VA’s National Center for PTSD: In the vanguard of trauma research

Since its founding in 1989, the National Center for PTSD has maintained a strong commitment to improve the care of Veterans through research into the prevention, causes, assessment and treatment of traumatic stress disorders and education of Veterans; others affected by trauma; professionals; and policymakers. Our research has a uniquely real-world perspective that ensures we are truly focused on Veterans. We are leaders in the translation of basic-science findings to clinical care and educational content. Our respect for military culture and for individual circumstances of Veterans and others impacted by trauma informs all the work we do—including the Center’s award-winning website — www.ptsd.va.gov — and our many publications, online resources and national programs.

To optimally carry out the Center’s mission, we align our research activities with these operational priorities: (1) establishing biomarkers to predict who develops PTSD, to diagnose PTSD, and to predict and measure response to treatment; (2) implementing research and education activities related to the DSM-5, the current manual used to diagnose mental disorders, published in 2013; (3) enhancing treatment efficiency, effectiveness and engagement; (4) developing strategies to examine and improve care delivery, models of care and system factors; and (5) developing research and strategies to promote implementation of best practices. Other activities focus on additional topics to ensure broad coverage of the field of traumatic stress studies.

Three key findings

Recent findings from Center researchers focused on OIF/OEF Veterans illustrate our commitment to investigating all issues relevant to Veterans with PTSD:

• PTSD as a long-term consequence of war—PTSD was assessed in nearly 600 current and former Army members before and roughly eight years after their Iraq service. Before deployment, 7.4 percent of service members met diagnostic criteria for PTSD. The percentage with PTSD at the long-term follow-up more than doubled from what was found soon after the soldiers’ return home from deployment, from 10.5 to 24.7 percent. This increase indicates a need for providers to recognize that PTSD symptoms can increase long after the post-deployment period. Findings support the rationale for periodic screening in VA and Department of Defense clinical settings to ensure that individuals with PTSD are identified and treated over the lifespan. (Longitudinal Examination of Posttraumatic Stress Disorder as a Long-Term Outcome of Iraq War Deployment, American Journal of Epidemiology, 1, 2016)
• PTSD and metabolic syndrome—PTSD is associated with metabolic syndrome, which is typically defined as the presence of three or more of the following: abdominal obesity, high blood pressure, abnormal lipids, and high blood sugar. PTSD may lead to metabolic syndrome via biological processes like immune and stress reactivity, as well as health-related behaviors like poor nutrition and substance use. Previous studies have not been able to determine whether PTSD leads to metabolic syndrome, or whether the relationship operates in the opposite way, with metabolic syndrome making PTSD symptoms worse. In a longitudinal study of a sample of 1,355 men and women with PTSD who had served in Iraq or Afghanistan assessed 2.5 years apart, the prevalence of metabolic syndrome was just under 40 percent, nearly double the prevalence of U.S. adults ages 20 to 39 in the general population (20.3 percent). Using analytic techniques that allowed for tests of directionality, the authors found that PTSD symptoms increased metabolic syndrome severity. These results are notable given that the sample was relatively young, and suggest the possibility that PTSD, like any chronic stress, may predispose young Veterans to premature aging. Treating PTSD may lower these risks. (Longitudinal associations between post-traumatic stress disorder and metabolic syndrome severity, Psychological Medicine, July 2016)
• PTSD and sexual health—Researchers studied 1,581 men and women enrolled in the Veterans After-Discharge Longitudinal Registry (VALOR) to explore the impact of PTSD on sexual health. In both men and women, PTSD was associated with lower sexual satisfaction, but being married or living with a partner was associated with higher rates of sexual activity and satisfaction. Other findings differed by gender. Women, but not men, with PTSD were less likely to be sexually active and to report sex-life satisfaction than those without PTSD. After the researchers adjusted for other factors that could affect sexual function, such as certain drugs, there was no effect of PTSD on rates of sexual dysfunction, as determined by related diagnoses or prescriptions in medical records. Overall, this study is important because it illustrates the myriad of ways that PTSD can affect individuals. It also highlights how some effects cut across men and women, but others are gender-specific.  (Sexual Health in Male and Female Iraq and Afghanistan U.S. Veterans With and Without PTSD: Findings from the VALOR Cohort, Journal of Traumatic Stress, June 2016)

About the author: Dr. Lauren Sippel is the associate director for research at the National Center for PTSD executive division, and an assistant professor of psychiatry at the Geisel School of Medicine at Dartmouth. She is interested in developing ways to harness social relationships to enhance trauma recovery.