Address mental health needs of returning troops, study says

"Invisible" war wounds could overwhelm military facilities and bring community health care into the mix.

By Susan J. Landers — Posted May 19, 2008

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Nearly a third of the 1.6 million troops deployed since 2001 in Iraq and Afghanistan return with posttraumatic stress disorder, depression or traumatic brain injury, yet only slightly more than half receive even minimal treatment, according to a new RAND Corp. study.

Unless these wounds are appropriately treated, they can have far-reaching consequences, including risks of other psychological problems, higher rates of suicide and physical health ills. They also can result in such long-term societal and personal troubles as homelessness, domestic violence and other major strains on families.

"Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery," is the first report that is independent of the Defense Dept. and Veterans Affairs health system, the RAND researchers said.

The study findings were presented at an April 28 Capitol Hill briefing.

Given the large numbers of military personnel needing treatment, the report concluded that demand will exceed the capacity of the Dept. of Defense and VA health facilities and tap into community health resources available through private, employer-based insurance and TRICARE, the military's health insurance.

RAND researchers surveyed a sample of 1,965 recently returned military personnel who had been deployed in Iraq or Afghanistan. All were guaranteed confidentiality.

Assuming the prevalence of the disorders among those surveyed was representative of all troops deployed to Iraq and Afghanistan, the researchers estimated that about 300,000 individuals currently have PTSD or major depression and 320,000 have experienced a probable traumatic brain injury, or TBI.

In addition, many troops reported having experienced a probable TBI, but it was not possible to know from the survey the severity of the injury or whether there was any ongoing impairment, the researchers said.

Money-saving treatments

While the wounds may be as old as warfare itself, an understanding of the disorders and treatments for them have made advances in recent years, said report author Terri Tanielian, a senior social research analyst and co-director of RAND's Center for Military Health Policy Research.

Evidence-based treatment, especially for PTSD and depression, can save money over the long term by increasing productivity and reducing the number of suicides among the generally young and healthy service personnel affected, noted the report.

But despite the effectiveness of treatments, the researchers found that only 53% of returning troops who met criteria for PTSD or major depression sought care in the past year. Among those reporting a probable TBI, 57% had not been evaluated by a physician for a brain injury.

The service members surveyed said they feared that their career prospects may worsen or that colleagues' trust in them would diminish if they sought mental health care. Some were concerned about the quality of the care available or the side effects of medications that might be used.

Gaps in the ability to provide quality care also was detected by the RAND researchers.

"What is most worrisome is that these problems are not yet fully understood, particularly TBI, and systems of care are not yet fully available to assist recovery for any of the three conditions," they write. "Thus, the invisible wounds of war require special attention and high priority."

In a related development, on April 28, President Bush signed into law the Traumatic Brain Injury Act, which authorizes appropriations to fund studies at the Centers for Disease Control and Prevention and the National Institutes of Health, to help identify therapeutic interventions and rehabilitation guidelines for those with TBIs, including returning veterans.

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Invisible wounds

About 31% of troops returning from Iraq and Afghanistan have mental health conditions or possible traumatic brain injuries, according to a RAND Corp. survey of nearly 2,000 veterans:

69.3% had no disorder.

11.2% had posttraumatic stress disorder or depression but no TBI.

7.3% had PTSD or depression and TBI.

12.2% had TBI only, no PTSD or depression.


Source: "Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery," RAND Corp., April 17

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