Post-deployment Health Research Articles

Deployment Stressors of the Iraq War

A comprehensive understanding of the stressors of the Iraq War is needed to ensure appropriate postdeployment assessments and to inform empirical inquiries. Yet we are unaware of any published studies that address the range of stressors experienced by this cohort. Thus, in the present study, we report the results of an interpretive literature review of mainstream media reports published from the beginning of the Iraq War in March 2003 to March 2005. This literature revealed a combination of stressors associated with traditional combat, insurgency warfare, and peacekeeping operations. The increasing deployment of National Guard/Reservist personnel, older soldiers, and women highlights additional stressors associated with sexual harassment and assault, preparedness and training, and life and family disruptions. This is a cause for concern as war-zone stressors have been implicated in postdeployment health outcomes, including intimate partner violence and child maltreatment, immediate physical and mental health, and long-term adjustment.

Postdeployment Evaluation of Health Risk Communication after Exposure to a Toxic Industrial Chemical

Increasing emphasis is being placed on the appropriate communication of deployment-related risks among military service members. This report validates risk communication on the postdeployment health assessment (PDHA), in the context of a known, low-level exposure to a toxic industrial chemical. In late 2003, 245 soldiers were exposed to hexavalent chromium at an industrial site in Iraq; of those, 227 had completed PDHAs on file for review. Despite being directed to document this exposure upon redeployment, only 55 soldiers (24.2%) specifically reported chromium exposure. Increasing age and time at the industrial site were associated with increased reporting of exposure. Although providers documented deployment exposure concerns for only 65.4% of this population, this was much more often than for other redeploying service members. The PDHA is a risk assessment and risk communication tool that has sources of misclassification, and results must be interpreted with caution when individual or population occupational and environmental risks resulting from deployment are assessed.

War's Impact May Not Appear Until Months After Return

War's Impact May Not Appear Until Months After Return

Bringing It All Back Home: Social Work and the Challenge of Returning Veterans

The June 2007 DOD Task Force on Mental Health report cited here suggests the current system of care is inadequate and unable to meet the needs of veterans now and into the future. This is so, not only because of a lack of human power, but also because of the underlying theoretical and methodological assumptions on which the system is based. The report states emphatically that the current system is not succeeding in providing successful care for those affected by the current Iraq war or in building resilience among the soldiers and their families as a whole. This report challenges the way that health and mental health care in the United States has been provided, not only to veterans and their families, but also to all of those affected by exposure to violence. In recent years, social workers, and others working in the formal health and mental health sector, have been required to apply a medical model that treats psychosocial issues as though they were diseases, to be managed through dosed therapies designed to reduce symptoms. This medical model is different from the biopsychosocial framework on which social work practice is built and the strengths perspective, which places each person as the subject rather than the object of his or her own life (Robbins, Chatterjee, & Canda, 2006). Therefore, the DOD critiques of the model of care for serving mental health needs of soldiers, veterans, and their families present social work with an important opportunity, if not an obligation. Namely, to bring its methods of inquiry to bear on the problems of reintegrating war veterans into society, as well as understanding and mitigating the effects of exposure to violence on soldiers and civilians alike. The need to build resilience and promote effective reintegration processes for active-duty soldiers, veterans, and their families is not a problem for practitioners alone. It is an issue that requires stringent intellectual inquiry to locate, test, and provide more successful models of intervention, and in so doing, shed light on the contemporary discourse regarding trauma and recovery, violence, and transformation. The task force report (DOD, 2007) provides a detailed account of the scope of the current problem facing the Departments of Defense and Veterans Affairs. According to the report, which uses data from the Post-Deployment Health Reassessment administered to service members from 90 to 120 days after returning from deployment, * 38 percent of soldiers and 31 percent of Marines report psychological symptoms. * 49 percent of returning National Guard members report psychological symptoms. * Hundreds of children have experienced the deployment of one or both parents. * Psychological concerns among family members have yet to be quantified. The report emphasizes the prevalence of co-occurring diagnoses, most frequently posttraumatic stress disorder (PTSD) and traumatic brain injury, sometimes complicated by physical injury and disability. The report states that such a range of injuries require a seamless continuum of biopsychosocial care (DOD, 2007) that is unavailable in the current system. One issue raised by the report is the emerging public health problem presented by a cohort of men and women returning from repeated deployments with untreated mental health and neuropsychological issues. Of greater concern is the loss to the nation of the enormous leadership potential that this returning cohort represents. Viewed through a strengths perspective lens (Scurfield, 2006), these men and women represent essential resources to address current and emerging social, economic, and developmental problems here at home. A BRIEF HISTORY Some history is useful to help us understand how work involving emotional and physical difficulties resulting from the effects of external real-world stressors was ceded to the medical model. The diagnosis of PTSD formally entered the nomenclature in 1980. …

