Mental Health in the Armed Forces
Anthony Ng, MD, chief medical officer, Acadia Hospital
Tuesday, July 17, 2012
With the winding down of the military in Iraq and Afghanistan, this has been met with relief and joy with the prospect of lessening loss of American lives. Over the past ten years roughly, we as a nation have certainly witnessed the physical toll on our soldiers. However, the emotional toll on them has also been extremely high. In a recent report released by the Armed Forces Health Surveillance Center showed there was a 65 percent increase in mental health disorders since 2000 in active duty troops. This report looked at a 12 year period between 2000 and 2011 and noted that more than 936,000 active service members were diagnosed with at least one mental disorder -- 85 percent had diagnoses of adjustment disorder, depression, alcohol abuse. Also, post-traumatic stress disorder (PTSD) increased six fold between 2003 and 2008 with more than 100,000 with this diagnosis by 2011, though the report did not look specifically at correlation to deployments.
This report also shows that nearly 70 percent of all mental health problems were related to “life circumstances," which is a category that includes deployment, bereavement and relationships. In a twelve year period, rates of mental illness related to life circumstances were stable until 2003 and peaked in 2005. It then declined and increased in 2009. According to this report, women, service members 20 and younger and health care workers were the most vulnerable. For women, it was twice as high as men. Healthcare workers had higher rates, especially with PTSD.
These numbers may be an underestimate to the actual numbers of service men and women who may have some mental health disorders. Despite the military aggressive efforts to address mental health issues amongst its troops, especially around suicides, there may be still systemic challenges to an accurate portrayal of mental health issues in the military. Continued stigma about mental health may still be a significant deterrent to both reporting and the treatment of mental disorders.
However, this report serves to highlight the significant public health concerns facing our armed forces. Mental health disorders take significant tolls on soldiers. It could mean their ongoing ability to perform their tasks effectively, to continue as a soldier, and also any potential functional disabilities they may have after discharge. In addition to diagnosable disorders, many soldiers may have developed maladaptive coping behaviors to deal with the various stresses they had to endure, though not necessarily to a level of a diagnosable condition, but yet, may have significant public health impact. A good example would be a soldier smoking more to cope with stress. His increased smoking may lead to increases in anxiety as well as the various medical risks associated with increased smoking. There may also be some unique challenges and mental health concerns between active duty soldiers and reserve/guard soldiers due to varying level of supports, both within their armed branches and in the community.
In addition to the individual soldiers, families of our soldiers are equally at significant risks for mental health disorders. While they may not experience combat trauma, the families are equally at risk from other trauma of deployment, separation, as well as other life circumstances. Any efforts to address the mental health needs of our soldiers must be done in conjunction with prevention and intervention for their families to achieve the best mental health outcomes.
The most important strategy is to educate and recognize early signs of mental health distress in both the soldiers and their families. This includes changes in the relationship, for example, more arguments. When their work performances started to be impacted negatively is also another sign that stress is taking a toll. Increased substance use, feelings of significant periods of depression and anxiety are also important indicators that help is needed. Of course, when thoughts of suicide occur, immediate help should be obtained.
There are many resources to help deal with mental health distress for both soldiers and their families. They can do it through the mental health services available through the various branches. They often try to be as confidential as possible about any evaluation and treatment. The Veterans Administration also has many services for mental health issues. The VA has been devoting more resources recently in recognition of the growing mental health needs of our military. The National Center for Post-Traumatic Stress Disorder (NCPTSD) has significant online resources for PTSD. They can be located at http://www.ptsd.va.gov/public/index.asp. Local hospital and clinics may have additional mental health resources for both the soldiers and families who do not wish to access services within the military. In many communities, many support groups have been created to help veterans deal with both the physical and mental health tolls of their work. The Wounded Warrior Project may have some additional resources for both veterans and their families.
The most important intervention for mental health issues in our troops and their families is early recognition and treatment. While the fighting in Iraq and Afghanistan are winding down, their struggles with the mental health impacts from these deployments, as well as the tremendous stresses for both them and their families, are ongoing. We must be supportive of them when they seek help and make available all resources.