MedicalResearch.com Interview with:
Charles R. Marmar, MD
The Lucius Littauer Professor and Chair, Department of Psychiatry, NYU Langone Medical Center and Director of the Steven and Alexandra Cohen Veterans Center at NYU Langone
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Marmar: Approximately 2.7 million men and women served in Vietnam, and, for those who returned, many have suffered for decades from a variety of psychological problems resulting from their experiences and other injuries such as traumatic brain injury (TBI).
The 25-year National Vietnam Veterans Longitudinal Study (NVVLS) was a way we could determine at various points in time how veterans were faring emotionally four decades after their service. While the vast majority are resilient, there are still over 270,000 Vietnam veterans who still have some form of post-traumatic stress disorder (PTSD) and one-third of these veterans have depression.
We followed up with veterans who participated in the National Vietnam Veterans Readjustment Study (NVVRS) from 1984 to 1988 who were evaluated for PTSD. The NVVRS group represented a probability sample of those who served in Vietnam. Of the 1,839 participants still alive, 1,409 participated in at least one phase of the NVVLS, which involved a health questionnaire, health interview and clinical interview.
The results showed that between 4.5 percent and 11.2 percent of male Vietnam veterans and 6.1 and 8.7 percent of the female veterans are currently experiencing some level of PTSD.
About 16 percent of veterans in the study reported an increase of more than 20 points on a PTSD symptom scale compared to 7.6 percent who reported a decrease of greater than 20 points.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Marmar: The primary take-home message is that the majority of men and women who served in Vietnam are resilient across 40 years. However, equally important, the minority of individuals who are symptomatic 15 years ago or more are likely to have increases rather than decreases in the severity of the symptoms. That is why it is never too late to seek help and benefit from psychotherapy, medications, and, where indicated, marital and family therapy.
PTSD can be debilitating, especially when there are other issues involved such as depression, substance abuse and now the social and health challenges that may accompany aging.
Veterans should know that they are not alone and that there is no stigma attached to seeking help. As a society, we should strive to make mental health services more affordable and available to veterans and their families.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Marmar: Tracking the effects of war-time trauma in Vietnam War veterans is enormously helpful for future studies.
In fact, there is a novel five-year multicenter study well underway led by researchers at our Cohen Veterans Center that is looking into objective biological markers of post-traumatic stress and traumatic brain injury (TBI) in returning soldiers of the wars in Iraq and Afghanistan. The goal is to transform the way mental health disorders are diagnosed by identifying specific physiological markers that can tell clinicians definitively that a person is suffering from PTS, TBI, depression or a combination. Presently, there is no single valid diagnostic test that can independently confirm either diagnosis and we hope to change that. It is a multicenter effort. Emory University School of Medicine, Stanford University School of Medicine, Fort Detrick, and the Department of Defense are also involved in this research.
Marmar CR, Schlenger W, Henn-Haase C, et al. Course of Posttraumatic Stress Disorder 40 Years After the Vietnam War: Findings From the National Vietnam Veterans Longitudinal Study. JAMA Psychiatry. Published online July 22, 2015. doi:10.1001/jamapsychiatry.2015.0803.