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VA research on

Mental Health

Mental health conditions are common in the United States. According to the National Institute of Mental Health, an estimated 43.8 million adults aged 18 or older had a mental illness in 2014, representing about 18 percent of all U.S. adults—and this figure did not include substance-use disorders.

VA offers a wide range of mental health services to Veterans. The goal of VA mental health care is to support recovery and enable Veterans who experience mental health problems to live meaningful lives in their communities and achieve their full potential.

The Department aims to provide coordinated care for the whole person, not just for the person's mental illness. VA promotes the idea that having a healthy body, satisfying work, and supportive family and friends are integral to mental health. All Veterans who receive specialty mental health care have mental health treatment coordinators to help them define and work toward their overall mental health goals.

Mental health services are available in VA's mental health specialty clinics, primary care clinics, nursing homes, and residential care facilities. Those with serious mental health problems may take part in specialized programs such as mental health intensive case management, day centers, work programs, and psychosocial rehabilitation.

Emergency mental health care is available 24 hours a day, seven days a week at VA medical centers. Facilities that do not have 24-hour emergency rooms must provide emergency services through a local non-VA hospital.

Veterans thinking about hurting or killing themselves or others, experiencing an emotional crisis, feeling hopeless or engaging in self-destructive behavior such as drug abuse, should call the Veterans Crisis Line at 1-800-273-TALK (8255). Press 1 for Veterans.

Selected Major Accomplishments

  • 1941: Set up a research lab at the Northport, New York, to conduct clinical and biomedical research in neuropsychatric disorders
  • 1989: Created the National Center for PTSD to address the needs of Veterans and other trauma survivors with posttraumatic stress disorder (PTSD)
  • 1997: Identified a gene associated with a major risk for schizophrenia
  • 2003: Determined that while atypical antipsychotic drugs vary in cost, there is limited evidence of differences in effectiveness
  • 2006: Developed, through VA's TIDES project, an evidence-based collaborative approach to depression management
  • 2013: Determined an association between homelessness among Veterans and childhood problems such as abuse and family instability
  • 2015: Found that a loss of gray matter in three separate brain structures is common across a spectrum of psychiatric disorders widely perceived to be distinct

Overview

VA researchers are looking at potential new approaches for treating and preventing mental health disorders. They are also working on related projects 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, including Depression, Posttraumatic Stress Disorder, Substance Use Disorders, and Suicide Prevention.)

Among the areas VA researchers are focusing on 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 looking at 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.

The National Research Action Plan is a wide-reaching plan developed in 2013 by VA and the departments of Defense; Health and Human Services; and Education. The plan is designed to improve access to mental health services for Veterans, service members, and military families.

Implementation of the plan will improve scientific understanding of PTSD, traumatic brain injury (TBI), various co-occurring conditions, and suicide. Other goals of the plan include providing effective treatments for these diseases, and reducing their occurrence.

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.

VA's Center for Integrated Health Care, located in Canandaigua, New York, is dedicated to advancing research, education, and clinical consultation to enhance the integration of mental health and primary care services for Veterans. The Center of Excellence for Suicide Prevention, also located in Canandaigua, integrates surveillance with intervention development to inform the implementation of effective suicide prevention strategies for Veterans.

The Center of Excellence for Research on Returning War Veterans in Waco, Texas, supports state-of-the-art research on the effects of combat exposure on mental health. Center researchers focus on preventing mental illness in Iraq and Afghanistan Veterans, and providing treatment and rehabilitation for those with mental illnesses.

The Center of Excellence for Stress and Mental Health, in San Diego, works to understand the neurobiological mechanisms of responses to trauma and, through this understanding, to develop and disseminate novel, effective treatments.

VA's National Center for PTSD is a VA group of research centers that focus entirely on the condition.

The department's Center for Mental Healthcare and Outcomes Research, in North Little Rock, Arkansas, conducts research to improve access to and engagement in evidence-based mental health and substance use care. The Brain Rehabilitation Research Center, in Gainesville, Fla., develops and tests treatments to substantially improve or restore motor, cognitive, and emotional functions that have been impaired by neurologic disease or injury. The Translational Research Center for TBI and Stress Disorders (TRACTS), in Boston, studies the complex changes in the brain, thinking, and psychological well-being that result from traumatic brain injury and PTSD.

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.

Older Veterans no more likely to have anxiety than non-Veterans—In 2014, a team from the VA Palo Alto Health Care System and Stanford University School of Medicine examined data on 7,000 men age 50 or older, and found that Veterans were no more likely than non-Veterans to have depression or anxiety.

