Mental Health Awareness within the Military

The Total Force

At the end of 2011 there were nearly 2.4 million total service members in the armed forces (1.5 million in the active component and 856,000 in the reserve component). The Army is the largest branch, with 38.6 percent of the active component. The Marine Corps, the smallest branch, makes up 13.8 percent of the active force. In the reserve component, the Army National Guard is the largest branch (42.2 percent), followed by the Army Reserve (23.9 percent). The Marine Corps Reserve is the smallest branch in the reserve component (4.6 percent) 

The Deployed

More than 2.6 million service members have been deployed in support of OEF/OIF since September 11, 2001 (IOM, 2012). As of December 31, 2010, more than half of those deployed were in the Army (including active and reserve components). Nearly one-third of those deployed were in the active-component Army. National Guard and reserves across branches constituted one-third of those deployed. More than 85 percent of those deployed were enlisted, and 12 percent were women. However, deployed women were not evenly distributed across services and pay grades. For example, deployed women were only 3.2 percent of E1–E4 in the Marine Corps, but 20.5 percent of O1–O3 in the Air Force. The average age of those deployed was 33.4 years. Deployed Marine Corps were the youngest on average (29.5 years) and deployed Air Force were the oldest (35.8 years). Those deployed from the reserves and National Guard were older on average (36 years) than active-component service members (32 years). More than two-thirds of the deployed had a high-school degree or equivalent, and more than 30 percent had at least some college education. Nearly 60 percent of those deployed were married, and nearly half had dependent children, 1.97 on average.

By the end of 2010, deployed service members had been deployed an average of 1.7 times: 57 percent once, 27 percent twice, 10 percent three times, and 6 percent four or more times. Those in the National Guard and reserves had fewer multiple deployments than those in the active component. The average length of deployments was 7.7 months, with the average length in the various services ranging from 4.5 months in the Air Force to 9.4 months in the Army. The average cumulative length of deployments for those who deployed multiple times was 16.9 months. The average dwell time between deployments was 21 months.

Military Families

Military families are more diverse than most statistics or research might suggest. For example, many families do not meet the criteria used for official counts of military families and, therefore, are not included in the data (for example, common-law spouses). As a result, we are looking at  information on only a subset of military families: those of service members in heterosexual marriages and parents with dependent children or adult dependents who live with them at least part of the time. The committee views the military's definition of family as narrow and out of step with the diversity in family arrangements in modern society. The committee did not find demographic data about parents or siblings of service members (who are sometimes relied upon for important caregiving responsibilities), unmarried partners, stepfamilies, children who are not legal dependents (for example, stepchildren or nonresidential children), gay families, service members acting as substitute parents, or other nontraditional family configurations. All DOD demographic data on military families and nearly all published studies focus on heterosexual, married military families. This section summarizes the limited family data reported by the 2011 DOD Demographics Profile of the Military Community.

PSYCHOLOGICAL HEALTH CONSEQUENCES OF DEPLOYMENT - Service Members

Compared with previous conflicts, during OEF and OIF the all-volunteer military has experienced more numerous deployments of individual service members; has seen increased deployments of women, parents of young children, and reserve and National Guard troops; and in some cases has been subject to longer deployments and shorter times at home between deployments. Many of those who have served in OEF and OIF have readjusted with few difficulties, but others have had problems in returning home, reconnecting with family members, finding employment, and returning to school. Lingering health problems related to combat, including traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), can make reintegration more difficult.

Although the vast majority of OEF and OIF veterans felt proud of their service (96 percent), felt they became more mature as a result of their service (93 percent), and built selfconfidence while serving (90 percent), 44 percent have reported readjustment difficulties, 48 percent strains on family life, 47 percent outbursts of anger, 49 percent posttraumatic stress, and 32 percent an occasional loss of interest in daily activities (Pew Research Center, 2011).

As early as 2004 it was estimated that over one-fourth of troops returning from OEF and OIF were suffering from psychological health disorders (Hoge et al., 2004). Later estimates suggested that one-fifth of the troops reported symptoms of PTSD or depression, and about the same fraction reported a probable TBI during deployment (Tanielian and Jaycox, 2008). Recent RAND Corporation reports note that a full one-third of returning OEF and OIF service members reported symptoms of psychological health or cognitive problems (Hosek, 2011; Tanielian and Jaycox, 2008). RAND reports that 18.5 percent of a representative sample of returning service members met the diagnostic criteria for PTSD or depression, 19.5 percent reported a probable TBI during deployment, and 7 percent met the criteria for a psychological health problem and TBI (Tanielian and Jaycox, 2008)

Acoording to the National Institute of Health (NIH), the leading health consequences of deployment, including TBI, PTSD, major depression, substance use disorder, and suicide  are comment in soldiers. NIH focused on these conditions because many of the DOD prevention programs are intended to prevent these particular conditions or to mitigate negative outcomes that may be associated with them. Although this chapter is organized by condition, the committee recognizes that the conditions discussed often do not occur in isolation. Many conditions addressed in this report share the same risk factors, are risk factors themselves for other conditions, and frequently co-occur. For example, PTSD has common risk factors with depression, is a risk factor for depression, and commonly co-occurs with depression and TBI (IOM, 2013a). Likewise, suicidality is higher among individuals with all of these disorders than in those without them. Tobacco use and nicotine addiction, although not addressed in this report, are also more common in individuals with depression, PTSD, substance use disorders, and other psychological conditions than in individuals without them (IOM, 2009a).

Based on the literature of psychological health disorders in OEF and OIF active-duty members and veterans, the 2013 IOM report Returning Home from Iraq and Afghanistan concluded that our understanding of the health consequences of service in Iraq and Afghanistan remains incomplete; even simple questions such as prevalence rates of physical and psychologic morbidity after military service in Iraq or Afghanistan continue to lack precision. For example, the literature reviewed by the committee that prepared that report found PTSD prevalence rates ranging from approximately 1 percent to 30 percent in different studies. Those widely varying prevalence estimates have added to the public's confusion, have not been informative for health care planning, and fail to assist in projecting long-term reintegration needs.

NIH noted that these differences might be explained by variations in study design factors, including population sampling strategy; data collection instruments and methods, deployment characteristics (e.g., combat exposure; length of deployment, number of deployments, and time elapsed after deployment), and demographic and service-related characteristics (e.g., active-duty versus reserves and National Guard, military training and occupation, and service branch).

In particular, variations in assessment strategies, such as measuring documented psychological health diagnoses among those seeking health care versus anonymous screening, can yield vastly different results, which highlights some of the challenges to accurate identification of those who may benefit from intervention. It has proved difficult to account for, understand, and reconcile those differences in order to provide the insights and answers needed for effective public policy, prevention, treatment, and reintegration

Source: NIH Mental Health Studies