Veteran health

Veterans have been selflessly serving America for decades, have healthcare providers been providing them with the same dedicated service? The number of veterans is expected to rise in the next couple years. According to the Army Surgeon General report, there have been 2.2 million service members in Iraq and Afghanistan (2006). Another statistic from the Department of Defense concludes that there are over 1.2 million people serving in active duty, active  reserve, or national guard in all branches of the military (Bureau of Labor Statistics, 2011). In addition, there are still many veterans with health needs from previous wars that are not included in the last two statistics. The Veteran Affairs estimates there are over five hundred thousand veterans in Missouri alone (2011). With military service affecting so many clients, health providers need to know how to assist Veterans and their families. “In War there are no unwounded soldiers” (Narosky). War leaves a deep mark on military service men and women. The most commonly noted mental disorders noted are post-traumatic stress disorder, other anxiety disorders,  depression, and substance abuse. Out of these post-traumatic stress disorder (PTSD) has been found to be the most common (Bagalman, 2013). In Operation Enduring Freedom, Operation Iraqi Freedom. and Operation New Dawn PTSD has been found to affect 29% of veterans (Bagalman, 2013). Another alarming statistic that is commonly reference is the high suicide rate in the military; in 2005 alone, 6,256 veterans committed suicide (McCarl, 2013) There is a study, that looked at over one thousand Marines who had deployed to Iraq or Afghanistan  to determined demographic and psychosocial predictor variables of having a mental disorders by asking Marines to complete a survey then checking their health records (Booth-Kewley, Schmied, Highfill-McRoy, Larson, Garland & Ziajko, 2013). Interestingly, the study found that those most satisfied with their leadership were statically more likely to have a psychiatric diagnosis ( Booth-Kewley,, Schmied, Highfill-McRoy, Larson, Garland & Ziajko, 2013). It is projected that over 30% of Veterans will have a mental health diagnosis by 2014 (National Council of Behavioral Health, 2012). “The Department of Veteran Affairs has listed eight symptoms that indicate a mental disorder they are changes in sleep, appetite, decreased energy or motivation, problems with attention,  uncharacteristic irritability or angry, feelings  of worthlessness, unhealthy reckless behaviors, thoughts of suicide, and  problems functioning at home, work, or school.” It is important to note majority of veterans/military personnel do not develop a mental illness. However there are many adjustments that all service men and women need to make in order to transition between deployment and home smoothly (2013). The most common adjustment issues come from relationships, medical issues, financial hardships, and feelings of guilt, shame, or anger (Department of Veteran Affairs, 2013). Relatives often become the forgotten wounded of war. There are relatively few studies that investigate the health of military families. Being young and experiencing the possibility of losing a guardian can causes psychological concern. Children have been found to have more anxiety, emotional,  and behavioral problems three years after a parent was deployed (Chandra,  Lara-Cinisomo, Jaycox, 2010) Being a long distance, from loved ones causes relationship strain. Nearly 70% of respondents mentioned deployments lasting for at least a year in a study of military families (Zeber, Noel, Pugh, Copeland, Parchman, 2010). This creates a significant burden on spouses, children, caretakers, or friends. Military service affects millions of Americans and healthcare providers need to know how to provide for veterans as well as the families of veterans. A common belief is that the department of veteran affairs can meet these mental health needs of veterans. However, National Guard and Reserve troops are now commonly being deployed both these sections make up the Reserve Component. When not-deployed the Reserve Component trains one weekend a month and all the military personnel work civilian jobs on the side. There are two surveys that the Department of Defense requires to monitor the health of returning personnel the Post Deployment Health Assessment (PDHA) and Post Deployment Health Re-Assessment (PDHRA). The results show that half of those that indicated PTSD symptoms in Post Deployment Health Assessment improved by the Reassessment however, the number of PTSD cases doubled in the Reassessment(Milliken, Auchterionie and Hoge, 2007),. Remarkably, it was found that Active Duty and Reserve Component had significantly difference results(Milliken, Auchterionie and Hoge, 2007). Depression rates doubled in Active Duty, but tripled in the Reserve Component(Milliken, Auchterionie and Hoge, 2007). Substance abuse rates have increased to 12% in Active Duty and 15% in Reserve Component(Milliken, Auchterionie and Hoge, 2007). These differences are believed to be caused by a gap in healthcare. On Active Duty, personnel have on-going access to healthcare and will remain with their unit. In the Reserve Component there former service members are often geographically dispersed after deployment, so the soldiers loses a support system and Department of Defense health benefits expire six months after deployment for Reserve personal. Even when they are still under Department of Defense coverage they have to go to a military base or Veteran affairs facilities to receive this care. So where do these Reserve post-deployment soldiers go for treatment? They are in the civilian healthcare system. Health care professionals need to meet the needs of those affected by war. There is the age old quote, You don’t know a person until you have walked a couple miles in his shoes. One of the first steps to better care for Veterans and their families is for civilian healthcare provider to learn more about military culture to better relate to those serving in the military. Something as small as knowing a few of the abbreviations like IED means Improvised Explosive Device and DOD stands for Department of Defense. Military life is a culture with emphasis on discipline, group cohesion, and national pride. Secondly, It would be helpful for providers to ask every client about prior military experience in their own life or a loved one. Finally, there are many assessment tools that providers can use to determine whether further mental health treatment is required including Combat Exposure Scale, Trauma Symptom checklist, One of these is the Primary Care PTSD contains four simple questions for a physician to ask (Unknown). There are follow up questions if the client answers yes three times, but this can be completed in ten to fifteen minutes(Unknown). Military service affects a wide scope of Americans. Families and children are often affected by the stress of deployments as well as service member. In addition, many American’s with prior or current military service are seeking civilian healthcare. Civilian healthcare providers can better serve Veterans, but it will take additional training and resources to meet their health needs.

