The US framework for understanding, preventing, and caring for the mental health needs of service members who served in combat in Afghanistan and Iraq: a brief review of the issues and the research

Abstract

This paper reviews the psychological health research conducted in the United States in support of combat veterans from Iraq and Afghanistan, using the Military Psychological Health Research Continuum, which includes foundational science, epidemiology, etiology, prevention and screening, treatment, follow-up care, and services research. The review is limited to those studies involving combat veterans and military families. This review discusses perplexing issues regarding the impact of combat on the mental health of service members such as risk and resilience factors of mental health, biomarkers of posttraumatic stress syndrome (PTSD), mental health training, psychological screening, psychological debriefing, third location decompression, combat and suicide, the usefulness of psychotherapy and drug therapy for treating PTSD, role of advanced technology, telemedicine and virtual reality, methods to reduce stigma and barriers to care, and best approaches to the dissemination of evidence-based interventions. The mental health research of special populations such as women, National Guardsmen and reservists, and military families is also presented. The review concludes by identifying future areas of research.

Factors influencing the adoption of telemedicine for treatment of military veterans with post-traumatic stress disorder

“…Although no difference in dropout rates was observed when comparing in-person treatment with telemedicine-based treatment, studies did show that dropouts engaged in the telemedicine method for a longer period of time before deciding to discontinue treatment (20,25). In addition, telemedicine effectiveness was unaffected by age, ethnicity, or demographics of veterans (23,24,26).…”

“…Negative patient perception and ideas about telemedicine was another prominent theme that may pose as a barrier to adoption. Studies found that some veterans had negative expectations of outcomes and did not believe that the delivery method would be as effective as in-person treatment (21)(22)(23). Although findings proved this to be false, these negative opinions may hinder the treatment process or prevent engagement in treatment completely (21).…”

Suicidal ideation among young Afghanistan/Iraq War Veterans and civilians: Individual, social, and environmental risk factors and perception of unmet mental healthcare needs, United States, 2013

“…Some evidence has suggested that suicide-related outcomes are associated with deployment and combat exposure (Schoenbaum et al, 2014; Bryan et al, 2015a); however, study results have been mixed (Kang et al, 2015; Reger et al, 2015). Collectively, these risk factors have informed public health prevention efforts and clinical efforts including suicide screening, risk assessment, and mental health treatment (Logan et al, 2011b; Pringle et al, 2013; Castro, 2014; McCarthy et al, 2015). …”

Suicide Among Military Personnel and Veterans Aged 18–35 Years by County—16 States

“…3,17 These advancements can be incorporated into comprehensive strategies and help address mental health problems. For example, Warner and colleagues 40 reported that pre-deployment mental health screening can be feasibly connected to ongoing mental health support during deployment.…”

“…Suicide-related morbidity and mortality have become health concerns among current military personnel and young Veterans, 3,4 thereby warranting suicide prevention strategies for these populations. 3,5–11 Surveillance data are critical to locating areas with the greatest burden of these deaths. 12 …”