Controversy Builds About the Prevalence of PTSD in Vietnam Veterans
Newswise — Controversy continues to swirl concerning the findings of a landmark study that estimated the percentage of Vietnam veterans suffering from posttraumatic stress disorder (PTSD).
Traumatic stress experts have renewed a clash over the results of the 1988 National Vietnam Veterans Readjustment Study (NVVRS), which originally estimated that 30.9 percent of veterans endure the effects of PTSD during their lifetime, and that 15.2 percent still suffered from PTSD more then ten years after the war. The actual prevalence of PTSD in veterans is vigorously debated among the field’s leading researchers, with long-lasting public policy implications for veterans of all U.S. wars, including the current conflict in Iraq.
New opinions by several parties involved are reported in the August issue of the Journal of Traumatic Stress, published by the International Society of Traumatic Stress Studies (ISTSS).
Bruce P. Dohrenwend, PhD, of Columbia University, et al. conducted a recent reanalysis of the NVVRS, which found an 18.7 percent prevalence rate of lifetime war-related PTSD and 9.2 percent of current PTSD at the time of the study. The authors say that the finding of lower rates is the result only of differences in the definition of the disorder and does not represent a significantly lower total number of soldiers impacted…
The key finding of their study, according to Dohrenwend et al., was that the NVVRS confirms a “strong dose/response relationship between severity of exposure to war-zone stressors and PTSD.” The more soldiers are exposed to the horrors of war, the more likely they are to suffer from posttraumatic stress.
Richard J. McNally, PhD, of Harvard University, argues that the original NVVRS and the more recent Dohrenwend reanalysis overestimated the prevalence of PTSD in veterans by using faulty criteria for diagnosing the disorder. According to McNally, 5.4 percent of Vietnam veterans showed clinically significant functional impairment at the time of the NVVRS study.
“Eliminating cases who exhibit no functional impairment is an important way to address a chief concern of the NVVRS’s critics,” said McNally. “Not all emotional changes wrought by serving in a war zone are symptoms of disease or disorder.”
A number of experts disagree with McNally’s interpretation of the data, including the original authors of the NVVRS study. William E. Schlenger, PhD, of Duke University Medical Center, et al., claim McNally misrepresents the findings of Dohrenwend et al.’s analysis.
“[McNally’s] erroneous statements and misrepresentations seem clearly to be not random,” said Schlenger et al. “Instead, they appear to have been crafted to support a specific bias that has significant policy implications, i.e. that PTSD prevalence among Vietnam veterans is a minor problem, and the real problem is veterans faking combat exposure and PTSD symptoms to qualify for service-connected disability.”
According to Dean Kilpatrick, PhD, of the National Crime Victims Research and Treatment Center Medical University, “In my view, the reexamination by Dohrenwend and colleagues is a major contribution to this public policy debate…It confirms that most veterans of the Vietnam War were resilient, but that an important subset continued to have PTSD over a decade after the war was over.”
Despite disagreements on numbers and methods, the experts concur that the government has a responsibility to adequately treat veterans with PTSD. “Regardless of [frequency], the central issue is whether resources are sufficient to meet current demand,” said McNally. “The key question is, 'If a veteran seeks mental health care, will that be able to obtain prompt access to state-of-the-art, evidence-based [care]?' If not, then we must increase resources."
The International Society for Traumatic Stress Studies is an international multidisciplinary, professional membership organization that promotes advancement and exchange of knowledge about severe stress and trauma.
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