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Dartmouth Medical School Dartmouth-Hitchcock Medical Center


Study documents veterans' diagnoses

By Katherine Dawson

Stecker is based at the White River Junction VA.

Mental health conditions are common among men and women returning from military combat, but help for those conditions is not always easy to find. DMS researcher Tracy Stecker, Ph.D., set out to examine exactly how prevalent mental health problems are among combat veterans. Among other conclusions, she discovered a high rate of diagnoses of post-traumatic stress disorder (PTSD), indicating that many veterans are in need of treatment.

Stecker used a national Veterans Affairs database to examine the incidence of various medical and mental health conditions for combat veterans from 2001 to 2006. The most common diagnosis among veterans who received care at VA medical centers was pain, with almost half reporting pain. The next two most common diagnoses were for mental health conditions: depression (affecting about 13% of patients) and PTSD (about 12%).

Worse: To make things worse, Stecker says, many veterans suffering from these and other mental health conditions never receive treatment for them. And it's likely that this assessment underestimates the prevalence of mental health problems.

Stecker published her findings in the journal Psychosomatics, highlighting the particularly damaging combination of pain, PTSD, and depression, which often afflict patients together. Stecker says the most effective treatments for PTSD are exposure therapy and cognitive behavior therapy, but the fact that many of these problems can be found together in a single patient, along with self-medication with alcohol and drugs, can make treatment even more difficult than it would otherwise be.

Pain: Although most VA medical centers are equipped to deal with pain, not all have psychiatric or counseling facilities. Stecker recommends locating psychiatric staff at pain centers to help treat patients with both diagnoses.

The next most common diagnoses were for depression and PTSD.

When adequate mental health care is not provided, it can lead to long-term problems. Many veterans are redeployed before ever receiving help, which can make them even more in need of help when they complete their service. And PTSD can sometimes be triggered long after active duty ends. For example, Stecker notes, after Hurricane Katrina struck the Gulf Coast, there was a local increase in the number of Vietnam veterans reporting problems with PTSD.

Seek: Stecker says the stigma associated with psychiatric disorders is the primary reason veterans do not always seek treatment, but recent research shows this stigma seems to be decreasing. This could be due to better awareness regarding mental illness, or, says Stecker, because veterans are now "struggling so much with their conditions that stigma is no longer a barrier to attempting to attain help."

She plans to use the findings as the basis for a trial on the use of mental health care by veterans.

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