Post Deployment Care for Returning Combat Veterans

VA Connecticut Health Care System, West Haven, CT 06511, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 05/2012; 27(9):1200-9. DOI: 10.1007/s11606-012-2061-1
Source: PubMed


Since September 11, 2001, 2.4 million military personnel have deployed to Iraq and Afghanistan. To date, roughly 1.44 million have separated from the military and approximately 772,000 of these veterans have used VA health care. Combat deployments impact the physical, psychological, and social health of veterans. Given that many veterans are receiving care from non-VA providers, it is important that all community health care workers be familiar with the unique health care needs of this patient population, which include injuries associated with blast exposures (including mild traumatic brain injury), as well as a variety of mental health conditions, such as post-traumatic stress disorder. Other important health concerns are chronic musculoskeletal pain, medically unexplained symptoms, sequelae of environmental exposures, depression, suicide, substance abuse, sleep disturbances, and impairments in family, occupational and social functioning. Elevated rates of hypertension and tobacco use remind us that deployment may result not only in immediate impacts on health, but also increase risk for chronic disease, contributing to a growing public health burden. This paper provides a comprehensive review of these health concerns and offers practical management guidelines for primary care providers. In light of relationships between physical, psychological and psychosocial concerns in this population, we recommend an interdisciplinary approach to care directed toward mitigating the long-term health impacts of combat.

Full-text preview

Available from:
  • Source
    • "Findings from one study showed that Army National Guard members who had previously deployed to either Afghanistan or Iraq were 90% more likely than members who had not deployed to score below the general population norm on the physical function subscale of the Medical Outcomes Study 36-Item Short Form Health Survey (SF- 36), and were also significantly more likely to have a positive screen for post-traumatic stress disorder or major depression (Kline et al., 2010). The most common post-deployment diagnoses are 1) musculoskeletal problems; 2) mental disorders; and 3) symptoms, signs and ill-defined conditions (Spelman et al., 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper argues the benefits of characterizing occupational transitions as movement between figured worlds, which are socially constructed units that are characterized by particular people and activities, and that shape identities. Further, positive withdrawal, which is a purposeful decision to limit participation when the requirements of engaging surpass self-perceived ability, describes limited engagement with a figured world. To illustrate the utility of this lens, the community reintegration of military service members as they finish deployment and return to family and community life is explored. The figured worlds of military and family are drawn from first person accounts of deployment and reintegration experiences from the perspectives of both service members and spouses. The constructs of figured world and positive withdrawal are found to be useful ways to describe community reintegration for both service members and families and the complex shifts in identity associated with the transition process. The framework presented expands on the occupational science literature by presenting a framework for non-linear, bidirectional occupational transitions in which individuals return to familiar settings rather than enter novel ones. The constructs of figured world and positive withdrawal can contribute to future theory development and research with populations that experience similar occupational transitions.
    Full-text · Article · Dec 2015 · Journal of Occupational Science
  • Source
    • "Approximately 2.4 million United States military personnel have been deployed to Iraq and Afghanistan since September 11, 2001. Military deployment and combat has historically shown to result in medical [1] [2] [3] [4], psychological [5] [6] [7] [8], and social problems [9] [10] [11] [12] [13], all of which affect veterans' post-deployment health across the life course [13] [14] [15] [16]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE To describe returning veterans’ transition experience from military to civilian life and to educate health care providers about culture-centered communication that promotes readjustment to civilian life. METHODS Qualitative, in-depth, semi-structured interviews with 17 male and 14 female Iraq and Afghanistan veterans were audio recorded, transcribed verbatim, and analyzed using Grounded Practical Theory. RESULTS Veterans described disorientation when returning to civilian life after deployment. Veterans’ experiences resulted from an underlying tension between military and civilian identities consistent with reverse culture shock. Participants described challenges and strategies for managing readjustment stress across three domains: intrapersonal, professional/educational, and interpersonal. CONCLUSIONS To provide patient-centered care to returning Iraq and Afghanistan veterans, health care providers must be attuned to medical, psychological, and social challenges of the readjustment experience, including reverse culture shock. Culture-centered communication may help veterans integrate positive aspects of military and civilian identities, which may promote full reintegration into civilian life. PRACTICE IMPLICATIONS Health care providers may promote culture-centered interactions by asking veterans to reflect about their readjustment experiences. By actively eliciting challenges and helping veterans’ to identify possible solutions, health care providers may help veterans integrate military and civilian identities through an increased therapeutic alliance and social support throughout the readjustment process.
    Full-text · Article · Jun 2014 · Patient Education and Counseling
  • Source
    • "In recent research by Spelman, Hunt, Seal and Burgo-Black (2012) best practices for care guidelines include integrated teams of primary care, mental health, and social work. As there is a significant overlap with a variety of physical, psychological, and psychosocial health concerns, interdisciplinary teams play a role in veteran–centered care (Spelman et al., 2012). DoD and VA case managers have integrated, collaborated, and incorporated a new and evolving care management paradigm to meet the complex bio-psychosocial, functional, and medical needs of Polytrauma veterans, SMs and their extended families (Amdur et al., 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: The conflicts in Afghanistan and Iraq, also known as Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn, have created unique challenges for rehabilitation teams, including nurse and social work case managers. Active duty service members, National Guard and Reservists have deployed in large numbers and as many as 20% have been exposed to blast injury, which can result in polytrauma and traumatic brain injury, the "signature injury" of the war, as well as psychological trauma, and painful musculoskeletal injuries. In addition, there are also documented emotional injuries associated with the constant stress of war and the frequency of exposure to the graphic scenes of war. Findings/conclusions: The Departments of Defense and Veterans Affairs work closely to provide comprehensive care coordination and case management for service members and veterans who have honorably served our country. This article describes the case management collaborative between Veterans Affairs and the Department of Defense that ensures service members and veterans receive their entitled healthcare services. Clinical relevance: The complex care needs of these returning service members require astute case management in addition to clinical care. This collaboration ensures the best life-long outcomes and will be discussed in detail in this article.
    Preview · Article · Sep 2013 · Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses
Show more