WASHINGTON — If the averages apply, at least 500 Oklahoma National Guard soldiers who returned earlier this year from Afghanistan will show symptoms of post-traumatic stress disorder.
Identifying and treating those soldiers is one of the great challenges for the modern military, and both military and mental health professionals said they still aren't very good at it.
Officials with the U.S. Defense Department, Veterans Affairs, the National Institutes of Health and other agencies gathered last week for a workshop on post-traumatic stress.
Despite monumental efforts by the military to grapple with PTSD and suicide, the numbers aren't encouraging.
Dr. Michael Kilpatrick, deputy director of force health protection and readiness programs at the U.S. Department of Defense, said about 5 percent of those in the military show signs of post-traumatic stress when they are screened before going on deployments.
That number goes up to 20 percent among those who have had combat experience.
Only one in four of those showing signs of post-traumatic stress have sought any sort of treatment.
“If 75 percent of the people who need care aren't getting it, we aren't doing our job right,” Kilpatrick said.
In greater numbers?
Medical professionals suspect the number of military members with post-traumatic stress is even higher.
James Mundt, a senior scientist at the Center for Psychological Research, Training and Consultation, said surveys with anonymous reporting show rates of post-traumatic stress disorder two to four times higher than the military's screening.
Symptoms are greater among the National Guard and Reserves.
Diagnosing post-traumatic stress disorder is difficult, said Susan Borja, an administrator in the National Institute of Mental Health's traumatic stress research program.
Post-traumatic stress symptoms can look like depression or anxiety, both common mental health problems. Those with traumatic brain injuries have similar symptoms, and about half of those with PTSD have an alcohol abuse problem.
“We're not very good at parsing out the disorders,” Borja said.
Someone might be sent for treatment for alcohol or drug abuse or seek help for domestic issues when PTSD is the underlying problem.
If diagnosing PTSD is tough, getting people with the disorder to seek help has proved even more difficult, said Col. Charles Engel, a psychiatric epidemiologist who directs the U.S. Army's Deployment Health Clinical Center.
“The average between someone showing symptoms of PTSD and first treatment is 12 years,” Engel said. “The average service in the military is only five years. Good intentions are not enough.”
The military has tried “resilience training,” intended to prevent people from getting PTSD by teaching them how to deal with traumatic events.
Paula Schnurr, deputy executive director of the Veterans Affairs National Center for PTSD, said resilience training was a popular idea several years ago, but “we just don't have the evidence that it works.”
Prevention of PTSD remains elusive.
“That isn't the $50,000 question — it is the $50 million question,” Borja said. “We haven't found a magic preventer.”
Drugs can be effective for some people, but they don't work for everyone and can be a risky way to treat PTSD when so many patients also have some form of alcohol or drug abuse.
The most effective treatment for PTSD remains psychotherapy, preferably soon after the traumatic event is experienced, mental health professionals agree.
“Unfortunately, that's not realistic,” Borja said. “We don't have the resources to give every soldier that intense treatment. Where the field is going, is to try to predict who is likely to develop the disorder. We're just not very good at it yet.”
The military still relies on service members and their families to ask for help, which doesn't always work. The good news is that those who seek therapy from a qualified professional have a good chance at a normal life, and resources are available for those who need help.
“Recovery is possible,” Schnurr said. “We can see recovery even in Vietnam veterans who have had a lifetime of PTSD.”
If 75 percent of the people who need care aren't getting it, we aren't doing our job right.”
Dr. Michael Kilpatrick,