Study Tracks Stress Disorder Among Vietnam Vets

For years there has been controversy over how many Vietnam veterans suffer from post-traumatic stress disorder — a psychiatric condition that can result from experiencing a terrifying danger. Using combat records for the first time, a landmark study in the journal Science comes up with a number lower than the onetime estimate of 30 percent but still significant: close to 20 percent.

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A new study attempts to settle the debate over how many Vietnam veterans had post-traumatic stress disorder. When soldiers came home from Vietnam, psychiatrists, the military and the Veterans Administration didn't recognize the existence of mental illness caused by exposure to combat trauma. It was the veterans themselves who fought for the creation of the diagnosis we now know as PTSD. Once PTSD was officially recognized, there was more controversy and often bitter debate over just how many vets were affected.

NPR's Joseph Shapiro reports on the new research.

JOSEPH SHAPIRO reporting:

Post-traumatic stress disorder is a psychiatric condition that can result from experiencing a terrifying danger. PTSD can cause anxiety, flashbacks and extreme wariness that sometimes gets in the way of a person's ability to hold a job or to get along with others. It was 20 years ago when researchers first tried to come up with a number for how many Vietnam vets had PTSD.

Dr. BRUCE DOHRENWEND: (New York State Psychiatric Institute) And there have been only two nation-wide studies of PTSD and Vietnam veterans, and these two studies came up with very, very different rates of PTSD.

SHAPIRO: That's Bruce Dohrenwend. He's a psychologist and epidemiologist at the New York State Psychiatric Institute. He led the work on the new study, the third nation-wide study. He said it was needed because those earlier reports came up with numbers that were so far apart. One said 15 percent of veterans had dealt with PTSD.

The other found rates twice as high - 31 percent, or nearly a third of all returning veterans. That second study was ordered by Congress. It's known as the National Vietnam Veterans Readjustment Study, and like many things with the Vietnam War, it was surrounded by controversy.

Richard McNally is a professor of psychology at Harvard. He's argued that 31 percent just seemed too high.

Professor RICHARD McNALLY: (Harvard University) Some of the issues and criticisms that had been raised mainly by historians of military psychiatry who had pointed out how do you get 30 percent PTSD rates when only about 15 percent of the men who served in Vietnam were actually assigned to combat units?

SHAPIRO: That gave rise to the notion of the phony combat vet, that some soldiers were simply lying about fighting in combat. The authors of one book argued that of Vietnam veterans getting benefits for PTSD, 75 percent were fakers. So Bruce Dohrenwend, the researcher in New York, went and found what he called a gold mine of data, actual combat records that allowed him to verify the claims of a sample of 260 veterans in the original study. If they said they were in a firefight or saw someone die, he'd check if it really happened. Dohrenwend's study is being published in the journal Science.

Dr. DOHRENWEND: And our general conclusion is that by and large, the veterans were telling us the truth. We can find very little evidence of falsification.

SHAPIRO: Less than a half percent. Dr. Matthew Friedman runs the National Center for PTSD for the Department of Veterans Affairs.

Dr. MATTHEW FRIEDMAN (Department of Veterans Affairs): This is terribly important in terms of some of the debates that are going on right now about, you know, how reliable are these things, and so it's a landmark study and it's very, very important.

SHAPIRO: The VA's own inspector general has noted that the number of veterans getting PTSD benefits is up 80 percent in recent years. The VA has asked independent researchers to look at the issue. Matthew Friedman of the VA.

Dr. FRIEDMAN: The Institute of Medicine, at the request of the VA, is looking into the whole issue of PTSD, the diagnostic validity, the assessment process. The data that Bruce Dohrenwend has collected are extremely valuable in giving people confidence. They are a very strong rebuttal to some of the critics of the PTSD diagnostic assessment process in general.

SHAPIRO: There's still that other question. So how many Vietnam veterans did develop PTSD, 15 percent or 31 percent? Researcher Bruce Dohrenwend.

Dr. DOHRENWEND: Our numbers were 18.7 percent, lifetime, close to 20 percent.

SHAPIRO: Dohrenwend says that's a lot, but it's not 30 percent. That earlier study counted all kinds of PTSD, even if it was caused by some event, like being in a serious car accident, that happened before or after the veteran was in Vietnam. And the definition of PTSD has changed over time. The new study counts only those whose PTSD was so severe that they had trouble carrying on their everyday lives.

Joseph Shapiro, NPR News.

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