DoD's Millenium Cohort Study Tracking Health of 108,000+ Service Members

From the Air Force wire:

5/29/2007 - WASHINGTON (AFPN) -- When a landmark Defense Department-sponsored health study was launched six years ago, one of its goals was to evaluate the impact of future deployments on long-term health. The investigators did not know how timely the project would be.

Today, the Millennium Cohort Study has enrolled tens of thousands of participants who have deployed in support of the war on terrorism, said Navy Cmdr. (Dr.) Margaret Ryan, the study's principal investigator and director of the Defense Department Center for Deployment Health Research, part of the Naval Health Research Center, in San Diego.

The participants are voluntary, and will allow researchers to gain more insight into combat PTSD and its long-range implications.

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Continuing:

The study was designed in the late 1990s "in the wake of the first Gulf War to answer some of the most difficult questions that couldn't really be answered retrospectively after that conflict," Commander Ryan said.

The joint-service study was established to evaluate the health risks of military deployments, occupational exposures and general military service, Commander Ryan explained, noting that about 108,000 servicemembers have signed up to take part since program enrollment began in July 2001.

Participants' health is evaluated over a 21-year period, Commander Ryan said, noting the size of the cohort -- the group participating in the study - likely will total more than 147,000 people. "About 40 percent of our cohort has deployed to one of the more recent operations, either in Iraq or Afghanistan or surrounding regions, in support of the global war on terrorism," she said.

Involvement in the study is voluntary and participants are selected randomly, Commander Ryan said. All information is secure and safeguarded, she added. Participants report their health status every three years and can fill out either paper or online surveys, Commander Ryan said. "We do strongly encourage people to use the online option," she said. "It's a very secure way to transmit information."

Dr. Tyler C. Smith will replace Commander Ryan as the study's principal investigator later this year, as the Navy physician is slated to take a new duty assignment at Camp Pendleton, Calif.

The study is providing valuable data that will help military epidemiologists understand possible cause-and-effect relationships between combat-zone deployments and problems such as post-traumatic stress disorder, Doctor Smith said. "We have the ability to look at a large group of individuals who were deployed and not deployed," he said. "And we can see what factors predict new-onset PTSD, and how PTSD evolves over time. That's what we've been focusing on."

Evaluating the incidence of PTSD among servicemembers wasn't possible until recently, "simply because we didn't have a cohort in place like this that's large and population-based," Doctor Smith explained. "So we're learning things that we really haven't been able to investigate in the past," he said.

Source: USAF

If you're interested in being a participant in the Cohort survey project (you even get to choose a free gift when you register online), see the 2007 Questionnaire.

What Is It About Combat PTSD?

More discussion going on here on this post.

When I did my research last year for Moving a Nation to Care, one day it occurred to me that, depending upon the volume I had in my hands, what we call post-traumatic stress disorder never seemed to settle on one name. It's had at least 80 at last count, in fact (all are in Moving's Chapter Notes, p. 161-162).

But never one that sticks. What is it about PTSD?

I've been opening my book events by listing a few of these 80 out loud, asking what people think about having so many confusing names for the same thing (the second installment of Gen. Wes Clark Community Network's Troops & Vets series on 'Society and the Soldier' begins in the same way):

Traumatic neurasthenia. Railway spine. War syndrome. Gross stress reaction. Old sergeant syndrome. Neurocirculatory asthenia. Vietnam disease. Cerebro-medullary shock. Simple continued fever. Disordered action of the heart. Buck fever. Swiss disease...

When we speak of post-traumatic stress disorder, or PTSD, most of us are familiar with a handful of the labels given the after-effects of war. We’ve probably heard that it used to be called ‘nostalgia’ or ‘irritable heart’ during the Civil War. During World War I it became ‘shell shock’ in reaction to the arrival of powerful industrial weapons of war like the quick firing artillery piece, the machine gun and the magazine rifle. By World War II it became ‘combat fatigue’ or ‘battle fatigue.’ The second-to-last stop before arriving at the definition we use today was ‘post-Vietnam syndrome.’

While these are the more well-known of labels given to modern post-traumatic stress disorder, by merely repeating these more familiar terms, we lose sight of an important aspect of the history of PTSD: the human resistance to acceptance of the condition – no matter what it’s called. The fact that one generation after another has to ‘rediscover’ PTSD and give it its own name offers a glimpse into society’s desire not to have to own up to it, not to have to dig too deeply into the dark recesses of it, not to expand on our understanding of it, perhaps not even to believe it exists.

