Research Paper: Mental and Health Issues a Soldier Goes Through After the War

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Mental Health

Nearly 40% of all soldiers returning from Iraq and Afghanistan received Mental Health diagnoses (Seal, Metzler, Gima, Bertenthal, Maguen & Marmar, 2009). That number is likely to be underestimated, due to the fact that the Post-Deployment Health Assessment (PDHA) screenings take place immediately upon returning from active duty but that many soldiers do not start to exhibit symptoms of mental illness for three months or even longer after returning (Milliken, Auchterlonie & Hoge, 2007). Between 8 and 14% of all soldiers are reporting "serious functional impairment due to either PTSD or depression," (Thomas, Wilk, Riviere, McGurk, Castro, & Hoge, 2010, p. 1). Understanding mental health issues among American veteran populations is a pressing public health concern.

That soldiers experience mental health issues should come as no surprise; exposure to combat and even to peacekeeping missions involves an incredible amount of stress and trauma. The horrors of active duty have been documented since Thucydides wrote his history of the Peloponnesian Wars in the fifth century, BCE. Since the Vietnam War era especially, discourse and research have blossomed in the area of mental health related to veterans.

Mental health issues among soldiers is a public health as well as a private health concern, because many active duty personnel will be returning to combat service and their mental health is directly relevant to their performance whether they remain in service or experience attrition. Mental health issues can lead to impairments related to job performance or social functioning. These can undermine the stability of families and communities.

It is also important to understand the particular types of mental health issues that impact soldiers because of the way returning veterans contend with reintegrating into the civilian population. Drug abuse and aggression are common mental health symptoms among veteran populations, especially among young men (Seal, Metzler, Gima, Bertenthal, Maguen & Marmar, 2009). It is therefore critical that symptoms like aggression be identified and addressed as soon as possible, as the soldier could present direct harm to self or others. Understanding the risk factors and warning signs becomes a critical endeavor when the soldier may pose a danger to self or others, and treatment options need to be readily available. However, there are ethical issues at stake in the study of mental health in veteran populations. The armed service is not being all that it can be as a source of guidance and support for soldiers and their families. In cases where there are mental health services available, the barriers to receiving care may be seemingly insurmountable.

Systematic research has revealed prevalence rates of the most commonly reported and diagnosed mental health issues. The top three mental health disorders diagnosed in soldiers include posttraumatic stress disorder (PTSD), major depression, generalized anxiety, and alcohol misuse/substance abuse (Milliken, Auchterlonie & Hoge, 2007; Hoge, Castro, et al., 2004). Of these mental health diagnoses, most were PTSD-related, followed by depression (Seal, et al., 2009). Rates of PTSD and depression among veterans ranges between 9 to 31% depending on the level of functional impairment that is being measured and reported (Thomas, et al., 2010). Male veterans were more likely to be diagnosed with PTSD or alcohol-related problems than females, who were more likely to be diagnosed with depression (Seal, et al., 2009). Veterans also experience psychological problems that might not receive official diagnoses, such as problems related to family and relationships (Milliken, Auchterlonie & Hoge, 2007).

Furthermore, recent research has also investigated possible connections between service-related PTSD and aggressive behaviors (Thomas, Wilk, Riviere, McGurk, Castro, & Hoge, 2010). There is a high rate (about 50%) of aggression comorbidity with both PTSD and depression, and also alcoholism comorbidity with both PTSD and depression (Thomas, et al., 2010). Multiple deployments may increase the risk for developing PTSD (Reger, Gahm, Swanson & Duma, 2009; Seal, Metzler, Gima, Bertenthal, Maguen & Marmar, 2009). Rates of PTSD are also higher among soldiers who experienced combat vs. those who did not but were on peacekeeping missions abroad, such as Afghanistan (Hoge, Castro, et al., 2004). The difference between combat vs. noncombat exposure is significant. Incidences of PTSD may be two to three times higher among veterans exposed to combat (Thomas, et al., 2010).

Interestingly, Bliese, Wright, Adler, Thomas & Hoge (2007) found that mental health issues increased significantly at about 120 days after deployment, "relative to immediate integration," (p. 141). The Post-Deployment Health Assessment (PDHA) screenings are insufficient means of diagnosing soldiers returning from activity duty. These findings would suggest that soldiers may need to be monitored for at least three months postdeployment, in order to prevent the worsening of symptoms or to detect problems.

