More than a quarter of all Americans experience a diagnosable mental health disorder in any given year, and a 2009 Department of Veterans Affairs (VA) study revealed that nearly 40 percent of Iraq and Afghanistan veterans enrolled to receive VA health care have at least one mental health diagnosis. This prevalence, and the variety and interrelatedness of many mental health conditions, have made mental health an area of particular focus for VA research in recent years.
VA’s mental health research topics include addictive disorders; anxiety disorders; dementia, cognitive and memory disorders; mood disorders; neurobiology of mental illness; traumatic brain injury (TBI); psychotic disorders; post-traumatic stress disorder (PTSD); sleep disorders; suicide; and mental health services delivery.
VA devotes considerable resources to discovering and disseminating information about the causes and treatments of mental health disorders:
- About a third of the 19 Centers of Innovation (COINs) funded by the VA’s Health Services Research and Development Service (HSR&D) are focused on mental health and related issues.
- Within HSR&D, two Quality Enhancement Research Initiative (QUERI) programs – the Mental Health QUERI, coordinated in Little Rock, Arkansas, and the Substance Use Disorder QUERI, coordinated in Palo Alto, California – are dedicated to improving access to care and outcomes among veteran patients.
- At VA Medical Centers (VAMCs) around the country, 15 Mental Illness Research, Education and Clinical Centers (MIRECCs) and Centers of Excellence (CoEs) conduct mental health research and help practitioners implement the discoveries of VA investigators.
VA investigators, who worked on a total of 539 funded research projects in FY 2014, study mental health issues from the molecular level to outcomes within the entire health care system. VA’s mental health research topics include addictive disorders; anxiety disorders; dementia, cognitive and memory disorders; mood disorders; neurobiology of mental illness; traumatic brain injury (TBI); psychotic disorders; post-traumatic stress disorder (PTSD); sleep disorders; suicide; and mental health services delivery. Many of these topics are prioritized in response to the National Research Action Plan (NRAP), established in 2013 to foster collaboration and streamlining in the mental health research of the departments of Defense, Veterans Affairs, Health and Human Services, and Education.
Mental Illness and Cognition
One of the challenges in determining causes of and treatments for mental health disorders is that their symptoms or associated conditions often overlap, and make it difficult to determine whether they are tied to one or the other, or both. Many VA investigators confront the task of disentangling these associations.
Philip Harvey, Ph.D., a health sciences researcher at the Miami VAMC and director of the Division of Psychology at the University of Miami Miller School of Medicine, has spent much of his career investigating debilitating mental health issues – including schizophrenia, for which about 100,000 veterans receive treatment at VA centers, and bipolar disorder, which affects about 120,000 Veterans Health Administration (VHA) patients. Though neither disorder is service-related, veterans are nevertheless at a higher risk for them, relative to the population as a whole.
“Both [of these illnesses] are associated with very high levels of everyday disability across multiple domains: social, vocational, and residential,” said Harvey. Schizophrenic patients encounter a disability rate of about 80 percent across those domains, and those with bipolar disorder, a rate of about 60 percent. This level of impairment significantly reduces the quality of life for patients, and contributes greatly to overall costs of care.