By this I mean to ask, why is that we have so many (80, and easily many more if we actually made it a point to look) different labels used througout the centuries for the same general malady? Do we have as many altering labels for other conditions, too? If not, why does nostalgia, or irritable heart, or battle fatigue, or PVS or now again PTSD never seem to 'stick'?

Continuing in the Troops & Vets piece:

Indeed, even today there is a rejection bubbling under the surface surrounding the use of post-traumatic stress disorder. Many doctors and counselors and soldiers believe the term falls short of the mark, saying that ‘psychological injury’ or ‘deployment-related stress’ or ‘combat-related stressors’ more accurately describe what’s going on here; others don’t like the term because it’s become ‘too political.’ Of course, whatever you call the aftereffects of war, it’s always been political, with a fixation on labels instead of the issue.

No surprise, then, that House VA Affairs Chairman Bob Filner made these comments at the open of last week's symposium on PTSD:



Description:

The House Veterans' Affairs Committee held a PTSD Health Care Symposium to discuss improved ways to provide mental health care services to veterans. Mental health care providers, medical doctors and researchers discussed how families, school systems, business owners, law enforcement and the community are affected and what every American should know about PTSD. Chairman Bob Filner gives opening remarks.

So, it's obvious we are still not at peace with the latest label for war trauma, PTSD. What is it about PTSD?

Glancing Back on Memorial Day

Most everyone by now has chimed in on their Memorial Day thoughts. I've wanted to wait a bit and have a chance to let the past few days soak in before adding mine.

I'm feeling very blessed to be with my family, and to have a nice break at long last this coming week. My husband and I drove alongside a handful of small town cemetaries yesterday, flags waving, many people visiting. It was a sunny day and yet always in the back of my mind was the knowledge that we are in the midst of a very sacred remembrance day...yet another year at war with so much more loss and pain.

Great losses have been paid. Many now funnel their griefwork into helping another generation returning home scarred by war. Penny Coleman and others like her are just such healers.

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I've been planning a post on a special lady since my New York City book tour stop last weekend. Penny Coleman, whose Flashback: Posttraumatic Stress Disorder, Suicide and the Lessons of War is now available in paperback and comes highly recommended (even withholding Penny's gracious penning of Moving a Nation to Care's foreword). To give a glimpse of Penny's work, a highly-coveted interview in Library Journal in which she describes what compelled her to write her book:

I wanted to hear how other women had survived their husbands' suicides and whether they blamed themselves, their husbands or the war. So I began interviewing other women whose husbands were also veterans of the war in Vietnam, who came home with what is now known as PTSD (post traumatic stress disorder), and had subsequently taken their own lives.

The more I talked to other widows, the angrier I got. We all blamed our selves for not having loved enough, or noticed enough, or intervened appropriately. We had failed; we were abandoned. The government knew better and they didn't tell us. They exploited the stigma attached both to PTSD and to suicide that isolated and silenced us.

I was about two years into my research when the US invaded Afghanistan and then Iraq. What had been primarily an historical investigation was transformed into a cautionary tale.

Penny's work has been transformed and has been transforming.

It's becoming a tradition that I think of Penny and Daniel on Memorial Day, along with all of my other new military friends that have shared so much with me on this journey. From last year's post, just as appropriate today:

I...dedicate this Memorial Day to those who've worn the uniform, served in combat, yet go unrecognized on our KIA lists or memorial walls at their death. Penny Coleman's late husband, Daniel O'Donnell, became one such casualty of the Vietnam War when he took his life after battling something later referred to as posttraumatic stress disorder [PTSD].

I had only weeks earlier been first contacted by Penny. She has since become a well-timed and much-appreciated mentor to me on my journey this past year exploring the topic of combat PTSD. Taking my hand (literally last weekend -- that's us in the picture above at my Barnes & Noble book signing in New York City on May 18), Penny answered my questions and listened to a novice's tales of woe like a soulful sage. After sending Cho and me at ePluribus Media a copy of Flashback -- our review -- she agreed to an exclusive interview.

A few comments that are especially compelling:

In a perfect world, a great deal more energy would be put into solving international problems other than with soldiers. The military keeps experimenting with prophylactic measures (pre-induction screenings, in-service therapies, deployment durations, unit organization, training variants, post-service questionnaires, etc.), and hoping they have finally solved the problem. They have not. But their optimism has consistently translated into a lack of preparedness, a lack of resources, and a lack of commitment to preventive rather than curative measures.