An Assessment of Beliefs About Mental Health Care Among Veterans Who Served in Iraq

This study assessed beliefs about mental health treatment in a group of soldiers newly returning from the war in Iraq. Participants were 20 National Guard soldiers who had served in Operation Iraqi Freedom. Soldiers who in phone interviews screened positive for a mental disorder were asked about advantages and disadvantages of seeking treatment, who would or would not support treatment seeking, and facilitators and barriers to treatment seeking. Stigma was portrayed as a major disadvantage to treatment seeking. Yet most participants indicated that people would be supportive of treatment seeking. Reducing symptoms was a major advantage of care. Barriers, especially those viewed as "self-induced," such as pride, not being able to ask for help, and not being able to admit to having a problem, were considered major impediments. The findings suggest that interventions developed to engage veterans in care must be directed toward cognitive factors that motivate treatment seeking.

Postdeployment Health Reassessment: A Sustainable Method for Brigade Combat Teams

The Postdeployment Health Reassessment (PDHRA) was mandated in 2006 and the 3rd Infantry Division was the first unit to perform a large-scale implementation. This article outlines a reproducible model for conducting PDHRA using only existing resources. The PDHRA (DD 2900) screening and referral processes are reviewed and data on positive screens are reported. Of the 12,817 soldiers who participated in the mass screening, 1,460 (11.4%) were referred for behavioral health, 815 (6.4%) for primary care, 71 (0.01%) for specialty services, and 9 (0.001%) for emergency services. Consult requests were higher in maneuver brigades than in support units (12.1% versus 8.6% for behavioral health and 6.9% versus 4.4% for primary care referrals). All (1,460, 100%) of the behavioral health consults were completed on-site and the unit incurred no additional financial cost in conducting this process. This method for performing a large-scale implementation of the PDHRA provides a flexible, efficient, and cost-effective process that could be implemented at the brigade combat team level without difficulty and in most locations without significant impact on other medical demands.

Division Mental Health in the New Brigade Combat Team Structure: Part II. Redeployment and Postdeployment

Recent Army transformation has led to significant changes in roles and demands for division mental health staff members. This article focuses on redeployment and postdeployment. The postdeployment health assessment behavioral health screening and referral process and redeployment plan are reviewed, and data on postdeployment rates of negative events are reported. All soldiers and many of their families participated in an aggressive education program. Of the 19,500 soldiers screened, 2,170 (11.1%) were referred for behavioral health consultation; of those referred, 219 (10.1%) were found to be at moderate or high risk for mental health issues (1.1% of total screened). Of the moderate/highrisk soldiers, 146 (71.9%) accepted follow-up mental health treatment upon return to home station. Fewer cases of driving under the influence, positive drug screens, suicidal gestures/ attempts, crimes, and acts of domestic violence were seen, in comparison with rates seen after an earlier deployment of this unit to Iraq. A formalized approach with command support and coordination can have a positive impact on successful referral and treatment and reduce negative postdeployment events.

Provider and patient perspectives regarding health care for war-related health concerns

Objective To gain insight about Department of Defense providers’ and health care beneficiaries’ opinions regarding provider–patient communication of health care for post-deployment health concerns. Methods Thirty-five Department of Defense primary care providers and 14 military beneficiaries participated in focus groups at five military medical treatment facilities. We audiotaped, transcribed, and qualitatively analyzed semi-structured focus group interviews to determine attitudes and beliefs about war-related health concerns, symptoms, and health care quality. Results Focus groups revealed important insights about provider and patient perspectives of communication and care in four general areas: physician–patient trust, validity of symptoms and concerns, exchange of health information, and barriers to care. Conclusion Provider–patient communication contributes to patient satisfaction with medical care; poor communication may contribute to decreased patient satisfaction and provider effectiveness. The military health care system poses several challenges to provider–patient communication: the dual nature of the provider's role, the occupational relationship between illness and health care, pre- and post-deployment issues, and continuity of care impact patient and provider perspectives. The prevalence of various beneficiary and provider concerns regarding health care communication requires further study, particularly for the severely wounded. Practice implications The quality of information exchanged and of the interpersonal relationship impact medical decision making, particularly in occupational health settings such as the military. Attention to these issues may improve patient outcomes including satisfaction, adherence, trust, health status, and quality of life.

