Findings from a congressionally mandated study of Vietnam War veterans found continuing post-traumatic stress disorder (PTSD) and high levels of comorbid depression among war-zone vets.
For veterans who served in the military but outside the war zone during the years of the Vietnam War, self-reports of PTSD symptoms over 25 years are low and stable—but for war-zone veterans, mean levels are higher and increasing, according to the National Vietnam Veterans Longitudinal Study (NVVLS), published online on July 22 by JAMA Psychiatry.
Using the Clinician-Administered PTSD Scale (CAPS-5) for the DSM-V, researchers estimated the prevalence of current war zone-related PTSD among all war-zone vets to be 4.5% (95% CI, 1.7% to 7.2%); 10.8% met a more expansive definition of PTSD (95% CI, 6.5% to 15.1%), and 17.0% had war-zone PTSD in their lifetime (95% CI, 11.9% to 22.2%).
Comorbid major depression occurred in 36.7% (95% CI, 6.2% to 67.2%) of vets with current war-zone PTSD, according to the study. Researchers concluded that about 271,000 Vietnam war-zone veterans have current full PTSD plus subthreshold war-zone PTSD, and one-third of them have current major depressive disorder. “These findings underscore the need for mental health services for many decades for veterans with PTSD symptoms,” the study's authors wrote. Limitations of the study include the lengthy interval between data collection points and reduced follow-up sample sizes because of eligible participants' deaths and declinations, the authors noted.
The NVVLS is the follow-up assessment of 2,348 Vietnam vets who participated in the National Vietnam Veterans Readjustment Study (NVVRS), which was implemented from 1984 through 1988. An accompanying editorial noted that although the NVVLS PTSD estimates are lower than those in the previous study, these figures probably don't reflect the full disease burden.
“The study is of vital importance to subsequent generations of war veterans and underscores medical service needs for PTSD and related comorbidities extending decades after service,” the editorialist wrote. “The study also highlights a need to reconsider changes to the PTSD definition, a definition intimately connected with the Vietnam generation and the foundation for the past 25 years of epidemiologic, neurobiological, and clinical knowledge and evidence-based treatment practices.”