That said, all of the following would be an improvement--which is to say that the suggestions on this list are not currently being done. Deploying soldiers should be thoroughly screened for any sign of past or current mental or emotional problems. Soldiers in a combat zone who express concern about their mental state should not be shamed and ignored, but sent immediately for counseling, if not home.

Psychotropic drugs should never be used in a combat zone. Every effort should be made to protect troops from injury, either mental or physical, and that would include putting them in situations where civilians are routinely killed. When they come home, psychiatric evaluations should be mandatory and de-stigmatized, and there should be periodic follow-ups, perhaps for the rest of their lives.

Treatment for all war injuries, physical and psychiatric, should be absolutely free and compensation should be paid to those who can no longer work. Every candidate for the military, every soldier and every veteran should be thoroughly warned about the predictable incidence of PTSD and the statistical likelihood that it will end in suicide.

That is a wholly incomplete list, but it includes some of the true costs of war that are being currently ignored. If it seems prohibitively expensive, then perhaps we can no longer afford war.

I could go on and on about Penny -- and I do. She's worth every word and more. Thank you, Penny for sharing your journey and advice and friendship with me. A great pleasure to have met you last weekend. For anyone not familiar with Penny's work, head over to Flashback's companion website. And if you're fortunate enough, you may be able to catch another run of the play of the same name when it arrives on Broadway!

Flashback the play, is structured as an "argument" between two main characters, the widow of a Vietnam veteran suicide and a veteran who trained and served with her husband and remained a friend until his death. Woven through their efforts to sort feelings of guilt and responsibility, five other widows speak, with exquisite personal detail, about their attempts to cope with both psychic and social injuries before and after the deaths of their husbands.

Most Americans are unaware of the deep and lasting wounds suffered so predictably and frequently by combat veterans. These characters describe a commonality of symptoms that provide compelling evidence of the reality of combat-related PTSD and the predictable outcome of ignoring its lethal effects. Because they speak without conventional anti-war rhetoric or partisan accusation, their words are accessible to a broad cross-section of Americans, both those who support and those who disagree with our current military ventures, including military families.

To all of our military families, our nation is honored by your service.

My thoughts with you as always.


Related Posts

• Memorial Day: Honoring ALL of the Fallen
  
• First Peek: Interview with Author Penny Coleman
  
• Moving a Nation to Care Sample Chapter // Philadelphia, New York City Book Tour Stops

One Soldier's Story of Leadership and PTSD

The Seattle Times today offers an in-depth look at one soldier's story of commitment, leadership and PTSD:

By the end of his tour in Iraq, Command Sgt. Maj. Thomas Adams was crushed by memories. Too many memorial services for dead soldiers. Too many visits to the wounded in the hospital wards. Too many innocents -- men, women and children -- blown up by insurgent bombs or killed inadvertently by his Fort Lewis brigade.

Adams, the highest-ranking enlisted soldier in his brigade, started taking tranquilizers to help him sleep. In an unusual step, he shared his struggles with the homeward-bound troops.

At a dusty desert base in Kuwait, Adams went from unit to unit, telling his fellow soldiers that he was not OK and would seek counseling when he returned. He urged others to do the same. ... Since his return, Adams has shown a different kind of fortitude, emerging as a powerful advocate challenging the Army to better confront the mental wounds of war. His efforts helped expand mental-health counseling at Fort Lewis for returning soldiers -- and improve training for Iraq-bound soldiers on the emotional hardships of combat.

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Article quoted from extensively for educational purposes.

Continuing:

"I had all generals from all walks of life come down and tell us how good we are and sprinkle holy water on us," said Adams, referring to his pre-Iraq training. "But not one professional came and talked to us about what it's going to be like when we lose somebody for real." ...

A Defense Department task force, in recent draft findings, cited the mental-health threats to soldiers as "one of the most pervasive and potentially disabling" costs of war. The task force noted that 38 percent of soldiers report psychological concerns upon their return from deployment, and concluded the Army has insufficient staff and funds to adequately care for those soldiers.
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It's a challenge that was largely unforeseen by Pentagon leaders. Before 9/11, then-Defense Secretary Donald Rumsfeld embraced a vision of push-button warfare, which emphasized long-range bombers, missile-defense systems and other high-tech equipment rather than a reliance on ground troops. [I write about what is termed the 'Revolution in Military Affairs,' or RMA, in the downloadable excerpt of Moving a Nation to Care: Post-Traumatic Stress Disorder and America's Returning Troops.]

