These results support accumulating data indicating that work stress is a significant occupational health hazard in the routine military work environment. Targeting and eliminating sources of job stress should be a priority for the U.S. military to preserve and protect the mental health of military personnel.

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Combat and Operational Stress Control (COSC) continues to be a vital component of medical operations in support of military forces serving in Afghanistan in Operation Enduring Freedom and elsewhere. Although numerous studies cover postdeployment mental health, and several cover in-theater conditions, data on behavioral health clinical service provision are presented here to elucidate from COSC provider "boots on the ground" how operations have been executed in one part of the Operation Enduring Freedom theater between 2007 and 2010. The most common types of stressors that led to care included combat, mission demands, home front concerns, and relationships with leaders and peers within units. Classes and consultation for sleep difficulties and anger management were of high interest. Frequent behavioral health diagnoses were depressive and anxiety disorders as well as exacerbation of a previously diagnosed condition. Management of suicidality and other psychiatric emergencies are discussed, as well as care outcomes. The authors present lessons learned regarding the importance of Operational Relationships/Tactical Politics, reducing stigma and barriers to care, collaboration with chaplains, and other strategies seen as supporting COSC success.