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Peterson AL. General Perspective on the U.S. Military Conflicts in Iraq and Afghanistan After 20 Years. Mil Med 2021; 187:248-251. [PMID: 34850070 DOI: 10.1093/milmed/usab496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
It has been 20 years since the September 11, 2001 terrorist attacks on America. The ongoing military conflicts in this region are the longest sustained conflicts in U.S. history. Almost 3 million military personnel have deployed, with over 7,000 fatalities and more than 53,000 wounded in action. The most common psychological health condition associated with combat deployments is PTSD. No data exist to compare the prevalence of PTSD across war eras. Therefore, a potential proxy for PTSD risk is the number of combat-related deaths, because this figure has been consistently tracked across U.S. military conflicts. This commentary includes a table of death statistics from major military conflicts, which shows that fewer military personnel have deployed, been killed, sustained wounds, and, one might conclude, suffered from PTSD than any other major U.S. military conflict in history. Advances in the military equipment, tactics, and healthcare programs perhaps mitigated casualties and suffering among Iraq/Afghanistan veterans compared to previous wars. The estimated causality differences across various military conflicts are not meant to minimize the significant contributions and sacrifices made by this new generation of military warriors but to help us gain perspective on military conflicts over the past century as we recognize the 20th anniversary of 9/11.
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Affiliation(s)
- Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX 78229, USA
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Migliore L, Braun L, Stucky CH, Gardner C, Huffman S, Jumpp S, Bell E. Considerations for Acute and Emergent Deployed Mental Health Patient Management and Theater Transports: A Scoping Review. Mil Med 2020; 186:e932-e942. [PMID: 33382426 PMCID: PMC8399236 DOI: 10.1093/milmed/usaa568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/09/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022] Open
Abstract
Background Although combat stress and psychiatric casualties of war have consistently contributed to the need for deployed patient transport to higher echelons of care, little is known regarding specific evidence-based strategies for providing psychological support and optimal transport interventions for warriors. Study Objective The purpose of this scoping review is to map existing literature related to considerations for deployed mental health patient transport. The review’s primary aims are to identify the existing scientific research evidence, determine research and training gaps, and recommend critical areas for future military research. Methods We used Arksey and O’Malley’s six-stage scoping review methodological framework (identify the research question, identify relevant studies, select studies, chart data, report results, and consultation). Using a systematic search strategy, we evaluated peer-reviewed literature from five databases (PubMed, CINAHL, PsycINFO, Web of Science, and Embase) and gray literature from the Defense Technical Information Center. All publications were independently screened for eligibility by two researchers during three review rounds (title, abstract, and full text). Results We identified 1,384 publications, 61 of which met our inclusion criteria. Most publications and technical reports were level IV evidence and below, primarily retrospective cohort studies and epidemiologic surveillance reports. Few rigorously designed studies were identified. Eight research themes and a variety of research and critical training gaps were derived from the reviewed literature. Themes included (1) characterizing mental health patients aeromedically evacuated from theater; (2) in-flight sedation medications; (3) need for aeromedical evacuation (AE) in-theater education, training, and guidelines for staff; (4) epidemiological surveillance of AE from theater; (5) mental health management in deployed settings; (6) suicide-related event management; (7) transport issues for mental health patients; and (8) psychological stressors of AE. Research is needed to establish clinical practice guidelines for mental health condition management in theater and throughout the continuum of en route care.
