The holy grail of military psychiatry

Neuron Culture covers a new study on predictors of PTSD in deployed American combat troops. Predicting whether a soldier will break down through combat has been one of the Holy Grails of military psychiatry and the impressive results of this study suggest that this may be getting closer.

World War One was the crucible of military psychiatry as it became clear that even the bravest and best soldiers could break down due to combat stress.

When World War Two arrived, the British and American militaries invested a great deal in psychological screening to attempt to distinguish which soldiers would break down more quickly.

The project was widely regarded as a failure as the only reliably predictor seemed to be the duration and ferocity of the combat the soldier was exposed to.

However, as Dobbs notes, this new study finds that a simple measure of physical health could be a powerful way of preventing half of all PTSD cases in combat deployed troops.

The study found that the least healthy 15% of the troops in the study who saw combat accounted for well over half — 58% — of the post-combat PTSD cases, as indicated by either the study’s own criteria or by self-report of a PTSD diagnosis from the soldiers during follow-up.

This is a pretty stunning result. And it certainly suggests that, as the study put it, “more vulnerable members of the population could be identified and benefit from interventions targeted to prevent new onset PTSD.” The beauty of this finding is that fairly general measures of health are the indicators, so you can predict a lot from fairly simple and easy-to-collect data.

Obviously not all of the 15% who scored lowest on PTSD; but that bottom 15% accounted for more cases than do the entire remaining 85%. So at a time when we are much concerned with reducing PTSD in combat troops, it seems fairly plain that we could cut the PTSD rate by more than 50% simply by keeping the least healthy 15% — as measured by fairly simple health questionnaires we already have in any and — out of combat zones.

He also notes a curiosity that while the study was on US troops, the paper was published in the British Medical Journal, and wonders whether there were some PTSD politicking that meant it was rejected from American journals.

As we’ve discussed before, PTSD is perhaps the most politicised psychiatric diagnosis. It was originally called post-Vietnam syndrome and was created to allow the US healthcare system treat Vietnam veterans.

The direct effects of trauma where never previously thought to be a mental illness in itself, although it was known to be a risk factor for a number of conditions.

Psychologist Dave Grossman, author of On Killing, convincingly argues that Vietnam was particularly conducive to combat trauma for US troops, owing to the fact that US forces had no front line and hence no ‘safe’ areas to relax in, and that they often found themselves fighting a irregular army of civilians including women and children.

Link to Neuron Culture on predicting PTSD in combat troops.
Link to full-text of study from BMJ.