Because Veterans, especially those who served in combat, have generally experienced more stress and trauma in their lives than non-Veterans, the team had expected to see higher rates of depression among Veterans. Instead, they found just the opposite. Older Veterans actually scored better than non-Veterans in the same age group.

The team found 11 percent of Veterans reported elevated rates of depression, compared with 12.8 percent of non-Veterans. For anxiety, 9.9 percent of Veterans reported elevated levels, versus 12.3 percent for non-Veterans. These differences were not considered statistically significant.

Vietnam Veterans, however, were twice as likely to have elevated depression and anxiety, compared with World War II or Korean War Veterans in the study. The team said further studies are needed to explain this finding.

Psychological effects of Boston Marathon bombing—Many Veterans living in the Boston area who have been diagnosed with PTSD experienced anxiety, flashbacks, unwanted memories, and other psychological effects as a result of the bombing that took place near the finish line of the Boston Marathon in April 2013, according to a 2013 study conducted by VA's National Center for PTSD.

Researchers conducted 71 telephone interviews within a week of the bombing. Because they had symptom data from Veterans they had interviewed two months previously, they were able to compare their level of PTSD symptoms with results from the interviews.

Of those interviewed, 38 percent reported that they were emotionally distressed by the bombing and the subsequent lockdown of Boston and other communities. A majority of those participating said the bombing caused them to experience flashbacks and the reemergence of unwanted memories related to their own past trauma.

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.

Interrelationship of mental health issues

A 2015 study by researchers at the VA Palo Alto Healthcare System and Stanford University identified a common pattern across a spectrum of psychiatric disorders widely perceived to be quite distinct.

The research team analyzed 193 peer-reviewed papers that contained magnetic resonance images of the brains of 7,381 patients diagnosed with schizophrenia, bipolar disorder, major depression, addiction, obsessive-compulsive disorder, and a cluster of related anxiety disorder.

They found a loss of gray matter (the darker tissue of the brain and spinal cord, consisting mainly of nerve cell bodies and branching dendrites) in three separate brain structures—the left and right anterior insula, and the dorsal anterior cingulate.

These structures are part of a larger network in the brain associated with higher-level executive functions such as concentrating in the face of distractions, multitasking or task switching, planning and decision-making, and inhibition of counterproductive impulses.

Gray matter loss in the three brain structures was similar across patients with different psychiatric conditions, according to the researchers. The findings mirror those from a 2013 study that found shared genetic glitches across several categories of mental illness.

PTSD

In recent years, VA investigators have made important strides in understanding PTSD, an anxiety disorder often linked with combat. PTSD also occurs after other types of trauma including sexual or physical abuse or assault; terrorist attacks; serious accidents, such as car wrecks; and natural disasters, such as fires, tornadoes, hurricanes, floods or earthquakes.

Symptoms of PTSD include reliving the event; avoidance of situations that remind those who have undergone trauma of the event; negative changes in beliefs and feelings; and a feeling of being keyed up, also called hyperarousal.

Most people have some stress-related reactions after a traumatic event, but not everyone gets PTSD. Those whose reactions don't go away over time and disrupt their lives may have PTSD.

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

Schizophrenia

Schizophrenia is a serious psychiatric disorder affecting approximately 120,000 Veterans receiving VA health care, according to a study published in 2014. VA has adopted new models of care for those with schizophrenia and other serious mental illnesses.

Sorting out sounds with schizophrenia—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.

New vs. older antipsychotic drugs—In 2003, researchers from the VA Connecticut Healthcare System and Yale University learned 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 one of the newer medications (olanzapine) and one of the older ones (haloperidol).

Gene locations in people with schizophrenia—In 2014, VA researchers took part in an international study that identified 108 genetic locations where the DNA of people with schizophrenia tends to differ from those without the disease. About three-quarters of the genetic locations identified in the study had not been previously reported.

The study analyzed DNA from nearly 37,000 people in Europe and Asia with schizophrenia, and more than 113,000 without the disease. While most of the genes implicated in the study are expressed in the brain, others appear to play a role in the body's immune system, supporting a link between the immune system and schizophrenia.

Results of the study may eventually lead to new ways to diagnose and treat the disease.

Recognizing facial emotions with schizophrenia—Many patients with schizophrenia have difficulty recognizing others' facial emotions. A 2015 study led by researchers from the VA Greater Los Angeles Healthcare System tested an experimental device that delivers electrical current to specific parts of the brain on 36 Veterans with schizophrenia.

The team found that a single 20-minute session with the device, in which electrical current was applied to the outside of the prefrontal cortex, improved patients' ability to identify the emotion described in photographs of people displaying a variety of emotions. According to the researchers, this ability can be expected to last for an hour or two after the current is applied. The researchers are now looking into how such effects can be sustained long-term.

