Transcript presentation source

Operation Iraqi Freedom
I feel more a sense of anger sometimes. You see an Iraqi just
looking at you, and you wonder why is he looking at you. Is there
anything else he could be doing other than looking at you? Or a
car that won't get out of the way -- sometimes you just get angry
and want to ram it off the road. Sometimes I sit here, and I
wonder if a mortar round is going to come through these walls,
or if I go to chow now or wait until after -- you never know if the
mortar round will hit you or not if you wait five more minutes.
They tell you hearts and minds. Then you got to be mean, then
nice. You don't know what to be. On the roads you have to run
people off the road. There could be a VBIED [vehicle-born
improvised explosive device, or car bomb] or a guy taking his
kids to school. So you have to be all things at once. That is the
hardest part. You're always thinking which one you are going to
be, a nice guy or a mean guy. ...
Pvt. Josue Reyes
http://www.pbs.org/wgbh/pages/frontline/shows/company/view/
Chapter 1: Nine Men Strong: A Company of Misfits (9:30)
Chapter 2: Under Siege from an Invisible Enemy (10:15)
Chapter 3: Death of A Soldier (5:55-7:00, 8:15-9:30, 12:00-end)
Chapter 4: The Battle Becomes Even More Personal (0-3:40)
The Numbers
• Over 1 million soldiers deployed to Iraq (OIF) and
Afghanistan (OEF) since March 2003
• As of July 11, 2006Total
Deaths
KIA
WIA RTD
WIA NOT RTD
2542
2010
10,246
8628
OEF(Afghanistan) 314
161
319
496
Totals
2171
10,565
9124
OIF (Iraq)
2856
* Unknown if psychiatric injuries are included in these numbers. Some data
suggests that in the first few months of war that 6-7% of all Evac’s were for
psychiatric reasons, making it one of the top 5 reasons for evac. Stetz, M., McDonald, J.,
Lukey, B., & Gifford, R. (2005). Psychiatric diagnoses as a cause of medical evacuation. Aviation Space Environmental Medicine, 7(7Suppl),
C15-20.
Iraqi Casualties
Civilians
reported killed by
military intervention in Iraq
Min38960
Max 43397
www.iraqbodycount.net
Roberts,
L., Lafta, L., Garfield,
R., Khudhairi, J., & Burnham, G.
(2004). Mortality before and after
the 2003 invasion of Iraq: cluster
sample survey. The Lancet, 364,
1857-1864.
Hoge, C.W., Castro, A., Messer, S., McGurk, D., Cotting, D., & Koffman, R. (2004). Combat duty in Iraq and Afghanistan,
mental health problems, and barriers to care. The New England Journal of Medicine, 351(1), 13-22.
Sequela of War for Soldiers
•
•
•
•
•
PTSD and other mental illnesses
Physical illness- Fibromyalgia, Headaches,
Substance Abuse
Poor social and occupational functioning
Interpersonal Violence –(15-58% depending on
study size- (Marshall 2005))
– Related to: psychopathology variables (depression,
ASPD), childhood trauma variables (history of personal
assault by family), military service factors (length of
deployment, combat, participation in killing and rank),
relationship adjustment, and demographic factors (race
and age).
Rates of PTSD
• 2 studies by Hoge, et. al. One published in 2004 in
NEJM, and one in 2006 in JAMA.
– Mandated screening by DoD provided the data.
– Study #1- 15.6-17.1 % of all Iraq study participants
(n=1705) 3-4 months post-deployment, screened positive
for a mental disorder, mostly PTSD. (Afghanistan troops
experienced a 11.2%)
– 71-86% of these soldiers engaged in a firefight, the median
# of fights was 5. (Afghanistan- 31% and 2)
– 11.6% were injured, and 4.6% for Afghanistan, and was
significantly correlated to developing symptoms of PTSD.
– Only 23-40% of those that screened positive reported
receiving treatment.
Rates of PTSD
• Study #2– Population based descriptive study of ALL
Army soldiers and Marines who completed the
PDHA in a one year period from Iraq or
Afghanistan (Iraq n= 222,620, Afghanistan n=
16318, and other locations n=64967)
– Prevalence of mental health problem;
Iraq=19.1%, Afghanistan=11.3%, Other=8.5%
– 35% of OIF vets accessed mental health
services within one year of returning home.
Risk Factors
• Combat exposure and numerous exposures increase risk of
development of PTSD.
• National Guard or Reservist (Less likely to have social support
and treatment options post-deployment)
• Military sexual trauma
• Survival after serious injury
• Lack of support
• Ongoing Stressors- Marital or family discord, workplace or
social settings.