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Affiliation(s)
- Laurie Migliore
- Clinical Investigation Facility, David Grant USAF Medical Center, Fairfield, CA 94533, USA
| | - Lisa Braun
- Nursing Research, Naval Medical Center, Portsmouth, VA 23708, USA
| | - Christopher H Stucky
- Center for Nursing Science & Clinical Inquiry, Womack Army Medical Center, Fort Bragg, NC 28310, USA
| | - Cubby Gardner
- Air Force Medical Readiness Agency, Falls Church, VA 22041, USA
| | - Sarah Huffman
- Airman Readiness Optimization Division, 711th Human Performance Wing, Dayton, OH 45433, USA
| | - Savannah Jumpp
- Clinical Investigation Facility, David Grant USAF Medical Center, Fairfield, CA 94533, USA
| | - Emily Bell
- TriService Nursing Research Program, Uniformed Services University, Bethesda, MD 20814, USA
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Baker MT, Moring JC, Hale WJ, Mintz J, Young-McCaughan S, Bryant RA, Broshek DK, Barth JT, Villarreal R, Lancaster CL, Malach SL, Lara-Ruiz JM, Isler W, Peterson AL. Acute Assessment of Traumatic Brain Injury and Post-Traumatic Stress After Exposure to a Deployment-Related Explosive Blast. Mil Med 2019; 183:e555-e563. [PMID: 29788111 PMCID: PMC7263835 DOI: 10.1093/milmed/usy100] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are two of the signature injuries in military service members who have been exposed to explosive blasts during deployments to Iraq and Afghanistan. Acute stress disorder (ASD), which occurs within 2–30 d after trauma exposure, is a more immediate psychological reaction predictive of the later development of PTSD. Most previous studies have evaluated service members after their return from deployment, which is often months or years after the initial blast exposure. The current study is the first large study to collect psychological and neuropsychological data from active duty service members within a few days after blast exposure. Materials and Methods Recruitment for blast-injured TBI patients occurred at the Air Force Theater Hospital, 332nd Air Expeditionary Wing, Joint Base Balad, Iraq. Patients were referred from across the combat theater and evaluated as part of routine clinical assessment of psychiatric and neuropsychological symptoms after exposure to an explosive blast. Four measures of neuropsychological functioning were used: the Military Acute Concussion Evaluation (MACE); the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); the Headminder Cognitive Stability Index (CSI); and the Automated Neuropsychological Assessment Metrics, Version 4.0 (ANAM4). Three measures of combat exposure and psychological functioning were used: the Combat Experiences Scale (CES); the PTSD Checklist-Military Version (PCL-M); and the Acute Stress Disorder Scale (ASDS). Assessments were completed by a deployed clinical psychologist, clinical social worker, or mental health technician. Results A total of 894 patients were evaluated. Data from 93 patients were removed from the data set for analysis because they experienced a head injury due to an event that was not an explosive blast (n = 84) or they were only assessed for psychiatric symptoms (n = 9). This resulted in a total of 801 blast-exposed patients for data analysis. Because data were collected in-theater for the initial purpose of clinical evaluation, sample size varied widely between measures, from 565 patients who completed the MACE to 154 who completed the CES. Bivariate correlations revealed that the majority of psychological measures were significantly correlated with each other (ps ≤ 0.01), neuropsychological measures were correlated with each other (ps ≤ 0.05), and psychological and neuropsychological measures were also correlated with each other (ps ≤ 0.05). Conclusions This paper provides one of the first descriptions of psychological and neuropsychological functioning (and their inter-correlation) within days after blast exposure in a large sample of military personnel. Furthermore, this report describes the methodology used to gather data for the acute assessment of TBI, PTSD, and ASD after exposure to an explosive blast in the combat theater. Future analyses will examine the common and unique symptoms of TBI and PTSD, which will be instrumental in developing new assessment approaches and intervention strategies.
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Affiliation(s)
- Monty T Baker
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Drive, San Antonio, TX
| | - John C Moring
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | - Willie J Hale
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | - Stacey Young-McCaughan
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | - Richard A Bryant
- School of Psychology, University of New South Wales, 11 Botany Street, Sydney, New South Wales, Australia
| | - Donna K Broshek
- Department of Psychiatry, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA
| | - Jeffrey T Barth
- Department of Psychiatry, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA
| | - Robert Villarreal
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | - Cynthia L Lancaster
- Department of Psychology, University of Nevada, Reno, 1664 N Virginia Street, Reno, NV
| | - Steffany L Malach
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX
| | - Jose M Lara-Ruiz
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX
| | - William Isler
- Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Drive, San Antonio, TX
| | - Alan L Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX.,South Texas Veterans Health Care System, 7400 Merton Minter Boulevard, San Antonio, TX
