Cannabis use disorders and PTSD were significantly underdiagnosed in military veterans

What the researchers found

Researchers compared structured clinical interview diagnoses with VA electronic medical record diagnoses for 84 military veterans with confirmed cannabis use disorders. The structured interviews, considered the gold standard, found significant underdiagnosis of cannabis use disorders and PTSD in the VA system.

Other anxiety disorders were also underdiagnosed. In contrast, mood disorders and other substance use disorders were overdiagnosed compared to structured interview results. This pattern suggested clinicians were recognizing some conditions (depression, other substance problems) more readily than others (cannabis dependence, PTSD).

The findings indicated that routine clinical assessment was missing cannabis use disorders and trauma-related diagnoses at concerning rates.

Why it matters

Underdiagnosis means undertreated conditions. If clinicians are not identifying cannabis use disorders and PTSD in veterans, these conditions go unaddressed, potentially worsening outcomes and complicating treatment for the conditions that are identified.

The numbers in context

84 military veterans with confirmed cannabis use disorders. Cannabis use disorders: significantly underdiagnosed. PTSD and other anxiety disorders: significantly underdiagnosed. Mood disorders and other substance use disorders: overdiagnosed.

How the study worked

Cross-sectional study comparing structured clinical interviews (gold standard) with retrospective electronic medical record review for 84 military veterans with cannabis use disorders. Diagnosis rates were compared between the two methods.

What this study cannot tell us

Small sample size (84 veterans). All participants had cannabis use disorders, so the findings may not generalize to all veterans. Single VA site. The direction of the diagnostic bias may reflect clinical priorities rather than inability to diagnose.

How to read the evidence

Cross-sectional comparison study with structured interviews as gold standard. Small sample from a single VA site limits generalizability.

When this study was published

Published in 2012. VA screening and assessment practices have evolved since, with increasing attention to cannabis use and PTSD co-occurrence.

The bigger picture

The co-occurrence of cannabis use disorders and PTSD in veterans has become an increasingly important clinical issue. This study showed the VA system was better at recognizing some problems (depression, alcohol) than others (cannabis dependence, PTSD), creating treatment gaps.

Questions still open

• Would routine structured screening improve diagnosis rates? Are clinicians less likely to diagnose cannabis use disorder because they view cannabis as less harmful? Does PTSD underdiagnosis reflect stigma or screening gaps?

Common questions

Read the original research

The underdiagnosis of cannabis use disorders and other Axis-I disorders among military veterans within VHA.

Military medicine, 177(7), 786-8

Citation

Bonn-Miller, Marcel O; Bucossi, Meggan M; Trafton, Jodie A. (2012). The underdiagnosis of cannabis use disorders and other Axis-I disorders among military veterans within VHA.. Military medicine, 177(7), 786-8.

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