Returning Home from Iraq and Afghanistan Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and Their Families (2010) / Chapter Skim
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4 PRELIMINARY FINDINGS
4 PRELIMINARY FINDINGS
Pages 61-116
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From page 61... ...
have caused most of the deaths and nonfatal injuries. Injuries from blast exposure due to IEDs have resulted in numerous physical and mental health outcomes, such as traumatic brain injury (TBI)
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Those outcomes and possible readjustment needs associated with them are discussed below. Traumatic Brain Injury and Related Blast Injuries Throughout OEF and OIF, explosive devices have become more powerful, their detonation systems more creative, and their additives more devastating.
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. In the military literature, posttraumatic epilepsy in patients who initially survive penetrating head injury is associated with an increased risk of death and about a 5-year decrease in life expectancy (Corkin et al., 1984; Walker et al., 1971; Weiss et al., 1982)
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. Posttraumatic Stress Disorder and Traumatic Brain Injury PTSD (discussed in more detail below)
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. In a study of 100 OEF and OIF veterans, about 47% reported at least mild pain, and 28% reported moderate to severe pain; among the 67 veterans with chronic pain conditions, 82% had a documented diagnosis of musculoskeletal or connective tissue disorders (Gironda et al., 2006)
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The committee recommends that the Department of Veterans Affairs conduct research to determine the potential efficacy and cost effectiveness of developing protocols for the long-term management of service members who have polytrauma and traumatic brain injury. The approaches considered should include • Prospective clinical surveillance to allow early detection and intervention for health complications.
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Posttraumatic Stress Disorder PTSD is a commonly diagnosed mental health disorder in OEF and OIF service members. It can develop after the direct, personal experience or witnessing of an event that poses a perceived threat of death or serious injury.
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There is considerable evidence that symptoms of combat-related trauma and posttraumatic stress are inversely associated with service members' relationship quality and stability. For example, 30 years after their military service, 10% of the Vietnam veterans in a community sample reported they still had severe PTSD symptoms, and those 10% reported less satisfaction with their marriages and sex lives and more difficulties with parenting.
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From page 69... ...
. In a study of 66 male Vietnam veterans who had combat-related PTSD, emotional numbing was more strongly related than other symptoms to aspects of the parent–child relationship, including positive sharing, contact, and overall quality (Ruscio et al., 2002)
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In a study of Vietnam veterans, an increased risk of attempting suicide was observed during the early followup period (CDC, 1987) , but the increase in risk did not persist in a 30-year followup of the cohort (Boehmer et al., 2004)
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The committee is aware that DOD is taking steps to meet the mental health care needs of its service members, but more remains to be done. The committee recommends that the Department of Defense and the Department of Veterans Affairs quantify the number and distribution of mental health professionals needed to provide treatment to the full population of returning service members, veterans, and their families who suffer from mental health disorders, such as PTSD, major depression, and substance abuse, so that they can readjust to life outside of theater.
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. Using data from the Millennium Cohort Study, researchers found that reserve and National Guard personnel who experienced combat exposure were significantly more likely to engage in new-onset heavy weekly drinking or experience alcohol-related problems than nondeployed personnel (Jacobson et al., 2008)
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It also discusses the effects of deployment on a host of social issues, including education and employment; income, earnings, and wages; and such adverse outcomes as debt, homelessness, incarceration, crime, and risky driving. In many cases, data on those issues have not yet been studied or clarified for OEF and OIF veterans, so the committee often relied on information from studies of Vietnam veterans or veterans of other
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From page 74... ...
Deployment and Military Families Many men and women who return from the war zone adjust to their lives out of theater successfully; others have difficulty in adjusting or transitioning to family life, to their jobs, and to living in their communities. Families are stressed by routine physical separations from service members and profoundly so by soldiers' deployments to active combat zones.
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Most studies conducted after return from deployment focus on the consequences of symptoms of posttraumatic stress in service members and their families; few studies focus on the normative course of reintegration. However, apart from the eventual transition out of the military, perhaps the most challenging transition for military families is the return home from deployment.
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According to both broad and strict screening criteria, spouses and service members reported similar levels of major depression and generalized anxiety disorders. Spouses were more likely than service members, however, to seek care and less likely to be impeded in doing so by worries about stigma.
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An IOM study (2008a) on the health effects of the Gulf War concluded, however, that although there was a suggestive relationship between combat deployment and marital conflict, there was insufficient evidence to indicate an association with marital dissolution.
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appears to be positively correlated with the percentage of deployed service members who indicate that they plan to obtain a divorce or to separate after their return; for example, the MHAT-V estimates that around 6% of noncommissioned Army officers indicate plans to divorce at 1 month of deployment, compared to over 20% at 15 months of deployment (Office of the Surgeon Multinational Force–Iraq and Office of the Surgeon General United States Army Medical Command, 2008)
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A recent analysis of the occurrence of child maltreatment in military and nonmilitary families in 2000–2003 and the effect of deployment escalations after the September 2001 terrorist attacks in the United States found that the rate of substantiated maltreatment of children of military families doubled, whereas the rate in nonmilitary families was unchanged (Rentz et al., 2007)
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concluded that Vietnam veterans were negatively affected by deploying and attained fewer years of schooling; it used data from the Vietnam Era Twin Study of Aging and compared 44 twin pairs in which one twin was deployed to Vietnam and the other was not (Lyons et al., 2006)
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Using archival data from the NVVRS that included a cohort of 1,200 male and 432 female Vietnam veterans and 412 male and 304 female era9 veterans, Zatzick et al.
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There is evidence that veterans face discriminatory hiring practices. One study found that 66 midlevel managers and supervisors who were reviewing resumes of applicants were less likely to recommend the hiring of Vietnam veterans because of the perception of a higher probability of psychologic problems, although all the applicants (veterans and nonveterans)
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. Many military families are young and inexperienced in managing finances.
