Vietnam Veterans Continue to Feel Effects of War
About 16 percent of theater veterans experienced an increase in PTSD symptoms over the past 25 years. Only half as many—7.6 percent—reported a decrease in symptoms.
Decades after the Vietnam War, an estimated 271,000 U.S. veterans who served in the war have current posttraumatic stress disorder (PTSD) or subthreshold PTSD, and one-third of those also have current major depressive disorder, according to the National Vietnam Veterans Longitudinal Study (NVVLS), published in the September issue of JAMA Psychiatry.
The results of the National Vietnam Veterans Longitudinal Study are helping to fill a critical gap in researchers’ understanding of how military service 40 or more years earlier affects adjustment in later life, according to Charles Marmar, M.D.
David Hathcox
Besides its description of the troops who fought decades ago, the study shows their continuing need for access to care, concluded lead author Charles Marmar, M.D., a professor and chair of the Department of Psychiatry at the New York University School of Medicine, and colleagues. The study also points to some of the challenges that may lie ahead for Iraq and Afghanistan veterans, the study authors noted.
From 2012 to 2013, the NVVLS reassessed a sample of 2,348 veterans who were first studied 25 years ago as part of the National Vietnam Veterans Readjustment Study (NVVRS). The NVVLS was funded by the U.S. Department of Veterans Affairs.
“This methodologically superb follow-up of the original NVVRS cohort offers a unique window into the psychiatric health of these veterans 40 years after the war’s end,” wrote psychiatrist Charles Hoge, M.D., of the Center for Psychiatry and Neuroscience at Walter Reed Army Institute of Research in Silver Spring, Md., in an accompanying editorial.
The researchers used several measures to evaluate PTSD and depression, including the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the PTSD Checklist for DSM-5 combined with 10 items from the Posttraumatic Diagnostic Scale, termed the PCL-5+.
Veterans who served in Vietnam (“theater veterans”) overall had higher levels of PTSD than those who served at the same time but were stationed elsewhere (“era veterans”), said Marmar.
Based on the CAPS-5 criteria, the researchers found that 4.5 percent of male theater veterans had current PTSD and 17 percent met criteria for lifetime PTSD. Adding subthreshold PTSD to the CAPS-5 data resulted in a current prevalence of 10.8 percent and a lifetime rate of 26.2 percent. Among the small number of women included in the study, the current prevalence of PTSD based on CAPS-5 was 6.1 percent and lifetime prevalence was 15.2 percent.
By comparison, the NVVRS—which was implemented from 1984 through 1988—estimated that 15.2 percent of men and 8.5 percent of women who served in the war had current PTSD and that nearly 30 percent of the male and female veterans met lifetime criteria for PTSD.
Lower prevalence rates in the current study might seem encouraging but the present-day numbers may be affected by the deaths of veterans since NVVRS was carried out in 1988. Close to 20 percent of NVVRS participants died before recruitment for the current study. This number is unsurprising, given that “PTSD is strongly associated with mortality,” as Hoge noted.
Marmar and his colleagues used the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder (M-PTSD) to also measure changes in PTSD symptoms over time. About 16 percent of theater veterans experienced a deterioration in PTSD symptoms, but only half as many—7.6 percent—improved.
“For era veterans, self-reports of PTSD symptoms during 25 years are low and stable, whereas, for theater veterans, mean levels are higher and increasing,” wrote Marmar.
A total of 36.7 percent of all theater veterans with current war-zone PTSD also had comorbid major depression (although with a wide confidence interval); alcohol or drug abuse, however, were not associated with PTSD.
The NVVLS relied primarily on the DSM-IV version of the PCL with adjustments for new DSM-5 criteria, which “allows for direct comparisons across generations,” noted Hoge. However, he also returned to questions he has previously addressed about DSM-5 criteria for PTSD, especially the criteria for avoidance, a standard that Hoge pointed out “is problematic for military personnel and other first responders who learn to override reactions such as fear, helplessness, or avoidance as part of training.”
Despite those reservations, Hoge still found much to appreciate in the work of the NVVLS.
“No other study has achieved this quality of longitudinal information, and the sobering findings tell us as much about the Vietnam generation as about the lifelong impact of combat service in general, relevant to all generations,” he concluded. ■
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Published in print: October 3, 2015 – October 16, 2015
Published online: 26 October 2015
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