Showing papers in "U.S. Army Medical Department journal in 2008"

Combat duty in Iraq and Afghanistan, mental health problems and barriers to care.

Abstract: Background The current combat operations in Iraq and Afghanistan have involved US military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. Methods We studied members of 4 US combat infantry units (3 Army units and a Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or 3 to 4 months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and posttraumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. Results Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6% to 17.1%) than after duty in Afghanistan (11.2%) or before deployment to Iraq (9.3%); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23% to 40% sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. Conclusions This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. The recent military operations in Iraq and Afghanistan, which have involved the first sustained ground combat undertaken by the United States since the war in Vietnam, raise important questions about the effect of the experience on the mental health of members of the military services who have been deployed there. Research conducted after other military conflicts has shown that deployment stressors and exposure to combat result in considerable risks of mental health problems, including posttraumatic stress disorder, major depression, substance abuse, impairment in social functioning and in the ability to work, and the increased use of healthcare services. One study that was conducted just before the military operations in Iraq and Afghanistan began found that at least 6% of all US military service members on active duty receive treatment for a mental disorder each year. Given the ongoing military operations in Iraq and Afghanistan, mental disorders are likely to remain an important healthcare concern among those serving there. Many gaps exist in the understanding of the full psychosocial effect of combat. The all-volunteer force deployed to Iraq and Afghanistan and the type of warfare conducted in these regions are very different from those involved in past wars, differences that highlight the need for studies of members of the armed services who are involved in the current operations. Most studies that have examined the effects of combat on mental health were conducted among veterans years after their military service had ended. A problem in the methods of such studies is the long recall period after exposure to combat. Very few studies have examined a broad range of mental health outcomes near to the time of subjects' deployment. Little of the existing research is useful in guiding policy with regard to how best to promote access to and the delivery of mental health care to members of the armed services. Although screening for mental health problems is now routine both before and after deployment and is encouraged in primary care settings, we are not aware of any studies that have assessed the use of mental health care, the perceived need for such care, and the perceived barriers to treatment among members of the military services before or after combat deployment. We studied the prevalence of mental health problems among members of the US armed services who were recruited from comparable combat units before or after their deployment to Iraq or Afghanistan. We identified the proportion of service members with mental health concerns who were not receiving care and the barriers they perceived to accessing and receiving such care.

Warrior Resilience Training in Operation Iraqi Freedom: combining rational emotive behavior therapy, resiliency, and positive psychology.

Abstract: Warrior Resilience Training (WRT) is an educational class designed to enhance Warrior resilience, thriving, and posttraumatic growth for Soldiers deployed in Operation Iraqi Freedom. Warrior Resilience Training uses rational emotive behavior therapy (REBT), Army leadership principles, and positive psychology as a vehicle for students to apply resilient philosophies derived from Army Warrior Ethos, Stoic philosophy, and the survivor and resiliency literature. Students in WRT are trained to focus upon virtue, character, and emotional self-regulation by constructing and maintaining a personal resiliency philosophy that emphasizes critical thinking, rationality, virtue, and Warrior Ethos. The author, an Army licensed clinical social worker, executive coach, REBT doctoral fellow, and former Special Forces noncommissioned officer, describes his initial experience teaching WRT during Operation Iraqi Freedom to combat medics and Soldiers from 2005 to 2006, and his experience as a leader of a combat stress control prevention team currently in Iraq offering mobile WRT classes in-theater. Warrior Resilience Training rationale, curriculum, variants (like Warrior Family Resilience Training), and feedback are included, with suggestions as to how behavioral health providers and combat stress control teams might better integrate their services with leaders, chaplains, and commands to better market combat stress resiliency, reduce barriers to care, and promote force preservation. Informal analysis of class feedback from 1168 respondents regarding WRT reception and utilization is examined.

Malaria risk assessment for the Republic of Korea based on models of mosquito distribution.

Abstract: Data on climate, environment, and adult and larval mosquito collection sites throughout the Republic of Korea (ROK) were used to model the potential distribution of the 8 anopheline species known to occur there. These models were overlaid on predicted areas of malaria suitability to better define the distribution of malaria risk in the ROK. The concept of the "mal-area"- an area of co-occurrence of humans, parasites and vectors, where malaria transmission is possible-is explained. Quantification of the mal-area in the vicinity of 5 military installations in the north of the country suggested that they had very different malaria risks, depending on what the vector species were, and the method of calculation. An online mal-area calculator for malaria risk assessment (currently under development) is discussed.

Behavioral health activity and workload in the Iraq theater of operations.

Abstract: Deployed service members encounter greater stressors such as combat, separation from normal support groups, and high operational tempo in the Iraq theater of operations than in a stateside setting. Consequently, the services that behavioral health personnel provide during deployment include a wider breadth of activities than are tracked and provided in a US military medical treatment facility setting. The Combat and Operational Stress Control Workload and Activity Reporting System was developed to track the diverse behavioral health activities performed in theater. These activities during the period of January through June 2008 included psychoeducational classes (n=3,900), traumatic event interventions (n=535), command directed mental health evaluations (n=750), and casual walkabout/prevention contacts (n=80,400). These behavioral health treatment and prevention activities performed in the Iraq theater of operations are a crucial part of the medical support provided to troops in a harsh environment. These activities serve as force multipliers and help conserve the fighting strength of combat troops.

