Neither the Defense nor the Veterans Affairs department -- which operate the world’s largest electronic health records systems -- tracks treatments used for post-traumatic stress disorder, according to a report the Institute of Medicine issued last week. What’s more, Defense does not even know how many PTSD treatment programs it or the services provide.
Sandro Galea, professor and chairman of the department of epidemiology at Columbia University’s Mailman School of Public Health and chairman of the IOM committee responsible for the study said, “DoD and VA 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.” He added, "In addition, DoD has no information on the effectiveness of its programs to prevent PTSD."
According to the report, Treatment for Post-Traumatic Stress Disorder in Military and Veteran Populations, “no single source within the DoD or any of the service branches maintains a complete list of such [treatment] programs, tracks the development of new or emerging programs, or has appropriate resources in place to direct service members to programs that may best meet their individual needs.”
Defense and VA lack the capability to track the efficacy of PTSD treatment beyond prescriptions of psychotropic drugs, IOM reported. “The committee learned from the VA that it plans to add a template to its medical records to track psychotherapy progress notes. The committee does not know if the DoD has similar plans. Lack of a system to identify which treatments, other than pharmaceuticals, were provided to which patients, makes it difficult to determine the extent to which [cognitive processing therapy] or [prolonged exposure] therapy is being used at the local level and the outcomes of the treatments.”
IOM released its report as both Defense and VA grapple with the mental health costs of 11 years of war in Afghanistan and Iraq borne by an all-volunteer force of 1.4 million troops, many of whom have made multiple deployments since 2001.
The Armed Forces Health Surveillance Center reported last week that 102,549 active-duty service members, or 8 percent of the force, have been diagnosed with PTSD since 2001. The institute said in its report in fiscal 2010 that VA treated 82,239 Afghanistan and Iraq veterans for PTSD, or 24.6 percent of all veterans from those two wars treated by VA. These figures do not include 191,501 veterans of the two wars who used community-based vet centers, many of whom sought help for PTSD, report said.
The institute evaluated numerous forms of treatment that Defense and VA use. It said studies have shown both exposure therapy -- revisiting a traumatic event with a psychiatrist or counselor, and cognitive therapy -- confronting negative thoughts about a traumatic event such as survivor guilt, are effective PTSD treatments, but need more research backup.<
IOM cautioned against prescribing drugs, particularly selective serotonin reuptake inhibitors such as Prozac to treat PTSD. “The evidence was inadequate to determine the efficacy of SSRIs and all other drug categories in PTSD [treatment],” the report concluded.
The report also said there was a lack of empirical evidence to support therapies such as massage, biofeedback, yoga and acupuncture for PTSD treatment, which the Army surgeon general suggested in April.
VA should expand its telehealth technologies to treat rural veterans who live far from department hospitals or clinics, IOM recommended.