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Mental health impact of the Iraq and Afghanistan conflicts: A review of US research, service provision, and programmatic responses

Center for Deployment Health Research, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-5122, USA.
International Review of Psychiatry (Impact Factor: 1.8). 04/2011; 23(2):144-52. DOI: 10.3109/09540261.2011.558833
Source: PubMed

ABSTRACT

Although documentation that war inflicts psychological casualties dates back to the American Civil War and earlier, most research began after the Vietnam conflict, when studies focused on post-traumatic stress disorder (PTSD). With ongoing conflicts in Iraq and Afghanistan, there has been significant research to illuminate the epidemiology of war-related psychological casualties. Significant findings include an appreciation for the role combat plays in the development of mental disorders, including PTSD and traumatic brain injury (TBI). Recent research has endeavoured to understand and improve psychological resilience to temper potentially adverse mental health effects of military service in the theatre of combat operations. Over 2 million US service members have now deployed and returned over 3 million times to the Iraq and Afghanistan conflicts. Mental health providers in the Departments of Defense and Veterans Affairs healthcare systems have consequently observed steep increases in mental health service use among these personnel. The Departments have responded aggressively to bolster staffing levels, increase capacity, improve available services, and anticipate future needs. Scientists and clinicians continue efforts to understand the determinants, prevention, recognition, and treatment of combat-related mental disorders.

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    • "There is encouraging evidence (Adler, et al. 2009a, Adler, et al. 2009b, Frappell-Cooke, et al. 2010) that pre-deployment resilience training (e.g., the U.S. Army's Battlemind training and the British Marine's Trauma Risk Management training) can reduce post-deployment poor psychological outcomes. These results have led to the development and introduction of the Comprehensive Soldier Fitness (CSF; Casey 2011, Cornum, et al. 2011), a proactive and preventive approach to minimizing the incidence of negative psychological outcomes following combat, which emphasizes resilience training based on the Battlemind program (Wells, et al. 2011) "
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    ABSTRACT: There is significant heterogeneity in outcomes following mild traumatic brain injury (mTBI). While several host factors (age, gender, preinjury psychiatric history, etc.) have been investigated, the influence of preinjury psychological resilience and mood status in conjunction with mild TBI remains relatively unexplored. Euthymic mood and high resilience are potentially protective against anxiety and postconcussion symptoms, but their relative contributions are currently unknown. This prospective study obtained preinjury estimates of resilience and mood measures in addition to measures of anxiety (Acute Stress Disorder Scale and PTSD-Checklist-Civilian form) and postconcussion symptom severity (Rivermead Post Concussion Symptoms Questionnaire) < 24 hours (Baseline), 1 week, and 1 month postinjury in patients with either mTBI (n=46) or a comparison group with orthopedic injuries not involving the head (OI, n=29). The groups did not differ on preinjury resilience or mood status at Baseline, but differed significantly on measures of anxiety and postconcussion symptom severity at each subsequent study occasion. Multivariate linear regression analyses were conducted to determine if preinjury resilience and mood were significant contributors to anxiety and postconcussion symptoms during the first month postinjury after accounting for other known host factors (e.g., age at injury, gender, and education). Injury group and preinjury mood status were significant predictors for all three dependent variables at each study occasion (all p < .007). Preinjury resilience showed a positive trend only for acute stress severity at baseline, but demonstrated significant prediction of all three dependent measures at one week and one month postinjury. These results suggest that preinjury depressed mood and low resilience are significant contributors to the severity of postinjury anxiety and postconcussion symptoms, even after accounting for effects of other specific host factors.
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    • "To be sure, the stigma of a mental health diagnosis (Vogt, 2011), barriers in service availability (Seal et al., 2010), insufficient social support, and poor treatment motivation (Sayer et al., 2009) remain factors that may decrease the utilization of PTSD treatment resources. This is why efforts are directed to both increase the kinds of resources available (Wells et al., 2011) and to improve the utilization of these resources (Brief et al., 2011). One of the clear differences between Vietnamera and OIF/OEF veterans is the much higher number of women serving in the present military actions. "

    Full-text · Article · Jan 2012

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