PTSD Can Take Months to Strike Wounded Iraq and Afghanistan Vets

Finding may offer new insights into treating the emotional disorder

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By Steven Reinberg
HealthDay Reporter

FRIDAY, Oct. 6, 2006 (HealthDay News) -- Soldiers wounded during combat in Iraq and Afghanistan often develop post-traumatic stress disorder and depression months after getting out of a hospital, instead of soon after suffering their injuries, a new study found.

And the severity of the injuries also helps predict the risk of developing post-traumatic stress disorder (PTSD) or depression.

It's not clear why it's taking more than half a year, in some cases, for symptoms of PTSD and depression to emerge. However, the study authors speculated that the concentrated treatments and therapies offered in a hospital may temporarily ward off psychological problems, leaving them to surface once a soldier has been released and comes to realize the extent of the injuries.

The report was published in the October issue of The American Journal of Psychiatry.

"The rates of PTSD and depression are much lower immediately following the injury than what we were expecting," said lead researcher Dr. Thomas A. Grieger, of the Uniformed Services University of the Health Sciences and Walter Reed Army Medical Center, in Washington, D.C. "We were expecting rates of around 20 percent."

Instead, Grieger and his colleagues found the initial rate of PTSD and depression was 4 percent. The researchers expected the rates of PTSD and depression to be controlled early, as is often the case with victims of automobile accidents. "In contrast, in this [military] population, the rates went up instead of down with time," he said.

For the study, the researchers screened 613 soldiers, who were severely wounded between March 2003 and September 2004. Of those, 243 completed health assessments at one, four, and seven months after their injuries. The rates of PTSD were 4 percent at one month, 12 percent at four months, and 12 percent at seven months. Rates of depression were 4.4 percent at one month, 9 percent at four months, and 9 percent at seven months.

Grieger noted that 78 percent of those soldiers with PTSD or depression at seven months showed no signs of either condition at one month. "There is a need for ongoing evaluation of the individuals that have had these sorts of exposures," he said.

The reasons for these findings aren't clear, Grieger said. He noted, however, that soldiers in a hospital are getting psychiatric care and medication, which may not be continued after the soldiers leave. "It may be that these symptoms come on after they leave the hospital because they are not continuing with their medications," he said. "It may also be that individuals don't report symptoms in the immediate aftermath of the injury."

Grieger further speculated that it's only when the soldiers return home and realize the full impact of their injuries on their lives that PTSD and depression strike.

One expert thinks this study could be helpful in designing programs to prevent and treat PTSD and depression in military personnel.

"Being wounded is a risk factor for PSTD," said Dr. Matthew J. Friedman, executive director of the Department of Veterans Affairs National Center for Post-Traumatic Stress Disorder.

Friedman believes it's important to understand why some soldiers recover from PTSD and depression when they struggle with it early, and why others develop these problems later. "This would enable us to do a better job of developing preventive approaches and trying to improve the situation for people following hospital discharge," he said.

Another researcher noted the rates of PTSD and depression seen among wounded soldiers returning from Iraq and Afghanistan are about the same as those seen among non-wounded soldiers.

"One of the important findings is that wounded soldiers did not have higher rates of PTSD than healthy soldiers surveyed using the same instruments and criteria," said Dr. Charles Hoge, who's with the department of psychiatry and behavioral sciences at Walter Reed Army Institute of Research. "This suggests that the preventive psychiatry services that wounded service members receive at Walter Reed has been effective in mitigating PTSD symptoms."

"The increase from 4 to 12 percent from one to four months is exactly what we've been seeing among non-wounded soldiers," Hoge added, who co-authored the new study. "We know that soldiers may not report mental-health symptoms until several months after they return home, and this study shows that this is true also among the wounded."

More information

The U.S. National Institute of Mental Health can tell you more about PTSD.

SOURCES: Thomas A. Grieger, M.D., Uniformed Services University of the Health Sciences, Walter Reed Army Medical Center, Washington, D.C.; Matthew J. Friedman, M.D., Ph.D., executive director, Department of Veterans Affairs National Center for Post-Traumatic Stress Disorder, and professor, psychiatry and pharmacology and toxicology, Dartmouth Medical School, both in Hanover, N.H.; Charles Hoge, M.D., department of psychiatry and behavioral sciences, Walter Reed Army Institute of Research, Silver Spring, Md.; October 2006 The American Journal of Psychiatry

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