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Peterson AL, Baker MT, Moore CBA, Hale WJ, Joseph JS, Straud CL, Lancaster CL, McNally RJ, Isler WC, Litz BT, Mintz J. Deployed Military Medical Personnel: Impact of Combat and Healthcare Trauma Exposure. Mil Med 2019; 184:e133-e142. [PMID: 29931192 DOI: 10.1093/milmed/usy147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/25/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Limited research has been conducted on the impact of deployment-related trauma exposure on post-traumatic stress symptoms in military medical personnel. This study evaluated the association between exposure to both combat experiences and medical duty stressors and post-traumatic stress symptoms in deployed military medical personnel. Materials and Methods U.S. military medical personnel (N = 1,138; 51% male) deployed to Iraq between 2004 and 2011 were surveyed about their exposure to combat stressors, healthcare stressors, and symptoms of post-traumatic stress disorder (PTSD). All participants were volunteers, and the surveys were completed anonymously approximately halfway into their deployment. The Combat Experiences Scale was used as a measure of exposure to and impact of various combat-related stressors such as being attacked or ambushed, being shot at, and knowing someone seriously injured or killed. The Military Healthcare Stressor Scale (MHSS) was modeled after the Combat Experiences Scale and developed for this study to assess the impact of combat-related healthcare stressors such as exposure to patients with traumatic amputations, gaping wounds, and severe burns. The Post-traumatic Stress Disorder Checklist-Military Version (PCL-M) was used to measure the symptoms of PTSD. Results Eighteen percent of the military medical personnel reported exposure to combat experiences that had a significant impact on them. In contrast, more than three times as many medical personnel (67%) reported exposure to medical-specific stressors that had a significant impact on them. Statistically significant differences were found in self-reported exposure to healthcare stressors based on military grade, education level, and gender. Approximately 10% of the deployed medical personnel screened positive for PTSD. Approximately 5% of the sample were positive for PTSD according to a stringent definition of caseness (at least moderate scores on requisite Diagnostic and Statistical Manual for Mental Disorders criteria and a total PCL-M score ≥ 50). Both the MHSS scores (r(1,127) = 0.49, p < 0.0001) and the Combat Experiences Scale scores (r(1,127) = 0.34, p < 0.0001) were significantly associated with PCL-M scores. However, the MHSS scores had statistically larger associations with PCL-M scores than the Combat Experiences Scale scores (z = 5.57, p < 0.0001). The same was true for both the minimum criteria for scoring positive for PTSD (z = 3.83, p < 0.0001) and the strict criteria PTSD (z = 1.95, p = 0.05). Conclusions The U.S. military has provided significant investments for the funding of research on the prevention and treatment of combat-related PTSD, and military medical personnel may benefit from many of these treatment programs. Although exposure to combat stressors places all service members at risk of developing PTSD, military medical personnel are also exposed to many significant, high-magnitude medical stressors. The present study shows that medical stressors appear to be more impactful on military medical personnel than combat stressors, with approximately 5-10% of deployed medical personnel appearing to be at risk for clinically significant levels of PTSD.
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Affiliation(s)
- Alan L Peterson
- University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,South Texas Veterans Health Care System, 7400 Merton Minter Boulevard, San Antonio, TX.,University of Texas at San Antonio, One UTSA Circle, San Antonio, TX
| | - Monty T Baker
- Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Drive, San Antonio, TX
| | - Cpt Brian A Moore
- University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,University of Texas at San Antonio, One UTSA Circle, San Antonio, TX
| | - Willie J Hale
- University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,University of Texas at San Antonio, One UTSA Circle, San Antonio, TX
| | - Jeremy S Joseph
- University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | - Casey L Straud
- University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | | | - Richard J McNally
- Harvard University, 1230 William James Hall, 33 Kirkland Street, Cambridge, MA
| | - William C Isler
- Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Drive, San Antonio, TX
| | - Brett T Litz
- VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA.,Boston University, 64 Cummington Mall, Boston, MA
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
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Baker MT, Anderson SR, Arant-Daigle D, Cigrang JA, Young-McCaughan S, Johnson LG, Peterson AL. Psychiatric Aeromedical Evacuations: Clinical Characteristics of Deployed U.S. Military Personnel During Operation Iraqi Freedom. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/21635781.2016.1272021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Monty T. Baker
- Department of Behavioral Medicine, United States Air Force, RAF Alconbury, United Kingdom
- 59th Medical Wing, Wilford Hall Ambulatory Surgical Center and Behavioral Analysis Services, JBSA-Lackland, San Antonio, Texas
| | - Scott R. Anderson
