Report at a Glance
Posttraumatic stress disorder (PTSD)
is one of the signature injuries of
the U.S. conflicts in Afghanistan and Iraq. An estimated 8 percent of current
and former service members who were deployed to these areas have a PTSD
diagnosis. For these men and women, readjustment from combat zone deployments
and reintegration into families and communities may be significantly
hampered by chronic distress and disability in physical, psychological, social,
and occupational functioning.
In response to the growing PTSD burden among service members and veterans,
a provision of the National Defense Authorization Act for 2010 required
the Secretary of the Department of Defense (DoD), in consultation with the
Secretary of the Department of Veterans Affairs (VA), to commission an Institute
of Medicine (IOM) study to assess PTSD treatment programs and services
in DoD and VA. The study was conducted in two phases; the final report,
Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations,
contains the IOM committee’s comprehensive assessment of DoD and
VA efforts to prevent and treat PTSD in service members and veterans.
PTSD Symptoms and Prevalence
PTSD is characterized by a combination of mental health symptoms—such as
reliving a traumatic event, avoiding trauma-associated stimuli, and experiencing
mood swings and hyperarousal—that persist for at least 1 month and impair
normal functioning. Symptoms may occur soon after exposure to a traumatic
event or may be delayed, sometimes for years. Increased exposure to combatrelated
trauma is associated with increased risk for developing PTSD.
The U.S. conflicts in Afghanistan and Iraq are associated with a notable
increase in PTSD prevalence. Between 2004 and 2012, the percentage of all
active-duty service members with a diagnosis of PTSD increased from 1 to 5 percent. In 2012, 13.5 percent of U.S. Army service
members had PTSD, as did 10 percent of Marines,
4.5 percent of Navy personnel, and 4 percent of Air
Force personnel. The same year, more than half a
million veterans of all eras sought care for PTSD
through VA health care services—making up 9.2
percent of all VA users. Almost 24 percent of these
veterans (119,500) had served in the Afghanistan
and Iraq conflicts.
Overview of IOM Committee Recommendations
- DoD and VA should develop an integrated, coordinated, and comprehensive PTSD
management strategy that plans for the growing burden of PTSD for service members,
veterans, and their families, including female veterans and minority group members.
- DoD and VA leaders should communicate a clear mandate through their chain of
command that PTSD management, using best practices, has high priority.
- DoD and VA should develop, coordinate, and implement a measurement-based PTSD
management system that documents patients’ progress over the course of treatment
and long-term follow-up with standardized and validated instruments.
- DoD and VA should have available an adequate workforce of mental health care
providers—both direct care and purchased care—ancillary staff, and resources to meet
the growing demand for PTSD services. This includes clear training standards, referral
procedures, and patient monitoring and reporting requirements for all their mental
health care providers.
- Both departments should use evidence-based treatments as the treatment of choice
for PTSD, and these treatments should be delivered with fidelity to their established
protocols. Any new programs and services should be piloted and include an evaluation
process to establish the evidence base on their efficacy and effectiveness.
- DoD and VA should establish a central database or other directory for programs and
services that are available to service members and veterans who have PTSD.
- DoD and VA should increase engagement of family members in the PTSD management
process for service members and veterans.
- PTSD research priorities in DoD and VA should reflect the current and future needs of
service members, veterans, and their families. Both departments should continue to
develop and implement a comprehensive plan to promote a collaborative, prospective
PTSD research agenda.