Office of Research & Development

 

Mental Health

Mental Health icon

Mental health conditions such as depression and anxiety are common in the United States. More than 25 percent of Americans suffer from a diagnosable mental disorder in any given year. According to a recent survey, nearly 40 percent of Iraq and Afghanistan Veterans enrolled to receive VA health care may have at least one mental health diagnosis. Posttraumatic stress disorder (PTSD) was the most common diagnosis for Veterans, followed by depression.

To respond to these needs, VA offers a wide range of mental health services. In fact, VA is the largest single provider of mental health care in the nation. In a recent year, VA provided specialty mental health services to 1.3 million Veterans, many with mental health issues related to their combat deployments.

VA leaders have made it a priority to conduct research to improve our understanding and treatment of mental health conditions. VA's mental health research includes studies of diseases and disorders for all generations and eras of Veterans, and is especially strongly focused on mental health after deployments.

VA researchers are looking at potential approaches for treating and preventing mental health disorders. They are also looking at related issues such as developing and evaluating collaborative primary care models, and improving access to services from rural and other remote areas by using the Internet and other technologies.

(Please note that the area of mental health is also covered in several other topic pages on our website, such as Depression, Posttraumatic Stress Disorder, Substance Use Disorders, and Suicide Prevention.)

Selected Major Accomplishments

  • VA researchers identified a gene associated with a major schizophrenia symptom (hearing "voices"), the first time a symptom was traced to a specific gene.
  • VA's TIDES project provides an evidence-based collaborative approach to depression management.
  • While atypical antipsychotic drugs vary in cost, there is limited evidence of differences in effectiveness, according to a 2003 VA study.

Selected Milestones and Major Events

Overview

VA investigators have long been pioneers in understanding and treating mental health disorders. They compare existing treatments and explore potential new approaches to treat and prevent mental health disorders among Veterans of all ages and eras.

Mental health conditions such as depression and anxiety are common in the United States.

Among the areas in which VA researchers are focusing are mood disorders, such as depression and bipolar disorder; psychotic disorders, such as schizophrenia; PTSD and other anxiety conditions; and substance use disorders.

VA investigators are also focusing on the co-occurrence of mental health issues and physical disorders—for instance, depression in those with spinal cord injury, or substance abuse in patients with chronic pain.

VA's 15 Mental Illness Research, Education, and Clinical Centers (MIRECCs) were established by Congress with the goal of researching the causes and treatments of mental disorders, and using education to put new knowledge into routine clinical practice in VA. Specialized mental health centers of excellence are an essential part of VA's ability to meet Veterans' mental health needs.

Approaches to care

VA is continually updating its methods of providing mental health care based on current evidence from research about what works for Veterans.

For example, VA researchers have found that a team approach to providing care can improve the management of mental health conditions, as has been shown for other illnesses. VA's TIDES project is an evidence-based collaborative approach to depression management that has been successfully incorporated into the VA system. (TIDES is an acronym for "Translating Initiatives for Depression into Effective Solutions.")

VA's Quality Enhancement Research Initiative (QUERI) has been a leader in making knowledge gained through TIDES available to VA mental health practitioners. For example, a QUERI-funded adaptation of TIDES for human immunodeficiency virus (the virus that causes AIDS) led to improved physical and depression outcomes for those with HIV.

In 2007, VA established the Center of Excellence for Research on Returning War Veterans. The center supports state-of-the-art research on the effects of combat exposure on mental health. The center focuses on preventing mental illness in Iraq and Afghanistan Veterans, and providing treatment and rehabilitation for those with mental illnesses.

Another new approach to providing care is the use of telehealth systems, which allow VA's mental health professionals to provide effective care to Veterans who are not physically at the same facility.

Researchers recently found that a home electronic messaging program substantially reduced emergency room visits and hospitalizations in people with mental health issues such as depression, schizophrenia, PTSD, and substance use disorders. Daily messages were sent to patients through devices connected to their home telephone lines.

