Pentagon health care providers failed to perform critical follow-up for many troops diagnosed with depression and post-traumatic stress syndrome who also were at high risk for suicide, according to a new study released Monday by the RAND Corp.
Just 30% of troops with depression and 54% with PTSD received appropriate care after they were deemed at risk of harming themselves. The report, commissioned by the Pentagon, looked at the cases of 39,000 troops who had been diagnosed in 2013 with depression, PTSD or both conditions. USA TODAY received an advance copy of the report.
“We want to ensure that they get connected with behavioral health care,” said Kimberly Hepner, the report’s lead author and a senior behavioral scientist at RAND, a non-partisan, non-profit research organization. “The most immediate action — removal of firearms — can help to reduce risk of suicide attempts.”
The report, titled Quality of Care for PTSD and Depression in the Military Health System, also found that one third of troops with PTSD were prescribed with a medication harmful to their condition.
From 2001 to 2014, about 2.6 million troops have deployed to combat zones in Afghanistan and Iraq. Estimates on how many have been affected by post-traumatic stress vary widely — from 4% to 20%, according to the report. Meanwhile, suicide among troops spiked crisis proportions. The rate of suicide doubled between 2005 and 2012, according to the Pentagon. It has stabilized but has not diminished; the rate remains about the same for the part of the American public that it compares with, about 20 per 100,000 people.
The key intervention to prevent suicide involves talking to the service member about their access to firearms, Hepner said. It’s also one of the most sensitive, given the nature of their work and that many troops own their own guns.
“This is important for service members because suicide death by firearms is the most common method,” Hepner said. “So the provider needs to have that discussion about access to firearms. Not only their service weapon but their access to personal weapons.”
Guns accounted for 68% of suicides by active-duty troops in 2014, according to the Pentagon.
Commanders can be enlisted to put weapons out of troops’ reach, and family members may be asked to do so at home, she said. One reason that doesn’t happen more often, she said, is the stigma attached to mental health issues, and the effect notifying superiors may have on careers.
“These can be quite difficult conversations to have with service members,” Hepner sid. “Certainly limiting access to their service weapon would involve notifying their command.”
Researchers also found that one-third of troops with depression had received a prescription for benzodiazepine, an anti-anxiety medication.
“It is explicitly mentioned in guidelines for treatment of PTSD that benzodiazepines are contraindicated,” Hepner said. “We continue to see a relatively high rate of prescription for a medication we would hope would not be prescribed.”
Those troops need psychotherapy, not benzodiazepine, she said. The drugs can interfere with appropriate treatment, be habit forming and can interact badly with alcohol.
“It is at times easier and more immediate to provide a prescription for benzodiazepine versus helping getting into effective psychotherapy,” Hepner said.
There has been some improvement in mental health care for troops with depression, Hepner said.
“We’re seeing some movement in a positive direction,” she said. “But we believe that behavioral health care needs more attention.”
“The report findings and recommendations are being reviewed and will be used to shape our future direction to ensure we are improving patient care,” Laura Ochoa, a Pentagon spokeswoman, said Sunday. “We remain committed to providing the best quality mental health care to our patients. We will also continue to make the necessary adjustments and improvements to help those afflicted fully recover."