Double Jeopardy

PTSD, Brain Injury Put Veterans in 'Double Jeopardy'

Aaron Levin
More intensive clinical diagnoses and development of biological markers for PTSD could lead to better evaluation of veterans of the wars in Iraq and Afghanistan.

Although one in four veterans returning from Iraq and Afghanistan who visit a Veterans Affairs (VA) medical center receives a diagnosis involving mental health, better diagnostic tools are still needed to evaluate these troops, a prominent researcher told the House Appropriations Subcommittee on Defense in Washington, D.C., in January.

"Thirteen percent of the 100,000 first visits were diagnosed with PTSD," said Charles Marmar, M.D., vice chair and professor of psychiatry at the University of California, San Francisco, and associate chief of staff for mental health at the San Francisco VA Medical Center. "Those diagnoses were made by clinicians in face-to-face diagnostic interviews, usually in primary care."

Marmar noted that on this occasion, he was not speaking on behalf of the Department of Veterans Affairs since his remarks had not been cleared by the department.

Marmar was the main psychiatric witness before the committee. He reported on a study (in press with Archives of Internal Medicine) of more than 100,000 veterans of warfare in Iraq and Afghanistan. The committee room was so crowded that Capitol police turned away latecomers.

Rates of PTSD in this group were roughly similar to those of veterans of the Vietnam War, but there was one "striking" difference, he said. The present wars have seen a marked rise in traumatic brain injuries, largely due to roadside bomb explosions and motor vehicle accidents, along with gunshot wounds.

"Unfortunately, these closed head injuries are the same kind of events in the same settings that are likely to lead to terror and horror, which trigger posttraumatic stress," he said. "So the two occur together, creating a kind of double jeopardy."

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