POST TRAUMATIC STRESS DISORDER AMONG VETERANS 6
PostTraumatic Stress Disorder among Veterans
PostTraumatic Stress Disorder among Veterans
Theimportance of mental health cannot be gainsaid as far as thewellbeing of an individual in both the long-term and the short-termis concerned. Unfortunately, there has been an increase in the ratesof mental ailments in the contemporary human society. This hasnecessitated that a large number of studies be carried out toinvestigate the varied aspects of these ailments including causes,predisposing factors, signs and symptoms, diagnosis and prevention.Even more important is the capacity of these studies is coming upwith an effective treatment for these ailments. However, it hasalways been recognized that a large number of mental ailments arepredisposed by undesirable or traumatic episodes in an individual’slife. It is, therefore, not surprising that a large number of studieshave examined the prevalence of mental disorders, particularlypost-traumatic stress disorder among war veterans or evencurrently-serving soldiers. This is the case for Milliken et al(2007) article “longitudinalassessment of mental health problems among active and reservecomponent soldiers returning from the Iraq war”and McNally & Frueh (2013) article “Why are Iraq andAfghanistan War veterans seeking PTSD disability compensation atunprecedented rates?”.
Thearticle by Milliken et al was based on the gross underestimation ofthe mental health burden among soldiers returning from the Iraq warat the initial screening. Indeed, it is noted that the Department ofDefense established a population-wide screening at two points rightafter the soldiers deployed into Iraq returned, all in an effort topromote the early identification of problems pertaining to mentalhealth among the combat veterans. The main aim of this article was tomeasure or gauge the mental health requirements of soldiers comingback from Iraq, as well as the relationship of screening with theutilization of mental healthcare.
Thiswas a longitudinal, population-based, descriptive study pertaining toUnited States sldiers coming back from Iraq. The soldiers completedtwo tests including Post-deployment Health Assessment (PDHA), as wellas Post-Deployment Health Reassessment, with the last test beingtaken about 6 months from the first one. The research detailed in thepaper was quantitative in nature with the main outcome measures beingreferral and utilization of mental health services, screeningpositive for mental health problems such as alcohol abuse, majordepression and posttraumatic stress disorder.
Thestudy showed that the solders exhibited more mental health concernsand would be referred at considerably higher rates in the case ofPDHRA compared to the PDHA. Indeed, the combined screenings showedthat 42.4% and 20.3% of reserve and active component soldiers neededtreatment for mental health. It is noteworthy that soldiers regularlyreported alcohol abuse concerns with extremely few being provided orreferred for alcohol treatment. As much as the a majority of thesoldiers obtained care within 30 days after screening, a large numberof them were not referred. Nevertheless, the study showed no directassociation between treatment or referral and symptom improvement.This paper underlined the fact that rescreening soldiers a number ofmonths after they return from the battlefield would result in theidentification of a large number of ailments and disorders that theinitial screening may have missed. Indeed, it is noted that thereserve component soldiers who had reverted back to their civilianstatus had higher rates of PDHRA.
Thisarticle provides a comprehensive examination of the varied mentalailments that soldiers coming from the battlefield may be diagnosedwith. Of particular note is the fact that, as much as the mentalailments tested were primarily PTSD and alcohol misuse disordersamong others, it is noteworthy that the research would be applicablein studies regarding numerous other mental ailments. Even moreinteresting is the fact that the authors explain why there would be adisparity between the results of PTSD and PDHRA by stating thatsoldiers are often deterred from accessing treatment by thedeficiencies in confidentiality.
Whilethe article may be quite comprehensive, I think it falls a bit shortas far as explaining the deficiencies in the results for the twocategories of soldiers. Indeed, it does not explain what changesbetween the time the first screening is done and the second, so as toaccount for the change in the rates diagnosed. Is the diagnosisprimarily dependent on the openness of the patient himself or arethere deficiencies on the part of the healthcare officials carryingout the screening?
Thearticle by McNally & Frueh (2013), on the other hand, is based onthe increasing number of war veterans from Iraq and Afghanistan, whohave enrolled for service-connected disability compensation fornon-psychiatric and psychiatric medical problems. The main purpose ofthis article is to explore varied hypothesis pertaining to theextraordinarily high rates of veterans of Iraq and Afghanistan warsseeking disability compensation. It aims at evaluating datapertaining to the hypothesis in an effort to explain these highrates. Four hypothesis or questions that it aims at resolving includewhether questionnaire evaluations underestimate the PTSD rates,whether delayed-onset PTSD may explain the increased rates, whethermalingering may explain the rise, or whether economics would explainit. This a qualitative paper that seeks to explain the unprecedentedrates of disability seeking veterans, despite the historically lowinjuries, fatalities and Post-traumatic stress disorder.
Theauthors examined volumes of literature detailing issues pertaining tomental health compensation for veterans of war and noted that theincreasing rates are primarily driven by financial need rather thanpsychiatric disorder. This is especially considering that a largeproportion of the increase occurs among veterans who have limitedvocational training in which case they have lower capacity to makedecent living. Further, the researchers acknowledged that the significant proportion of the increase may be attributed toover-reporting of symptoms or malingering. On the same note, therates of PTSD would not be underestimated by the use of standardstructured diagnostic interview rather, it would actuallyoverestimate it. Further, delayed onset, while being a crucialfactor, plays an extremely small role in explaining the extraordinaryrise.
Thisarticle provides a comprehensive explanation of the reasons for theincrease in the reported rates of veterans from Iraq and Afghanistanwar who sign up for mental disability or PTSD compensation than inthe previous was despite the low casualty rates. The exploration ofthe four factors comes as fundamental considering the fact oftenresearch is blamed for misrepresentation of information. The articleseems balanced as far as explaining the role that the four factorsplay. However, I would think that there must be other factors thatwould still explain the disparity. Are there variations in the ratesreported in different times? Do the rates change in the case ofofficers in different ranks? If so, what would explain such changes?
McNally& Frueh (2013). “Why are Iraq and Afghanistan War veteransseeking PTSD disability compensation at unprecedented rates?”Journalof Anxiety Disorders27 (2013) 520–526
Milliken,C.S., Auchterlonie, J.L., & Hoge, C.W. (2007). Longitudinalassessment of mental health problems among active and Reservecomponent soldiers returning from the Iraq war.Journal of the American Medical Association,298(18), 2141-2148.