A Comparison of the Postdeployment Hospitalization Experience of U.S. Military Personnel Following Service in the 1991 Gulf War, Southwest Asia After the Gulf War, and Bosnia

Much attention has been given to the impact of deployment on the health of veterans from the 1991 Gulf War. Whereas increases in self-reported symptoms have been common, no specific exposures have been implicated. Some have suggested that stress from deployment is the chief cause for multisymptom conditions among Gulf War veterans, but comparisons with the health of other recent deployers have not been made. We sought to examine the impact of several large military deployments on hospitalization experience. Hospitalization records were examined for all active duty personnel deployed exclusively to the Gulf War, Southwest Asia after the Gulf War, or Bosnia. Cox's hazard modeling was used to assess time until first post-deployment hospitalization, separation from active duty, or December 31, 2000, whichever occurred first, while controlling for influential covariates and temporal changes. Personnel deployed to Southwest Asia after the 1991 Gulf War were at a slight increased risk for any-cause hospitalization and for 3 of the 14 major diagnostic categories when compared with veterans of the 1991 Gulf War. Personnel deployed to Bosnia were at a decreased risk for any-cause hospitalization and 12 of the 14 major diagnostic categories when compared with Gulf War veterans. These findings do not fully explain the complexity of postdeployment health experiences. Although the risk for hospitalization may be associated with regional deployment, it is unlikely that Gulf War veterans are at greater risk of hospitalization due to a specific exposure-related disease.

Are Brain-Injured Vets Getting Adequate Care?

Are Brain-Injured Vets Getting Adequate Care?

Enhanced cortisol suppression to dexamethasone associated with Gulf War deployment

To examine whether PTSD or post-deployment health symptoms in veterans of the first Gulf War (Operation Desert Shield/Storm) are associated with enhanced suppression of the pituitary-adrenal axis to low-dose dexamethasone (DEX). Plasma cortisol and lymphocyte glucocorticoid receptor (GR) number were measured at 08:00 h on two consecutive days, before and after administration of 0.5mg of DEX at 23:00 h in 42 male Gulf War veterans (14 without psychiatric illness, 16 with PTSD only, and 12 with both PTSD and MDD) and 12 healthy male veterans not deployed to the Gulf War or another war zone. In the absence of group differences in basal cortisol levels or GR number, Gulf War veterans without psychiatric illness and Gulf War veterans with PTSD only had significantly greater cortisol suppression to DEX than non-deployed veterans and Gulf War veterans with both PTSD and MDD. Gulf War deployment was associated with significantly greater cortisol suppression to DEX controlling for weight, smoking status, PTSD, and MDD; PTSD was not associated with response to DEX. Among Gulf War veterans musculoskeletal symptoms were significantly associated with cortisol suppression and those who reported taking anti-nerve gas pills (i.e., pyridostigmine bromide) during the war had significantly greater DEX-induced cortisol suppression than those who did not. The data demonstrate that alterations in neuroendocrine function are associated with deployment to the Gulf War and post-deployment musculoskeletal symptoms, but not PTSD. Additional studies are needed to examine the relationship of enhanced glucocorticoid responsivity to deployment exposures and chronic unexplained medical symptoms in Gulf War veterans.

Validation of the Deployment Risk and Resilience Inventory in French-Canadian Veterans: Findings on the Relation between Deployment Experiences and Postdeployment Health

This study had a twofold purpose: to validate the French-Canadian version of a measure of deployment risk and resilience factors and to examine the relation between deployment risk and resilience factors and postdeployment functioning. Canadian veterans at an outpatient clinic (n = 131) completed a mail-in survey that included a measure on deployment risk and resilience factors, the Deployment Risk and Resilience Inventory (DRRI) (1), as well as measures on psychological and physical health. Internal consistency and test-retest reliability coefficients for the DRRI scales were very good. As expected, DRRI risk factors were negatively associated with psychological and physical functioning, and DRRI resilience factors were positively associated with psychological and physical functioning. Low- as well as high-magnitude deployment risk factors were associated with functioning. The French-Canadian version of the DRRI is a reliable and valid measure of deployment risk and resilience factors. Deployment risk and resilience factors are associated with a host of problems in physical and psychological functioning for veterans.

A low-tech health monitor for the solar-photon sail

On-orbit deployment tests and operational missions for first-generation solar-photon sails may require a method of monitoring post-deployment sail health. A low-technology device capable of performing this function is the pinhole camera, combined with an inflatable hydrostatic beam mounted at the sail's center of mass.