The war in Iraq brought a different reality. The Army has been caught up in grueling urban combat that grinds on for months, and troop strength depends on the ability to maintain the emotional fitness of soldiers funneled back into repeat combat tours.

The piece goes on to explain that Adams returned home with PTSD and mild brain trauma (TBI). He suffered from blurred vision, forgetfulness, and deep depression after watching news reports. Often, he'd wished he'd died on the battlefield with his soldiers.

During a yearlong tour in Mosul, Iraq, Adams' Stryker brigade was subject to 1,387 attacks by roadside bombs, 84 assaults by vehicles packed with explosives, and daily threats from mortars, small-arms fire and rocket-propelled grenades.

The brigade lost 45 soldiers; 632 were wounded. By Adams' count, the brigade killed 550 insurgents. "What I'm telling you is that there's absolute carnage out there," Adams said. "We have to be ready for the trauma of today's battlefield."

Adams left for Mosul, Iraq, in 2004 with the 1st Brigade 25th Infantry Division Stryker Brigade. He served as command sergeant major, "the key liaison between enlisted soldiers and the commander." He fought for the best equipment and care for every single one of them -- and he didn't insulate himself from the fight or from the emotional needs of his troops.

"He was in the fight every day -- an absolute lead-from-the-front kind of guy," said Sgt. 1st Class Creed McCaslin, an expert marksman who helped protect Adams. For Adams, the hardest tasks came after the battles.

Three soldiers died in his arms after a December 2004 mess-hall bombing. In an almost daily ritual, he would visit the newly wounded at the Army hospital in Mosul. Some had lost an eye; others suffered severe burns or had legs and arms mangled by explosions. Adams would award a brass brigade coin stamped with the Stryker vehicles, while Col. Robert Brown, the company commander, handed out Purple Hearts to soldiers.

Back at the trailers, Adams counseled soldiers as they grieved over a lost buddy or agonized over a civilian death. During the course of the year, Adams tallied 186 men, women and children who fell victim to what he termed "the bad shoots," when civilian vehicles approached too close to a traffic checkpoint or families got trapped inside an insurgent position under assault from American troops. "You just can't imagine what that does to a soldier," Adams said. "What do you say to a guy that just blew away a woman and a kid because the enemy hid in that room with them and they all had to die? ... I wasn't prepared and I wish I was."

Adams shared his concerns with Lt. Gen. James Dubik, who as Fort Lewis commander made several trips to Mosul. Adams talked about the shortcomings in training and the monumental readjustments the soldiers would face upon their return.

Proving that committed, responsive leadership can move military culture stereotypes and stigma better than any legislation or decree can, Adams rolled up his sleeves once more when he and his brigade returned home in 2005:

By then, Dubik had worked with Madigan Army Medical Center to develop a screening program for brigade soldiers that included computerized surveys and at least one visit scheduled with a mental-health therapist between 90 and 180 days after their return.

Adams encouraged the soldiers to consider another option. They could call a military hotline to set up off-post counseling. Away from Fort Lewis, he believed, soldiers would talk more freely with less fear that their problems would filter back to their unit and hurt their career advancement.Then he made it easier to go. Soldiers would no longer have to clear the visits with squad leaders, platoon sergeants, platoon leaders and officers. He told soldiers in his brigade that they needed to confide only in an immediate superior, who would keep their confidentiality.

Adams also sought to change combat training. Soldiers already studied "in gum-bleeding detail" how and when to kill. Adams insisted they needed to know how they might feel after the act. "At a minimum, it should be a mandatory thing that we have to do. To discuss the real-world feeling, the emotions that you will go through -- unless you are some sort of psychopath -- when you kill another human being," Adams said.

Based on the ideas of Adams and others who had served in Afghanistan, Dubik said, Fort Lewis began "psychological preparation" for all soldiers headed into combat zones. Dubik also credits Adams with helping launch a senior leaders program, which brings together officers and top enlisted soldiers, as well as their spouses, to talk about the stresses of command.

But, of course, none of this arrived in time to help Adams himself.

Please read the entire piece to learn of Adams difficulties with reintegration following his time in Mosul. In a postscript, it was reported the Adams is now serving in Afghanistan, surely leading his troops once again as skillfully and compassionately as during his tour in Iraq. The man deserves our thanks for a job well done -- on the battlefield and on the home front as well.

Talk about the power of one. Adams embodies it in every way. Stay safe, be well, come home soon. We need you (and more like you) more than you might even know.