Panel proposes annual PTSD exams for veterans

Soldiers, veterans advocates and mental health officials in Iowa cheered recommendations released Friday calling for soldiers returning from battle to be screened for post-traumatic stress disorder at least once a year.

The Institute of Medicine called for annual testing as well as more research to determine how well various treatments for PTSD are working. Of the 2.6 million service members deployed to Iraq and Afghanistan, it’s estimated that 13 to 20 percent have symptoms of the disorder.

“It’s a great step in the right direction,” said Iowa National Guard Lt. Col. Steve Boesen. “Annual screenings would give soldiers more opportunities to get the help they need. A lot of our young soldiers are encountering a lot of very difficult situations that life doesn’t really prepare you to deal with.”

Boesen has been deployed three times, including twice to Afghanistan, where he commanded 1,000 National Guard infantry soldiers.

PTSD is triggered by a specific traumatic event, such as being in combat or witnessing death. The symptoms of the illness include a numbing of emotions, difficulty concentrating and exaggerated, startled responses to events.

Federal agencies have increasingly dedicated more resources to screen and treat soldiers, but considerable gaps remain, according to the Institute of Medicine, an independent group of experts that advises the federal government on medical issues.

Its recommendations often make their way into laws drafted by Congress and policies implemented by federal agencies.

Iowa Guard moving to more screenings

Even as the institute released its recommendations on Friday, the Iowa National Guard already was moving toward annual behavioral health screenings for soldiers, said Lt. Col. Mary Parmenter, an administrator for the Guard’s resiliency program.

A recently implemented screening program revealed a much higher than expected number of soldiers receiving or requiring behavioral health counseling, she said, illustrating the need for ongoing evaluations.

“I think it’s a very needed thing for the foreseeable future,” she said.

About 15,000 Iowa National Guard members have been deployed to Iraq, Afghanistan and other countries since the Sept. 11, 2001, terrorist attacks, and thousands of Iowans have been deployed with other military service branches.

P.J. Sesker-Green, a spokeswoman for the veterans services group Operation First Response from Grimes, praised the recommendation for increased screening.

More and earlier diagnoses are critical for a disorder she likens to cancer because of the way it metastasizes and becomes more debilitating over time.

“We could do every six months,” she said.

Barely more than half of those diagnosed with PTSD actually get treatment, often because soldiers worry it could jeopardize their careers. Also, when soldiers do get care, they’re not tracked to determine which treatments are successful in the long-term.

“A lot of these soldiers that come back, they’re not going to admit that they’ve got PTSD,” Sesker-Green said. “They’re not going to give you any indication whatsoever because they don’t want to be labeled.”

Next: Study which treatments work

The Department of Defense provides medical care to active members of the military, and the Department of Veterans Affairs cares for those who no longer serve. Sandro Galea, the chairman of the Institute of Medicine panel, said both departments offer many programs for PTSD.

“But treatment isn’t reaching everyone who needs it, and the departments aren’t tracking which treatments are being used or evaluating how well they work in the long-term,” said Galea, a professor and chairman of the epidemiology department at Columbia University.

The report concludes only the first phase of the Institute of Medicine study. The committee is collecting more data to judge the effectiveness of PTSD treatments used by the departments.

The institute recommended therapies supported by robust evidence, such as working with patients to change their thinking and emotional responses to stress.

But the committee’s analysis of other innovative treatments, including yoga, acupuncture and animal-assisted therapy, is hampered by a lack of evidence on their effectiveness.

The panel praised the two departments for issuing joint guidelines for managing PTSD, but it’s unknown whether their providers adhere to the guidelines.

The panel said that primary care doctors within the VA screen Iraq and Afghanistan veterans annually for symptoms of PTSD, and it recommends that the Defense Department do the same.

The panel said it hopes the departments will make more use of therapy through video conferences to allow patients in remote locations to get care.

The report said that the VA treated more than 438,000 veterans for PTSD in 2010, showing evidence of the widespread scope of the problem.