HARVARD GAZETTE ARCHIVES
Mental casualties of Vietnam War persist
Lessons learned could be applied to Iraq
By William J. Cromie
Harvard News Office
More than 30 years after the end of the war in Vietnam, the effect of lingering stress on Americans who fought there continues to cause stress among researchers.
A new study finds that almost 19 percent of the more than three million U.S. troops who served in Vietnam returned with post-traumatic stress disorder (PTSD). It's a condition that left them with invasive memories, nightmares, loss of concentration, feelings of guilt, irritability and, in some cases, major depression. More than ten years after the war, 10 percent of them still could not leave the war behind.
As bad as these numbers sound, however, they are significantly lower than those produced by an earlier study. In 1990, a national survey concluded that almost one in three (30.9 percent) of those who served in Vietnam came home with PTSD, and 15 percent of them still suffered with it.
However, the new study, conducted by researchers from Columbia University and the Harvard School of Public Health, came up with numbers similar to those of a 2004 report that major depression and anxiety dogged about 16 percent of soldiers and Marines who served in combat units in Iraq.
"What has been, and still can be, learned about PTSD and Vietnam veterans should be applicable to understanding the psychological risks to U.S. veterans of the war in Iraq," says Karestan Koenen of the Harvard School of Public Health.
Determining how many veterans will return from Iraq and Afghanistan with mental health problems, and how many will still be plagued by them decades later, will impact decisions about who will receive long treatment and counseling and how long it should be maintained. Underscoring this is a recent skyrocketing of claims for disability payments by Vietnam vets.
"During fiscal years 1999 to 2004, the total number of [Vietnam] veterans receiving disability compensation for PTSD increased by 79.5 percent," notes Richard McNally, professor of psychology at Harvard University. "During this period, PTSD disability payments jumped by 148.8 percent."
McNally raises the unanswered question: "Does this indicate an upsurge of delayed-onset of PTSD, or delayed presentation of PTSD among those who have suffered for decades and are only now seeking the help they need?"
What about the possibility of false claims? The Columbia-Harvard study found little evidence of exaggerated claims among the veterans. They were able to verify nearly all the reports of exposure to dangers and deaths that they witnessed. However, other researchers could verify reports of combat trauma in only 41 of 100 men recently seeking service-connected disability payments. These numbers prompted Bruce Dohrenwend, head of the Columbia-Harvard study, to emphasize that you can't generalize from one to the other.
Results of the Columbia-Harvard study and McNally's perspective on the situation both appear in the August 18 issue of the journal Science.
Trying to get it right
Dohrenwend, Koenen, and their colleagues also reported on another finding. The more trauma and hazards a veteran was exposed to, the more likely he was to develop PTSD. You would think that this would be a common sense conclusion, but, as with the mismatch between verified combat stress and claims of disability, everything needs to be checked.
One way the researchers did this was to look at Vietnam veterans still dealing with PTSD in 1990. Doing this revealed that 28 percent of veterans with the highest levels of combat exposure were still suffering from PTSD, compared to only 1 percent of those with the least exposure.
Trying to pin down how much trauma Vietnam combatants brought home with them, and are still living with, has been an up and down affair. In 1988, the U.S. Centers for Disease Control and Prevention concluded that about 15 percent of male veterans had developed PTSD but only a little more than 2 percent of them were still haunted by the disorder. (The war ended in April 1975.) The latter number was low enough for Congress to think about phasing out counseling and other mental health services.
Second thoughts, however, led Congress to support another look into the situation. Results from that effort, the 1990 National Vietnam Veterans Readjustment Study, hit like a rocket. It put the number of those mentally wounded by PTSD at a whopping 30.9 percent, those partially wounded at 22.5 percent, and those still suffering at 15.2 percent.
Critics quickly pointed out that only about 15 percent of those who served in Vietnam saw combat, yet more than three times that number had come down with full-blown or partial PTSD. Others found problems with the method used to conclude whether or not a person really suffered from combat-related trauma.
The unlikely conclusions reached by the national readjustment study also prodded the Columbia-Harvard group to take a closer look at all available information. For example, they used military records and historic accounts to measure exposure to combat stress and check the plausibility of veterans' accounts of traumatic events. They also examined the diagnoses by experienced psychiatrists of PTSD.
"The message from the National Vietnam Veterans Readjustment Study has been that the Vietnam War took a severe psychological toll on U.S. veterans," the Columbia-Harvard team notes. "Our results provide compelling reason to take this message seriously. It is especially notable that almost 10 percent suffered from current PTSD more than a decade after the war."
On the plus side, the research shows that the majority of veterans who had the highest exposure to the death, danger, and injuries of combat did not develop PTSD. In addition, most veterans who did experience PTSD impairment are now functioning as well or nearly as well as those who did not have PTSD.
The researchers conclude that "there appear to be protective factors that reduce vulnerability" to the onset of PTSD and the persistence that causes veterans to relive the stresses of combat for years afterward.
The trend "toward recovery over time cannot be explained entirely by treatment administered by mental health professionals, because less than half the veterans with past war-related PTSD received such treatment," the researchers note. "Investigations of other factors that may contribute to initial resilience and psychological readjustment after traumatic war experiences are needed."
That kind of information, together with accurate ways to verify reports of trauma, will be of great value in making sure that the mental casualties of combat in Iraq and Afghanistan receive the help they need when they come home.