17 percent of US troops with PTSD

Among a group of US servicemembers surveyed one year after their deployment in Iraq, 17 percent reported PTSD symptoms. These new findings were announced Army psychiatrist Charles Hoge this week during the American Psychiatric Association meeting in Toronto, USA Today reports.

Hoge, chief of psychiatry and neuroscience at the Walter Reed Army Institute of Research in Washington, D.C., is the leader of an ongoing mental health study of US servicemembers. His team's previous findings were published in July 2004 in The New England Journal of Medicine (more here).

The new findings suggest that the prevalence of PTSD among combat veterans may increase significantly as time passes. Previously, when troops were surveyed three-to-six months after their deployment in Iraq, 12 percent reported PTSD symptoms.

Stereotypes in mental health coverage

In the UK Online Press Gazette, Liz Nightingale of the charity Rethink asks journalists to avoid adding to the stigma against people with mental illness.
"Those that Rethink comes into contact with tell us time and again that media misrepresentation of mental illness is incredibly distressing and adds to the stigma that can be worse than the illness itself," Nightingale writes.

"Mentally Unfit, Forced to Fight"

The Hartford Courant runs the third installment of an exhaustive four-day investigative series about the military's handling of troops with mental health problems.

The Courant examines cases where servicemembers with previous mental health problems ended up commiting suicide, and cases where troops suffering from depression or PTSD were given anti-depressant medications and sent back to the war zone.

According to an editor's note:

To report this series, The Courant obtained records under the federal Freedom of Information Act, including never-before-released pre-deployment screening data for nearly a million troops and investigative reports into dozens of service members' deaths.

The Courant also interviewed more than 100 mental health experts, service members, family members and friends. The military does not publicly identify suicide cases. But The Courant was able to identify - in most cases for the first time - the service members who killed themselves in Iraq through records and interviews. Details of their deaths came from investigative reports and interviews with family, friends and fellow troops.

GAO knocks DOD PTSD referrals

The Government Accountability Office this week reported that, of the veterans returning from Iraq and Afghanistan who may be at risk for PTSD, only 22 percent were referred for further mental health evaluation.

The GAO--the investigative arm of congress--reviewed data provided by the Department of Defense from post-deployment health assessment forms completed by 178,664 servicemembers. The data from the forms indicated that 5 percent--9,145--may have been at risk for developing PTSD, but analysis of subsequent medical records showed that only 2,029--22 percent--of those servicemembers were then referred for further evaluation. (Read the full report, in PDF form, here.)

The GAO says:

DOD cannot provide reasonable assurance that OEF/OIF servicemembers who need referrals for further mental health or combat/operational stress reaction evaluations receive them.

and:

DOD has not identified the factors its health care providers used to determine which OEF/OIF servicemembers needed referrals. While DOD has taken steps to monitor the post-deployment process, these steps are not designed to identify the factors upon which DOD health care providers
base their clinical judgments in issuing referrals for further mental health or combat/operational stress reaction evaluations. Knowing these factors could help explain the variation in the referral rates and allow DOD to provide reasonable assurance that such judgments are being exercised appropriately.

We recommend that DOD identify the factors that DOD health care providers use in issuing referrals for further evaluations for mental health or combat/operational stress reaction to explain provider variation in issuing referrals.

In response to the GAO's analysis, the DOD explained it's approach as one of "watchful waiting":

The concept of watchful waiting is common in medical practice. Symptoms may present for any number of reasons that do not reach clinical significance or cannot be readily diagnosed. Frequently, individuals are provided the advice that they should pay attention to the symptoms and return if they do not dissipate or if they get worse. Watchful waiting is a clinically relevant position to take in the care of PTSD-related symptoms at the point in time at which the PDHA assessment is conducted.

"Watchful waiting" IS recommended as the best approach for early treatment of post-traumatic stress, by both the British NICE guidelines and the DOD/VA joint guidelines, but the DOD neglects to specify how it plans to "watch" those servicemembers who may be at risk.

More: For a look at how veterans groups interpret this, read a critical assessment from VA Watchdog's Larry Scott here.

World Press Freedom Day

The International News Safety Institute is marking World Press Freedom Day by launching a global inquiry into the causes of journalist deaths around the world. (Click here for the INSI press release.)

Also, Reporters Without Borders today released its "annual worldwide list of predators of press freedom to show which powerful people are attacking journalists and media outlets." (Click here for the RSF announcement.)

And the Committee to Protect Journalists chose today to release its list of the world's "10 Most Censored Countries." (Click here for the CPJ list.)