- Department of Behavioral Medicine, United States Air Force, RAF Lakenheath, United Kingdom
| | - Deborah Arant-Daigle
- 59th Medical Wing, Wilford Hall Ambulatory Surgical Center and Behavioral Analysis Services, JBSA-Lackland, San Antonio, Texas
| | - Jeffrey A. Cigrang
- School of Professional Psychology, Wright State University, Dayton, Ohio
- STRONG STAR Multidisciplinary PTSD Research Consortium, University of Texas Health Science Center at San Antonio, Texas
| | - Stacey Young-McCaughan
- STRONG STAR Multidisciplinary PTSD Research Consortium, University of Texas Health Science Center at San Antonio, Texas
- Division of Behavioral Medicine, Department of Psychiatry, University of Texas Health Science Center at San Antonio, Texas
| | - Leigh G. Johnson
- 59th Medical Wing, Wilford Hall Ambulatory Surgical Center and Behavioral Analysis Services, JBSA-Lackland, San Antonio, Texas
| | - Alan L. Peterson
- STRONG STAR Multidisciplinary PTSD Research Consortium, University of Texas Health Science Center at San Antonio, Texas
- Division of Behavioral Medicine, Department of Psychiatry, University of Texas Health Science Center at San Antonio, Texas
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Conway TL, Schmied EA, Larson GE, Galarneau MR, Hammer PS, Quinn KH, Schmitz KJ, Webb-Murphy JA, Boucher WC, Edwards NK, Ly HL. Treatment of Mental or Physical Health Problems in a Combat Zone: Comparisons of Postdeployment Mental Health and Early Separation From Service. J Trauma Stress 2016; 29:149-57. [PMID: 26990003 DOI: 10.1002/jts.22091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The primary aim of this study was to evaluate whether being treated for mental health or nonbattle physical injury during military combat deployment was associated with higher risk for postdeployment mental disorders and poorer career outcomes than seen in the general combat-deployed population. Service members treated in theater for mental health (n = 964) or noncombat injury (n = 853) were compared with randomly sampled personnel (n = 7,220) from the general deployed population on diagnosed mental disorders and early separation from service. Deployment, medical, and career information were obtained from Department of Defense archival databases. Over half of the personnel who received mental health treatment while deployed were diagnosed with 1 or more mental disorders postdeployment and/or were separated from service before completing their full-term enlistment. This was significantly higher than expected compared to the general deployed group, adjusting for demographic/military characteristics and mental health history (adjusted odds ratios [ORs] ranging 1.62 to 2.96). Frequencies of problems also were higher in the mental health-treated group than in the group treated for nonbattle physical injuries (significant adjusted ORs ranging 1.65 to 2.58). The documented higher risks for postdeployment adjustment problems suggested that especially those treated in theater by mental health providers might benefit from postdeployment risk-reduction programs.
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Affiliation(s)
- Terry L Conway
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Emily A Schmied
- Behavioral Sciences and Epidemiology Department, Naval Health Research Center, San Diego, California, USA
| | - Gerald E Larson
- Behavioral Sciences and Epidemiology Department, Naval Health Research Center, San Diego, California, USA
| | - Michael R Galarneau
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Paul S Hammer
- Navy Medicine Information Systems Support Activity, San Antonio, Texas, USA
| | - Kimberly H Quinn
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Kimberly J Schmitz
- Naval Center for Combat and Operational Stress Control, San Diego, California, USA
| | | | - Wayne C Boucher
- Mental Health Directorate, Naval Hospital Camp Pendleton, Marine Corps Base Camp Pendleton, California, USA
| | - Nathan K Edwards
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Hoa L Ly
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
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Peterson AL, Baker MT, McCarthy KR. Combat stress casualties in Iraq. Part 2: psychiatric screening prior to aeromedical evacuation. Perspect Psychiatr Care 2008; 44:159-68. [PMID: 18577121 DOI: 10.1111/j.1744-6163.2008.00170.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
TOPIC Exposure to combat-related trauma is a leading cause of posttraumatic stress disorder. Deployed military mental health practitioners serve important roles in the assessment, diagnosis, and aeromedical evacuation of psychiatric patients from the combat zone. PURPOSE To review the role of military mental health professionals working with psychiatric patients at a combat hospital and aeromedical staging facility in Iraq. SOURCE OF INFORMATION Military operating instructions, existing theoretical and research literature, and personal experiences of the authors while deployed to Iraq. CONCLUSIONS Psychiatric screening can help reduce risk in potentially unstable mental health patients prior to aeromedical evacuation. Civilian nurse psychotherapists and advanced practice psychiatric nurses will be needed to provide psychiatric follow-up care for the large number of military veterans returning from combat.
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Affiliation(s)
- Alan L Peterson
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, and Center for Clinical Health Psychology Research, Wilford Hall Medical Center, San Antonio, TX, USA.
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