This treatment should not be confused with electroconvulsive therapy, formerly known as shock therapy, which aims to induce a seizure via a lager electrical current, and is sometimes used as a last resort in treating major psychiatric illnesses.

Oxytocin nasal spray treatment—Hormones are message-sending chemicals sent out by glands in the body. They regulate various biological activities including growth, development, reproduction, energy use and storage, and water and electrolyte balance.

Oxytocin is a naturally occurring hormone that has wide-reaching effects on human bonding and intimacy, both romantic and maternal. It is made in the brain's hypothalamus. Under the brand name Pitocin, oxytocin is given to women in childbirth to start or strengthen their contractions.

A 2014 study by researchers with the VA Greater Los Angeles Healthcare System and the University of California has indicated that providing additional doses of the hormone through a nasal spray may help those with schizophrenia.

The research team provided 27 men with schizophrenia with either oxytocin or a placebo once a week for 12 weeks. All of the participants were also given training on social cognitive skills, including the ability to identify facial emotions, social perception, and empathy.

The team found that the group receiving oxytocin did significantly better than the group receiving a placebo in the area of "empathic accuracy"—understanding how others feel when they show emotion. They are now working to pinpoint the biochemical pathways oxytocin affects, and to see how much of an impact doses of oxytocin can have on the everyday lives of those with schizophrenia and autism.

Stress

Stress is a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances. It is a highly subjective phenomenon, experienced differently by every individual.

In 1963, VA began the Normative Aging Study, a longitudinal study that looks at the effects of aging on various health issues. Participants in the study undergo medical examinations every three to five years, and answer questions about behaviors affecting their health.

Using data from the study, a VA and Oregon State University team found in 2014 that the health of older men is particularly vulnerable to stressors, and that these stressors could contribute to a shorter life.

Of the 1,293 men in the study, those whose daily life was significantly stressful were three times more likely to die between 1989 and 2004 than people who found their lives to be not very stressful, or only moderately stressful.

In a commentary on the article on National Public Radio, a Harvard University researcher suggested that exercise, meditation, slow breathing, and moderation in drinking alcohol are good ways to reduce stress levels.

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, suicide was the 10th leading cause of death for all ages in the United States. There were 41,149 suicides in the United States in 2013. In VA's Suicide Data report for 2012, the department estimated that, in 2010, 22 Veterans committed suicide every day. 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

Selected Scientific Articles by our Researchers

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 one 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.

Polypharmacy with antipsychotic drugs in patients with schizophrenia: trends in multiple health care systems. Sun F, Stock EM, Copeland LA, Zeber JE, Ahmedani BK, Morissette SB. Antipsychotic use among patients with schizophrenia varies substantially among health care systems. Am J Health Syst Pharm. 2014 May 1;71(9):728-38.

Traumatic brain injury and risk of dementia in older Veterans. Barnes DC, Kaup A, Kirby KA, Byers AL, Diaz-Arrastia R, Yaffe K. TBI in older Veterans was associated with a 60 percent increase in the risk of developing dementia over nine years. Neurology. 2014 Jul 22;83(4):312-9.

Biological insights from 108 schizophrenia-associated genetic loci. Schizophrenia Working Group of the Psychiatric Genomics Consortium. The paper identifies 128 genes that may be associated with schizophrenia, spanning 108 conservatively defined loci. Eighty-three of those genes have not been previously reported. Nature. 2014 Jul 24;511(7510):421-7.

Oxytocin-augmented social cognitive skills training in schizophrenia. Davis MC, Green MF, Lee J, Horan WP, Senturk D, Clarke AD, Marder SR. Oxytocin may enhance the effectiveness of training when administered shortly before social cognitive training sessions. The effects were most pronounced on empathic accuracy. Neuropsychopharmacology. 2014 Aug;39(9):2070-7.

Do hassles mediate between life events and mortality in older men? Longitudinal findings from the VA Normative Aging Study. Aldwin CM, Jeong YJ, Igarashi H, Choun S, Spiro A 3rd. Veterans with high levels of stress are significantly more likely to die than those with low or moderate levels of stress or "hassles." Exp Gerontol. 2014 Nov:59:74-80.

Identification of a common neurobiological substrate for mental illness. Goodkind M, Eickhoff SB, Oathes DJ, Jiang Y, Chang A, Jones-Hagata LB, Ortega BN, Zaiko YV, Roach EL, Korgaonkar MS, Grieve SM, Galatzer-Levy I, Fox PT, Etkin A. A meta-analysis of 193 peer-reviewed papers identified a common pattern of loss of gray matter in three brain structures across a spectrum of psychiatric disorders that are widely perceived to be distinct. JAMA Psychiatry. 2015 Apr:72(4):305-15.

