The relationship between combat and psychiatric breakdown has been well recognised for decades. The change to smaller, professional armed forces has reduced the risk of large-scale acute psychiatric casualties, and should have led to a corresponding decrease in long-term ill health, but this expected reduction seems not to have happened. Likewise, attempts at preventing psychiatric injury, by screening before deployment or debriefing after, have been disappointing. Three reasons for this are proposed: a rethinking of the relationship between trauma and long-term outcome, catalysed by the attempts of US society to come to terms with the Vietnam conflict; a broadening of the scope of psychiatric injury as it moved to the civilian sector; and the increased prominence of unexplained syndromes and contested diagnoses such as Gulf War syndrome. Traditional psychiatric injury is predictable, proportionate and can, in theory, be managed. These newer forms of injury are in contrast unanticipated, paradoxical, ill understood and hard to manage. Traditional approaches to risk management by reducing exposure have not been successful, and may increase risk aversion and reduce resilience. However, the experiences of civilians in wartime or the military show that people are not intrinsically risk-averse, provided they can see purpose in accepting risk. (+info)
Perceived stress, heart rate, and blood pressure among adolescents with family members deployed in Operation Iraqi Freedom.
(2/16)
This study compared the impact of the 2003 Operation Iraqi Freedom on heart rate (HR) and blood pressure (BP) and self-reported stress levels among three groups of self-categorized adolescents: (1) military dependents with family members deployed; (2) military dependents with no family members deployed; (3) civilian dependents. At the onset and end of the "major hostilities" of Operation Iraqi Freedom, 121 adolescents (mean age = 15.8 +/- 1.1 years) completed questionnaires evaluating the psychological impact of the war and were evaluated for HR and BP. The military deployed dependents exhibited significantly higher HR than other groups at both evaluations (both p < 0.04). Ethnicity by group interactions indicated that European American-deployed dependents had higher stress scores at both time points (p < 0.02). Military dependent European Americans exhibited higher systolic BP compared to the other groups on the second evaluation (p < 0.03). (+info)
Deployment-related stress and trauma in Dutch soldiers returning from Iraq. Prospective study.
(3/16)
BACKGROUND: Some questionnaire studies have shown increased mental health problems, including probable post-traumatic stress disorder (PTSD), in soldiers deployed to Iraq. AIMS: To test prospectively whether such problems change over time and whether questionnaires provide accurate estimates of deployment-related PTSD compared with a clinical interview. METHODS: Dutch infantry troops from three cohorts completed questionnaires before deployment to Iraq (n=479), and about 5 months (n=382, 80%) and 15 months (n=331, 69%) thereafter. Post-traumatic stress disorder was evaluated by questionnaire and clinical interview. RESULTS: There were no group changes for general distress symptoms. The rates of PTSD for each cohort were 21, 4 and 6% based on questionnaires at 5 months. The deployment-related rates of PTSD based on the clinical interview were 4, 3 and 3%. CONCLUSIONS: There was a specific effect of deployment on mental health for a small minority. Questionnaires eliciting stress symptoms gave substantial overestimations of the rate of PTSD. (+info)
War & military mental health: the US psychiatric response in the 20th century.
(4/16)
Involvement in warfare can have dramatic consequences for the mental health and well-being of military personnel. During the 20th century, US military psychiatrists tried to deal with these consequences while contributing to the military goal of preserving manpower and reducing the debilitating impact of psychiatric syndromes by implementing screening programs to detect factors that predispose individuals to mental disorders, providing early intervention strategies for acute war-related syndromes, and treating long-term psychiatric disability after deployment. The success of screening has proven disappointing, the effects of treatment near the front lines are unclear, and the results of treatment for chronic postwar syndromes are mixed. After the Persian Gulf War, a number of military physicians made innovative proposals for a population-based approach, anchored in primary care instead of specialty-based care. This approach appears to hold the most promise for the future. (+info)
Psychosocial buffers of traumatic stress, depressive symptoms, and psychosocial difficulties in veterans of Operations Enduring Freedom and Iraqi Freedom: the role of resilience, unit support, and postdeployment social support.