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randomly drawn from four study populations: Gulf War regular military (n = 985) , Gulf War National Guard and reserves (n = 911)
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are not discriminated against in employment based on past, present, or future military service" (Employer Support of the Guard and Reserve, 1994)
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(2008) reported that 72.5% of women and 41.6% of men in their sample experienced sexual harassment during their military service; these findings are similar to those of earlier work that reported rates
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Servicewomen's use of mental health–care services was low: only half the women that experienced military sexual assault and exhibited depressive symptoms reported receiving any recent mental health treatment. There are now substantial shortages of qualified mental health specialists in the military, in which professional "burnout" and attrition rates are high (American Psychological Association Presidential Task Force on Military Deployment Services for Youth, Families, and Servicemembers, 2007; Department of Defense Task Force on Mental Health, 2007; Office of the Surgeon Multinational Force–Iraq and Office of the Surgeon General United States Army Medical Command, 2008; Tanielian and Jaycox, 2008)
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found childhood physical abuse prevalence of 38% and 27% among Marine Corps servicewomen and servicemen, respectively -- far higher than the rates of 5% and 3% derived from the National Comorbidity Survey11 (Kessler et al., 1999)
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. The greater likelihood of being their children's primary caregiver may make female service members particularly vulnerable to mental health problems when military service demands, such as long and unpredictable hours even while based at home, conflict with their maternal role.
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Women and Posttraumatic Stress Disorder The literature shows that civilian women have higher rates of depression and anxiety disorders, including PTSD, than civilian men (Kessler et al., 2005; Tolin and Foa, 2006)
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was 44% black, 44% Hispanic, and 12% Asian and Pacific Islander. Racial and ethnic discrimination during military service was significantly associated with poorer physical health but not mental health (Sohn and Harada, 2008)
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Several studies of Gulf War veterans have found that minority-group veterans had a greater prevalence of PTSD. In a study by Kang et al.
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used the 2001 VIPS to assess the association between perceptions of discrimination and self-reported mental and physical health in Latino, Asian and Pacific Islander, black, and white veterans. They found that racial and ethnic discrimination during military service was significantly associated with poorer physical health but not mental health.
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It is critical for VA and DOD to provide for the acute needs of returning veterans and their families, but it is equally important to plan for the long-term consequences and ensure that there will be adequate resources and infrastructure to continue to provide care, services, and compensation to OEF and OIF veterans and their families over many decades. In the short run, a variety of factors will keep the public costs associated with deployment-related needs deceptively low: the low age of the average OEF or OIF veteran, the potential latency of service-related health conditions (such as PTSD)
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The pattern among veterans of the Korean War is less clear: the number of veterans receiving disability and pensions peaked around 1978, or 25 years after the war, but total real benefits appeared to plateau. The number of Vietnam veterans receiving disability and pensions and total real spending on their benefits are still rising, as are the number of veterans of the Persian Gulf War who receive disability and pensions.
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Source data are derived from the US Census Bureau's Statistical Abstracts of the United States, 1970, Table 406; 1974, Table 534; 1980, Table 640; 1990, Table 569; 1995, Table 579; and 2008, Table 508, which up to 2000 cite the Annual Report of the Secretary of Veterans Affairs and after 2000 cite VA's Annual Accountability Report. On the basis of data from past wars, Figures 4.1 and 4.2 strongly suggest that the total number of OEF and OIF veterans seeking government assistance for their service-related healthcare and disability needs and the magnitude of public compensation for those needs will rise for many decades after the conclusion of the conflicts.
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These survivors of very severe injuries need more intensive care than the most severely wounded service members from prior wars, implying that extrapolating from past conflicts might result in an underestimation of the overall burden of need for persons impacted by OEF and OIF. Furthermore, accelerated and lengthened overseas deployment, reduced dwell times between deployments, and repeated reintegration into life outside theater for the returning OEF and OIF service members and their families may result in additional burdens that are poorly understood, including higher rates of divorce, juvenile delinquency, or disruptions in communities that lose workers called up to National Guard or reserve units.
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2000. Long-term mortality trends in patients with traumatic brain injury.
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2009. Visual impairment and dysfunction in combat-injured servicemembers with traumatic brain injury.
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2004. Long-term survival after traumatic brain injury: A population-based analysis.
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CDC, 2006. Traumatic Brain Injury: A Guide to Criminal Justice Professionals.
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2009. Systematic review of the literature on pain in patients with polytrauma including traumatic brain injury.
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2004. The Hawaii Vietnam Veterans Project: Is minority status a risk factor for posttraumatic stress disorder?
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2009. Traumatic brain injury, polytrauma, and pain: Challenges and treatment strategies for the polytrauma rehabilitation.
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2009. Separating deployment-related traumatic brain injury and posttraumatic stress disorder in veterans: Preliminary findings from the Veterans Affairs traumatic brain injury screening program.
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2009. Gulf War and Health Volume 7: Long-Term Consequences of Traumatic Brain Injury.
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2003. Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: Population-based survey of 30,000 veterans.
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2007a. Auditory dysfunction in traumatic brain injury.
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2004. Employment retention after moderate-severe traumatic brain injury (TBI)
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2008. Prevalence of chronic pain after traumatic brain injury: A systematic review.
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1999. Impact of traumatic brain injury on the family: A critical review.
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2005. Long-term survival following traumatic brain injury.
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2008. Underdstanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder.
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2000. Comparative mortality of adults with traumatic brain injury in California, 1988-1997.
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2009b. VHA Directive 2009-028: Polytrauma-Traumatic Brain Injury (TBI)
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2008. In the line of fire: Traumatic brain injury among Iraq War veterans.
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