Hospital admissions dropped by 80 percent for patients receiving the messages, and emergency room admissions for that group dropped by 60 percent within the first six months of the program, compared to the six-month period before it began.

Anxiety disorders

Anxiety is a normal biological reaction to a stressful event. In some cases, however, anxiety continues for a long period and may worsen over time, with symptoms such as nightmares, racing pulse, and overreactions. In persistent cases, anxiety disorders such as PTSD, panic disorders, and phobias may develop.

In a recent international study of people with generalized anxiety disorder, including Veterans, the drug quetiapine was able to dramatically reduce troublesome symptoms. The drug, known commercially as Seroquel, already treats schizophrenia, bipolar disorder, and depression.

A study of the brain activity in special operations forces showed how they manage to keep their cool and perform well under pressure. The study used MRI scans to examine brain activity in Navy SEALS and in other healthy male subjects.

During tasks performed in the study, the SEALs showed more activity in parts of the brain linked to emotional control. They also had less anticipatory anxiety over what would happen in the next moment. Follow-up investigations could provide insights to help improve military training, according to the researchers.

Depression

Depression is one of the most common and costly mental disorders. VA researchers are developing more effective drugs to treat depression by probing the biological roots of the condition. They are also exploring the benefits and risks of a wide variety of existing and potential new treatments.

Additional information on this topic can be found on our Depression Web page.

Posttraumatic stress disorder (PTSD)

In recent years, VA investigators have made important strides in understanding PTSD, an anxiety disorder often linked with combat, but which also occurs after other types of trauma.

Recent studies have used brain scans to distinguish between patients with and without PTSD; shown a drug called prazosin to be effective for PTSD nightmares; and shown that the drug risperidone may not help Veterans with PTSD who have not responded to serotonin reuptake inhibitor (SRI) drugs.

Additional information on PTSD can be found on our PTSD Web page.

Schizophrenia

Schizophrenia is a serious psychiatric disorder that affects some 100,000 Veterans receiving VA health care. VA has adopted new models of care for those with schizophrenia and other serious mental illnesses.

In 1997, a VA research team found that the difficulty many people with schizophrenia have in sorting out sounds, leading them to hear voices, has to do with a defective gene linked to mental illness. It was the first time a schizophrenia symptom was traced to a specific gene.

In 2003, VA researchers found that while a new generation of antipsychotic drugs, called atypicals, were more expensive than older drugs, there was only limited evidence of differences in effectiveness between the newer and older medications.

In 2009, a VA-funded research team began probing the genetic basis of schizophrenia and bipolar disorder, which together affect some 170,000 VA patients. Researchers are scanning DNA from as many as 38,000 Veterans, looking for gene variants found in those with mental illness but not in others.

More recently, VA researchers, along with their international colleagues, have found difference in postmortem brain samples of people with and with and without schizophrenia. In those with schizophrenia, certain genes were "underexpressed" in the nodes of Ranvier, which are gaps between neurons that conduct nerve impulses to help brain cells communicate. This means that people with schizophrenia have genetic differences that are reflected in their brain tissue.

Other researchers have found that people with schizophrenia who completed intensive computer-based cognitive training were better able to distinguish between reality and their own internal thoughts. The research suggests that some brain impairments in schizophrenia can change if patients receive the right training.

Substance use disorders

VA supports a broad portfolio of research looking at substance abuse prevention, screening, and treatment. Additional information on substance use disorders can be found on our Substance Use Disorders Web page.

Suicide prevention

According to the Centers for Disease Control and Prevention, an estimated 30,000 to 32,000 lives are lost to suicide each year in the United States, including those of Veterans. As part of its efforts to address this problem, VA has established a toll-free, confidential Veterans Crisis Line at 1-800-273-8255.

Veterans and their families can also chat online with trained counselors at www.VeteransCrisisLine.net. Registration with VA or enrollment in VA health care is not necessary.

Additional information on this topic can be found on our Suicide Prevention Web page.

