Review of Landmark Study Finds Fewer Vietnam Veterans With Post-Traumatic Stress

Far Fewer Vietnam Veterans Suffered From PTSD Than Previously Thought
by Benedict Carey

Left: A Vietnam veteran examined the names engraved on the Vietnam Veterans Memorial in Washington.

Far fewer Vietnam veterans suffered from post-traumatic stress as a result of their wartime service than previously thought, researchers are reporting today, in a finding that could have lasting consequences for the understanding of combat stress, as well as for the estimates of the mental health fallout from the Iraq war.

The report, published in the journal Science and viewed by experts as authoritative, found that 18.7 percent of Vietnam veterans developed a diagnosable stress disorder that could be linked to a war event at some point in their lives, well under the previous benchmark number of 30.9 percent. And while the earlier analysis found that for 15.2 percent of the veterans the symptoms continued to be disabling at the time they were examined, the new study put that figure at 9.1 percent.

The findings come at a time of simmering debate over the emotional effects of service in Iraq which, with its lack of a conventional front echoes the Vietnam experience more than it does other wars…

Politicians have clashed over the Department of Veterans Affairs’ budget, including its $3 billion annual bill for mental health, in part because of a suspicion that the estimated rates of post-traumatic stress, based on Vietnam veterans, were too high. Last year, the department commissioned a review of combat stress disability claims for evidence of exaggeration.

The debate has angered some trauma researchers, and infuriated veterans’ groups who say that as it is, mental health services too often fall short.

I’d like to think that this study would help settle the debate, and that both sides would see that this was good science, said the report’s lead author, Dr. Bruce Dohrenwend, a psychiatric researcher at Columbia University and the New York State Psychiatric Institute.

It’s true we found a significant reduction in the lifetime prevalence of these disorders, Dr. Dohrenwend said, but on the other hand we also found that more than 9 percent had current pathology, which is a substantial number of people, or about a quarter-million of the Americans deployed in Vietnam.

Richard McNally, a psychologist at Harvard who is skeptical of the earlier estimate, agreed, saying that the new study confirmed his and others’ suspicions. It knocks the 30 percent number out of the box, Dr. McNally said.

But, he added, the findings should not be used as a justification for short-changing services that are needed to help veterans of Iraq or Vietnam.

Bobby Muller, president of Vietnam Veterans for America in Washington, who was paralyzed from the chest down after taking a bullet in Vietnam, said that focusing only on the reduced numbers in the new study threatened to undermine financing for veterans’ services and appreciation for the seriousness of combat-related disorders.

The fact is, Mr. Muller said, that veterans suffering mental health problems have been under assault, the diagnosis has been continuously attacked in terms of its legitimacy, funding has not been ramped up to handle these problems for vets returning from Iraq, and now people will see this study and say, Oh look, the problem is not as bad as we thought it was.’ He added, This is absolutely the last thing we need.

A spokeswoman for the Veterans Affairs department said it had no comment on the study or on whether it would have any affect on mental health benefits for veterans. The department would need time to evaluate the findings, the spokeswoman said.

The new report is an analysis of a landmark 1988 study in which researchers tracked down 1,200 Vietnam veterans around the country and interviewed them, some in-depth, carefully checking for symptoms of psychological distress, like nightmares, flashbacks and hair-trigger irritability. The researchers in that study concluded that 15.2 percent of the veterans qualified for a diagnosis of post-traumatic stress, and about twice that number, 30.9 percent, did so at some point in their lives, sometimes years after the war.

But military historians soon began to question the numbers. The 30 percent estimate seemed high, they argued, given that 15 percent of Americans deployed to Vietnam served in combat roles.

Later studies raised questions about whether some veterans were suffering traumatic reactions to war-related events, or to other, unrelated factors.

The new analysis took these concerns into account, and corrected for them. The researchers pored over data from the original 1988 study, and checked it against extensive military records and records of exposure to combat. They found that many servicemen in noncombat roles were exposed to considerable horrors, from shelling and ambushes to caring for the wounded, and that very few exaggerated their experiences.

But a number of veterans whose difficulties were diagnosed as post-traumatic disorder developed it before serving in the war. Others developed symptoms that could not be linked to any specific traumatic event a crucial element in the diagnosis. And there were some veterans who exhibited symptoms, like nightmares, that were not severe enough to be disabling.

Correcting for these cases lowered the number of veterans who at some point in their lives suffered from the disorder to fewer than one in five and the number who currently suffered from post-traumatic stress to about one in 10. The more exposure troops had had to combat, the higher their risk of the disorder, the study found.

Dr. Matthew J. Friedman, executive director of the National Center for Post-Traumatic Stress Disorder for the Department of Veterans Affairs, said the new study should establish beyond question that post-traumatic stress disorder is both a common and legitimate diagnosis in returning soldiers. We can quibble about the numbers, he said, but the point is that it’s a lot of people, and the potential demand on services is substantial. Some veterans who were told of the findings yesterday said they doubted that the methodology used in the study took into account the experience of many former soldiers. The analysis defined combat exposure by objective measures that may have missed the harrowing experiences people had while serving and the private, subjective feelings of helplessness that followed.The most important figure in the study, most agreed, was the rate of chronic mental suffering. War is not healthy for children, and what this shows is how unhealthy it is, and who has to pay for the lifelong consequences of that, said Michael Gaffney, a lawyer in Washington who served in an artillery unit in Vietnam in 1968 and 1969. And the meat grinder is still operating, in Iraq.