Prior to the military conflicts in Iraq and Afghanistan, wars and conflicts have been characterized by such injuries as infectious diseases and catastrophic gunshot wounds. However, the signature injuries sustained by United States military personnel in these most recent conflicts are blast wounds and the psychiatric consequences to combat, particularly posttraumatic stress disorder (PTSD), which affects an estimated 13 to 20 percent of U.S. service members who have fought in Iraq or Afghanistan since 2001. PTSD is triggered by a specific traumatic event - including combat - which leads to symptoms such as persistent re-experiencing of the event; emotional numbing or avoidance of thoughts, feelings, conversations, or places associated with the trauma; and hyperarousal, such as exaggerated startle responses or difficulty concentrating. As the U.S. reduces its military involvement in the Middle East, the Departments of Defense (DoD) and Veterans Affairs (VA) anticipate that increasing numbers of returning veterans will need PTSD services. As a result, Congress asked the DoD, in consultation with the VA, to sponsor an IOM study to assess both departments' PTSD treatment programs and services. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment is the first of two mandated reports examines some of the available programs to prevent, diagnose, treat, and rehabilitate those who have PTSD and encourages further research that can help to improve PTSD care.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON THE ASSESSMENT OF ONGOING EFFORTS IN THE TREATMENT OF POSTTRAUMATIC STRESS DISORDER
• Reviewers
• Preface
• Acronyms
• Summary
  • COMMITTEE’S STATEMENT OF TASK AND APPROACH
  • NEUROBIOLOGIC RESEARCH ON PTSD
  • DOD AND VA PROGRAMS FOR PTSD
  • CO-OCCURRING CONDITIONS AND PSYCHOSOCIAL COMPLEXITIES
  • ACCESS TO CARE
  • FINDINGS AND RECOMMENDATIONS
  • PHASE 2
• 1. Introduction
  • COMMITTEE’S CHARGE
  • COMMITTEE’S APPROACH
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. History, Diagnostic Criteria, and Epidemiology
  • HISTORY OF PTSD
  • DIAGNOSTIC CRITERIA FOR PTSD
  • EPIDEMIOLOGY OF PTSD IN THE GENERAL POPULATION
  • EPIDEMIOLOGY OF PTSD IN MILITARY AND VETERAN POPULATIONS
  • SUMMARY
  • REFERENCES
• 3. Neurobiology
  • ADAPTIVE AND MALADAPTIVE STRESS RESPONSES
  • MODELS FOR THE DEVELOPMENT OF PTSD
  • FACTORS THAT INFLUENCE THE DEVELOPMENT OF PTSD
  • IMPLICATIONS FOR PTSD PREVENTION, DIAGNOSIS, AND TREATMENT
  • BIOMARKERS
  • SUMMARY
  • REFERENCES
• 4. Programs and Services for PTSD in the Department of Defense and the Department of Veterans Affairs
  • THE DEPARTMENT OF DEFENSE HEALTH CARE SYSTEM
  • MENTAL HEALTH CARE IN THE DEPARTMENT OF DEFENSE
  • TRANSITIONING BETWEEN THE DEPARTMENT OF DEFENSE AND THE DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE SYSTEMS
  • THE DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE SYSTEM
  • MENTAL HEALTH CARE IN THE DEPARTMENT OF VETERANS AFFAIRS
  • COLLABORATIVE EFFORTS BETWEEN THE DEPARTMENT OF DEFENSE AND THE DEPARTMENT OF VETERANS AFFAIRS
  • RESEARCH IN THE DEPARTMENT OF DEFENSE AND THE DEPARTMENT OF VETERANS AFFAIRS
  • COST CONSIDERATIONS
  • SUMMARY
  • REFERENCES
• 5. Prevention
  • OVERVIEW OF PTSD PREVENTION
  • PRETRAUMA PREVENTION EFFORTS
  • INTERVENTIONS FOR TRAUMA-EXPOSED PEOPLE
  • PREVENTION IN THE DEPARTMENT OF DEFENSE
  • PREVENTION IN THE DEPARTMENT OF VETERANS AFFAIRS
  • SUMMARY
  • REFERENCES
• 6. Screening and Diagnosis
  • SCREENING
  • CONSIDERATIONS REGARDING SCREENING IN THE DEPARTMENT OF DEFENSE AND THE DEPARTMENT OF VETERANS AFFAIRS
  • SCREENING IN PRIMARY CARE
  • SCREENING TOOLS
  • DIAGNOSIS
  • QUALITY OF LIFE, DISABILITY, AND RESILIENCE MEASURES
  • SUMMARY
  • REFERENCES
• 7. Treatment
  • PSYCHOSOCIAL TREATMENTS FOR CHRONIC PTSD
  • PHARMACOTHERAPY
  • COMBINED PSYCHOTHERAPY AND PHARMACOTHERAPY APPROACHES
  • INTEGRATIVE COLLABORATIVE CARE
  • EMERGING THERAPIES FOR PTSD
  • GUIDELINES FOR TREATMENT OF PTSD
  • SUMMARY
  • REFERENCES
• 8. Co-Occurring Psychiatric and Medical Conditions and Psychosocial Complexities
  • CO-OCCURRING PSYCHIATRIC CONDITIONS AND PTSD
  • CO-OCCURING MEDICAL CONDITIONS AND PTSD
  • CO-OCCURRING PSYCHOSOCIAL PROBLEMS AND PTSD
  • SUMMARY
  • REFERENCES
• 9. Access to Care
  • BARRIERS TO CARE
  • BARRIERS TO DELIVERY OF EVIDENCE-BASED CARE
  • FACILITATORS OF CARE FOR PTSD
  • SUMMARY
  • REFERENCES
• 10. Findings and Recommendations
  • ANALYZE
  • IMPLEMENT
  • INNOVATE
  • OVERCOME
  • INTEGRATE
  • PHASE 2
  • REFERENCES
• APPENDIXES
  • Appendix A Committee Member Biographies
  • Appendix B Congressional Legislation
  • Appendix C Posttraumatic Stress Disorder Programs in the Department of Defense

This study was supported by Contract No. W81XWH-10-C-0290 between the National Academy of Sciences and the Department of Defense. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Suggested citation:

IOM (Institute of Medicine). 2012. Treatment for posttraumatic stress disorder in military and veteran populations: Initial assessment. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.