Scientists and physicians have tried countless methods to treat the nightmares, anxiety, and flashbacks of posttraumatic stress disorder (PTSD) in soldiers, from talk therapy to drugs designed to press the “delete” button on specific memories. Now, one group of researchers proposes another solution: Prevent the condition in the first place by predicting who is most likely to get it. In a new study, they say a 105-question survey already given to all U.S. soldiers may be able to do just that.
“It’s a very important study,” says Sharon Dekel, who studies PTSD at Harvard Medical School in Boston, but was not involved in the new work. Only a minority of people exposed to trauma develop the disorder, and the new work may lead to better screening methods for this “vulnerable population,” she adds.
U.S. Army soldiers have taken the Global Assessment Tool (GAT), a survey about their mental health, every year since 2009. The confidential questionnaire asks soldiers to rate their agreement with statements like “My leaders respect and value me,” and “I believe there is a purpose to my life.” It’s meant to help soldiers understand their own strengths and weaknesses. But Yu-Chu Shen, a health economics researcher at the Naval Postgraduate School in Monterey, California, wondered whether the survey could also predict the likelihood of someone developing PTSD or depression.
So she and colleagues designed a study to see how soldiers’ GAT scores aligned with later illnesses. They looked at 63,186 recruits who enlisted in the Army between 2009 and 2012 and had not yet been exposed to combat. The team then compared the scores with how the same soldiers fared on a postduty comprehensive health assessment that also looked for signs of PTSD and depression.
Shen and her colleagues found that soldiers who had scored in the bottom 5% of mental health attributes on the GAT prior to deployment were significantly more likely to show signs of depression or PTSD upon their return than the other 95%, they report today in BMC Psychology. The idea that some people might be better suited for stressful environments than others is not new, Shen says. “I think it might be something that people already know intuitively. We just put quantitative measures to it.”
Shen adds that although the GAT wasn’t designed to predict depression or PTSD, a similar survey could identify soldiers who may benefit from preventive interventions, such as group therapy sessions designed to teach coping skills, or being moved to noncombat positions. Her own experience in a suicide prevention training program mandatory for all civilian naval employees convinced her that focusing such efforts on the vulnerable could yield better results. “[The suicide prevention program] is probably only effective for 2% of the population,” she says. “Having a more targeted intervention for the high-risk population is probably a better use of time and resources.”
One limitation of the study is that it counted only soldiers who showed signs of PTSD or depression within 30 days of returning from combat. Previous research has shown that many soldiers with initial symptoms recover soon after, whereas others experience delayed-onset symptoms that can go undetected in the first few months after combat. Another factor is the soldiers themselves. If they get the impression that the survey is being used to determine who is fit to serve, they may answer questions falsely in an attempt to demonstrate positive mental health.
For now, Shen is leaving those issues to psychologists. She and her team are starting to explore the effects of an individual’s mental health on their entire unit. Can one depressed soldier bring down others and put the group at risk? Can unit-level interventions be more effective than individual ones? The GAT survey remains in use for confidential assessments of soldiers while the army continues to work on interventions it hopes will build resilience in its fighting men and women.