(5/16)
BACKGROUND: Little research has examined the role of protective factors such as psychological resilience, unit support, and postdeployment social support in buffering against PTSD and depressive symptoms, and psychosocial difficulties in veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). MATERIALS AND METHODS: A total of 272 OEF/OIF veterans completed a survey containing PTSD and depression screening measures, and questionnaires assessing resilience, social support, and psychosocial functioning. RESULTS: Lower unit support and postdeployment social support were associated with increased PTSD and depressive symptoms, and decreased resilience and psychosocial functioning. Path analyses suggested that resilience fully mediated the association between unit support and PTSD and depressive symptoms, and that postdeployment social support partially mediated the association between PTSD and depressive symptoms and psychosocial functioning. LIMITATIONS: Generalizability of results is limited by the relatively low response rate and predominantly older and reserve/National Guard sample. CONCLUSIONS: These results suggest that interventions designed to bolster unit support, resilience, and postdeployment support may help protect against traumatic stress and depressive symptoms, and improve psychosocial functioning in veterans. (+info)
Combat-related posttraumatic headache: diagnosis, mechanisms of injury, and challenges to treatment.
(6/16)
CONTEXT: Studies have revealed the rates of posttraumatic stress disorder (PTSD) and concussion among US soldiers returning from combat, but only one study has focused on the subpopulation of soldiers with headache. OBJECTIVES: To determine the rate of PTSD among US soldiers with comorbid chronic posttraumatic headache attributed to head injury, to identify common mechanisms of head injury, and to identify the common challenges a healthcare provider must face when treating US soldiers with chronic posttraumatic headache attributed to head injury. METHODS: Between July 2007 and December 2008, the author examined 42 US Army soldiers with complaint of chronic headache. In March 2009, the author retrospectively reviewed the outpatient records for diagnoses, mechanisms of injury, and challenges to treatment. RESULTS: The rate of concussion, defined by the Defense and Veterans Brain Injury Center Working Group on the Acute Management of Mild Traumatic Brain Injury in Military Operational Settings, was 95%. The rate of PTSD, as determined either with the PTSD Checklist or by confirming a prior diagnosis by another healthcare provider, was 97.9%. Both rates are remarkably higher than rates reported in the literature. The most common mechanisms of injury were proximity to blast (18 [45.2%]) and direct target of blast (15 [35.7%]). The most common treatment challenges were overuse of headache-abortive medications (10 [23.8%]) and poor patient followup (7 [16.7%]). CONCLUSION: Physicians should be aware that the rates of PTSD and concussion for US soldiers, most often linked to involvement in or proximity to a blast, are higher for soldiers complaining of chronic headache. Physicians should also be aware of the potential for overuse of medications in this patient population. (+info)
Combat-related mental health disorders: the case for resiliency in the long war.
(7/16)
More US military service members have been deployed since 9/11 than in the previous 40 years. A greater number of these deployed service members are surviving, which has increased the incidence of combat-related mental health disorders among veterans of "The Long War." The societal cost of caring for veterans with such disorders is expected to surpass that of the Global War on Terror, which is estimated at $600 billion. Because the prospect of stopping all deployment is remote, standardized prevention and treatment methods must be used to eliminate these "invisible wounds of war." It is imperative that high-quality, evidence-based, and cost-effective treatments--pharmaceutical and nonpharmaceutical--be developed. Although no approved medication currently exists for the prevention of posttraumatic stress disorder, the blood pressure medication propranolol has shown promise in erasing the behavioral expression of fear memory and may be useful for preventing more severe emotional disorders. In addition, a nonpharmaceutical method known as stress inoculation training is ideally suited to military populations and should be incorporated into military training programs. Furthermore, osteopathic physicians can improve resilience in the communities they serve by considering the dynamic of body, mind, and spirit in their patients. Applying these methods, teaching self-regulation traits, and removing barriers to care will build resiliency among service personnel for The Long War. (+info)
Psychiatric diagnoses and punishment for misconduct: the effects of PTSD in combat-deployed Marines.
(8/16)