By Ms. Ellen Crown, Army MedicineAugust 15, 2013
Experts from Department of Defense and Veterans Affairs gathered to discuss the future of mental health and traumatic brain injury research during the Military Health System Research Symposium Aug. 14, in Fort Lauderdale, Fla.
Discussion leaders included Health Affairs Director of Medical Research Dr. Terry Rauch; Acting Chief Officer of the VA Office of Research and Development Dr. Timothy O'Leary; U.S. Army's Combat Casualty Care Research Program Director Col. Dallas Hack; Deputy Director of the Defense and Veterans Brain Injury Center Katherine Helmick; and Uniformed Services University School of Medicine's Center for the Study of Traumatic Stress Director Dr. Robert Ursano.
Dialogue turned toward the National Research Action Plan, which is the result of an executive order signed a year ago by President Obama to improve access to mental health services for veterans, service members, and military families. The plan directs DOD and the VA to work with the U.S. Department of Health and Human Services and the U.S. Department of Education to share resources and complete certain goals, such as complete within the next year the current DOD-CDC-Brain Trauma Foundation mTBI/concussion classification project to clarify what is known and unknown about mTBI and the critical gaps that need to be addressed.
"The National Research Action Plan creates a common roadmap for medical leadership to follow as we move forward to work on incredibly complex issues," said Hack, who is stationed at the U.S. Army Medical Research and Materiel Command.
"The National Research Action Plan demonstrates a dedication across multiple agencies to close critical research and care gaps, both in the military and civilian sector," added Rauch.
Since September 11, 2001, more than 2.5 million service members have deployed to Iraq and Afghanistan in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. The Armed Forces Health Surveillance Center data indicates there have been more than 250,000 cases of TBI in the military from 2000--2012. However, more than 80 percent of these were the result of non-combat injuries.
"Clearly, we are not going to stop seeing traumatic brain injuries, even in times of no war," said Hack.
The NRAP also addresses the frequently co-occurring conditions, such as depression; substance abuse related to alcohol, tobacco, and other drugs, including the misuse and abuse of prescription drugs; and chronic pain, each of which can complicate the prevention and treatment of PTSD, TBI, and suicidal behaviors.
"The interrelationships between TBI, PTSD, and suicidality are complex, to say the least," admitted Ursano. "In fact, I think it was this war that highlighted these areas in relation to each other, as an opportunity for further investigation for research and treatment."
Announced within the NRAP is also the creation of two joint research consortia, including the Consortium to Alleviate PTSD and the Chronic Effects of Neurotrauma Consortium. The two consortia will be established within the next 6 months and are within the first phase of the NRAP.
CAP is a collaborative effort between the University of Texas Health Science Center -- San Antonio, San Antonio Military Medical Center and the Boston VA Medical Center, with the goal of developing the most effective diagnostic, prognostic, novel treatment, and rehabilitative strategies to treat acute PTSD and prevent chronic PTSD.
CENC is a collaborative effort between Virginia Commonwealth University, the Uniformed Services University of the Health Sciences, and the Richmond VA Medical Center, with the goal of examining the factors which influence the chronic effects of mTBI and common comorbidities in order to improve diagnostic and treatment options. A key point will be to further the understanding of the relationship between mTBI and neurodegenerative disease.
"Mild traumatic brain injury is an area we need to continue to focus on, in terms of rapid evaluation, treatment and patient management," said Helmick, explaining that most service members with TBI have a mild injury or concussion. "With a mild TBI, most service members can have a full recovery."
In its first 12 months, NRAP will focus on developing a more precise system to diagnose TBI and standardizing data on TBI and PTSD. Longer term goals include confirming biomarkers for PTSD and TBI, identifying changes in brain circuitry after successful treatment, and exploring genetic risk factors.
"The plan lays out the next five years, but this is really a lifelong commitment," O'Leary said. "That is the promise we make to our warfighters."