Service Members Return Research Articles

Preliminary Findings of a Four-Session Psychoeducational Group for Combat-Related Posttraumatic Stress Disorder

This brief report reviews preliminary data on the utility of a four-session coping skills group for symptoms of Posttraumatic Stress Disorder (PTSD) in an active duty population. While a concerning number of active duty service members return from deployments with posttraumatic stress presentations, treatment engagement and retention can be difficult to attain. To address treatment engagement concerns, a brief psychoeducational group was developed and implemented. Results of this retrospective analysis indicate that the group was experienced as tolerable to a subset of patients, as enrollees endorsed a willingness to recommend the group to peers, and a slight majority completed the group. Moreover, participants who completed the group experienced a statistically significant decrease in PTSD symptoms. While only 20% of enrollees experienced clinically significant improvement in reported PTSD symptoms, this was superior to a matched sample of patients engaged in individual treatment only. This brief group may serve as an addition to current treatment regimens, though limitations indicate that further research and development is warranted.

Return-to-Duty Rates Following Minimally Invasive Spine Surgery Performed on Active Duty Military Patients in an Ambulatory Surgery Center.

Low back pain is a primary health care utilization driver in the US population. Health care evaluation visits for low back pain are as common as medical evaluation for the common cold. Low back pain is the most common reason for reductions in activities of daily living and work activity in the general population. Although these statistics are compelling, in the military population, there is arguably a significantly greater economic impact on the military population, as the cost to train, retain, and deploy a service member is a tremendous cost. The current study retrospectively examines surgical outcomes, return to duty, and patient-centric outcomes among 82 active duty or reserve military patients who underwent an outpatient minimally invasive spine surgery Laminotomy Foraminotomy Decompression for the treatment of lumbar spinal stenosis in an ambulatory surgery center. Overall, our results indicate that within the 82 active duty military service members, 100% of the service members return to duty within 3 mo. Additionally, there was a significant reduction in self-reported pain and disability 12 mo postoperative, whereas the average length of surgery was 62 min with an average estimated blood loss of 30.64 mL. The current study indicates that minimally invasive procedures for the treatment of lumbar spinal stenosis in an ambulatory surgery center setting are an effective option for active duty servicemen to reduce return-to-duty rates and symptomatic back-related pain and disability.

Facilitating reintegration for military service personnel, veterans, and their families: An introduction to the special issue.

As service members return from active duty and, in some cases, exit the military, they face a process of reintegration (also referred to as community reintegration) as they seek to resume participation in their life roles as civilians. Facilitating this dynamic process of reintegration for service members, veterans, and their families-including outlining potential strategies for supporting this return to civilian life and its demands, roles, and responsibilities-is the focus of this Special Issue. Reintegration has been framed as a national priority (U.S. Department of Veterans Affairs, 2015) and has been a point of emphasis of efforts at federal, state, and local levels. As the articles in this issue suggest, multiple public, private, and voluntary systems and the communities to which service members, veterans, and their families return can help influence their health outcomes and, ultimately, their reintegration. (PsycINFO Database Record

Challenges Facing Military Spouses During Postdeployment Reintegration: A Review of the Literature and Current Supports

ABSTRACTThe reintegration period when service members return from deployment and transition back into family life is usually filled with joy, but can also involve unique stressors and challenges. In this review, the authors synthesize the empirical literature on the well-being of military spouses during reintegration across 6 domains: mental health, social/role functioning, relationship functioning, spiritual functioning, physical health, and financial well-being. In each domain, the authors provide an overview of current support programs available to military spouses to aid in reintegration. Recommendations for future research and programming are offered.