Self-Rated Health and Health Care Utilization after Military Deployments

Self-rated general health is one element of the standard health assessment required of U.S. military service members upon completion of major deployments. A cohort study of 22,229 male U.S. Army and Air Force personnel returning from Europe or Southwest Asia in 2000 used survival analysis methods and Cox proportional hazard models to examine postdeployment self-rated health (SRH) status and subsequent hospitalization, separation, and ambulatory care visits. Self-rated health was fair/poor for 1.5% and good for 20.4%; 11% documented at least one health concern. During 30,433 person-years of follow-up (median, 1.5 person-years), there were 22.8 hospitalizations per 1,000 person-years and 4.0 ambulatory care visits per person-years. After adjustment, deployers with fair/poor SRH had an increased risk for hospitalization (hazard ratio [HRI, 1.6; 95% confidence interval [CI], 1.0,2.7); the risk was lower for those with good SRH (HR, 1.3; 95% CI,1.1,1.5). Deployers with fair/poor SRH health had an increased risk for illness-related ambulatory care visits (HR, 1.8, 95%; CI, 1.6,2.1) and administrative visits (HR, 1.4; 95% CI, 1.1,1.7), but not injury-related visits (HR, 1.2; 95% CI, 0.8,1.7). Self-reported low health status and other health concerns identify military members with higher levels of health care needs following return from major deployments.

The ACTH Response to Dexamethasone in Persian Gulf War Veterans

The basis of postdeployment health symptoms in Gulf War veterans remains poorly understood. Alterations in the feedback regulation of the hypothalamic-pituitary-adrenal (HPA) axis have been demonstrated in posttraumatic stress disorder (PTSD) and other bodily disorders related to stress. The objective of this article was to examine whether similar HPA axis alterations are related to Gulf War deployment, postdeployment health symptoms, or PTSD. Plasma adrenocorticotropic hormone (ACTH) was measured on consecutive mornings at 08:00 h before and after a low dose of oral dexamethasone (DEX) at 23:00 h in Gulf War veterans with PTSD (n = 14), Gulf War veterans without PTSD (n = 11), and healthy veterans never deployed to a war zone (n = 12). Both Gulf War veterans with PTSD and Gulf War veterans without PTSD had significantly lower post-DEX ACTH levels than the nonexposed veterans, in the absence of group differences in basal ACTH or DEX levels. Among Gulf War veterans, post-DEX ACTH levels were significantly associated with musculoskeletal symptoms. Gulf War deployment and postdeployment health symptoms appear to be associated with alterations in feedback regulation of the pituitary gland that suggests a possible common link between postdeployment health symptoms and other chronic stress-related conditions.

New Freedom Commission Members Assess Report's Impact

New Freedom Commission Members Assess Report's Impact

Women in the Military: New Perspectives, New Science

Journal of Women's HealthVol. 14, No. 9 EditorialsWomen in the Military: New Perspectives, New ScienceJonathan B. Perlin, Susan H. Mather, and Carole L. TurnerJonathan B. PerlinSearch for more papers by this author, Susan H. MatherSearch for more papers by this author, and Carole L. TurnerSearch for more papers by this authorPublished Online:28 Nov 2005https://doi.org/10.1089/jwh.2005.14.861AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Women in the Military: New Perspectives, New Science." , 14(9), pp. 861–862FiguresReferencesRelatedDetailsCited ByGender Disparities Among Veterans: The High Rate of Post-Traumatic Stress Disorder Among Women in the Military28 February 2014 | Military Behavioral Health, Vol. 2, No. 1Prevalence and Predictors of Postpartum Depression Among Arabic Muslim Jordanian Women Serving in the MilitaryJournal of Perinatal & Neonatal Nursing, Vol. 27, No. 1War-Related Stressors as Predictors of Post-Deployment Health of Air Force WomenWomen's Health Issues, Vol. 21, No. 4Perceptions of, and reactions to, environmental heat: a brief note on issues of concern in relation to occupational health29 December 2010 | Global Health Action, Vol. 3, No. 00Integration of Women Veterans into VA Quality Improvement Research Efforts: What Researchers Need to Know15 January 2010 | Journal of General Internal Medicine, Vol. 25, No. S1Women in Parole7 August 2007 | International Journal of Offender Therapy and Comparative Criminology, Vol. 52, No. 4 Volume 14Issue 9Nov 2005 InformationCopyright 2005, Mary Ann Liebert, Inc.To cite this article:Jonathan B. Perlin, Susan H. Mather, and Carole L. Turner.Women in the Military: New Perspectives, New Science.Journal of Women's Health.Nov 2005.861-862.http://doi.org/10.1089/jwh.2005.14.861Published in Volume: 14 Issue 9: November 28, 2005PDF download

