Health Screening for Military Veterans: Do It Right Now!

Alcohol use disorder (AUD) and post traumatic stress disorder (PTSD) are two of the most common disorders among U.S. military veterans that often occur concurrently. Although both disorders are individually associated with poor health and wellbeing, past studies have shown that the rates of physical and mental health problems are higher in patients with co-occurring AUD and PTSD. Researchers from the National Center for PTSD and the VA San Diego Healthcare System published a study in 2018 that examined the burden associated with the co-occurrence of AUD/PTSD relative to either disorder occurring alone among US military veterans.

The study was conducted using data from the the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 3,157 US veterans aged 21 and older. Overall, the sample group consisted of 14.8% probable current AUD, and 16.4% current PTSD, but only 2.8% comorbid AUD/PTSD. Comorbid is a term used when two or more disorders or diseases occur at the same time. As part of the study, veterans were asked about their primary source of healthcare and their current mental health care situation.

The study assessed AUD and PTSD along with probable depressive and anxiety disorder, physical and mental functioning, quality of life, and cognitive functioning.

Results showed that, patients with comorbid AUD/PTSD or PTSD only were more likely to have co-occurring depression and anxiety, and current suicidal ideation compared to veterans with AUD only. Additionally, they also scored lower on mental, physical and cognitive functioning, and quality of life measures. Compared to PTSD only, the comorbid group was, again, much more likely to have attempted suicide in their lifetime. The difference in the rates of depression and anxiety between the two groups was also very high. However, some similarities between the two groups suggests that the increased burden associated with PTSD/AUD is largely driven by problems associated with PTSD. This may have been because the AUD/PTSD group was very small and there was unevenness in the size of the diagnostic groups.

There were also some other limitations associated with the study, which could have brought about discrepancies in the final results. The prevalence of AUD could have been underestimated because AUD is primarily associated with young adults, but the study mostly consisted of older white men. Moreover, suicide attempts were asked in terms of entire lifetime, so it is not certain if they had occurred before or after military service. Nevertheless, the overall findings reflect the mental and physical health burden associated with co-occurring AUD and PTSD.

The results stress the importance of screening veterans for AUD and PTSD given that less than half of veterans with these disorders are receiving mental health treatment. It also highlights the need for further research to understand how to reach out to and engage these veterans in screening, assessment, and treatment for such disorders.

Reference: Norman, S.B., Haller, M., Hamblen, J.L., Southwick,S.M., Pietrzak, R.H. 2018 The Burden of Co-Occurring Alcohol Use Disorder and PTSD in U.S. Military Veterans: Comorbidities, Functioning, and Suicidality. Psychology of Addictive Behaviors 32(2): 224-229

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