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Report: 1 in 5 combat vets has PTSD or TBI

A new report from a civilian research organization has found that about one in five combat veterans have experienced post-traumatic stress disorder, traumatic brain injury or both.

Those rates are similar to what military studies have shown. But the new report from the Rand Corp., “Invisible Wounds of War,” also found that only half of combat vets with PTSD and/or TBI seek help — and only half of those who seek help “receive minimally adequate care.”

In what Rand says is the first analysis of its kind, the study says direct medical care, lost productivity and suicide among veterans of the wars in Iraq and Afghanistan ultimately could cost the nation $4 billion to $6 billion for PTSD, and $591 million to $910 million for TBI.

In the meantime, the report found, the military may be wasting tens of thousands of dollars treating service members with methods that have not been proven effective, such as group therapy or psychiatric drugs never independently tested on people with PTSD.

“If 50 percent of those needing care for PTSD and depression received treatment and all care was evidence-based, this larger investment in treatment would result in cost savings overall,” the report said.

If 100 percent of those needing help got evidence-based care, the cost savings could be as much as $1.7 billion.

Military studies also have looked at why many service members don’t seek mental health treatment, and have concluded that stigma — the fear of appearing weak, of deserting the team, or qualms about how a mental-health diagnosis could affect careers — is the largest factor.

A team of 25 Rand researchers surveyed 1,965 service members from 24 communities across the country and found:

• 44 percent feared diagnosis of mental health problems could harm their careers.

• 44 percent feared having a security clearance denied.

• 39 percent hoped friends and family would be more helpful than a therapist.

• 38 percent feared co-workers would have less confidence in them if it became known that they had sought help.

Those results are not unexpected. But the Rand survey also offered a surprising new finding: 45 percent of troops feared that any medications prescribed for their conditions would have too many side effects.

The number of people involved is huge. The report said about 300,000 veterans of Iraq and Afghanistan suffer from PTSD or major depression, and about 320,000 may have experienced TBI during a combat deployment.

Researchers said the Pentagon and Department of Veterans Affairs have done much to reduce gaps in care — but much remains undone. For example, those seeking VA care “may face long wait times for appointments, particularly in facilities resourced primarily to meet the demands of older veterans,” Rand found.

And of those who reported a probable TBI — defined as any change in consciousness after a blast or a blow to the head — 57 percent had not been evaluated by a physician for brain injury.

Beyond the monetary costs, researchers said they feared that, like Vietnam, another generation of veterans faces higher risk for smoking, overeating, unsafe sex, suicide and death.

Studies have shown those with PTSD are more likely to miss work for health reasons, because the disorder manifests in physical symptoms, such as headaches or other pains. People with PTSD also are more likely to have relationship problems that can lead to abuse or divorce, as well as diminished capacity for strong relationships with their children.

“There is also a possible link between these conditions and homelessness,” Rand found.

Rand made recommendations for both VA and the military to provide better care — some of which both departments are already working on. For example, Rand recommended more treatment programs, as well as hiring and training more mental health care providers.

They said official policies should encourage troops and veterans to seek care in a confidential manner, and that all care be evidence-based and given by trained providers. To do this, there must be better means of monitoring the health-care system, researchers said.

Rand also said VA and the Defense Department should invest more in research to close gaps in care and allow them to plan more effectively.

As more troops return from combat, researchers said civilian care providers also should become better-trained to meet their needs.

“The systems of care for meeting these needs have been improved, but critical gaps remain,” Rand found. “Without effective treatment, these conditions carry significant long-term costs and negative consequences.”