Therefore, services targeted to soldiers should focus on these key areas. Prevention and intervention services are both warranted. Future research must investigate the ideal preventative measures, as many mental health issues will go unreported once they evolve due to social stigmas surrounding the seeking of care (Hoge, Castro, Messer, McGurk, Cotting & Koffman, 2004). In fact, barriers to care remain the most problematic area from a public health perspective. Stigma is the most commonly reported barrier to receiving mental health care services, even when such services are available (Hoge, Castro, et al., 2004). As little as 23 to 40% of soldiers diagnosed with mental health issues sought mental health care; which is a large number of veterans considering that nearly 40% of all Iraq and Afghanistan veterans were given mental health diagnoses by military psychiatrists (Hoge, Castro, et al., 2004).

The United States armed forces need to be more aggressive in mandating that any soldier exhibiting symptoms get diagnosed and treated immediately as if the problem were a combat-related injury. A culture of machismo may permeate the armed forces to the degree where seeking mental health services is perceived as a sign of weakness. The problem does seem to extend beyond the boundaries of the military, though. As Britt, Greene-Shortridge, & Castro (2007) point out, the civilian public also cultivates and propagates a social stigma against persons with mental disorders. Internalization of the stigma can actually worsen the mental health issues, leading to severe cases of low self-esteem and reduced motivation to seek care (Britt, Greene-Shortridge & Castro, 2007). In addition to social stigma, many soldiers also worry about anonymity especially with regards to substance or alcohol abuse (Milliken, Auchterlonie & Hoge, 2007). Furthermore, reporting mental health concerns is associated directly with attrition from military service: an obvious barrier to care (Milliken, Auchterlonie & Hoge, 2007). Kim, Thomas, Wilk, Castro & Hoge (2010) also note that specific barriers to care other than stigma can in some cases prevent a soldier from seeking mental health services. Issues such as time or transportation can be barriers to care. A lack of awareness of what mental health services entail may be another significant barrier to care that needs to be taken into consideration when drafting policy related to veterans' services. Milliken, Auchterlonie & Hoge (2007) also found "the existing Department of Defense mental health system to be overburdened, understaffed, and underresourced," (1).

Many soldiers would benefit from pre-screening services, which would alert the military to risk factors and target appropriate post-deployment interventions. The pre-deployment rates of PTSD, depression, and other mental health issues among soldiers is on par with the civilian population, suggesting that active duty may be causally related to the exacerbation of pre-existing conditions. As many as 9.3% of soldiers are estimated to have some type of mental illness such as PTSD, depression, or generalized anxiety before deployment (Thomas, et al., 2010).

Twelve months postdepolyment, many soldiers still experience symptoms of a mental illness, showing that treatment is inadequate and that symptoms will worsen with time if left unattended (Thomas, et al., 2010). Because the primary types of mental illness have been identified through systematic and longitudinal research, it is time to address the causes and solutions to the problems such as depression, anxiety, and PTSD. Veteran-specific services are necessary, as soldiers will have issues that are unique to their cohort. Civilian psychologists cannot provide the targeted interventions most helpful for veteran populations because the experience of combat and even non-active duty can present variables absent in the civilian population.

Furthermore, Hoge, Auchterlonie & Milliken (2006) point out that the survey instruments used in the Post-Deployment Health Assessment (PDHA) may be flawed and could be missing some people with mental illnesses immediately upon postdeployment status. This would suggest that the Department of Defense needs to raise the bar and its standards for assessment as well as treatment. Changing the ways soldiers view their work, changing the organizational culture, and transforming the general social stigmas related to mental health is no easy task. A paradigm shift is needed, in order to provide the interventions needed to prevent problems. Soldiers who have been diagnosed with mental illnesses need to be given high standards of support, to eliminate stigmas and encourage openness and honesty.

From a public health standpoint, family systems theory lends insight into how a returning soldier contends with reintegration. Risk factors will… [END OF PREVIEW]

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"Mental and Health Issues a Soldier Goes Through After the War."  Essaytown.com.  May 11, 2013.  Accessed June 19, 2019.
https://www.essaytown.com/subjects/paper/mental-health-issues-soldier-goes-war/3398435.