Karestan Koenen, PhD
Timothy S. Paul
Experts estimate that half of patients suffering from post traumatic stress disorder (PTSD) are not identified, and treatment for those who are diagnosed is only partially effective. To address these challenges, a new consortium of nationally-recognized experts on PTSD will work together to improve diagnosis and treatment of the disorder.
Karestan Koenen, PhD of Columbia’s Mailman School of Public Health is the lead epidemiologist for the project, which is organized by Draper Laboratory, an independent not-for-profit laboratory in applied research, engineering development, education, and technology transfer.
In diagnosing PTSD, doctors must rely on a patient’s subjective reports and willingness to communicate how he or she is feeling, yet one of the symptoms of PTSD is avoidance. “When a patient doesn’t want to talk, you’re not going to get a good assessment,” says Dr. Koenen. “We need an algorithm or test to help clinicians diagnose PTSD so they don’t have to rely on self-report alone.”
Scientists are already working to identify reliable biomarkers. Notably, a new study, co-authored by Dr. Koenen and Sandro Galea, MD, DrPH, Chair of the Department of Epidemiology, presents evidence of a genetic factor in the development of the disorder. Other research is looking at stress response and neuroendocrine factors. These independent efforts have thus far been limited to small, homogenous study groups. As lead epidemiologist, Dr. Koenen will work with consortium members to design new studies to test if the biomarkers are effective for the general population.
Another challenge for physicians has been identifying the right treatment for PTSD and when treatment is needed. “A significant number of people who experience trauma recover without any treatment,” says Dr. Koenen. “We need a good way to figure out who needs treatment and which treatment approach would work best for them—whether it’s cognitive behavioral therapy, medication, or something else.”
PTSD has been diagnosed in more than 200,000 troops returning from combat in Iraq and Afghanistan, but it is also commonly found in civilians who have been involved in an accident or assault or have suffered the unexpected loss of a loved one. Approximately 8% of the U.S. population will suffer from PTSD at some point in their life. The disorder can lead to panic attacks, substance abuse, depression, suicide, and a host of serious medical complications, most notably, cardiovascular disorders.
Dr. Koenen is a clinical psychologist and epidemiologist with 15 years of experience in PTSD research. She has treated affected veterans, written a book on women with PTSD related to child sexual abuse, and pursued research on the neurobiology and genomics of the disorder. Dr. Koenen and Dr. Galea are among the authors of a new Institute of Medicine report on how the Department of Defense and the Veterans Administration is providing care for PTSD.
August 15, 2012