More on our Website

VA Brochure: Mental Health

Study confirms that depression can shorten life, VA Research news feature

Understanding the complex link between diabetes and cognitive health. VA Research news feature

Chaplaincy and mental health, VA Research Currents, Winter 2013-14

Outdoor activities improve mental health in Veterans, study finds. VA Research Currents, Winter 2013-14

The emotional burden of killing in war, VA Research Currents, Fall 2013

For Veterans with PTSD, videoconferencing proves effective for delivering therapy, VA Research Currents, May 2013

Mental Health, VA Quality Enhancement Research Initiative.

Center for Mental Healthcare and Outcomes Research

Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), U.S. Department of Veterans Affairs

Selected Scientific Articles by our Researchers

Home telemental health implementation and outcomes using electronic messaging. Godleski L, Cervone D, Vogel D, Rooney M. Patients receiving daily questions on a home messaging device including alerts, data, and educational components were hospitalized less than others, and indicated a high level of satisfaction with home messaging programs. J Telemed Telecare, 2012 Jan;18(1):17-9.

Molecular and genetic evidence for abnormalities in the nodes of Ranvier in schizophrenia. Roussos P, Katsel P, Davis KL, Bitsios P, Giakoumaki SG, Jogia J, Rozsnyal K, Collier D, Frangou S, Siever LJ, Harotunian V. The messenger RNA expression of multiple nodes of Ranvier genes was decreased in schizophrenia. These results point to abnormalities in the expression of genes and protein associated with the integrity of the Nodes of Ranvier. Arch Gen Psychiatry, 2012 Jan;69(1):7-15.

Computerized cognitive training restores neural activity within the reality monitoring network in schizophrenia . Subramaniam K, Luks TL, Fisher M, Simpson GV, Nagarajan S, Vinogradov S. Schizophrenia patients suffer from severe cognitive deficits, such as impaired reality monitoring. The study's findings demonstrate that a serious behavioral deficit in schizophrenia, and its underlying neural dysfunction, can be improved by well-designed computerized cognitive training. Neuron, 2012 Feb 23;73(4):842-53.

Extended release quetiapine fumarate (quetiapine XR) monotherapy as maintenance treatment for generalized anxiety disorder: A long-term, randomized, placebo-controlled trial . Katzman MA, Brawman-Mintzer O, Reyes EB, Olausson B, Liu S, Eriksson H. During randomized treatment, Quetiapine XR monotherapy reduced the risk of anxiety symptom recurrence in patients with generalized anxiety disorder stabilized on quetiapine XR. Int Clin Psychopharmacol, 2011 Jan;26(1):11-24.

Altered insula activation in anticipation of changing emotional states: Neural mechanisms underlying cognitive flexibility in Special Operations Forces personnel . Simmons AN, Fitzpatrick S, Strigo IA, Potterat EG, Johnson DC, Matthews SC, Orden KF, Swain JL, Paulus MP. Elite warriors show combined minimal reactivity during negative stimuli and an enhanced ability to efficiently change their physiological state. These neural changes may underlie their ability to perform well in stressful situations. Neuroreport. 2012 Mar 7;23(4);234-9.

Psychological effects of the marathon bombing on Boston-area Veterans with posttraumatic stress disorder . Miller MW, Wolf EJ, Hein C, Prince L, Reardon AF. Participants with PTSD were assessed by telephone within 1 week of the end of the Boston Marathon bombing; 42.3 percent of participants reported being personally affected by the bombings or the manhunt that followed. J Trauma Stress. 2013 Dec;26(6):762-6.

Association between traumatic brain injury and risk of posttraumatic stress disorder in active-duty Marines . Yurgil KA, Barkauskas DA, Vasterling JJ, Nievergelt CM, Larson GE, Schork NJ, Litz Bt, Nash WP, Baker DG; Marine Resiliency Study Team. Even when accounting for predeployment symptoms, prior TBI, and combat intensity, TBI during the most recent deployment is the strongest predictor of post-deployment PTSD symptoms. JAMA Psychiatry. 2014 Feb 1;71(2);149-57.

VA & Other U.S. Goverment Online Resources