In the first comprehensive review of the government's programs for treating post-traumatic stress disorder in service members and veterans, a panel of experts recommended on Friday that the Defense Department and the Department of Veterans Affairs expand access to services, particularly for people in rural areas, in the National Guard or Reserves, or in combat zones.
The report, by the Institute of Medicine, also concluded that the two departments need to improve their assessment of how well their many treatment programs work, as well as find better ways of coordinating care that can begin overseas and then continue on bases or in small towns across the country.
"There is a tremendous amount of good-will effort in both departments to provide good treatment," said Dr. Sandro Galea, a professor of epidemiology at Columbia University and the chairman of the committee. "The challenge is that in the rush to deliver treatment, assessment and monitoring has not been implemented rigorously, and that is a missed opportunity."
The nearly 400-page report represents the first half of a multiyear review of the broad range of P.T.S.D. screening and care services provided by the two departments. A second report, to be released in 2014, will assess emerging treatments.
The Pentagon is financing the study by the institute, part of the National Academy of Sciences. The 14 panel members included leading academicians in the fields of psychiatry, social work, family medicine and public health.
P.T.S.D., an anxiety disorder set off by traumatic experiences, is estimated to affect as many as one in five of the 2.6 million service members who have deployed to Iraq or Afghanistan since 2001. The disorder, with symptoms that include flashbacks, sleeping disorders, irritability and hypervigilance, often does not emerge for months or even years after a deployment.
In the second phase of its review, the panel hopes to get comprehensive data and demographic information on the troops and veterans who have received a diagnosis of P.T.S.D., as well as on the treatment they received and the cost of that care.
Those statistics would provide a significant step forward in understanding the breadth and depth of P.T.S.D., since current efforts to estimate its prevalence vary widely. "The data exists," Dr. Galea said. "But it is scattered in many systems."
The report, based on a review of literature, interviews and a visit to Fort Hood in Texas, found that the two departments have a wide array of programs for treating P.T.S.D. But it raised questions about the consistency of those programs, and about whether the two departments know which are effective.
Dr. Galea said that treatment and rehabilitation programs can vary from base to base, and that even when services are standardized, they are often carried out differently.
In describing barriers to care, the panel noted that both departments have hired thousands of health care providers in recent years, yet are still short of the personnel they need. Other obstacles included inaccessibility of services in rural areas or combat zones, fears among service members that their careers will be hurt if they seek treatment, and a lack of time in busy work schedules for lengthy treatment regimens.
The report suggested that the broader use of telemedicine or virtual reality therapies could help expand treatment to inaccessible areas. It called on both departments to consider alternative therapies, like yoga, in conjunction with the most widely accepted ones, cognitive processing and prolonged exposure.
And it said that the Defense Department should screen troops for P.T.S.D. annually, and not just before and after deployments, since the disorder can take years to emerge. The Department of Veterans Affairs already does annual screening, the report said.
In a statement, the Pentagon said it was reviewing the report and had already begun addressing some of its recommendations.
By James Dao
New York Times
July 14, 2012