YOKOTA AIR BASE, Japan — Roughly half of the soldiers who return from war with post-traumatic stress disorder don’t seek treatment, and many more drop out of therapy early, according to military research presented at last week’s American Psychiatric Association’s annual meeting.
“Fewer than half of the soldiers who report symptoms of combat-related PTSD receive the care they need,” Maj. Gary H. Wynn, a research psychiatrist at Walter Reed Army Institute of Research, said during a presentation to the association. “And of those soldiers who do start treatment, between 20 percent and 50 percent walk away before its completion.”
Army analysis of multiple studies suggests that most servicemembers have at least one experience during deployment that could lead to PTSD, and 15 percent of U.S. infantrymen who have deployed to Iraq or Afghanistan have returned with the disorder, a condition characterized with such symptoms as depression, anger, mistrust, panic, guilt and violent behavior, physical pain, dizziness and trouble sleeping, Wynn said.
Experiences that can lead to PTSD include receiving incoming artillery, rocket or mortar fire, being attacked or ambushed or knowing someone seriously injured or killed, he said.
Despite these alarming findings, few servicemembers seek help, research shows. And there’s a common misperception that the military can simply order a servicemember to report for PTSD treatment, Wynn said in a phone interview Tuesday.
Military members retain the right to refuse psychiatric treatment or medication, unless they are a risk to themselves or others, he said, adding that it wouldn’t be good therapy to order people into care.
“You want them to be engaged and not feel forced,” he said.
The fact that today’s soldiers are professionals, rather than draftees, might also be a factor in their reluctance to engage in PTSD therapy, said retired U.S. Army Lt. Col. David Johnson, now executive director of the Center for Advanced Defense Studies in Washington, D.C.
“Soldiers in an all-volunteer force want to be selected for combat missions and they are afraid that psychological testing will prevent them from deploying,” Johnson said.
The Army needs to reduce the stigma associated with PTSD and, “let people know it doesn’t harm your career,” he said, adding that recent rule changes mean soldiers can’t be denied a security clearance simply because they’ve been diagnosed with PTSD.
Getting soldiers to seek treatment is only half the battle; doctors must also find ways to keep them in treatment.
A soldier might drop out of PTSD therapy for a variety of reasons, including a lack of trust for mental health professionals, a belief that psychological problems tend to work themselves out or a perception that seeking mental health treatment should be a last resort, Johnson said.
While it’s possible to see a physical wound heal, it’s not obvious when somebody has overcome PTSD.
“Soldiers don’t like the idea of open-ended therapy,” Johnson said, adding that psychiatrists and psychologists could be motivated to keep troops in therapy longer than necessary since they get paid based on how much therapy they provide. “I don’t think soldiers are dropping out of treatment because they don’t think it works. Perhaps they think it works and nobody can tell them when it is done.”
Regardless of the reasons, Wynn said it’s important that troops get the help they need.
“We’ve learned that keeping soldiers who are already enrolled in PTSD treatment from dropping out is the most important strategy for improving outcomes,” he said.
The key, Wynn said, is to keep the troops interested.
Treatments that include video games, alternative medicine and outdoor activities, such as fly fishing, are common methods.
“We want guys to continue these things after they finish treatment,” he said.
Army infantrymen are highly likely to experience at least one event that could lead to post traumatic stress disorder, including:
• 93 percent report coming under fire from artillery, rockets or mortars.
• 91 percent say their unit has been attacked or ambushed.
• 87 percent say they know someone who has been seriously injured or killed.
- Source: Maj. Gary Wynn, Walter Reed Army Institute of Research