Depression and anxiety symptoms in male Veterans and non-Veterans: the Health and Retirement Study. Gould CE, Rideaux T, Spira AP, Beaudreau SA. In a community-based sample of men aged 50 and older, Veteran status was not associated with the presence of elevated depression and anxiety symptoms. Int J Geriatr Psychiatry, 2015 Jun;30(6):623-30.

The effect of transcranial direct current stimulation on social cognition in schizophrenia; a preliminary study. Rassovsky Y, Dunn W, Wynn J, Wu AD, Iacoboni M, Hellemann G, Green ME. Transcranial direct current stimulation appears to be safe and may have potential therapeutic effects on emotion identification in schizophrenic patients. Schizophr Res. 2015 Jul:165(2-3):171-4.

Military blast exposure, ageing and white matter integrity. Trotter BB, Robinson ME, Milberg WP, McGlinchey RE, Salat DE. Blast exposure may negatively affect brain-ageing trajectories at the microstructural tissue level. Brain. 2015 Aug;138(Pt 8):2278-92.

Blood-borne revitalization of the aged brain. Castellano JM, Kirby ED, Wyss-Coray T. A review of brain rejuvenation studies in the broader context of systemic rejuvenation research, discussing mechanisms for blood-borne brain rejuvenation and suggesting promising avenues for future research and development of therapies. JAMA Neurol. 2015 Oct;72(10):1191-4.

Long-acting intranasal insulin detemir improves cognition for adults with mild cognitive impairment or early-stage Alzheimer's disease dementia. Claxton A, Baker D Hanson A, Trittschuh EH, Cholerton B, Morgan A, Callaghan M, Arbuckle M, Behl C, Craft S. Intranasal insulin detemir, which is longer-lasting than regular insulin, improves cognition and daily functioning for adults with Alzheimer's disease or mild cognitive impairment. J Alzheimers Dis. 2015;44(3):897-906.

Psychotherapy for depression in older Veterans via telemedicine: a randomised, open-label, non-inferiority trial. Egede LE, Acierno R, Knapp RG, Lejuez C, Hernandez-Tejada M, Payne EH, Frueh BC. Telemedicine-delivered psychotherapy for older adults with major depression is not inferior to same-room treatment. Lancet Psychiatry, 2015 Aug;2(8):693-701.

Randomized trial of cognitive-behavioral therapy versus light therapy for seasonal affective disorder: acute outcomes. Rohan KJ, Mahon JN, Evans M, Ho SY, Meyerhoff J, Postolache TT, Vacek PM. Cognitive behavioral therapy for seasonal affective disorder and light therapy are comparably effective for seasonal affective disorder, and both may be considered as treatment options. Am J Psychiatry, 2015 Sep 1;172(9):862-9.

The VA augmentation and switching treatments for improving depression outcomes (VAST-D) study: Rationale and design considerations. Mohamed S, Johnson GR, Vertrees JE, Guarino PD, Weingart K, Young IT, Yoon J, Gleason TC, Kirkwood KA, Kilbourne AM, Gerrity M, Marder S, Biswas K, Hicks P, Davis LL, Chen P, Kelada A, Huang GD, Lawrence DD, LeGwin M, Zisook S. Design of a trial of three "next-step" strategies for Veterans who do not achieve remission with their first antidepressant: switching to another antidepressant (bupropion-SR) or augmenting the current antidepressant with either another antidepressant (bupropion-SR) or with an atypical antipsychotic (aripiprazole). Psychiatry Res, 2015 Oct 30:229(3):760-70.

Direction of association between depressive symptoms and lifestyle behaviors in patients with coronary heart disease: the Heart and Soul Study. Sin NL, Kumar AD, Gehi AK, Whooley MA. Among patients with coronary heart disease, depressive symptoms were linked to a range of lifestyle risk factors and predicted further declines in physical activity, medication adherence and sleep quality. Ann Behav Med, 2016 Jan 27. (Epub ahead of print)

The effect of enemy combat tactics on PTSD prevalence rates: a comparison of Operation Iraqi Freedom deployment phases in a sample of male and female Veterans. Green JD, Bovin MJ, Erb SE, Lachowicz M, Gorman KR, Rosen RC, Kean TM, Marx BP. The nature of combat may be a risk factor for the development of PTSD among males. Factors other than enemy tactics may be more important to the development of PTSD among females. Psychol Trauma. 2015 Dec 14. (Epub ahead of print.)

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