• Personal Characteristics- coping skills, interpersonal
relatedness, attachment, shame, stigma sensitivity, past trauma
history, and motivation for treatment.
• Co-morbid psychiatric or medical disorders
• Previous history of trauma
• Race, Gender, Socioeconomic Status
Protective Factors
• Personal Characteristics- Coping skills,
interpersonal relatedness, attachment, etc.
• Social Support- use and acceptance of social
resources
• Good social and occupational functioning prior
to trauma
• Age (Under age 44)
• Education
• Socioeconomic Status
Why only 40%
•
•
•
•
•
•
Stigma
Fear loss of opportunity for promotion
Loss of security clearance
Elimination from the service
Fear that they will let their “buddies” down
Culture of the Military – A sign of
Weakness
Why only 40%
• Those that are symptomatic, are more likely
to feel this way, and less likely to seek
treatment (Hoge et. al. 2004).
• Members of my unit might have less
confidence in me
• My unit leadership might treat me differently
• My leaders would blame me for the problem
• I would be seen as weak
• It would harm my career
• There would be difficulty getting time off work
for treatment
http://www.pbs.org/wgbh/pages/frontline/shows/heart/view/
A Soldier’s Heart:
Chapter 1: Homecoming
Chapter 2: The Psychological Impact of War
Websites
• National Center for PTSDhttp://www.ncptsd.va.gov/index.html
• Post Traumatic Stress Disorder Guidelines (joint VA/DoD)http://www.oqp.med.va.gov/cpg/PTSD/PTSD_Base.htm
• PBS- Frontline- “A Soldier’s Heart”http://www.pbs.org/wgbh/pages/frontline/shows/heart/
• PBS- Frontline – “A Company of Soldiers”http://www.pbs.org/wgbh/pages/frontline/shows/company/
• DoD Mental Health Screeninghttp://www.mentalhealthscreening.org/military/index.aspx
• http://www.defenselink.mil/multimedia/ & Wikimedia
commons for photos
•
•
•
•
•
•
•
•
•
•
•
•
•
•
References
Ballenger, J., Davidson, J., Lecrubier, Y., Nutt, D., Marshall, R., Nemeroff, C., Shalev, A., and R. Yehuda.
(2004). Consensus Statement Update on Posttraumatic Stress Disorder From the International Consensus
Group on Depression and Anxiety. The Journal of Clinical Psychiatry, Vol. 65 (supplement 1), p. 55-62.
Brewin, CR (2001). Invited Essay: A cognitive neuroscience account of posttraumatic stress disorder and
its treatment. Behaviour research and therapy, 39. 373-393
Friedman, M.J. (2006). Posttraumatic stress disorder among military returnees form
Afghanistan and Iraq. American Journal of Psychiatry, 163 (4), 586-593.
Hoge, C.W., Castro, A., Messer, S., McGurk, D., Cotting, D., & Koffman, R. (2004).
Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. The New England
Journal of Medicine, 351(1), 13-22.
Hoge, C.W., Auchrterlonie, J., & Milliken, C.S. (2006). Mental health problems, use of
mental health services, and attrition from military service after returning from deployment to Iraq or
Afghanistan. Journal of the American Medical Association, 295 (9), 1023-1032.
Jones, E., and Wessely, S., (2003). “Forward Psychiatry” in the Military: Its Origins and Effectiveness.
Journal of Traumatic Stress. Vol 16:4, 411-419.
Management of Post-Traumatic Stress. Washington, DC: VA/DoD Clinical Practice Guideline Working
Group, Veterans Health Administration, Department of Veterans Affairs and Health Affairs, Department of
Defense, December 2003. Office of Quality and Performance publication 10Q-CPG/PTSD-04.
Marshall, A., Panuzio, J., & Taft, C. (2005). Intimate partner violence among military veterans and active
duty servicement. Clinical Psychology Review, 25(7), 862-876.
Prigerson, H., Maciejewski, P., & Rosenheck, R. (2001). Combat trauma: trauma with highest risk of
delayed onset and unresolved posttraumatic stress disorder symptoms, unemployment and abuse among
men. The Journal of Nervous and Mental Disease, 189(2), 99-108.
Roberts, L., Lafta, L., Garfield, R., Khudhairi, J., & Burnham, G. (2004). Mortality before and after the
2003 invasion of Iraq: cluster sample survey. The Lancet, 364, 1857-1864.
Stetz, M., McDonald, J., Lukey, B., & Gifford, R. (2005). Psychiatric diagnoses as a cause of medical
evacuation. Aviation Space Environmental Medicine, 7(7Suppl), C15-20.