Aeromedical Evacuations from Operation Iraqi Freedom: A Descriptive Study

To describe health patterns in evacuated military members during Operation Iraqi Freedom (OIF) and utilize demographic, diagnostic, and pre- and postdeployment health information to understand the utility of data collected for aeromedical evacuations. We conducted a descriptive analysis of U.S. evacuees from 2003 using data from the U.S. Transportation Command's Regulating and Command & Control Evacuation System and the Defense Medical Surveillance System. The typical patient was an Army male under the age of 29 requiring orthopedic or surgical care. Disease/nonbattle injuries were six times as common as battle injuries and 94% were classified as routine evacuees. Eighty-six percent had health data available in the Defense Medical Surveillance System. Two thirds had pre- and/or postdeployment questionnaire data. Combining data sources increases our understanding of disease patterns in deployed troops. Targeted preventive interventions can then be implemented. Changes in the U.S. Transportation Command's Regulating and Command & Control Evacuation System database can improve its utility as an epidemiological tool.

Bill Says Pentagon Must Upgrade Mental Health Services

Back to table of contents Next article Government NewsFull AccessBill Says Pentagon Must Upgrade Mental Health ServicesChristine LehmannChristine LehmannSearch for more papers by this authorPublished Online:18 Jun 2004https://doi.org/10.1176/pn.39.12.0390001aAre the Department of Defense (DoD) and the armed forces devoting enough resources to meet the mental health needs of the troops before, during, and after deployment to combat areas?The amendment's cosponsors: Reps. Brian Baird (D-Wash.) (top) and Patrick Kennedy (D-R.I.).An amendment to the Fiscal 2005 DoD budget bill (HR 4200) by Reps. Patrick Kennedy (D-R.I.) and Brian Baird (D-Wash.) calls on the secretary of defense to study that question and present the findings to Congress within 90 days of the bill's enactment.HR 4200 was approved with the amendment by the House of Representatives last month and awaits Senate action.“The amendment will force the DoD to address tough issues such as how the decision to seek mental health care can impact a serviceman's career and the extent to which the military's lack of firm confidentiality policies hinders treatment of soldiers and combat veterans,” a press release from Kennedy stated.The amendment will also require the DoD to examine disparities between the mental health services available to active-duty military and members of the Reserve and National Guard.Kennedy sent Defense Secretary Donald Rumsfeld a letter last month signed by 30 of his House colleagues stating that deficiencies in mental health services available to deployed troops were mentioned during testimony before the House Government Reform Subcommittee on National Security in March and the House Armed Services Total Force Subcommittee in January.The representatives signing the letter asked DoD to assess whethertroops are being thoroughly and accurately assessed for health and mental health problems as required by legislation.troops have enough combat-stress control units in Iraq to meet their mental health needs.troops know that seeking help for stress and psychological problems doesn't mean they are weak and that treatment can be beneficial.troops know that seeking help will not damage their careers.returning troops, including reservists and National Guard personnel, have adequate mental health care follow-up and psychiatric support.“We are concerned about the accessibility and continuity of postdeployment mental health services. A seamless transition of care from the Department of Defense to the Department of Veterans Affairs is crucial to avoiding any gap in postdeployment mental health coverage,” the congressional letter stated.Although a transitional health care benefit program for reservists was extended from 120 days to 180 days, the program ends in December.“We are concerned that military personnel who develop post-traumatic stress symptoms months after deployment won't have benefits,” the letter said.The representatives asked the DoD to assess whether military families are being informed in a timely and accurate manner of all their options for obtaining and maintaining mental health services.The amendment can be accessed online at<http://thomas.loc.gov> by searching on the bill number, HR 4200, and clicking on “National Defense Authorization Act for Fiscal Year 2005 (Placed on Calendar in Senate) [H.R.4200.PCS].” ▪ ISSUES NewArchived

Self-rated health and subsequent health care use among military personnel returning from international deployments.

Individual health status assessment upon completion of U.S military deployments was standardized in 1999 with a brief health assessment questionnaire. This cohort study analyzed health status responses and their relationship to postdeployment health outcomes among 16,142 military personnel who completed a health questionnaire after a deployment ending in 1999. Respondents were Army and Air Force personnel returning from Europe or Southwest Asia. Fourteen percent documented at least one health concern and 1.8% had fair/poor self-rated health. In the 6 months after deployment, 1.4% were hospitalized, 25% made five or more outpatient visits, and 4% separated from military service. Deployers with fair/poor self-rated health were at a significantly increased risk for high use of outpatient services (risk ratio, men 1.8, women 1.7) but not for hospitalization or separation. Self-report of low health status or other health concerns may help identify deployers with higher health care needs after future deployments.