

"It provides a more accurate gauge of the treatment needs," said Harvard University psychologist Richard J. McNally, who wrote a commentary accompanying the research in today's issue of the journal Science.

But other experts and some veterans groups criticized the study, saying it used criteria so narrow that it excluded many vets who should have been included.

"It uses a naive formulation of what represents a trauma exposure and so covers only a small percentage of people actually exposed to traumatic events," said Arthur Blank Jr., a Bethesda psychiatrist who treated soldiers in Vietnam and later served for 12 years as director of the federal network of counseling centers for combat veterans.

Symptoms of PTSD include flashbacks, emotional numbness, hypervigilance and exaggerated startle responses that leave a person impaired after experiencing one or more traumatic events.

The new findings come at a delicate time in the nation's decades-old effort to grapple with the psychological impacts of war -- and with the monetary costs of dealing with those impacts.

The Department of Veterans Affairs, which spends almost $10 billion a year on PTSD benefits and mental health care services generally, has in recent years initiated a number of reviews of how PTSD is diagnosed and treated. Many veterans believe that those moves have been motivated by a desire to cut back on help for ailing vets.

Cost issues have become prominent amid recent revelations that the number of veterans receiving compensation for PTSD -- about 216,000 last year -- has grown seven times as fast as the number receiving benefits for disabilities in general. And that figure does not include most of the more than 100,000 veterans who have sought mental health services since returning from Iraq and Afghanistan.

"Vietnam was a war without fronts, where it was very hard to tell civilians from enemies, and there was no safe place, no lines to get behind," said the report's senior author, Bruce P. Dohrenwend, a psychologist at the New York State Psychiatric Institute in Manhattan.

"The thing about Iraq is it is also a war without fronts," he said. "We need to do more work on Vietnam and apply what we learn to Iraq."

The controversy over PTSD's prevalence dates back to 1988, eight years after the disorder was formally added to the American Psychiatric Association's official handbook of mental disorders.

That year saw the release of two independent studies of PTSD in Vietnam vets. One, by the Centers for Disease Control, concluded that 15 percent had experienced PTSD at some point and 2 percent still did as of that year. By contrast, the National Vietnam Veterans Readjustment Study (NVVRS) found that 31 percent had suffered from PTSD and 15 percent still did.

Although the latter study is widely considered to be superior and is most often cited today, some critics have contended that its numbers were inflated. That view has recently been invoked by conservative commentators who have implied that many veterans are malingerers who have exaggerated their traumas and are bilking taxpayers.

The new study reviewed notes from interviews with hundreds of veterans in the NVVRS and compared their tales with military records, news reports and other documents to verify their stories. The team found virtually no evidence of exaggeration or falsification.

Matthew J. Friedman, executive director of VA's National Center for PTSD, said that finding alone is a major achievement. When interviews are done well, he said, "verbal reports are reliable."

But by excluding some veterans -- including those whose impairment was considered minor and the few whose reports of trauma, while plausible, could not be confirmed -- the team concluded that 19 percent of Vietnam vets had PTSD at some point and 9 percent still did as of 1988. That is almost 40 percent lower than the NVVRS figures.

Blank and others said the new measure is false because it excludes, among others, medics who witnessed traumas every day without being injured themselves.

But the difference is not worth quibbling over, said VA's Friedman. "Multiply 19 percent times 3-plus million people who served in Vietnam, and you get a big number," he said.

The Institute of Medicine, which advises Congress, recently released a report backing up current diagnostic criteria for PTSD and is looking into treatments and compensation. But another new government study, which was to provide an updated look at Vietnam vets 20 years after the NVVRS to learn about the longer-term effects of PTSD, was recently killed by the VA before it started, angering veterans and others.

Friedman said he could not say why the agency spiked the study, but others said they could guess.

"All these studies do is find more problems," said William Schlenger, a psychologist and PTSD expert with Abt Associates of Cambridge, Mass. "So the government gets into a frame of, 'Why spend this money to find problems we can't afford to fix?' "

Source: Washington Post

Added: Now read the more correct analysis of the situation without the politics involved.