Dialectical behavior therapy deployed: an aggressive alternative to traditional mental health on the noncontiguous battlefield.

Abstract: This paper provides a description of the Witmer Wellness Center, the first successful military application of dialectical behavior therapy in a theater of war. Dialectical behavior therapy is a dynamic and provocative evidenced-based modification of cognitive behavioral treatment developed by Dr Marsha Linehan for patients with severe emotional dysregulation. One of the primary concepts of dialectical behavior therapy is that self-harming behaviors are learned, and provide evidence of maladaptive coping that is reinforced in an invalidating environment. Dialectical behavior therapy recommends a hierarchy of goals to effectively address the behaviors associated with dysregulation. Chief among these goals is reducing risk of violence to self or others. Dialectical behavior therapy is especially well-suited for the complex and dynamic environment of the noncontiguous battlefield with its chronic threat of ultraviolence, strain of nonresponse, shifting rules of engagement, and extended duration and frequency of combat deployments. The Witmer Wellness Center program uses an intensive outpatient organizational structure and minimal, but innovative, modifications to standard dialectical behavior therapy designed to meet the special requirements of Warriors in a combat zone. The Wellness Center program was designed and implemented during Operation Iraqi Freedom 07-09, at a time during the troop surge when suicide rates among US forces had reached an unprecedented level.

The US Air Force Aerial Spray Unit: a history of large area disease vector control operations, WWII through Katrina.

Abstract: The US Air Force has had a long history of aerial applications of pesticides to fulfill a variety of missions, the most important being the protection of troops through the minimization of arthropod vectors capable of disease transmission. Beginning in World War II, aerial application of pesticides by the military has effectively controlled vector and nuisance pest populations in a variety of environments. Currently, the military aerial spray capability resides in the US Air Force Reserve (USAFR), which operates and maintains C-130 airplanes capable of a variety of missions, including ultra low volume applications for vector and nuisance pests, as well as higher volume aerial applications of herbicides and oil-spill dispersants. The USAFR aerial spray assets are the only such fixed-wing aerial spray assets within the Department of Defense. In addition to troop protection, the USAFR Aerial Spray Unit has participated in a number of humanitarian/relief missions, most recently in the response to the 2005 Hurricanes Katrina and Rita, which heavily damaged the Gulf Coasts of Louisiana, Mississippi, and Texas. This article provides historical background on the Air Force Aerial Spray Unit and describes the operations in Louisiana in the aftermath of Hurricane Katrina.

Medical civil-military operations: the deployed medical brigade's role in counterinsurgency operations.

Abstract: Medical civil-military operations are a critical combat multiplier directly supporting the counterinsurgency fight. Army Medical Department Soldiers support medical civil affairs activities at all levels from platoon to the United States Mission-Iraq (Department of State) initiatives enhancing the legitimacy of medical services in the Iraq Ministry of Health, Ministry of Defense, Ministry of the Interior, and Ministry of Justice. The civil-military operations mission of the deployed Task Force 62 Medical Brigade has also evolved into a broad mission encompassing over 120 contractors including Iraqi-American, Bilingual Bicultural Advisors-Subject Matter Experts serving as case management liaison officers and medical trainers, as well as Iraqi Advisor Task Force members providing medical atmospherics, assessments, training, and the overall management of Iraqi linguists supporting all level III medical facilities.

Maximizing patient thermoregulation in US Army forward surgical teams.

Abstract: : Creating universal minimal thermoregulation standards for all Forward Surgical Teams (FST) may decrease morbidity and mortality of combat damage control patients. These standards will also decrease blood and IV fluid requirements for each individual patient, decreasing the logistical challenges for the FSTs. The importance of maintaining body core temperature in these combat damage control surgery patients cannot be overemphasized.

The deployed electronic medical record.

Abstract: This article reviews the current state of the electronic medical record in the deployed environment, with a discussion of challenges faced in the course of mission execution. Focus discussion includes current system architecture, system integration, interoperability, networking, and security concerns. The Department of Defense electronic medical documentation system does function, and records care from the point of injury through enduring care within the Veterans Health Administration. However, there is a high cost in dollars and man-hours, which should be aggressively addressed and improved.

The comprehensive care plan: building the strength to do well tomorrow.

Abstract: The Warrior Transition Units provide Soldiers an opportunity to focus fully on healing, with the goal of returning to duty or returning to civilian life as a successful Veteran, with success defined as employable (or a life-care plan established), capable of maintaining relationships, and proud of their service to the nation. The success of the individual Warrior Transition Unit will be determined by how well they assist their Warriors in Transition. The Warrior Transition Unit cadre must ask: Is our WTU doing everything it can to build-up our Warriors? Are we providing them with the tools to develop their Strength to Do Well Tomorrow?

Effectiveness of critical event debriefings during Operation Iraqi Freedom II.

Abstract: Team members of a US Army medical combat stress control unit provided critical event debriefings for military personnel who were directly involved in a traumatic event during Operation Iraqi Freedom II Each person attending the debriefing was then given a short 5-question survey immediately following the session Out of the 396 participants who completed the survey questionnaire, 273 felt the debriefing given by the team was helpful, 97 had no opinion, and 26 did not feel it was helpful This particular combat stress control team was located in Taji, Iraq The data was collected from debriefings conducted from the beginning of March 2004 to mid-January 2005