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Friday, February 22, 2008

War-Related Mental Health Problems of Today's Veterans: New Clinical Awareness

This one is an oldie, but still a goodie.

Appearing in the July 2005 issue of the Journal of Psychological Nursing, this 11-page article is a good all-purpose clinical guide that can help us all better understand the diagnosis and treatment of combat PTSD. Download your own pdf copy to learn more about the following issues and more:

  • War-related Emotional Responses
  • Screening Questions for PTSD
  • Stressors Faced by Today's Soldiers
  • Medications Used to Treat PTSD

In educational interest, article(s) quoted from extensively.

A brief excerpt:

With the increasing involvement of the United States in military actions in Afghanistan and Iraq, the number of veterans of these conflicts can be expected to rise steadily. Veterans of these actions and of the first Gulf War are unlike veterans of previous wars in many ways, and may experience different etiologies of illnesses related to their exposure to war. Health care professionals caring for these veterans must be aware of their potential problems if they are to treat them effectively.

The armed forces of the current era differ from those of the Vietnam and previous eras. In 1973, the all-male draft initiated as the Selective Service Act of 1948 was terminated. Since that time, the military has been composed of a much smaller, all-volunteer force. Today, the U.S. military is a diverse and complex population.

Ethnic minorities make up significant portions of the armed forces, ranging from 24% in the Air Force to 40% in the Army (Cozza et al., 2004). Approximately 16% of the active U.S. armed forces are women, and more than 50% of service members are married (Cozza et al., 2004).

A significant number of active duty personnel are drawn from National Guard and Reserve components. Such personnel may be exposed to significant stress related to deployment. Dates of their deployment are often unpredictable, and the duration of their active duty may not be known when they are deployed, creating an unstable environment for service members and their families. ...

War is an extremely stressful event that creates an atmosphere of confusion and uncertainty, and forces participants to face possible injury, loss, and death. The combat environment, with its violence, physical demands, and separation from loved ones, may precipitate a wide range of emotional distress or psychiatric disorders.

For example, as evidence of the emotional effects of the current war, 19.5% of an Army study group returning from Iraq reported perceiving they had a moderate or severe mental health problem (Hoge et al., 2004).

The psychiatric differential diagnoses for military patients at war is broad. The clinical picture will vary over the course of a war, depending on several factors, including individual patient characteristics, available social supports, and the time elapsed since the precipitating event. It is useful to consider the range of emotional responses in the context of the multi-phasic traumatic stress response, dividing the course of mental health issues into three phases based on the length of time since the event(s) precipitating emotional distress (Cozza et al., 2004):

  • An immediate phase, during or immediately after a traumatic event.
  • A delayed phase, in the aftermath of combat.
  • A chronic phase, months to years after a precipitating event.
Various aspects and diagnostic considerations during each of the three phases are detailed in Table 1. Veteran patients seeking service in the civilian sector will usually be in the chronic phase of illness. In the following section, we will discuss the most common mental health problem expected to occur in veterans returning from the conflicts in Afghanistan and Iraq—posttraumatic stress disorder (PTSD).

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