Student Veterans and Service Members in Higher Education by Jan Armino, Tomoko Kudo Grabosky, and Josh Lang

Reviewed by: Student Veterans and Service Members in Higher Education by Jan Armino, Tomoko Kudo Grabosky, and Josh Lang Tyler Billman Jan Armino, Tomoko Kudo Grabosky, and Josh Lang. Student Veterans and Service Members in Higher Education. New York, NY: Routledge, 2015. 186 pp. Hardcover: $109.33. ISBN: 978-0-415-73973-3. As U.S. service members return home from military service abroad, higher education professionals grapple with how best to serve a community of student veterans that continues to grow in both size and diversity. Serving today’s student veterans requires both practical understanding and sensitivity, as student veterans often juggle unique goals and pressures. To this end, Student Veterans and Service Members in Higher Education provides a meaningful context for examining veteran and service member expectations, needs, and challenges as we work to help them navigate higher education. The text is a finale for a team of authors that spent “two years collecting and analyzing data and writing results” (p. xii) and is part of the Key Issues on Diverse College Students series through Routledge publishing: Jan Arminio (Professor and Director of Higher Education at George Mason University), Tomoko Kudo Grabosky (Licensed Professional Counselor and Associate Professor at Shippensburg University), and Josh Lang (Co-founder of the Pennsylvania Student Veterans Coalition and Business Analyst at VetAdvisor Services). These authors have collaborated to provide sound theoretical perspectives and practical uses for higher education practitioners like me who continue to pursue strategies for improving service to student veterans and service members (SVSM). Their work addresses the growing need for higher education practitioners to gain familiarity with this specialty population and, in doing so, helps mitigate the underrepresentation of SVSM in academic literature. The book consists of eight chapters that provide a historical and cultural context in which to view SVSM as well as theoretical frameworks, best practices, and future directions. In Chapter 1, “Historical Context of Student Veterans and Service Members,” the authors discuss veteran educational benefits in the U.S. and the events that prompted them. In this chapter, the authors made sense of the relationship between worthwhile benefits and an effective military, as well as the economic context and the public view of SVSM benefits throughout U.S. history. The authors also included helpful charts outlining post-Vietnam benefit programs, the year instituted, the program’s requirements, and an explanation of the benefit received by an SVSM (pp. 16-17). This chapter is [End Page 636] especially helpful in learning about the different types of educational benefits awarded to SVSM as well as some foundational background. Chapter 2, “Cultural Context,” discusses the unique cultural differences SVSM experience entering college. This chapter provides an in-depth look at the multi-site case study the authors conducted to show the cultural conflicts that SVSM experience in the college environment. From there, the authors offer a compare and contrast between the cultures that exist in U.S. military and higher education, as well as cultural differences that exist specifically for SVSM as they transition to college. While higher education literature is full of articles and books that specifically talk about the transition process, the integration from military to civilian life is an important one to learn, especially for higher education professionals that have not served themselves. Finally, the authors supply an introduction of Berry’s (2005) model of acculturation to provide a framework for understanding these cultural differences between the two environments of military and higher education that is evident from SVSM responses. The authors contend that Berry’s model “takes into account the existence of power differentiation and dynamics between SVSM (non-dominant group) and higher education (dominant group)” and “offers various approaches that SVSM can use in order to acculturate in a college environment” (p. 35). The authors also use Berry’s model to “describe acculturation strategies of both SVSM (non-dominant group) and higher education (dominant group)” (pp. 35-36). The authors begin to dive into their multi-site case study findings in Chapter 3, “Facilitators and Barriers to Success.” The authors used two public institutions, one a community college (CC) and one a research-extensive institution (RI), for their study sites. This allowed the authors to...

Supporting our military families: a case for a larger role for occupational therapy in prevention and mental health care.

More than 2 million U.S. military servicemembers have deployed to Afghanistan or Iraq since September 11, 2001. Unlike during prior conflicts, many servicemembers leave spouses and children behind. Long, multiple deployments cause strain on family at home, with new challenges arising when servicemembers return from combat and reintegrate into family and civilian life. In World Wars I and II, occupational therapy practitioners played a significant role in supporting servicemember reintegration. However, their presence in program delivery in this practice area is limited. Occupational therapy researchers and practitioners can make a valuable contribution by helping families tailor daily activities and routines to address challenges and optimize health and wellness. However, barriers such as reimbursement for services, workforce availability, and access to military families have limited the profession's full engagement. Advocacy is needed to help establish occupational therapy as a key component of the mental and preventive health care teams serving military servicemembers.

