In addition, the field of TBI research is in agreement that repetitive mild TBI can result in a loss of abilities and is linked to behavioral health issues. What has not been directly confirmed is whether repetitive mild TBI can cause a progressive neurodegenerative condition, such as chronic traumatic encephalopathy (CTE). Currently the VA is working with the DOD [Department of Defense] on a joint initiative (Chronic Effects of Neurotrauma Consortium) to determine if there is a causal relationship between repetitive mild TBI and CTE and if therapeutic development is possible.

One major effort is the Marine Resiliency Study (MRS), involving some 2,600 Marines who deployed to Iraq and Afghanistan. Beginning in 2008, the research team conducted clinical interviews on Marine bases and collected psychological, social, and biological data before deployment and then multiple times after deployment.

Finally, VHA funded over 140 research studies during the past fiscal year, including research on both pharmacological and non-pharmacological therapies for TBI, and research on tele-rehabilitation and how the VA can improve its support of caregivers of veterans with TBI.

[Editor’s note: The department has a Traumatic Brain Injury Advisory Committee and its last report to Congress is available at http://www.healthquality.va.gov/guidelines/Rehab/mtbi/concussion_mtbi_full_1_0.pdf]

 

As America has drawn down its overseas military deployments and commitments, along with the size of its military personnel base, what are you seeing as the major trends in regard to posttraumatic stress disorder (PTSD), including the patient base size, new research and treatments, and your overall understanding of the condition itself?

Approximately 1 in 5 veterans of the wars in Iraq and Afghanistan has been diagnosed with PTSD, often co-occurring with another mental disorder or a physical illness.

One major effort is the Marine Resiliency Study (MRS), involving some 2,600 Marines who deployed to Iraq and Afghanistan. Beginning in 2008, the research team conducted clinical interviews on Marine bases and collected psychological, social, and biological data before deployment and then multiple times after deployment. Researchers are analyzing the data to identify risk and resilience factors for combat-related PTSD. The team recently published two articles in JAMA Psychiatry. One shows deployment-related brain injury to be a significant risk factor for PTSD. Another implicates high levels of inflammation in the body as a PTSD risk factor.

VA clinical trials provided much of the evidence that cognitive processing therapy (CPT) and prolonged exposure therapy are effective treatments for PTSD. In 2013, VA researchers demonstrated that veterans using either therapy not only showed reductions in their PTSD symptoms, but also used VA’s mental health services considerably less than in the year before they began therapy. Now, a head-to-head comparison of CPT and prolonged exposure therapy is underway (CSP #591 – CERV PTSD) to learn more about which type of therapy is better for a patient.

Additional areas of PTSD research include studies of alternative treatments, such as meditation and yoga and studies to increase the use of evidence-based treatments. Other researchers are working on projects to improve veterans’ access to and engagement in evidence-based PTSD treatments. Large-scale investigations promise additional insight into risk factors for PTSD that could prevent or mitigate onset following traumatic exposure.

VA is also studying the use of service dogs for veterans with PTSD. A multisite study will provide eligible veterans with either an emotional support dog or a service dog that has been specifically trained to perform tasks that mitigate PTSD. Researchers will look for improvements in participants’ PTSD symptoms, quality of life, participation in society, and employment status. Another study will examine the impact of dogs adopted from an animal shelter on PTSD symptoms.

During the last 18 months, VA and other federal research funding agencies have worked together to address the mental health needs of veterans through the National Research Action Plan (NRAP), developed in response to President Obama’s Executive Order. The plan outlines the vision for PTSD, TBI, and suicide prevention research and describes requirements intended to help the agencies successfully reach important research goals over the next few years.

One major result of the plan has been the establishment of new research consortia devoted to PTSD and TBI. These consortia were jointly developed by VA and the Department of Defense and approved for funding for five years at the beginning of FY 2014. The overall funding level is estimated at $107 million from the two departments. PTSD consortium studies focus on potential biomarkers (e.g. indicators that can be determined from a laboratory test) and the use of advanced brain imaging to gain a deeper understanding of the condition.

 

One of the most impressive achievements of your organization since the inception of the VA has been the continuing commitment and investment through the VHA into state-of-the-art medical/health research and development (R&D). Can you give our readers a sense of what the annual investment of finance and personnel by VHA is in this area?

VA Office of Research and Development (ORD) plays a key role in advancing the health and care of veterans and is uniquely positioned to lead a national transformation of American health care. As part of the largest integrated health care system in the United States, VA R&D draws upon engaged patients and families, committed clinician-scientists, and an unparalleled national health care delivery structure.

These resources provide a rich base for VA to deliver the best health care and develop cutting-edge medical treatments for veterans, their families, and the nation. VA is committed to using evidence-based results to address the needs of the entire veteran population. Although the VA research program focuses on benefiting current and future veterans, the outputs of VA research ultimately affect the entire nation. Through VA’s focused mission to advance health care for veterans, VA research serves as a 21st-century model for how American medicine is transformed through scientific inquiry and innovative thought, leading to evidence-based treatments successfully implemented into practice.