Bagalman, E. (2013). Mental disorders among oef/oif veterans using va health care: Facts and figures. Congressional Research Service, Booth-Kewley,, S., Schmied, E., Highfill-McRoy, R., Larson, G., Garland, C., & Ziajko, L. (2013). Predictors of psychiatric disorders in combat veterans. BMC Psychiatry, 13(130), Retrieved from http://www.biomedcentral.com/1471-244X/13/130 Bureau of Labor Statistics., Retrieved from http://www.bls.gov/ooh/Military/Military-Careers.htm

Chandra A, Lara-Cinisomo S, Jaycox L et al. Children on the homefront: the experience of children from military families. Pediatrics 2010;125:16–25.

Department of Veteran Affairs. Retrieved from http://www.va.gov/vetdata/Veteran_Population.asp McCarl, L. (2013). "to have no yesterday»': The rise of suicide rates in the military and among veterans. Creighton Law Review, 46, 394-416. Milliken, Auchterionie and Hoge (2007). JAMA 298-2141-2148

Narosky, J. Quote

National Council for Behavioral Health “Meeting the Behavioral Health Needs of Veterans: “Operation Enduring Freedom and Operation Iraqi Freedom” (Nov. 2012)

Office of the Army Surgeon General Mental Health Advisory Team (MHAT) IV, Final Report (Nov 06)

Office of the Army Surgeon General Mental Health Advisory Team (MHAT) VII Report, (May 2011)

Unknown. Retrieved from http://www.mirecc.va.gov/docs/visn6/2_Primary_Care_PTSD_Screen.pdf Unknown. US Department of Veteran Affairs, (2013). Picture this: Veteran mental health challenges and solutions Zeber, J., Noel, P., Pugh, M., Copeland, L., & Parchman, M. (2010). Family perceptions of post-deployment healthcare needs of iraq/afghanistan military personnel. Mental Health in Family Medicine, (7), 135-143.