Mental Health Needs of Returning Veterans

As more service members return from war zones around the world, clinicians must be prepared to treat them. Veterans with PTSD and other mental disorders must overcome the stigma associated with seeking treatment, and clinicians must equip these patients and their family members to deal with challenging symptoms. Clinicians should learn about military culture and jargon to better understand these patients and should become familiar with veteran resources to direct veterans and their families to the appropriate services. Clinicians may also need to communicate with their patients' employers to help both parties deal with illnesses such as PTSD. A coordinated effort is needed to meet the needs of veterans and their families, and clinicians play an integral role in recognizing and meeting those needs.

Deployment-Related Insomnia in Military Personnel and Veterans

Insomnia is a prevalent disorder that greatly impacts military personnel, especially those deployed in support of combat efforts. Deployment-related stressors like combat exposure, mild traumatic brain injury (mTBI) irregular sleep-wake schedules, and adjustment to the return home all contribute to insomnia. However, insomnia can also exacerbate the deployment experience and is a risk factor for traumatic stress reactions such as PTSD, depression, and suicide. Military personnel with mTBI are significantly impacted by insomnia; the majority experience sleep disruption and this can impede recovery and rehabilitation. As more service members return home from deployment, treatment is vital to reduce the impact of insomnia. Preliminary outcome data, showing positive results for reduction of sleep disruption, has been found with treatments such as combined cognitive behavioral treatment of insomnia (CBTI) and imagery rehearsal therapy (IRT), preference-based interventions, as well as efforts to broadly disseminate CBTI. The recent literature on the impact and treatment of deployment-related insomnia is reviewed.

Recommendations for Counselors and Community Service Providers Working with Military Families

A growing body of research has identified challenges facing military families, and the evidence suggests that the wars have placed stress on family members. This article synthesizes results from a longitudinal study conducted with nondeployed parents of military children ages 7 to 17. The objective of this article is to provide counselors and community service providers who work with military families, particularly those in the civilian sector who are serving these families as service members return home, recommendations on several key topics relevant to military families. The following topics addressed include: 1) The importance of discussing changes in household responsibilities during and after parental deployment; 2) Family communication plans and how to improve quality of communication between youth, parents, and the military couple; 3) Assessing the non-deployed spouse and parent stress around reintegration with youth and the returning parent; and 4) Alerting parents and families about potential changes in the behavior of children and youth, and possible sources of stress during and after deployment.

Personal Accounts: Reaching Out

Personal Accounts: Reaching Out

Evidence-Based Screening, Diagnosis, and Treatment of Substance Use Disorders Among Veterans and Military Service Personnel

Substance use disorders (SUDs) are among the most common and costly conditions in veterans and active duty military personnel, adversely affecting their health and occupational and personal functioning. The pervasive burden of SUD has been a continuing concern for the Department of Veterans Affairs (VA) and Department of Defense (DoD), particularly as large numbers of service members return from Operations Enduring and Iraqi Freedom. The VA and DoD have prioritized implementation of evidence-based practices and treatment services to enhance the recognition and management of SUD in general medical and SUD specialty-care settings. This article summarizes the clinical practice guidelines for identifying, diagnosing, and treating SUD in VA and DoD general medical and SUD specialty-care settings, highlights evidence-based pharmacotherapy and psychosocial interventions for managing SUD, and describes barriers to successful treatment of veterans and service members at risk for SUD in VA and DoD health care systems.

Brain-derived neurotrophic factor in traumatic brain injury, post-traumatic stress disorder, and their comorbid conditions: role in pathogenesis and treatment

As US military service members return from the wars in Iraq and Afghanistan with elevated rates of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), attention has been increasingly focused on TBI/PTSD comorbidity, its neurobiological mechanisms, and novel and effective treatment approaches. TBI and PTSD, and their comorbid conditions, present with a spectrum of common clinical features such as sleep disturbance, depression, anxiety, irritability, difficulty in concentrating, fatigue, suicidality, chronic pain, and alterations in arousal. These TBI and PTSD disorders are also thought to be characterized by overlapping neural mechanisms. Both conditions are associated with changes in hippocampal, prefrontal cortical, and limbic region function because of alterations in synaptogenesis, dendritic remodeling, and neurogenesis. Neural changes in TBI and PTSD result from pathophysiological disturbances in metabolic, cytotoxic, inflammatory, and apoptic processes, amongst other mechanisms. Neurotrophins have well-established actions in regulating cell growth and survival, differentiation, apoptosis, and cytoskeleton restructuring. A body of research indicates that dysregulation of neural brain-derived neurotrophic factor (BDNF) is found in conditions of TBI and PTSD. Induction of BDNF and activation of its intracellular receptors can produce neural regeneration, reconnection, and dendritic sprouting, and can improve synaptic efficacy. In this review, we consider treatment approaches that enhance BDNF-related signaling and have the potential to restore neural connectivity. Such treatment approaches could facilitate neuroplastic changes that lead to adaptive neural repair and reverse cognitive and emotional deficits in both TBI and PTSD.

Psychological services for returning veterans and their families: evolving conceptualizations of the sequelae of war‐zone experiences

The provision of effective and timely behavioral health care for veterans returning from the conflicts in Iraq and Afghanistan has become the focus of national attention. In this special issue, attempts to provide psychological care for service members and their families are examined in light of three key constructs. First, it is contended that at no other time in history has more attention been paid to the psychological consequences of engaging in combat. Second, for the first time in recorded warfare, psychological morbidity is likely to far outstrip physical injury associated with combat. Finally, although posttraumatic stress disorder and traumatic brain injury are serious concerns, most service members return without significant physical or psychological injury and will be able to return to functioning without notable problems. Accurate diagnosis, a focus on resilience, and the expectation of readjustment are essential precepts that should guide clinical efforts and resource allocation.

Away from Home: The Effect of Military Deployment on Spousal Labor Force Participation

Over 1,000,000 service members were deployed away from their families in the first 5 years since the start of the U.S. military campaign in Afghanistan and Iraq, and over 350,000 service members experienced two or more deployments. Although deployments disrupt the contribution of service members to household production, little evidence exist about the effect of deployments on spouses. This paper uses unit deployment to Afghanistan and Iraq to identify an effect of deployment on spousal labor force participation. Combining administrative pay records with responses to surveys of active duty personnel, I find that deployment reduces spousal labor force participation by 2.8 percentage points. This reaction varies by the age of the youngest child in the family. Deployment reduces spousal labor force participation by 4.9 percentage points in families with children under age 6. I also find that spouses decrease their labor force participation several months before service members are actually deployed, and return to the labor force several months after service members return from deployment.

Conversion From External Fixation to Definitive Fixation: Periarticular Injuries

Extremity injuries sustained by uniformed service combatants pose a significant challenge to military orthopaedic surgeons. The wounding mechanisms in Operation Iraqi Freedom and Operation Enduring Freedom consist of blasts, penetrating injuries, and blunt injuries. The mortality of warriors has decreased overall because of the improvements in head, neck, and torso body armor. Consequently, the severity of extremity wounds has increased. Because of the far-forward surgical assets (surgeons and advanced equipment), these patients are stabilized rapidly and their injured extremities are treated early (ie, revascularized, débrided, stabilized). However, multiple challenges exist in the timing of definitive reconstructive efforts once these injured service members return to military medical centers in the continental United States.